搜索结果：Journal of managed care & specialty pharmacy

Cardiovascular-kidney-metabolic (CKM) syndrome has emerged as a major global health burden and driver of cardiovascular disease (CVD), the leading cause of death worldwide. Effective management of CKM depends on timely identification of underlying risk factors. Nevertheless, participation rates in primary care-based screenings are low. Consequently, CKM syndrome oftentimes remains undetected until organ damage is clinically present. Community pharmacies offer an accessible, yet underused, setting to enhance early detection. APOSCREEN-1 evaluates the feasibility and diagnostic yield of a pharmacy-based multi-parametric screening for cardiovascular-kidney-metabolic health. APOSCREEN-1 is a prospective single-arm clinical trial conducted in 20 community pharmacies in the German state of Schleswig-Holstein. Adults (n = 1000) aged ≥ 40 years with predefined risk criteria are included. Participants undergo standardized point-of-care testing (glycated hemoglobin, lipid profile, urinary albumin, blood pressure). Additionally, clinical history is assessed and results are transmitted to the study center via an online platform. Patients meeting pre-defined thresholds of the tested parameters are followed up by confirmatory laboratory testing at the study center or at the participants' general practitioner. Primary outcomes include completion rate, implementation metrics from the pharmacy perspective, and the number needed to screen to detect unknown or insufficiently managed cardiometabolic risk factors. Secondary outcomes comprise participant metrics, diagnostic metrics of the screening, evaluation of the clinical impact. This study aims to address the unmet need for scalable prevention of CVD by identification of CKM syndrome risk factors outside traditional primary care settings. Evidence on feasibility, acceptance, and diagnostic benefit may support the use of community pharmacies as an additional access point for early CKM syndrome detection. Future interventional studies will be required to evaluate structured follow-up pathways and long-term effectiveness. This study was registered with the German trial registry (Deutsches Register klinischer Studien) on 29.01.2026, under trial number DRKS00039149.

BackgroundCancer cachexia is a complex metabolic syndrome that causes a gradual loss of skeletal muscle mass that cannot be fully reversed by normal nutritional support. It has considerable impact on patient's health, but it is still not well-known and well-managed in most cancer care settings. This study sought to investigate healthcare professionals (HCPs) perceptive of cachexia in cancer patients.MethodsAn exploratory qualitative study design was employed. Semi-structured face-to-face interviews were conducted with physicians, pharmacists and nurses working at a specialized cancer care hospital in Lahore. Audio-recorded interviews were transcribed verbatim, and data were analyzed using deductive thematic analysis to identify key themes and sub-themes.ResultsA total of 10 HCPs participated in this study (n = 3 doctors, n = 3 nurses and n = 4 pharmacists). Five main themes were identified: Understanding cachexia, management of cachexia, inter-professional collaboration, needs of patients and families, and quality care of cachexia. Participants generally perceived cachexia as a form of expected or disease-related weight loss, reflecting limited differentiation between pathological cachexia and normal clinical decline. Management approaches were predominantly symptom-driven and largely focused on nutritional interventions. Multi-professional collaboration was described as effective strategy to support patient care. The needs of patients and families were reported to be addressed with sensitivity and structured support. Furthermore, quality management practices demonstrated a proactive orientation, emphasizing organized care processes.ConclusionThe study concluded that strengthening education, establishing structured care pathways, integrating palliative and supportive care principles can enhance clinician's confidence. Moreover, mitigating conceptual and therapeutic gaps can improve the quality of cachexia care in cancer patients.

