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Objective To compare the real-world effectiveness and costs of eribulin to those of capecitabine in patients with metastatic breast cancer (MBC) pretreated with anthracyclines and taxanes. Methods This study extracted data from the Health and Welfare Database in Taiwan to identify MBC patients, and then eribulin and capecitabine users were matched at a 1:1 ratio by age, residential region, Charlson Comorbidity Index score, and molecular subtype of BC cell. The overall survival (OS) and time-to-treatment discontinuation (TTD) curves were plotted using the Kaplan–Meier method. Healthcare utilization and costs between the two groups were compared. Results A total of 24,550 MBC patients were identified, and 298 patients were enrolled in each group after matching. The median OS was 11.8 months for eribulin (95%CI: 11.5–13.5 months) and 15.2 months for capecitabine (95%CI: 15.3–17.9 months; HR = 1.7, p 4 prior chemotherapy agents (OS: HR 1.1, 95%CI 0.8–1.5; TTD: HR 1.2, 95%CI 0.9–1.7). The total healthcare costs per patient during the treatment period were NT$580,523.8 for eribulin versus NT$497,223.8 for capecitabine (p, Highlights • This study provides a better understanding of the effectiveness of eribulin in refractory MBC patients. • Despite the potential biases, our study results suggest that eribulin has shorter OS and TTD when compared to capecitabine. • The difference no longer exists when the drugs are both initiated as sixth- or later-lines of chemotherapy. • The rate of G-CSF use and the total medical and medication costs were found to be higher with eribulin treatment.

Heterotopic ossification (HO) in patients with spinal cord injury could lead to local tissue swelling and sometimes mimic the clinical presentation of deep vein thrombosis. Recognition and effective management is critical. We report the case of a bedridden patient with spinal cord injury presenting with diffuse right lower limb swelling caused by external venous compression from HO. The patient underwent surgery and local radiation therapy. Postoperative venography disclosed a marked improvement in the blood flow, and symptoms were alleviated. We discuss the role of venography in the diagnosis and treatment of venous compression in the setting of HO.

Background New developments in medications for metastatic breast cancer (MBC) can be of great benefit to patients, but unfortunately these medicines also increase expenditures. Cost-utility analyses (CUAs) are needed to allocate health resources properly, and health utility values are required to calculate quality-adjusted life years in those CUAs. Objective The aims of this study were to measure health utility values for several MBC-related health states and certain breast cancer treatment-related grade 3/4 adverse drug reactions (ADRs). In addition, we examined whether different methods and respondents’ characteristics would influence the utility values elicited. Methods A cross-sectional survey was conducted. The visual analogue scale (VAS) and time trade-off (TTO) methods were used to measure health utilities. Four MBC and nine ADR health states were selected for evaluation based on literature review and expert opinion. Information about respondents’ demographic and clinical characteristics were collected to examine the relationship between utilities and participant characteristics. Results A total of 102 patients participated in this study. The TTO-elicited values were higher than the VAS-derived scores except for two MBC-related health states. Among the MBC health states assessed, the TTO preference score ranged from 0.04 (palliative MBC) to 0.62 (responding MBC). For grade 3/4 ADRs, the mean TTO-derived utility values ranged from 0.35 (nausea/vomiting) to 0.79 (fatigue). The ranking of the preference scores derived from the VAS was similar to that of the TTO-elicited scores. Conclusion This study obtained health state utility values for MBC and grade 3/4 ADRs using both the TTO and the VAS, which provides useful data for future CUAs., Highlights • This study obtained health state utility values for metastatic breast cancer (MBC) and grade 3/4 adverse drug reactions (ADRs) using both the time trade-off (TTO) and the visual analogue scale (VAS), which provides useful data for future cost-utility analyses. • Among the MBC health states assessed, the TTO preference score ranged from 0.04 (palliative MBC) to 0.62 (responding MBC). • For grade 3/4 ADRs, the mean TTO-derived utility values ranged from 0.35 (nausea/vomiting) to 0.79 (fatigue).

An efficient organic light-emitting diode based on the BCzPh:CN-T2T exciplex as an emitting layer (EML) has been fabricated by exploiting charge balance and favorable molecular orientations. To fur...

The increasing interest and demand for skin whitening products globally, particularly in Asia, have necessitated rapid advances in research on skin whitening products used in traditional Chinese medicine (TCM). Herein, we investigated 74 skin whitening prescriptions sold in TCM pharmacies in Taiwan. Commonly used medicinal materials were defined as those with a relative frequency of citation (RFC) > 0.2 and their characteristics were evaluated. Correlation analysis of commonly used medicinal materials was carried out to identify the core component of the medicinal materials. Of the purchased 74 skin whitening prescriptions, 36 were oral prescriptions, 37 were external prescriptions, and one prescription could be used as an oral or external prescription. After analysis, 90 traditional Chinese medicinal materials were obtained. The Apiaceae (10%; 13%) and Leguminosae (9%; 11%) were the main sources of oral and external medicinal materials, respectively. Oral skin whitening prescriptions were found to be mostly warm (46%) and sweet (53%), while external skin whitening prescriptions included cold (43%) and bitter (29%) medicinal materials. Additionally, mainly tonifying and replenishing effects of the materials were noted. Pharmacological analysis indicated that these medicinal materials may promote wound healing, treat inflammatory skin diseases, or anti-hyperpigmentation. According to the Spearman correlation analysis on interactions among medicinal materials with an RFC > 0.2 in the oral skin whitening prescriptions, Paeonia lactiflora Pall. (white) and Atractylodes macrocephala Koidz. showed the highest correlation (confidence score = 0.93), followed by Ziziphus jujuba Mill. (red) and Astragalus propinquus Schischkin (confidence score = 0.91). Seven medicinal materials in external skin whitening prescriptions with an RFC > 0.2, were classified as Taiwan qī bái sàn (an herbal preparation), including Angelica dahurica (Hoffm.) Benth. & Hook. f. ex Franch. & Sav., Wolfiporia extensa (Peck) Ginns, Bletilla striata (Thunb.) Rchb. f., Atractylodes macrocephala Koidz., Ampelopsis japonica (Thunb.) Makino, Paeonia lactiflora Pall. (white), and Bombyx mori Linnaeus. Skin whitening prescriptions included multiple traditional Chinese medicinal materials. Despite the long history of use, there is a lack of studies concerning skin whitening products, possibly due to the complex composition of traditional Chinese medicine. Further studies are required to assess the efficacy and safety of these traditional Chinese medicinal materials for inclusion in effective, safe, and functional pharmacological products.

Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p

Objective Treatment options for HER-2-positive metastatic breast cancer (mBC) patients have expanded markedly since trastuzumab approval in 1998. Several other regimens are now available, including pertuzumab plus trastuzumab plus docetaxel, T-DM1, capecitabine plus lapatinib, and trastuzumab plus lapatinib. This study assesses the cost-effectiveness of four treatment sequences for HER-2-positive mBC according to the Taiwanese National Health Insurance Administration (TNHIA). Methods Costs (U.S. Dollars) and effectiveness (quality-adjusted life years) of four treatment sequences for HER-2-positive mBC patients were examined using a Markov model over a lifetime horizon. Transition probabilities, disease progression, and probability of adverse events and survival were derived from clinical trial data. Costs and health utilities were estimated from TNHIA, Taipei Medical University Hospital, and the literature. Deterministic, probabilistic sensitivity analyses and a scenario analysis examined parameter uncertainty and accounted for drug wastage in dosage and cost calculations. Results Sequence 3 (1st line: trastuzumab plus docetaxel; 2nd line: T-DM1; 3rd line: trastuzumab plus lapatinib) was the most cost-effective sequence followed by sequence 1 (1st line: pertuzumab plus trastuzumab plus docetaxel; 2nd line: T-DM1; 3rd line: capecitabine plus lapatinib), and sequence 4 (1st line: trastuzumab plus docetaxel; 2nd line: trastuzumab plus lapatinib; 3rd line: trastuzumab plus capecitabine), respectively. The model was sensitive to costs and transition probabilities, but not particularly sensitive to the wastage assumption. Conclusions From the perspective of the TNHIA, trastuzumab plus docetaxel as 1st line followed by T-DM1 and trastuzumab plus lapatinib as 2nd and 3rd line represents the most cost-effective strategy among the four sequences considered for treating HER-2-positive mBC patients., Highlights • In health systems in which resources are scarce, treatment selection should be carefully considered to preserve efficiency. • We conducted a CEA of four treatment sequences for HER-2-positive mBC in Taiwan, accounting for intravenous drug wastage. • Results of such analyses can be useful to policymakers as they decide on coverage of expensive new anticancer treatments.

To describe and evaluate the intentional combination of Angio-Seal (AS) and Perclose ProGlide (PP) in achieving haemostasis in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR).This study cohort was divided into two groups: dual PP versus one AS with one PP (AS + PP) used for common femoral artery haemostasis. The baseline, procedural characteristics and all outcomes (defined according toVARC-2 criteria) were prospectively collected and retrospectively compared.Overall, a total of 151 consecutive patients (68 men; 80.9 ± 7.3 years old) were evaluated. Of these, 51 patients (33.8%) underwent TAVR using the dual PP, and 100 (66.2%) using one AS with one PP. There were no significant differences in the baseline characteristics of both patient groups, except higher incidence of chronic pulmonary disease in dual PP group (21.6% vs 7%, P = 0.009). Patients in AS + PP group had lower rate of arterial stricture (21.6% vs 8%, P = 0.017), arterial dissection (13.7% vs 4.0%), requiring endovascular intervention for puncture site issues (21.6% vs 9.0%, P = 0.031). Less procedural time (139.8 ± 36.9vs97.9 ± 31.4 min, P 0.001)contrast medium consumption (223.9 ± 88.3vs174.1 ± 49.7 ml, P 0.001) were also observed in AS+PP group. There were no statistically significant differences between 2 groups in regards of closure device failure, major and minor vascular complications, nor major and minor bleeding.Intentional combination of one PP and one AS for femoral access haemostasis in patients undergoing TAVR is feasible and safe, with low risk of vascular and bleeding complications.

Objective: To assess the psychometric properties of the Chinese version of the Gout Impact Scale (GIS), a gout-specific HRQoL measure.Methods: This was a single-center, cross-sectional, obs...

Objective Despite the increasing prevalence and costs of breast cancer (BC), little is known about its adverse event (AE)-related costs in Asia. This study aimed to estimate the healthcare expenditures of AEs in patients with BC in Taiwan. Methods This is a retrospective claims database analysis. The medical costs associated with BC AEs during the first-line treatment period were estimated by use of both a matching method and the generalized linear model (GLM). Results A total of 50,010 patients diagnosed with breast cancer were identified. Using the case-control matching method, pneumonitis/pneumonia was the AE associated with the greatest total healthcare costs (NT$ 66,889), followed by arthralgia (NT$55,380). In the GLM, the estimated costs ranged from NT$ 1,045 for fatigue to NT$ 116,652 for left heart failure. Moreover, the estimated total healthcare incremental cost increased with the number of AEs (NT$18,157 for 1 AE, NT$33,827 for 2 AEs, NT$39,052 for 3 AEs, NT$53,348 for 4 AEs, and NT$54,215 for 5 AEs and above). Conclusions The findings indicate that AEs among patients with BC were associated with a substantial economic burden, and healthcare expenditure rose significantly as the number of AEs increased.

Natural medicinal materials have been used to promote breast milk secretion. Here, we investigated the natural medicinal materials prescribed in traditional Chinese medicine (TCM) pharmacies across Taiwan to induce lactation. We collected medicinal materials from 87 TCM pharmacies, identified them in the prescriptions, and analyzed their drug contents. We examined their botanical origins, biological classifications, traditional usage, and modern pharmacological properties. We used the TCM Inheritance Support System to identify core medicinal materials in galactogenous prescriptions. We collected 81 medicinal materials from 90 galactogenous prescriptions. Leguminosae accounted for 12%, whereas Apiaceae accounted for 7% of all materials examined. The primary medicinal plant parts used were roots and seeds. Nineteen frequently used medicinal materials had a relative frequency of citation of greater than or equal to 0.2. According to their efficacy, 58% were warm, 54% were sweet, and 63% were tonifying; 74% of the frequently used medicinal materials have been showed efficacy against breast cancer. The primary core medicinal material was Angelica sinensis (Oliv.) Diels, whereas the secondary core medicinal materials were Tetrapanax papyrifer (Hook.) K. Koch and Hedysarum polybotrys Hand.-Mazz. Most galactogenous prescriptions consisted of multiple materials from Leguminosae and Apiaceae. The mechanisms underlying galactogenous efficacy warrant further investigations.

