Medication Management (United States)

Abstract Background Ulcerative colitis (UC) requires effective therapeutic strategies to induce and maintain remission. Upadacitinib, a selective JAK1 inhibitor, has shown strong efficacy in clinical trials; however, real-world evidence in Latin American populations remains scarce. The UPARECOL-UC study evaluated the effectiveness and safety of upadacitinib in Colombian patients with UC during induction (8–16 weeks) and maintenance (24 weeks) under routine clinical practice. Methods A prospective multicentre cohort study was conducted across Colombian reference centres including adults with confirmed UC (clinical, endoscopic, and histological criteria) who initiated upadacitinib between 2024 and 2025 for ≥8 weeks. Effectiveness outcomes included clinical response, clinical remission, and steroid-free remission. Objective biomarkers (C-reactive protein, faecal calprotectin, haemoglobin) were monitored at baseline and follow-up. Safety variables included adverse events (AEs), serious AEs, infections, and treatment discontinuation. Results A total of 47 patients were included in the induction analysis. After 8–16 weeks, clinical remission was achieved in 61.7% (29/47), with steroid-free remission in 71.4% of responders. At week 24, clinical remission increased to 90% (18/20), and steroid-free remission reached 88.2%. Endoscopic remission (Mayo 0–1) was 85% among patients reassessed endoscopically during maintenance. Significant reductions in inflammatory biomarkers were observed during follow-up, supporting clinical improvement. Colectomy occurred in 5.4% of patients during induction, with no colectomies during maintenance. Overall, 30.2% experienced any AE; acne was the most common (25.6%). Serious infections occurred in 4.7% . Treatment discontinuation due to AEs occurred in 9.3% of the cohort. No new safety signals were identified. Conclusion Upadacitinib demonstrated high real-world effectiveness for both induction and maintenance in this Colombian UC cohort, composed largely of patients with severe and treatment-refractory disease. Improvements in clinical outcomes were accompanied by significant reductions in inflammatory biomarkers. The safety profile was consistent with previous clinical and real-world data, supporting upadacitinib as an effective therapeutic option for UC in routine practice. Conflict of interest: Parra Izquierdo, Leidy Viviana: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Juliao Baños, Fabián: No conflict of interest Puentes-Manosalva, Fabian Eduardo: No conflict of interest Cuervo-Pico, Pedro-Eduardo: No conflict of interest Galiano, Maria Teresa: No conflict of interest Riveros, Javier: No conflict of interest Gomez Venegas, Alvaro: No conflict of interest Medrano-Almanza, Carlos Andres: No conflict of interest Perea, Daniel: No conflict of interest Ballesteros, Manuel: No conflict of interest Barreto Perez, Jonathan: No conflict of interest Cuadros-Mendoza, Carlos Augusto: No conflict of interest Guzman, Gerardo: No conflict of interest Gutierrez Raba, Aura: No conflict of interest Soto Mora, Jahir: No conflict of interest Dr. Frías-Ordoñez, Juan: No conflict of interest

Abstract Background Defaecatory urgency is a cardinal and distressing symptom in ulcerative colitis (UC), strongly associated with disease activity and reduced quality of life. Its resolution represents a key therapeutic goal, often paralleling mucosal healing and remission. Upadacitinib (UPA), a selective JAK1 inhibitor, has demonstrated robust efficacy for induction and maintenance of remission in UC; however, its specific impact on urgency in real-world Latin American settings remains poorly characterised. Methods We conducted a multicentre observational study including adults with moderate-to-severe UC treated with UPA 45 mg/day for induction and 30 mg/day for maintenance. Changes in defaecatory urgency (present/absent), clinical response (≥3-point decrease in Mayo score), and clinical remission (Mayo < 2) were evaluated at weeks 8–16 (induction) and 24 (maintenance). Biochemical remission was defined as faecal calprotectin < 150 µg/g and/or C-reactive protein < 5 mg/L. Absolute differences were calculated with 95 % confidence intervals (CI), and Fisher’s exact test was applied for categorical variables (p < 0.05). Results A total of 47 patients with UC were included; mean age 39.8 ± 14.6 years; 59.6 % female; 83 % previously exposed to at least one anti-TNF agent. At baseline, 66 % of patients reported defaecatory urgency, which decreased to 31.9 % after induction (Δ − 34.1 %; 95 % CI − 49.5 to − 18.7; p = 0.001) and 25.5 % at six months (p = 0.003). Clinical response was achieved in 81.2 % (95 % CI 66.1–91.4), and clinical remission in 61.7 % (95 % CI 46.4–75.1). Improvement in urgency strongly correlated with clinical remission (r = 0.72; p < 0.001). Biochemical remission (faecal calprotectin < 150 µg/g or CRP < 5 mg/L) occurred in 57.4 % of patients. No serious adverse events were observed; mild transaminase elevations occurred in 8.5 %. Conclusion Upadacitinib rapidly and sustainably reduced defaecatory urgency in Colombian patients with moderate-to-severe UC, with improvement in over two-thirds of cases and a strong association with clinical remission and biomarker normalisation. These findings provide the first real-world Latin American evidence highlighting upadacitinib’s impact on patient-centred symptomatic control in ulcerative colitis, supporting its role as an effective induction and maintenance therapy.