As patients live longer with cancer, traditional treatment models centered around hospitals and infusion centers increasingly burden patients, caregivers, and health care systems alike. These burdens are logistical, financial, and emotional, and they are especially profound for older adults and individuals in rural or underserved areas, who face added challenges in accessing centralized care. To address these growing inequities and systemic pressures, Mayo Clinic piloted an innovative model of home-based chemotherapy through its Cancer CARE (Connected Access and Remote Expertise) Beyond Walls program - CCBW. This program reimagines oncology care by integrating virtual oversight, remote patient monitoring (RPM), mobile health services, and a unified software platform connected to the electronic medical record. From April 1, 2023, to August 31, 2023, the CCBW pilot enrolled 10 patients who, collectively, received 93 intravenous chemotherapy infusions at home. Clinical safety was closely monitored through a virtual command center, with RPM data and mobile care teams enabling timely intervention when needed. Across the pilot, there were no infusion reactions or catheter-related infections, and the minor complications, including two cases of hypokalemia and two unrelated falls, were successfully managed within the home setting, avoiding emergency department visits or hospitalization. Feedback from seven patients underscored the acceptability and advantages of this home-based approach. From the original 10 pilot participants, 8 patients received surveys, of whom 7 responded. One respondent skipped select survey items. Among respondents, six of six reported feeling comfortable remotely interacting with the care team by phone or tablet, and seven of seven reported feeling emotionally supported by the care team. These early findings suggest that delivering chemotherapy in the home is not only clinically feasible and safe, but that it is also valued by patients. The CCBW model holds promise for reshaping oncology care delivery by leveraging digital health tools and decentralized service models to meet patients where they are. With a larger randomized trial launched in August 2023, just after this pilot implementation study, further evaluation will help determine the model's scalability, cost-effectiveness, and long-term outcomes. If successful, this approach could serve as a scalable blueprint for expanding access to cancer treatment across diverse populations and geographies, while supporting broader shifts in U.S. health care policy toward more patient-centered, home-based care.

Community Urgent Eyecare Services (CUES) utilises primary care optometrists to reduce urgent eyecare demand within ophthalmology and general practice (GP). This large-scale study evaluated CUES in Greater Manchester (GM), including assessing the embedded Independent Prescribing (IP) pathway. This retrospective, GM-wide analysis evaluated CUES data from 1st January to 31st December 2024. Primary care data included patient pathways, case mix and IP outcomes. Index of Multiple Deprivation (IMD) deciles were assigned to explore socioeconomic associations with CUES access. Secondary care data included sampling CUES referrals to Manchester Royal Eye Hospital (MREH), assessing diagnostic agreement with Eye Emergency Department (EED) clinicians and determining the proportion of cases potentially manageable by IP optometrists in primary care. In 2024, GM CUES managed 54,994 patients; 69.9% were self-presenting, and 78.2% were assessed, managed and discharged without referral. Furthermore, 5.2% of cases were referred to General Medical Practitioners (GPs), resulting in 83.4% overall being retained in primary care. Patients in the most deprived IMD decile attended more frequently. IP-episode discharge rate was significantly higher (87.5%, p = 0.000001) than non-IP episodes (78.1%). In the referred sub-sample, diagnostic agreement with EED clinicians was 75.0%, with 40.0% of these cases being potentially manageable within primary care had IP capacity been available. Primary care National Health Service prescriptions (FP10 prescriptions) were issued for 73.0% (N = 362) of IP cases with corticosteroids (43.7%, N = 190), antibiotics (14.3%, N = 62) and antimuscarinics (12.4%, N = 54) being the most common. GM CUES managed and discharged most cases in primary care, reducing GP and EED demands. Greater IP optometrist availability could broaden CUES' scope and increase effectiveness.