Prostate cancer is the most common malignancy diagnosed in North American men. Although medical advances have improved survival rates, men treated for prostate cancer experience side-effects that can reduce their work capacity, increase financial stress, and affect their career and/or retirement plans. Working-age males comprise a significant proportion of new prostate cancer diagnoses. It is important, therefore, to understand the connections between prostate cancer and men’s work lives. This scoping review aimed to summarize and disseminate current research evidence about the impact of prostate cancer treatment on men’s work lives. Electronic databases were searched to identify peer-reviewed articles published between 2006 and 2020 that reported on the impact of prostate cancer treatment on men’s work. Following scoping review guidelines, 21 articles that met inclusion criteria were identified and analyzed. Evidence related to the impact of prostate cancer on work was grouped under three themes: (1) work outcomes after prostate cancer treatment; (2) return to work considerations, and (3) impact of prostate cancer treatment on men’s finances. Findings indicate that men’s return to work may be more gradual than expected after prostate cancer treatment. Some men may feel pressured by financial stressors and masculine ideals to resume work. Diverse factors including older age and social benefits appear to play a role in shaping men’s work-related plans after prostate cancer treatment. The findings provide direction for future research and offer clinicians a synthesis of current knowledge about the challenges men face in resuming work in the aftermath of prostate cancer treatment.

Significance: Diffuse optical imaging (DOI) provides in vivo quantification of tissue chromophores such as oxy- and deoxyhemoglobin (HbO2 and HHb, respectively). These parameters have been shown to be useful for predicting neoadjuvant treatment response in breast cancer patients. However, most DOI devices designed for the breast are nonportable, making frequent longitudinal monitoring during treatment a challenge. Furthermore, hemodynamics related to the respiratory cycle are currently unexplored in the breast and may have prognostic value. Aim: To design, fabricate, and validate a high optode-density wearable continuous wave diffuse optical probe for the monitoring of breathing hemodynamics in breast tissue. Approach: The probe has a rigid-flex design with 16 dual-wavelength sources and 16 detectors. Performance was characterized on tissue-simulating phantoms, and validation was performed through flow phantom and cuff occlusion measurements. The breasts of N = 4 healthy volunteers were measured while performing a breathing protocol. Results: The probe has 512 unique source-detector (S-D) pairs that span S-D separations of 10 to 54 mm. It exhibited good performance characteristics: ma drift of 0.34%/h, ma precision of 0.063%, and mean SNR > 24 dB up to 41 mm S-D separation. Absorption contrast was detected in flow phantoms at depths exceeding 28 mm. A cuff occlusion measurement confirmed the ability of the probe to track expected hemodynamics in vivo. Breast measurements on healthy volunteers during paced breathing revealed median signal-to-motion artifact ratios ranging from 8.1 to 8.7 dB. Median DHbO2 and DHHb amplitudes ranged from 0.39 to 0.67 mM and 0.08 to 0.12 mM, respectively. Median oxygen saturations at the respiratory rate ranged from 82% to 87%. Conclusions: A wearable diffuse optical probe has been designed and fabricated for the measurement of breast tissue hemodynamics. This device is capable of quantifying breathing-related hemodynamics in healthy breast tissue.

There are significant differences in costs and effectiveness among the second-line treatment options for type 2 diabetes (T2DM). We aimed to evaluate the cost-effectiveness of the second-line anti-diabetic therapy in T2DM patients inadequately controlled on metformin (MET) in Taiwan from the perspective of the National Health Insurance (NHI).The Cardiff T2DM model was used to predict the occurrence of mortality, diabetes-related complications, and drug adverse events. Five second-line treatments were selected for the analysis: sodium-glucose cotransporter 2 inhibitors (SGLT-2-i), glucagon-like peptide-1 receptor agonists (GLP-1-RA), dipeptidyl peptidase-4 inhibitor (DPP-4-i), sulfonylurea (SU), and insulin (INS). Treatment efficacy data were obtained from meta-analyses and randomized clinical trials, whereas cost data were derived from the NHI databases.The analysis found that SU + MET (DPP-4-i as triple therapy) had the lowest cost, and SU + MET (SGLT-2-i as triple therapy) was associated with a mean incremental benefit of 0.47 quality-adjusted life years (QALYs) at an incremental cost of NT$2769, resulting in an incremental cost-effectiveness ratio (ICER) of NT$5840/QALY. Compared to their next less costly strategies, SGLT-2-i + MET (SU as triple therapy) and SGLT-2-i + MET (DPP-4-i as triple therapy) had ICER values of NT$63,170/QALY and NT$64,090/QALY, respectively. These results were fairly robust to extensive sensitivity analyses, but were relatively sensitive to baseline HbA1c, HbA1c threshold, and utilities.The addition of either SU or SGLT-2-i to MET was found to be cost-effective, using the 2019 forecast for GDP per capita of Taiwan (NT$770,770) as the willingness to pay (WTP) threshold.

The rapid development and diversified application modules of unmanned aerial vehicles (UAVs) have boosted economic development. According to Teal Group, a renowned aerospace analysis company, non-military UAV production will increase to $14.5 billion in 2028. The purpose of this study is collecting estimates of the future development and application modules of UAVs, to which related industries and users can refer. Hopefully, this study can benefit the development of the local UAV industry. With the popularity of UAVs, there arises UVA operation-related risk worth our concern. Taiwan's Civil Aeronautics Administration has placed emphasis on formulation of regulations and risk management in relation to UAV application. Although there are third party liability insurance products available on the market, they fail to cover the financial loss incurred upon UAV users. In view of this fact, this study also takes into concern current UAV third party insurance and related risk management. Users are expected to conduct risk management and reduce loss.