The objective of this study is to investigate the equilibrium thermodynamic and structural properties of small proteins in the presence of an implicit solvent using the SMMP package. The work primarily focuses on performing parallel tempering simulations for the peptides Met-enkephalin. The thermodynamic parameters, such as specific heat and average energy, structural properties like radius of gyration and end to end distance with respect to temperature were calculated as functions of temperature to analyze the stability and Conformational behavior of the proteins.

The ASHP Pharmacy Forecast 2026 is written to identify and contextualize emerging trends that will influence healthcare, health systems, and the pharmacy profession. It provides recommendations to inform strategic planning that should prompt action by pharmacists and health-system leaders. Drawing on "the wisdom of crowds" concept, a survey was constructed by an advisory committee with 6 themes, each with 7 focused statements and a seventh theme on preparedness (54 survey items in total). A survey panel of 383 pharmacy leaders was purposefully designed to capture opinions from a wide range of pharmacists across the United States. Panelists were asked to consider the likelihood of the statements occurring in the next 5 years as being likely, somewhat likely, somewhat unlikely, or very unlikely. Forecast panelists also assessed health systems' preparedness (from very unprepared to very prepared) for 12 of the statements. The 6 survey themes identified were Policy, Drug Costs, and the Financial Stability of Health Systems; Stabilizing the Pharmaceutical Supply Chain; Patients as Consumers of Health Care; Realizing the Potential of Therapeutic Advances; Environmental Sustainability and Resilience; and Transforming Safety. The survey was completed by 298 respondents, yielding a 78% response rate. Descriptive statistics of the survey results were provided to chapter authors to inform commentary with strategic recommendations for each theme. The Pharmacy Forecast provides insights into large-scale, long-term trends that will influence healthcare and the pharmacy profession over the years ahead. Insights from the report can stimulate strategic thinking and provide a starting point to proactively position leaders, their teams, and departments for potential future trends.

A hipertensa o arterial secunda ria se trata de uma enfermidade oriunda de fator justifica vel, ou seja, pela pro pria nomeaa o, adjacente a alguma condia o.Existe um fator identifica vel, de cara ter revers vel quando manejado adequadamente.Na perspectiva epidemiolo gica, considera-se que cerca de 10% a 20% dos casos totais de hipertensa o arterial siste mica (HAS).