Hemophilia is an X-linked bleeding disorder previously thought to present only in men. This sentiment is rapidly changing as the information around women and girls' experiences of bleeding symptoms has evolved, sparking intense discussion among researchers, clinicians, patients, and patient advocates regarding appropriate nomenclature. The primary objective of this narrative review is to build a comprehensive understanding of how women with hemophilia experience symptoms, how those symptoms are managed, navigate barriers to care, as well as discuss what can be done to alleviate barriers amongst this population. This is a qualitative narrative review which incorporates literature search strategies alongside testimonial from patient advocates to inform study priorities. This review identified multiple barriers to care for women and girls with hemophilia, including recognizing symptoms of abnormal bleeding, feeling comfortable asking for help, dealing with stigma from clinicians, getting an appropriate referral, accessing screening, facing challenges along the diagnostic pathway, and receiving treatment for symptoms. Another challenge is the wide variety of places a woman or girl may go to seek care for her bleeding symptoms, including primary care providers, gynecologists, hematologists, emergency medicine physicians, and rheumatologists. We conclude that while important strides have been made in this area in research and understanding, gaps remain. The research gaps in the differential symptom presentation when compared to men, potential efficacy and effectiveness of treatments in women as well as gender based behavioral difference are crucial to improving care and mitigating barriers for this cohort. This literature review combines information on symptoms, blood and genetic screening, diagnosis, treatment, current barriers to care, and next steps into a comprehensive perspective of the current available research. Evidence indicates that women with hemophilia are more likely than men to experience concerns related to family planning. In addition, women, in general, are more likely to engage in presenteeism rather than absenteeism when managing menstrual symptoms, attending work or school while unwell, which can result in reduced productivity. While screening techniques exist, novel rapid assays are being developed that could be more effective for screening women, particularly those who require multiple screenings before a diagnosis can be established. This can be combined with increased screening protocols to systematically identify carriers within families affected by hemophilia to ensure diagnosis. However, current efforts tend to focus on women of childbearing age, although premenarchal girls also experience hemophilia-related symptoms. The modalities of care for women and girls with hemophilia are numerous including pharmaceuticals such as factor replacement therapy, desmopressin, antifibrinolytic drugs, nonfactor therapy, and hormonal therapy. Additionally, assistance from physiotherapists, rheumatologists, and orthopedic surgeons can help manage joint related complications. Even with many care options, significant barriers to care persist, including the minimization of symptoms, avoidance of medical care, normalization of symptoms due to family history, and difficulties accessing care because of caregiving responsibilities. Existing care structures should be leveraged to provide better support for women and girls with hemophilia and symptomatic carriers. These could include more information provided within caregiving support groups, changes in guidelines, and wider understanding from the medical community as women and girls with hemophilia may seek assistance for their symptoms at a wide variety of clinical locations.

Building on prior development work, the objective of this study of health care utilization of all Weill Cornell Medicine health insurance beneficiaries over a six-year period was to demonstrate the validity of the Charlson Comorbidity Health Analytics (CCHA), a summed weighted measure of 38 chronic conditions in adults and children, that prospectively predict longitudinal risk of hospital admissions, repeated admissions and resultant high cost in populations. The objective of the Charlson Comorbidity Health Analytics (CCHA) is to provide a new foundational framework for population management strategies by identifying the highest risk patients who can then be the focus for interventions designed to reduce unplanned hospitalizations and resultant high costs. All 27,190 Weill Cornell Medicine beneficiaries in the years 2016-2021, that is, employees and their dependents, including spouses/partners and their children, were linked across the years in a de-identified way, and CCHA was calculated from claims data. In addition to basic demographics, data included all outpatient and inpatient claims, including payments for each service over each year, excluding pharmacy. While two pharmaceuticals are part of the CCHA (anticoagulants and anti-psychotics), no data about pharmaceuticals was available for this analysis. First, CCHA from each year 2016-2021 was evaluated cross-sectionally as a predictor of that year's hospitalizations and costs. Second, the CCHA from 2016 beneficiaries who were followed for five years were used to predict longitudinal risk of hospitalizations, repeated hospitalizations, and costs in each of the next five years. Then the CCHA was compared to the CMS Chronic Conditions Warehouse 30 (CCW30) measure. Finally, the CCHA from any given year (2016-2021) was analyzed for its predictive ability over the remaining one to five years of follow-up to predict hospitalizations, repeated hospitalizations, and costs. Of the total 27,190 beneficiaries over the six years, 55.8% were employees (66.2% women with an average age of 40.9 years), and 25.7% children (average age of 6.1 years). The Charlson Comorbidity Health Analytics (CCHA) score from an index year longitudinally predicts the risk of hospitalizations--including repeated hospitalizations--which drive healthcare costsover six years (p&#x2009;<&#x2009;.01), providing the foundation for interventions in the highest risk patients. Moreover, the 2016 CCHA was a more significant predictor of readmission in 2017-2021 than a 2016 admission. In addition, comorbidity from any index year can be used to predict subsequent admissions and costs; therefore, it works in dynamic populations, like employers and unions that have changes in beneficiaries over time. The Charlson Comorbidity Health Analytics is a method for prospectively identifying the small percent of patients who are at high longitudinal risk for unplanned hospitalizations and high costs. Intervention efforts can then be focused on high-comorbidity patients at high risk [1], with the goal of preventing health deterioration leading to health crises. Comorbidity Health Analytics provides a new foundational framework for population management strategies and specifically for interventions designed to reduce unplanned hospitalizations and thereby reduce costs.