We propose a texture synthesis method based on generative adversarial networks, focusing on a cultural emblem, called Batik, of southeastern Asian countries. We propose a two-stage training approach to construct the network, first generating patches and then combining patches to generate the entire Batik image. Regular repetition and synthesis artifact removal are jointly considered to guide model training. In the evaluation, we show that the proposed generator fuses two Batik styles, removes blocking artifacts, and generates harmonious Batik images. Qualitative and quantitative evaluations are provided to show promising performance from several perspectives.

To investigate the healthcare expenditures and length of stay (LOS) of sepsis-related hospitalizations in Taiwan.This is a retrospective claim database study. Data were obtained from the two-million-sample longitudinal health and welfare database (LHWD). Adult patients hospitalized with sepsis between 2010 and 2014 were identified by International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes, and these patients were divided into three levels of sepsis severity. The amount and distribution of their total medical expenditures were investigated.In total, 62,517 patients with 97,790 sepsis-related hospitalizations were included in the present study. It was found that ward fees and medicines comprised the largest component of expenses for sepsis-related hospitalizations. In addition, our study results indicated that the median sepsis-related hospitalization cost was 66.4 thousand New Taiwan Dollar (NT dollars) in 2014, and a significant temporal change was found between 2010 and 2014. The median LOS in a hospital and in an intensive care unit were 11 and 7 days, respectively. Both expenditures and LOS were found to increase with sepsis severity.This study provides an updated and better understanding of the costs and LOS of sepsis-related hospitalizations in Taiwan. It was found that ward fees and medicine fees were the major components of hospital costs.

The present data article aims to describe the input parameters for a Markov model assessing the cost-effectiveness of four treatment sequences for patients with HER-2 positive metastatic breast cancer. The model input parameters include costs for physician visits, drugs, adverse event management, computed tomography (CT) scan, laboratory tests, echocardiogram, utilities, disutilities as well as the shape and scale parameters of a log-logistic distribution used for the transition probabilities. Keywords: Markov model, Metastatic breast cancer, Cost-effectiveness analysis, Treatment sequence

Aim. This study aimed at (1) examining the misconceptions of patients with diabetes in Taiwan and (2) examining the association between patients’ diabetes knowledge and their demographic characteristics. Methods. A cross-sectional survey was conducted at a metropolitan hospital in northern Taiwan. A total of 501 outpatients with diabetes were recruited, mostly from the hospital’s endocrinology and metabolism clinic, nephrology clinic, and dialysis center. A self-developed questionnaire that consisted of demographic information and a diabetes knowledge test was administered. The knowledge test included 10 True/False questions and 6 multiple-choice questions that aimed at identifying patients’ common misconceptions about diabetes. Results. A perfect score on the diabetes knowledge test was 16 points, and the mean±SD score of the respondents was 11.5±2.8. The most common misconception was “People can always feel when their blood sugar level is high.” (64%), followed by “Taking insulin hurts the kidneys and may result in a need for dialysis.” (52%) and “Being a vegetarian helps control blood sugar levels.” (48%). The total knowledge scores were significantly associated with education levels (rs=0.39, p<0.001), average monthly income (rs=0.28, p<0.001), and age (rs=−0.34, p<0.001). Conclusions. Certain misconceptions are prevalent among patients with diabetes, particularly in those with older age, lower education levels, or lower income. Healthcare providers need to work to eliminate common misconceptions and modify diabetes educational programs accordingly to help patients manage diabetes more effectively.

Background It remains unclear whether the use of new oral anticoagulants, compared with warfarin, is economically beneficial in Asian countries. Objective The objective of this study is to compare the health care costs and utilization between dabigatran and warfarin in a real-world nonvalvular atrial fibrillation (NVAF) population. Research design Data were obtained from the Taiwan National Health Insurance Database, and patients with an NVAF diagnosis between June 1, 2012, and May 31, 2014, were identified using the International Classification of Diseases, Ninth Revision code of 427.31. The patients in the dabigatran cohort were matched 1:2 to those in the warfarin cohort by sex, age, residential region, and a propensity score that incorporated a major bleeding history, CHADS2 score, and Charlson Comorbidity Index. The all-cause health care utilization and associated costs of the 2 treatment groups were compared at 3 and 12 months. Results A total of 1149 patients taking dabigatran were identified and matched with 2298 warfarin users. During the 3-month observation period, the likelihood of having at least 1 hospitalization among dabigatran users was significantly lower than that of warfarin users (odds ratio=0.78; P=0.001). Patients in the dabigatran group incurred lower mean emergency department costs ($2383.1 vs. $3033.6), mean ischemic stroke-related hospitalization costs ($8869.5 vs. $13,990.5), and mean all-cause hospitalization costs ($32,402.2 vs. $50,669.9) at 3 months. However, both the mean and median outpatient costs of warfarin users were consistently lower than those of dabigatran users ($17,161.2 vs. $24,931.4 and $10,509.0 vs. $20,671.5, respectively). Similar trends were observed at 12 months, except that the 2 groups had comparable total health care costs. Conclusions The use of dabigatran is associated with lower emergency department and all-cause hospitalization costs but greater outpatient costs in a real-world, NVAF patient population compared with warfarin.

To better understand the economic burden of gout patients in Taiwan, a nationwide retrospective study was conducted to compare the healthcare costs and utilization between gout and gout-free patients.The Longitudinal Health Insurance Database (LHID) 2010 was used to identify gout cases and matched gout-free controls. Gout cases were defined as having (1) at least three instances of diagnoses of gout on medical claims, or (2) one diagnosis of gout with at least one gout-related pharmacy claim in 2011. A control cohort was matched with cases at a 3:1 ratio by age, gender, residential area, and the Charlson Comorbidity Index. All medical utilization and costs per patient within the 365 days following the index date were compared between cases and controls.Out of 993,332 beneficiaries, a total of 21,376 matched gout patients met the gout inclusion criteria. Compared to controls, gout patients had more outpatient visits (mean = 31.2 vs 22.6), inpatient visits (mean = 1.7 vs 1.5), and ER visits (mean = 1.9 vs 1.7) (all p .0001), as well as more outpatient costs (median = USD $634 vs $404), inpatient costs (median = USD $1330 vs $1254), and ER costs (median = USD $87 vs $89) (all p .05).Gout patients had higher medical utilization and costs than gout-free patients. In gout patients, all-cause and gout-related utilization were mostly outpatient visits, whereas most of the all-cause and gout-related costs were due to hospitalization. The study findings could be useful for future economic evaluations and healthcare resource allocation.

