Background: Bariatric surgery has evolved over the past 2 decades yet assessing trends of bariatric surgery utilization in the growing eligible population is lacking. Aim: This study aimed to update the trends in bariatric surgery utilization, changes in types of procedures performed, and the characteristics of patients who underwent bariatric surgery in the United States, using real-world data. Method: This retrospective descriptive observational study was conducted using the TriNetX, a federated electronic medical records network from 2012 to 2021, for adult patients 18 years old or older who had bariatric surgery. Descriptive statistical analysis was conducted to assess patients’ demographics and characteristics. Annual secular trend analyses were conducted for the annual rate of bariatric surgery, and the specific procedural types and proportions of laparoscopic surgeries. Results: A steady increase in the number of procedures performed in the United States over the first 6 years of the study, a plateau for the following 2 years, and then a decline in 2020 and 2021 (during the coronavirus disease 2019 pandemic). The annual rate of bariatric surgery was lowest in 2012 at 59.2 and highest in 2018 at 79.6 surgeries per 100,000 adults. During the study period, 96.2% to 98.8% of procedures performed annually were conducted laparoscopically as opposed to the open technique. Beginning in 2012, the Roux-en-Y gastric bypass (RYGB) procedure fell to represent only 17.1% of cases in 2018, along with a sharp decline in the adjustable gastric band (AGB) procedure, replaced by a sharp increase in the sleeve gastrectomy (SG) procedure to represent over 74% of cases in 2018. Conclusions: Bariatric surgery utilization in the United States showed a moderate decline in the number of RYGB procedures, which was offset by a substantial increase in the number of SG procedures and a precipitous drop in the annual number of AGB procedures.

Background: Obesity poses a significant public health and economic challenge in the United States (U.S.), with rising prevalence, particularly among individuals enrolled in Medicaid—the nation’s public health insurance program for low-income populations. Anti-obesity medications (AOMs) have become integral to managing obesity, but trends in their utilization and spending within Medicaid remain underexplored.Objective: To examine Medicaid’s utilization, reimbursement, and price trends for AOMs from 1999 to 2023.Methods: A retrospective analysis assessing the utilization, reimbursement, and pricing of older and newer AOMs. Yearly prescription numbers and reimbursement were calculated for seven AOMs billed through Medicaid between 1999 and 2023. The average expenditure per prescription was used as an indicator of drug pricing.Results: AOM prescriptions rose from 13,855 in 1999 to 938,663 in 2023, a 6,674% increase. Spending surged by over 77,805,466% due to the introduction of newer, more effective medications, including Wegovy and tirzepatide. The largest share of the market growth in 2023 was driven by these medications.Conclusion: The significant increase in AOM utilization and spending highlights the growing burden of obesity on Medicaid, emphasizing the need for policy measures to manage rising costs and ensure equitable access to treatment.

Purpose: Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors represent major advancements in the management of type 2 diabetes. However, many patients remain suboptimally managed with these therapies. This underutilization highlights the need for practical implementation strategies in real-world settings. Community pharmacists can play a crucial role in integrating these therapies into diabetes care. This study aimed to evaluate community pharmacists’ knowledge, counseling practices, perceived barriers, and clinical decision-making regarding these therapies. Methods: A cross-sectional, questionnaire-based survey was conducted among licensed community pharmacists in the Qassim region, Saudi Arabia. Results: A total of 211 community pharmacists participated in this study. Of these, 83.4% were male and 16.6% were female. The participants’ perceived levels of knowledge of the pharmacology and basic concepts of GLP-1 receptor agonists and SGLT-2 inhibitors were high, with mean scores (± SD) of 13.41 ± 2.43 and 13.36 ± 2.59, respectively, out of a maximum of 16. However, knowledge related to clinical therapeutics and evidence-based decision-making was low, with only 24.2%, 23.7%, and 32.2% of the participants correctly answering the three patient-based case scenarios. Many participants counseled and discussed these therapies in patients with type 2 diabetes. However, the participants reported several barriers, including high medication costs (67.3%), concerns about side effects (33.2%), challenges with patient adherence (28.4%), and limited time to engage in discussions with patients (22.7%). Notably, 88.2% of the participants indicated that continuing professional development in diabetes therapy is required. Conclusion: Many participants had substantial gaps in their applied knowledge of clinical therapeutics and persistent barriers to clinical engagement remained. Targeted educational strategies and system-level support are crucial for enhancing the role of community pharmacists in managing type 2 diabetes.

Therapeutic drug monitoring (TDM) is key to optimizing vancomycin therapy, as accurate sampling timing ensures valid drug levels and supports safe, effective clinical decisions. This study aimed to assess the timing accuracy of blood draws for vancomycin TDM, evaluate its clinical implications, and identify predictors of timing errors. A cross-sectional study was conducted at King Saud University Medical City, involving 103 patients from October 2023 to December 2023. The primary outcome was adherence to the blood sampling timing guidelines. Secondary outcomes included clinical cure rates, acute kidney injury incidence, and in-hospital mortality. Of the analyzed samples, 80.6% were improperly timed. Clinical cure rates were significantly higher among patients with correctly timed samples (75%) compared to those with incorrectly timed samples (57.83%). Timely sampling improved cure rates for pulmonary and skin infections (85.71%), while improper timing reduced them to 72.22% and 62.5%, respectively. Improper timing was linked to higher in-hospital mortality (30.12%) and acute kidney injury (15.66%). Multivariate analysis revealed that bacteremia significantly reduced the likelihood of clinical cure (odds ratio = 0.387, 95% confidence interval [0.160, 0.933], P = .035), while 3 times daily dosing significantly increased the odds of correctly timed samples (odds ratio = 5.1, 95% confidence interval [1.125, 23.11], P = .035). This study highlights the critical role of accurate timing in vancomycin TDM for achieving favorable patient outcomes and reducing adverse events. Strengthened institutional protocols and targeted training programs are essential to improve adherence to sampling guidelines and enhance patient safety.