Formulary exclusions and drug utilization management, including prior authorization and step therapy, reduce drug spending but may limit timely treatment access. To estimate formulary-based rejections and subsequent dispensing of initial attempts to fill single-source branded drug prescriptions. Retrospective, national, all-payer cohort study using IQVIA Formulary Impact Analyzer, which represents anonymized, patient-level, adjudicated US outpatient pharmacy claims, from January 2018 through September 2024. The study focused on 1.17 million individuals attempting to fill 2 million single-source branded drug prescriptions for the first time. Attempt to fill a single-source branded drug prescription for the first time. The primary outcomes were (1) rejection for formulary exclusion or utilization management (prior authorization or step therapy) of an initial prescription fill attempt and (2) failure of dispensing of the rejected molecule or another member of the same therapeutic class within 90 days of the initially attempted fill. Among more than 2 million initial fill attempts (commercial insurance, 0.84 million; stand-alone Medicare prescription drug plan, 0.40 million; Medicare Advantage prescription drug plan, 0.39 million; Medicaid fee-for-service, 0.21 million; Medicaid managed care, 0.10 million; health insurance marketplace [exchange] plan, 0.06 million), 68.0% were paid on the initial fill attempt, while the remainder were rejected for formulary exclusion (14.8%) or rejected due to requiring prior authorization or step therapy, ie, utilization management (17.2%). Formulary-based rejections increased 67.4% over the time frame examined, from 24.3% (2018) to 40.7% (2024), and rejections were most common among exchange (48.7%) and Medicaid managed care (49.8%) compared with Medicare prescription drug plans (24.0%) and Medicare Advantage prescription drug plans (19.8%). Of the 32% of attempts that were initially rejected, 38.6% ultimately resulted in the rejected molecule being filled within 90 days and nearly half (48.4%) resulted in no medication fill in the same therapeutic class within that time frame. Treatment initiation was delayed an average of 12.2 days (SD, 17.8 days) after initial rejection among those ultimately receiving the same molecule or a therapeutic substitute. Among this large, diverse sample of individuals in the United States, formulary rejections were frequent and often resulted in delayed or absent treatment, highlighting trade-offs between cost and access to medicines.

Trofinetide (TROF) became the first approved pharmacologic treatment for Rett syndrome (RTT) in the United States in March 2023; however, real-world evidence comparing TROF-treated and untreated individuals is limited. This study aimed to compare the baseline demographic and clinical profiles of those treated with TROF vs untreated in routine clinical practice. This retrospective cohort study used linked IQVIA Anonymized Patient Level Database medical claims and a specialty pharmacy database. Individuals with &#x2265;1 medical claim for RTT between 01/01/2021 and 09/30/2024 (study period) were identified. Treated individuals had &#x2265;1 TROF prescription during 04/01/2023 to 09/30/2023 (identification period), with first prescription set as index; untreated individuals had no TROF prescription. A risk-set sampling approach was used to assign proxy index dates to untreated individuals to improve comparability and reduce immortal time bias. Individuals with cerebrovascular disease or brain trauma before RTT diagnosis and those without 12 months pre-and post-index enrollment were excluded. Baseline characteristics were assessed during the 12 months pre-index. Of 8047 individuals with RTT identified, 2950 met eligibility criteria; 766 (26.0%) were treated with TROF and 2184 (74.0%) remained untreated. Treated individuals were younger at index (15.4 vs 23.5 years), and a greater proportion were pediatric (&#x2264;17 years; 66.6% vs 38.3%). Females predominated in both groups, while males represented a smaller proportion of the treated (4.6% vs 10.8%). Treated individuals more frequently had documented nonspecific developmental delay (31.3% vs 21.6%), autism spectrum disorder (19.1% vs 15.7%), and core RTT-related neurodevelopmental features such as loss of acquired communication skills (23.8% vs 12.9%) and loss of acquired motor skills (11.1% vs 4.9%). Child neurology was the most common prescriber specialty in both groups and was more frequent among treated individuals (50.3% vs 26.8%). Overall comorbidity burden was broadly similar between groups. In this real-world analysis, only one-quarter of eligible individuals with RTT initiated TROF during the early post-approval period. TROF uptake appeared concentrated in younger, specialist-managed individuals with more clearly documented RTT-related features, while three-quarters remained untreated. These findings highlight the need to better understand treatment pathways and barriers to initiation in males and adults in routine RTT care.