Intravascular hemolysis (IVH) has been identified in patients with surgical prosthetic valves, but few have been reported after transcatheter aortic valve implantation (TAVI). We conducted a prospective analysis of 64 TAVI patients. The hemolysis profiles were collected at baseline and 6 months after TAVI. The echocardiography was performed at baseline and 6 months after TAVI. There are 14 patients (21.9%) with IVH before and 24(37.5%) after TAVI. The serum haptoglobin values before and 6 months after TAVI are 126.7 ± 75.1 vs 86.3 ± 57.1 mg/dl (p 0.001). More ≥moderate paravalvular leakage (PVL) (50% vs 7.5%, p 0.001), bicuspid aortic valve (BAV) (33.3% vs 5.0%, p = 0.004), use of 23 mm prosthesis (29.2% vs 7.5%, p = 0.03), higher residual valvular pressure gradient (17.9 ± 6.8 mm Hg vs 14.7 ± 5.7 mm Hg, p = 0.05), and lower effective orifice area index (1.05 ± 0.21 vs 1.21 ± 0.29, p = 0.03) were observed in patients with post-TAVI IVH. On multivariate regression analysis, BAV and ≥moderate PVL are independently related to post-TAVI IVH. With log-rank test, 1-year rates of readmission due to cardiovascular cause were significantly higher in patients with post-TAVI IVH (odds ratio 4.5; 95% confidence interval 1.3 to 15.6; p = 0.02), after adjusting age and gender. In conclusion, ≥moderate PVL and BAV are predictors of post-TAVI IVH, which is associated with increased cardiovascular readmission in 1-year follow-up.

Small bowel tumors are rare among all gastrointestinal (GI) cancers. The most common histological subtype is adenocarcinoma. Adenocarcinoma of the small bowel is difficult to diagnose, often presents at a late stage, and has a poor prognosis. We describe a case of a patient with adenocarcinoma of the small intestine who presented to the hospital with nonspecific GI symptoms and obscure GI bleeding. An initial examination using abdominal computed tomography revealed negative findings. The patient underwent subsequent enteroscopy with capsule endoscopy and double‐balloon endoscopy, and an early‐stage jejunal adenocarcinoma was finally diagnosed., Small bowel malignancy is rare. Imaging studies such as computed tomography (CT) have a limited role in the early diagnosis of small bowel malignancy. Capsule endoscopy and deep enteroscopy remain an important diagnostic tool after negative CT study.

Despite the first approval of biosimilars’ in 2010, biosimilar products usage has remained low in Taiwan. This cross-sectional survey study assessed healthcare professionals’ (HCPs)—hospital pharmacists, oncologists, and rheumatologists—knowledge, and attitudes toward biosimilars. More precisely, their knowledge and attitude towards biosimilars’ current usage and regulations in Taiwan were analyzed. The mean ± standard deviation knowledge score was 2.56 ± 0.86 out of 4 (n = 395), and a difference in knowledge score was determined according to the hospital types (p = 0.004). Rheumatologists possessed significantly higher confidence in their knowledge of biosimilars than other HCPs (p = 0.001). Pharmacists showed the highest acceptance—and rheumatologists the least—for switching patients from reference drugs to biosimilars (p = 0.02). Hospital type was associated with the respondent’s confidence in their knowledge (p = 0.04) and the preference for distinguishable naming of biosimilars (p = 0.007). Their knowledge scores were associated with their confidence in the efficacy and safety of biosimilars (p = 0.02). The study found that the current level of biosimilar knowledge of HCPs in Taiwan is low. The higher the knowledge score, the greater the confidence in biosimilars and the familiarity with relevant regulations.

To determine the economic burden of metastatic breast cancer (MBC) in Taiwan, we conducted a national retrospective claim database analysis to evaluate the incremental healthcare costs and utilization of MBC patients as compared to their breast cancer (BC) and breast cancer free (BCF) counterparts. Data were obtained from the National Health Insurance Claim Database and the Taiwan Cancer Registry database between 2012 and 2015. All healthcare utilization and costs were calculated on a per-patient-per-month (PPPM) basis and were compared among groups using the generalized linear model adjusting for age group, residential area, and Charlson comorbidity index group. A total of 1,606 MBC patients were matched to 6,424 BC patients and 6,424 BCF patients. The majority of overall MBC healthcare costs were attributed to outpatient costs (75.1%), followed by inpatient (23.2%) and emergency room costs (1.7%). The PPPM total healthcare costs of the MBC, BC, and BCF groups were TWD 7,422, 14,425, and 2,114, respectively. The adjusted PPPM total healthcare cost ratio of MBC to BCF was 4.1. Compared to BCF patients, the patients receiving both human epidermal growth factor receptor 2-targeted therapy and endocrine therapy incurred 28.1 times PPPM total costs. The adjusted PPPM total healthcare cost ratio of recurrent MBC to BCF was 2.3, while the ratio was 12.2 in the de novo MBC group. Patients with MBC are associated with substantial economic burden, particularly in outpatient costs. The study findings could be useful for MBC-related economic evaluations and health resource allocation.