Uvod: Medicinski dispečeri imaju ključnu ulogu u pružanju stručne medicinske pomoći putem telefona, pružajući podršku i usmjeravanje pozivateljima u situacijama opasnima po život. Budući da dispečerska služba djeluje neprekidno, zaposlenici rade u smjenama. Cilj je ovog rada istražiti kvalitetu spavanja medicinskih dispečera koji obavljaju smjenski rad. Istraživanje doprinosi proširenju spoznaja o učincima smjenskog rada na san u ovom specifičnom i nedovoljno istraženom profesionalnom kontekstu. Metode: Presječno istraživanje uključivalo je namjensko uzorkovanje za provođenje anketnog upitnika među medicinskim dispečerima u medicinskoj dispečerskoj službi koji obavljaju smjenski rad. Podaci su prikupljeni između srpnja i kolovoza 2023. godine pomoću anketnog upitnika Scale Quality Scale koji ocjenjuje šest područja kvalitete spavanja u proteklih mjesec dana: dnevna disfunkcija, oporavak nakon spavanja, poteškoće pri usnivanju, poteškoće prilikom ustajanja, zadovoljstvo snom i poteškoće u održavanju sna. Podaci su obrađeni i analizirani pomoću programa IBM SPSS Statistics 29. Upotrjebljena je deskriptivna i inferencijalna statistika. Rezultati: U istraživanju je sudjelovalo 59 dispečera; 52,50 % njih ocijenilo je svoju kvalitetu sna kao lošu. Najviša prosječna ocjena zabilježena je za tvrdnju „Nakon spavanja, moje misli su sabrane“ (M = 1,81), a podljestvica s najvišom ocjenom bila je dnevna disfunkcija (M = 9,86; SD = 6,88). Podljestvice oporavka nakon spavanja (M = 5,66), poteškoća kod ustajanja (M = 4,17) i zadovoljstva snom (M = 3,70) također su bile izraženije, dok su najniže ocjene zabilježene za održavanje sna (M = 2,71) i usnivanje (M = 3,29). Nisu utvrđene statistički značajne razlike u ukupnoj kvaliteti sna u odnosu na dob, spol i radni staž. Rasprava i zaključak: Više od polovice dispečera percipira svoj san kao loš, pri čemu dominira dnevna disfunkcija kao najizraženije područje poremećaja. Rezultati ukazuju na potrebu za specifičnim intervencijama, poput optimizacije rasporeda smjena i edukacije o higijeni sna, kako bi se smanjio negativan utjecaj smjenskog rada na njihovo svakodnevno funkcioniranje.

Hypoglycemia is a common complication of inpatient care for patients with diabetes. We sought to determine recent trends and demographic disparities in the rate of inpatient hypoglycemia. We used data from the Veterans Affairs (VA) health care system to identify all patients with type 2 diabetes hospitalized from 2016 to 2022. We determined rates of inpatient hypoglycemia (<70 mg/dL) and discharge diagnosis coding for hypoglycemia. We determined differences in rates of hypoglycemia by age, sex, and race and ethnicity, adjusting for other patient diagnoses, laboratory values, vital signs, and insulin use. Among 512,261 patients hospitalized with diabetes, 6.8% (34,918) had an episode of hypoglycemia (<70 mg/dL). This rate decreased by 17% from 2016 to 2022 (7.4% to 6.3%), while the rate of discharge diagnosis among those with hypoglycemia increased. After adjustment for other patient characteristics, the youngest and oldest patients, and those hospitalized in earlier years (vs. 2022) had significantly higher rates of hypoglycemia. Black (adjusted odds ratio [aOR] 1.42, 95% CI 1.36-1.49) or Hispanic patients (aOR 1.26, 95% CI 1.17-1.35) had a greater risk of hypoglycemia compared with non-Hispanic White patients, and women had borderline less hypoglycemia than men (aOR 0.95, 95% CI 0.89-1.00). Inpatient hypoglycemia in the VA health system has been declining, although there are race, age, and sex differences that remain unexplained. Recognition of hypoglycemia, defined as a discharge diagnosis, is increasing.

Introduction: A tenant of anticoagulation stewardship is bleeding risk mitigation through appropriate antiplatelet therapy (APT) and non-steroidal anti-inflammatory drug (NSAID) deprescribing. The Veterans Health Administration's (VHA) Direct Oral Anticoagulant (DOAC) Population Management Tool (PMT) alerts users to DOAC-treated patients co-prescribed NSAIDs with some sites piloting novel APT alerts. We aimed to evaluate APT and NSAID use in DOAC-treated patients across VHA, correlating with DOAC PMT and APT alert engagement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

A perícia médica criminal desempenha um papel crucial na avaliação da culpabilidade de um indivíduo que alega perda da capacidade de discernir a natureza criminosa da ação praticada. Caso seja comprovada essa condição, o sujeito é considerado inimputável e submetido a internação ou detenção com tratamento ambulatorial. Portanto, o objetivo deste estudo é analisar crimes com maior incidência da hipótese de inimputabilidade, a fim de discutir pontos relevantes para a perícia médica.