Blunt thoracic aortic injury (BTAI) is a rare but life-threatening consequence of high-energy trauma, most commonly involving the aortic isthmus. Contrast-enhanced computed tomography is essential for rapid diagnosis and therapeutic planning. Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment in hemodynamically stable patients because of its lower perioperative morbidity compared with open surgery. We report 2 cases of traumatic aortic isthmus pseudoaneurysm successfully treated with emergency TEVAR. A 34-year-old male motorcyclist presented with a 31 &#xd7; 28 mm isthmic pseudoaneurysm associated with bilateral hemothorax and pulmonary contusions. A 17-year-old male sustained a 23 &#xd7; 38 mm saccular pseudoaneurysm with pneumothorax following a similar mechanism of injury. Both patients underwent urgent TEVAR under general anesthesia using percutaneous femoral access; in the second case, adjunctive left subclavian artery stenting was required due to lesion proximity to the supra-aortic branches. Postoperative intensive care management included close hemodynamic and respiratory monitoring. These cases underscore the importance of rapid imaging, multidisciplinary coordination, and comprehensive perioperative management including anesthetic planning and critical care monitoring in the successful early management of BTAI. In our 2 patients, emergency TEVAR was associated with favorable early clinical outcomes, supporting its feasibility as part of a multidisciplinary treatment strategy in appropriately selected cases.

Only one-fifth of patients meeting the criteria for intravenous (IV) iron therapy received IV iron in the real-world practice. Pharmacists-providers collaborative iron deficiency (ID) clinic was developed to implement guideline-directed IV iron therapy. To evaluate the 4-year performance of the pharmacists-providers collaborative ID treatment clinic in the heart failure (HF) service. A single-center retrospective cohort study was conducted to evaluate the performance of the iron deficiency pharmacists-providers collaborative care clinic during the induction and maintenance phases of IV iron therapy. The study included patients who were seen by HF providers and received the IV iron consultation with HF pharmacists. The study included patients aged 18 years or older who were diagnosed with HF or pulmonary hypertension and received at least 1 dose of IV iron in outpatient settings. It was managed by the pharmacists-providers collaborative IV iron clinic. The primary outcome was adherence to all of the following criteria: the IV iron appropriate use criteria, laboratory requirements, and dosing during the induction course. The use of oral iron therapy was evaluated. A total of 187 patients were included in the final cohort. The median follow-up period of the IV iron consulting team was 372 (176, 623) days. One hundred fifty-two patients (81.3%) were adherent to the appropriate criteria. The most common reasons for nonadherence were the absence of maintenance laboratory requirements (15.5%), failure to administer all induction doses (1.6%), inappropriate use (1.1%), and incorrect dose (0.5%). Among 15 patients on oral iron therapy, the consulting team discontinued it in 3 patients (20.0%) during follow-up. The pharmacists-providers collaborative IV iron clinic was effective to implement IV iron therapy in heart failure care settings. These results highlight the importance of multidisciplinary care management for ID in real-world HF practice.

Background: Gout is the most common inflammatory arthritis, and the underlying cause of gout, chronic elevation of serum uric acid (sUA), is well understood. Despite this, only a minority of patients receive optimal therapy as it requires adherence to frequent lab monitoring and urate lowering therapy (ULT) titration to achieve target goals. Objective: To evaluate the effectiveness of the pharmacist-managed gout clinic at VA San Diego Healthcare System (VASDHS) in lowering sUA. Methods: This was a single center, retrospective chart review of all Veterans enrolled in the pharmacy gout clinic from January 1, 2017, to December 31, 2021, comparing baseline and final sUA. The primary outcome was reduction of sUA from baseline. Results: There was statistically significant reduction of sUA from baseline at months 3, 6, 9, and 12, with average sUA levels of 6.8 &#xb1; 1.7&#xa0;mg/dL, 6.4 &#xb1; 1.5&#xa0;mg/dL, 6.0 &#xb1; 1.6&#xa0;mg/dL, and 6.1 &#xb1; 2.2&#xa0;mg/dL, respectively (P < 0.001 for all values). Conclusion: This study suggests that the pharmacist-managed gout clinic can effectively lower and maintain sUA levels through the treat-to-target approach. Though the results of this study showed statistically significant sUA reduction, most patients did not reach their sUA goals by the end of the study. However, this finding may not be clinically relevant as patients can be above their sUA goal and still be gout flare free or have low frequency of flares.