Objectives To estimate the 3-month direct and indirect costs associated with osteoporotic fractures from both the hospital's and patient's perspectives in Singapore and to compare the cost between acute and prevalent osteoporotic fractures. Methods Resource use and expenditure data were collected using interviewer-administered questionnaires at baseline and at a 3-month follow-up between July 2013 and January 2014. Estimated osteoporotic fracture–related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, medications, transportation, health care and community services, special equipment and home/car modifications, and productivity loss. Results A total of 67 patients agreed to participate, giving a response rate of 64.4%. The mean (median) 3-month direct medical cost from the hospital's perspective was found to be SGD 3,886.90 (SGD 413.10), of which 74.2% was accounted for by inpatient services, 25.2% by outpatient services, and 0.6% by accident and emergency services. Moreover, considerable variation (SD = SGD 2,615.40) was observed in the costs of outpatient rehabilitation services. Findings were similar when the patient's perspective was taken. The total costs, with both direct and indirect costs included, were SGD 11,438.70 (acute) and SGD 1,015.40 (prevalent), of which 34.7% and 8.0%, respectively, were accounted for by inpatient services. Conclusions Hospitalization was associated with the highest cost borne by both the hospital and the patient, and informal care dominated indirect costs. Better knowledge of the financial consequences of fragility fractures could enable proactive and preventive measures to be undertaken, especially at sites of care with high cost drivers.

Background. Diabetes mellitus (DM) has become a significant worldwide public health problem and economic burden because a great proportion of healthcare costs has been spent on the treatment of DM and its related complications. The aim of this study was to examine the costs and length of stay (LoS) of hospitalizations due to diabetes-related complications in Taiwan. Methods. This study is a retrospective claim database analysis using the Longitudinal Cohort of Diabetes Patients, with 2012 used as the base year. The hospitalization costs and LoS per admission were estimated for each complication of interest using data from the LHDB 2004 to 2012 cohorts. The presence of eight DM-related complications were identified using the ICD-9-CM codes and procedure codes. ANOVA was used to examine the relationships of diabetes duration with the LoS and costs of the complications. Results. A total of 27,473 DM patients who were hospitalized in 2012 due to one of the examined DM-related complications were identified. The most common complications that caused the hospitalizations were nonfatal stroke (34.7%) and nonfatal ischemic heart disease (IHD) (28.7%). Amputation was the complication with the longest hospital stay, with a mean±SD of 21.6±14.1 days, followed by nonfatal stroke (13.6±11.3), ulcer (12.7±11.8), and fatal IHD (12.2±13.6). The complications with the greatest hospitalization cost were fatal IHD (mean=TWD 306,209.8; median=TWD 221,417.0; 1TWD=0.034USD) and fatal myocardial infarction (mean=TWD 272,840.1; median=TWD 174,008). Conclusions. This study indicates that DM-related complications are associated with significant hospital LoS and costs. The study results could be useful for economic evaluations of diabetes treatments and the estimation of the overall economic impact of diabetes.

To investigate the epidemiology trend and characteristics of sepsis-related hospitalizations in Taiwan, and to compare the differences among different severity levels of sepsis. This study is a retrospective national claim database analysis. Hospitalized adult patients with sepsis between 2010 and 2014 were identified from the Two-Million-Sample Longitudinal Health and Welfare Database (LHWD) by the International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM). The patients were divided into 3 severity groups based on their medical records during hospitalization. The study results showed that in Taiwan, there were 643 new cases of sepsis in 100,000 Taiwanese. The mortality of all septic patients in Taiwan was 287 per 100,000 people, and the case fatality was 29.2%. It was found that the mortality and incidence of sepsis in Taiwan have increased year by year, but there has been no significant change over time. In addition, demographic variation exists in the epidemiology of sepsis. In all the rates investigated, the men's were higher than the women's and the elderly's were higher than the youths’. The analysis results also showed that the respiratory system was the most common site of organ failure in septic patients. The incidence and mortality of any severity level of sepsis were 643, and 287 per 100,000 people in Taiwan, respectively, and the average case fatality was 29.2% during the study period (2010–2014). The respiratory system was the major infected site and site of organ dysfunction, especially in the more severe levels.

Osteoporosis is a major concern all over the world. With aging, a gradual loss of bone mass results in osteopenia and osteoporosis. Heritable factors account for 60–80% of optimal bone mineralization. Modifiable factors, such as weight-bearing exercise, nutrition, body mass, and hormonal milieu, play an important role in the development of osteopenia and osteoporosis in adulthood. Currently, anti-resorptive agents, including estrogen, bisphosphonates, and selective estrogen receptor modulators (SERMs), are the drugs of choice for osteoporosis. Other treatments include parathyroid hormone (PTH) as well as the nutritional support of calcium and vitamin D. New treatments such as tissue-selective estrogen receptor complexes (TSECs) are currently in use too. This review, which is based on a systematic appraisal of the current literature, provides current molecular and genetic opinions on osteoporosis and its medical treatment. It offers evidence-based information to help researchers and clinicians with osteoporosis assessment. However, many issues regarding osteoporosis and its treatment remain unknown or controversial and warrant future investigation.

591 Background: Multi-gene testing of primary breast tumors in early-stage breast cancer is used to classify the risk of developing distant metastases and predict the benefit of adjuvant chemotherapy. The association between the tumor genomic prognostic score (GPS) and response to neoadjuvant chemotherapy (NACT) and survival is not well characterized. Our objective was to describe the association between GPS and rates of pathologic complete response (PCR) and subsequent overall survival among women with or without PCR. Methods: We utilized the National Cancer Database to perform a hospital-based, retrospective cohort study of breast cancer patients ages 18 years and older. We included women diagnosed with first primary stages I-III hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer who received NACT and surgery between 2010 and 2017. Women were categorized as having low (0-10 or 200), intermediate (11-25 or 300), or high-risk (25-199 or 400) GPS based on OncotypeDX or MammaPrint scores. Multivariable modified Poisson regression models with robust error variance were used to estimate the crude and adjusted relative risk and 95% confidence intervals (CI) for PCR associated with GPS groups. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) and 95% CI for associations between the GPS and overall survival (OS) in women who did and did not have PCR. Results: A cohort of 3,446 women (mean [SD] age, 56.7 [12.0] years; median [interquartile range] follow-up of 47 [31-68] months) who received genomic testing and neoadjuvant chemotherapy were included in our analysis, of which 935 (27%) were low risk, 1,357 (39%) intermediate risk, and 1,154 (34%) high risk GPS. The relative risk of PCR for all women with high GPS was 1.81 (95% CI, 1.47-2.22; p < 0.001) in crude models and 1.49 (95% CI, 1.16-1.92; p = 0.002) after full adjustment compared to low GPS. Across all models, having a high GPS was significantly associated with achieving PCR in younger women ( < 65 years). In women ages ≥65 years, the association between GPS and PCR was not predictive nor statistically significantly. Among women with no response or partial response to NACT, high GPS was associated with a significantly increased risk of overall mortality (HR 2.41; 95% CI, 1.61-3.60; p < 0.001) compared to low GPS. Conversely, in women who did achieve PCR, GPS was not predictive of overall mortality across all age groups. Conclusions: In women with HR+/HER2- breast cancer, high risk GPS was predictive of PCR following NACT, primarily in younger women ( < 65 years). Our findings also indicated GPS was associated with lower OS in high-risk patients who do not achieve PCR and unpredictive of OS in those without PCR. The utility of tumor genomic testing in the neoadjuvant setting needs further investigation.

IntroductionOptimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR.Methods and analysisThe ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1–7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed.Ethics and disseminationEthic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017–1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals.Trial registration numberNCT03284827.

COVID-19 restrictions have transitioned in-person qualitative research interviews to virtual platforms. The purpose of the current article is to detail some benefits and concessions derived from our experiences of using Zoom to interview men about their intimate partner relationship breakdowns and service providers who work with men to build better relationships. Three benefits; 1) Rich therapeutic value, 2) There’s no place like home, and 3) Reduced costs to extend recruitment reach and inclusivity, highlighted Zoom’s salutary value, the data richness afforded by being interviewed from home, and the potential for cost-effectively progressing qualitative study designs. In particular, reduced labour and travel costs made viable wider reaching participant recruitment and multi-site data collection. The concessions; 1) Being there differently, 2) Choppy purviews and 3) Preparing and pacing, and adjusting to the self-stream revealed the need for interviewers to nimbly adjust to circumstances outside their direct control. Included were inherent challenges for adapting to diverse interviewee locations, technology limits and discordant audio-visual feeds. Amongst these concessions there was resignation that many in-person interview nuances were lost amid the virtual platform demanding unique interviewer skills to compensate some of those changes. Zoom interviews will undoubtedly continue post COVID-19 and attention should be paid to emergent ethical and operational issues.

We investigate p-type GaSb MOS capacitors with various HfO2 thicknesses grown using an atomic layer deposition. GaSb surfaces treated with ex-situ chemical solution and in situ remote hydrogen plasma are inspected. After a series of etching steps, the GaSb surfaces exhibit smooth topography, indicating that this combination of treatments is capable of realizing ultrathin dielectric deposition. After etching processes, the ultrathin (approximately 3 nm) HfO2 layer deposited successfully on GaSb exhibit high-permittivity (approximately 21) properties as well as equivalent oxide thickness (EOT) of 0.75 nm, which can be attributed to the flat surface. To the best of our knowledge, the EOT of GaSb capacitor prepared using the exploited approach is record low. Furthermore, we find that the interlayer present after hydrogen plasma treatment and forming gas annealing could efficiently passivate interface state density and achieve high $C$ – $V$ modulation. Compared with the benchmark of gate leakage current versus EOT, the electrical performance with low gate leakage current of the GaSb MOS capacitors demonstrates the high feasibility of the proposed treatments.

In the era of precision medicine and targeted therapy, diagnostic inaccuracy can have tremendous ramifications. We present the case of a 61-year-old man initially diagnosed with small cell lung cancer by pathology. Prior to initiating chemotherapy, multidisciplinary discussions led to an amendment of the diagnosis to medullary thyroid cancer.

The dedicated servo media (DSM) is the conventional perpendicular magnetic recording (PMR) media with an inserted servo recording layer between the data recording layer and the soft underlayer. By using the conventional PMR media as the reference, the design consideration on the layer structure, the preparation, the magnetic properties, the microstructure, including the $c$ -axis orientation and the growth of the layers, the surface roughness, and the recording performance for the DSM are reported.

Rehabilitation patients with malocclusions and dental arches defect is important separate question. It depends on differences in treatment planning this type of patients. Actually, there is prosthetic stage which replaces orthodontic preparation. There are two possibilities of this algorithm. 1 - orthognathic surgery and prosthetic dental arches reparation. 2 - simultaneously orthognathic and preimplantation surgery and at second stage - dental arches restoration (usually with dental implants). This approach opens many options: simultaneous surgery cut rehabilitation time, combination some operations gives simple approach for bone grafting and big resomves for bone harvesting, preliminary planning of surgery and prosthetic rehabilitation leads to best esthetic and functional results.

Prostate cancer diagnosis can occur at a time when men’s work and careers are central to their masculine identity, sense of purpose, and family life. In Canada, an aging male population, along with medical advances, has resulted in increasing numbers of working men being diagnosed with, and treated for, prostate cancer. Little is known about the linkages between men’s work and their experiences of prostate cancer. In this qualitative study, 24 Western Canadian men were interviewed to distil the connections between work, prostate cancer screening, diagnosis, and the decision to undergo radical prostatectomy. Data were analyzed using constant comparison in the context of masculinities theory. The findings demonstrated that work was central to men’s masculine identities and afforded financial security, social status, and a sense of personal growth. However, work-related strain and demands were also found to affect participants’ health and distance them from their families. A diagnosis of prostate cancer tended to diminish the importance of work, wherein participants focused on optimizing their health and strengthening family relations. In deciding on radical prostatectomy as a treatment to eradicate prostate cancer, few men considered the implications for returning to work. The current study findings indicate that clinicians and patients should explicitly explore and discuss how surgery side effects may affect work and career plans during treatment decision-making.