Barth syndrome is an ultrarare, complex, multisystem, X-linked metabolic and neuromuscular disease, which poses significant and wide-ranging burden to patients and caregivers. Pharmacologic management focuses on treatment of disease manifestations and prevention of secondary complications. Elamipretide, the first treatment indicated specifically for improving muscle strength in Barth syndrome, was approved in 2025 via accelerated approval warranting guidance for payers. To discuss managed care considerations in Barth syndrome including management of elamipretide, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in March 2026. This article provides a qualitative summary of the panel discussion along with key insights and suggested payer practices meant to support informed coverage decisions and guide future work such as collaboration, research, and advocacy. Key insights highlight that there are unique challenges in generating clinical trial evidence for treatments in ultrarare conditions, which leads to difficulties determining the value of these treatments and differences in whether they are covered among payers. Additionally, there are numerous elements of care to which patients with Barth syndrome and their caregivers need equitable access, which is complicated by involving multiple specialists and fragmentation. Suggested payer practices involve education, care delivery, and coverage and benefit design.

Pharmacy practice research has received increasing international attention but remains in its early stages in China. Understanding pharmacists' engagement in such research is essential for advancing pharmaceutical care and strengthening evidence-based practice. This study aimed to explore hospital pharmacists' perceptions of pharmacy practice research and identify the factors influencing their engagement in such research. This qualitative study employed semi-structured interviews with 21 pharmacists from Grade A tertiary hospitals across 14 provinces and municipalities in China. Participants were purposively sampled to ensure variation in their professional roles, experience, and geographic region. The interviews were conducted online, audio recorded, and transcribed verbatim. Data were analyzed using thematic analysis informed by the COM-B framework and were managed using NVivo 12. Coding was performed independently by two researchers, and discrepancies were resolved through discussion to enhance the analytical rigor. Three overarching themes and 18 subthemes were identified. Most participants recognized the importance of pharmacy practice research and expressed a strong willingness to engage, particularly when research activities were closely aligned with their clinical practices. The key motivations included professional fulfillment, career advancement, and personal research interests. The identified research needs focused on optimizing pharmaceutical service content and models and strengthening information system support to facilitate data access and decision-making. Institutional support, a positive research culture, and interdisciplinary collaboration were important facilitators of engagement. However, major barriers include insufficient time and staffing, limited research resources, and inadequate research competence. Hospital pharmacists in China generally recognize the value of pharmacy practice research; however, their engagement is shaped by capability-, opportunity-, and motivation-related factors, including research competence, organizational support, resource availability, and interdisciplinary collaboration. Strengthening research training, institutional support, and collaborative research environments may enhance pharmacists' engagement in pharmacy practice.

Controlling blood pressure (BP) reduces cardiovascular morbidity and mortality but is often not achieved in clinical practice. Tailoring therapy to an individual's hemodynamic profile using impedance cardiography (ICG) might attain efficient, effective BP control. An observational study of hypertensive patients managed by two large US primary care groups (PriMED and Premier) used therapeutic algorithms based on ICG-derived hemodynamics linked to clinical decision support tools to promote physician and patient engagement and medication adherence. The main outcome of interest was BP control according to contemporary (2014) guidelines (<140/<90 mmHg). A subset of PriMED patients was followed for six years, to evaluate clinical outcomes. Clinical information was extracted from electronic medical records. Of 14,058 patients, median (interquartile range (IQR)) age was 62 (51 to 71) years, 50% were women, and initial systolic and diastolic BP were 152 (145-162) mmHg and 90 (80-98) mmHg. The hemodynamic profile was vasoconstriction for 6,609 (47%) patients, hyperdynamic for 3,365 (24%) and mixed for 4,084 (29%). For PriMED, 92% achieved BP control at the second follow-up visit. For Premier, 81% achieved control at second follow-up, and 91% by the fourth visit. Annual control rates thereafter for both groups ranged from 82% to 93%. For 2,955 patients continuously managed by PriMED between 2016-2022, annual rates of myocardial infarction and stroke were 0.30% and 0.43%. Tailoring anti-hypertensive therapy according to hemodynamic profile in primary care is feasible, providing rapid and sustained BP control with low rates of myocardial infarction and stroke.

Sugammadex is highly effective in reversing neuromuscular block, but costly and not without known complications. Subjectively determined empiric dosing of sugammadex for routine antagonism of neuromuscular block risks over- or under-dosing patients and leads to increases in drug acquisition costs, especially in markets where generics remain unavailable. We hypothesized that our recently implemented sugammadex aliquoting policy and its administration guided by quantitative neuromuscular monitoring would lower the cost of empirically dosed sugammadex antagonism. This retrospective analysis of 524 patients evaluated the pharmacoeconomic impact of sugammadex aliquoting and administration guided by quantitative neuromuscular monitoring versus subjectively determined routine antagonism of neuromuscular block in adults having elective surgical procedures. This single-center retrospective deidentified chart review included adult patients having elective surgical procedures requiring general anesthesia. Cost of sugammadex ($129.05/200-mg vial) antagonism was based on the assumed routine administration of 1 vial. When using sugammadex aliquots (50&#xa0;mg/0.5&#xa0;mL), the dose saved was calculated as 200&#xa0;mg minus total aliquots used. Gross cost savings per patient were determined by subtracting cost (labor, supplies, drug acquisition) of individual aliquots from actual sugammadex vials acquisition cost. Using neostigmine ($1.99/10&#xa0;mg vial) and glycopyrrolate ($1.74/0.4&#xa0;mg vial), the total per-case cost was determined by the number of full vials administered. Actual net cost savings/case included sensor cost ($20.00) and hardware cost ($1995/monitor amortized over 7&#xa0;years) from gross savings per surgical case. In patients receiving sugammadex aliquots (n&#xa0;=&#xa0;258), the mean gross cost was $51.50 (mean gross savings, $77.55/case vs. full-vial). Neostigmine/glycopyrrolate (n&#xa0;=&#xa0;111) mean gross cost, $4.39/case. Patients managed without pharmacological reversal (n&#xa0;=&#xa0;63) incurred no drug costs (savings of 200-mg sugammadex vial, $129.05). For all patients, mean gross (drugs only) and net (including monitoring) costs per case were markedly lower with aliquoting ($51.50 and $71.66, respectively) compared with full-vial use ($129.05 and $149.21, respectively). Aliquoting yielded total hospital net savings (including quantitative monitoring) of $20,008. Aliquoting and dosing sugammadex guided by quantitative neuromuscular monitoring in this single center reduces annual drug acquisition costs and produces consistent savings across dose ranges.

For years, pharmacogenomics (PGx) has been transitioning from the laboratory to patient care. Utilization of PGx data in patient care is greater than ever, with over 80 institutions in the United States offering PGx services, including at least 12 in pediatric patient populations. There are over 300 drug products with PGx information in their labeling; many of which are commonly used in pediatric populations. Additionally, the increased use of next-generation sequencing (NGS) has led to increased availability of PGx data. Because PGx testing can provide patient-specific predictors for drug response, pharmacists are well positioned to assume a leadership role in PGx testing, clinical interpretation of results, and recommendations for individualization of drug therapy. Opportunities for pharmacists exist in both inpatient and outpatient settings, such as pharmacist-managed clinical PGx consultation services and educating patients about PGx testing. Given the potential for genetic and age-dependent factors to influence drug selection and dosing, pediatric pharmacists should be involved in the development of dosing recommendations and interprofessional practice guidelines regarding PGx testing in pediatric patients. Opportunities to become knowledgeable and competent in PGx extend from coursework as part of the pharmacy curriculum to postgraduate education (e.g., residencies, fellowship, continuing education). The Pediatric Pharmacy Association (PPA) acknowledges a need for pediatric pharmacists to have a working knowledge of PGx and recognizes the importance of PGx education for both students and practicing pharmacists with consideration for infants and children. This group also supports the need to have a subset of pharmacists specially trained in PGx with a pediatric focus.

According to the Infectious Disease Society of America (IDSA) 2016 guidelines for the management of candidiasis, the presence of Candida in the urine in asymptomatic patients is usually a colonization rather than an infection, which does not require antifungals treatment. This study aims to assess the management of candiduria at a tertiary hospital in Riyadh, Saudi Arabia, in comparison to IDSA guidelines and its impact on patient outcomes.&#xa0;This was a single-center, retrospective, cross-sectional study conducted at a tertiary care center in Riyadh, Saudi Arabia. All adult hospitalized patients (&#x2265;&#x2009;18 years old) who had a positive urine culture for a Candida species from Jan 2023 to Dec 2023 were included in the study. All Patients' data were extracted from electronic health records. IRB approval (E-23-8172) was granted.&#xa0;A total of 217 urine cultures that were positive for a Candida species were included in our study. 166 (76.5%) candiduria episodes were managed in accordance with the IDSA recommendations, while 51 (23.5%) were treated against these recommendations. Urinary symptoms were present significantly more in those who were treated against IDSA recommendations (4.2% vs 74.5%, P&#x2009;<&#x2009;0.00001). The in-hospital mortality rate (36.7% vs 29.4%, P&#x2009;=&#x2009;0.34) did not differ significantly between the two groups.&#xa0;This study showed that around 77% of candiduria patients were managed according to the IDSA guidelines. However, while the degree of adherence to the guidelines was high in asymptomatic patients, most of the symptomatic patients were managed inappropriately. Adherence to the guidelines' recommendations did not significantly affect patients' outcomes.

Locally advanced fungating breast cancer complicated by hemorrhage or infection represents a complex clinical condition that often requires a rapid and coordinated multidisciplinary approach. Although international guidelines, such as those developed by ESMO and NCCN, provide well-defined principles for the management of locally advanced breast cancer, they offer limited recommendations regarding the management of complicated fungating forms. We conducted a structured narrative review of the literature using the PubMed, Scopus, and Web of Science databases, including studies published between December 2019 and March 2026. Studies addressing locally advanced breast cancer and fungating forms complicated by hemorrhage or infection were included. Available data are heterogeneous and derive primarily from case reports, small case series and retrospective studies. Systemic therapy remains the cornerstone of oncologic control; however, the presence of acute complications often necessitates prioritization of local interventions depending on the patient's clinical stability. Hemorrhage may be managed through arterial embolization, hemostatic dressings or radiotherapy, whereas infection requires local wound care and targeted antibiotic therapy. These interventions aim to control acute symptoms and stabilize patients, thereby facilitating the subsequent integration of oncologic treatment. Emergency surgical intervention is reserved for selected cases, particularly when conservative measures fail to control bleeding or in the presence of persistent sepsis. The management of fungating breast cancer should be individualized and guided by the clinical presentation within a multidisciplinary team setting rather than by a rigid therapeutic sequence. This paper proposes a pragmatic, symptom-oriented clinical framework integrating all currently available therapeutic modalities (systemic therapy, radiotherapy, interventional radiology, surgery, and supportive care) with the aim of supporting decision-making in complex clinical scenarios.

Venous thromboembolism (VTE) is a common, potentially life-threatening condition. To improve care, a multidisciplinary Adult Outpatient Thrombosis Service (TS) was implemented in one region of Newfoundland and Labrador, Canada. This study evaluated the clinical effectiveness of the TS compared to usual care (UC) for patients with newly diagnosed VTE. We conducted a retrospective cohort study of adults with objectively confirmed VTE between 2017 and 2019. Patients managed by the TS were compared to those receiving UC. Data were obtained from linked administrative and clinical databases. Propensity score matching was applied to control for confounding. Primary outcomes included recurrent VTE and major bleeding. Secondary outcomes were all-cause hospitalizations, emergency department visits, and all-cause mortality. Incidence rate ratios (IRR) and 95% CIs were calculated using Poisson regressions; Cox models were used for mortality. A total of 1499 patients were included (TS: n = 464; UC: n = 1035). The TS group experienced significantly lower rates of adverse outcomes. VTE recurrence (IRR = 0.65, 95% CI: 0.29-0.67, p = < 0.001) and major bleeding (IRR = 0.33, 95% CI: 0.19-0.53, p = 0.011) were significantly reduced in the TS group, as were hospitalizations (IRR = 0.76, 95% CI: 0.64-0.92, p = 0.009). No significant difference was found in emergency department visits (IRR = 1.02, 95% CI: 0.79-1.32, p = 0.848). All-cause mortality was also lower (HR = 0.62, 95% CI: 0.48-0.81, p = 0.0004). Management of VTE within a multidisciplinary TS was associated with significantly lower rates of complications, hospitalizations, and all-cause mortality compared to UC. These findings suggest that a structured, specialized outpatient thrombosis care model may be associated with favorable clinical outcomes in real-world settings.