Yi-Ju Lin,1 Chin-Yuan Wang,2 Elizabeth H Chang,1,3,4 Ssu-Wei Cheng,5 Yu Ko1,4 1Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; 2Department of Internal Medicine, Division of Endocrinology and Metabolism, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 4Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; 5Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Objective: The aim of this study was to translate, adapt, and validate the Satisfaction with Oral Anti-Diabetic Agent Scale (SOADAS) in type 2 diabetes mellitus (DM) patients taking oral antidiabetic drugs (OADs) in Taiwan. Patients and methods: The SOADAS was translated to Chinese and was modified based on reviews of two physicians, five diabetes educators, and two patient focus groups. A cross-sectional interviewer-administered survey was conducted in adult patients with type 2 DM who were taking OADs. The Chinese version of the SOADAS (C-SOADAS), the EuroQol 5 dimensions 3-level (EQ-5D-3L) questionnaire, and a demographic questionnaire were administered to participants. Instrument structure, internal consistency, convergent validity, and known-group validity were assessed. Results: A total of 260 DM patients were recruited. The mean score of an individual item ranged from 3.6 to 3.9, while the mean total score (out of 25 possible points) was 18.7 points. Overall, floor and ceiling effects were negligible. The Cronbach’s α value was 0.81. All the four predetermined hypotheses for known-group validity assessment were fulfilled. In convergent validity testing, the C-SOADAS total scores were found to be correlated with EuroQol-Visual Analog Scale (EQ-VAS) scores (r = 0.2; p < 0.01) but not with EuroQol 5 dimensions (EQ-5D) index scores (r =0.02; p= 0.81). Conclusion: The 5-item C-SOADAS appears to be a psychometrically acceptable measure of OAD treatment satisfaction among type 2 DM patients in Taiwan. The tool may be incorporated into clinical practice to quickly assess treatment outcomes from patients’ perspectives. Keywords: diabetes mellitus, oral antidiabetic agent, satisfaction, validation, reliability, C-SOADAS, Taiwan

Objectives: 1) To develop both English and Chinese versions of the descriptions of health states describing different stages of breast cancer and different adverse effects related to tamoxifen and aromatase inhibitors for breast cancer and 2) to elicit individuals’ preferences for these health states from a group of oncology nurses. Methods: Twenty hypothetical health states and their descriptions were developed on the basis of literature review and oncology expert panel reviews. Health state utilities were obtained from 20 oncology nurses by using the visual analogue scale and standard gamble methods. After recalibration, the adjusted utility scores were on a scale of 0 (dead) and 1 (perfect health). Results: The health states developed represented different disease stages and the presence and type of treatment side effects in breast cancer. For each health state, various general healthrelated quality-of-life domains, such as pain/discomfort and ability to work, were included in the descriptions, along with a state-specific description. The mean utility score of respondents’ “current health” was greater than 0.9, while mean adjusted visual analogue scale– derived utility scores ranged from 0.256 to 0.860 and median adjusted standard gamble– derived utility scores ranged from 0.284 to 0.673. Among the side effects evaluated in the “no recurrence” health state, ischemic cerebrovascular events, pulmonary embolism, and spine fracture had the greatest utility detriment. Conclusions: The study results indicate the value that individuals place on the avoidance of disease progression and the side effects of hormonal therapies in breast cancer. The health state descriptions developed can be used in future research to obtain society’s utilities for use in a cost-utility analysis.

Background This study evaluated risks of emergency room visit (ERV) for out-of-hospital cardiac arrest (OHCA) in 2005–2011, among patients with cardiologic and metabolic syndromes (CMS), in association with ambient environments. Methods Pooled and area-specific weather related cumulative six-day (lags 0 to 5) relative risks (RRs) and confidence intervals (CIs) of ERV for OHCA were evaluated for CMS cases, using distributed lag nonlinear models and multivariate meta-analytical second-stage model in association with the daily average temperatures and daily concentrations of air pollutants. Results ERV risk increased as average temperature dropped to

We introduce a local order metric (LOM) that measures the degree of order in the neighborhood of an atomic or molecular site in a condensed medium. The LOM maximizes the overlap between the spatial distribution of sites belonging to that neighborhood and the corresponding distribution in a suitable reference system. The LOM takes a value tending to zero for completely disordered environments and tending to one for environments that perfectly match the reference. The site-averaged LOM and its standard deviation define two scalar order parameters, $S$ and $\ensuremath{\delta}S$, that characterize with excellent resolution crystals, liquids, and amorphous materials. We show with molecular dynamics simulations that $S$, $\ensuremath{\delta}S$, and the LOM provide very insightful information in the study of structural transformations, such as those occurring when ice spontaneously nucleates from supercooled water or when a supercooled water sample becomes amorphous upon progressive cooling.

Background: As the prevalence of diabetes mellitus (DM) continues to increase rapidly, there has been a rising need not only to assess the clinical outcomes but also the impact of DM on the health-related quality of life (HRQoL) of affected individuals. Most previous studies have found that having complications is strongly associated with decreased HRQoL in DM patients. As such, it is crucial to measure individuals’ preferences for DM-related complications in order to assess the magnitude of complications’ effect on overall HRQoL. In addition, preference scores are an essential component of cost–utility analyses (CUAs), which studies can incorporate healthcare costs, HRQoL and clinical outcomes of DM into one analysis. Objective: The aims of this study were to assess the preference scores of DM-related complications using both the standard gamble (SG), a choice-based method, and visual analogue scale (VAS), a scaling method. We also aimed to assess several possible factors that might be associated with the preference scores of the complications. Methods: This is a cross-sectional interview-administered survey, and 213 patients with type 2 DM were interviewed. The respondents’ preference scores of eleven DM-related complications were obtained using VAS and SG techniques. Demographic information, clinical characteristics and risk attitudes were also collected to explore factors that may affect patients’ preference scores. Results: Nearly one quarter of participants in Taiwan ranked at least one of the complications worse than death. The mean VAS scores ranged from 0.004 (amputation) to 0.47 (nocturnal hypoglycemia) while the mean adjusted SG scores ranged from 0.30 (blindness) to 0.66 (nocturnal hypoglycemia). There were significant differences in all of the complications’ preference scores depending on risk attitudes. Conclusion: Both the VAS and SG methods were used to elicit the preference scores of DM-related complications, and the preference scores derived could be useful for future cost utility analyses.

Aim To review and evaluate the most recent literature on the economic outcomes of pharmacist-managed services in people with diabetes. Background The global prevalence of diabetes is increasing. Although pharmacist-managed services have been shown to improve people's health outcomes, the economic impact of these programmes remains unclear. Methods A systematic review was conducted of six databases. Study inclusion criteria were: (1) original research; (2) evaluation of pharmacist-managed services in people with diabetes; (3) an economic evaluation; (4) English-language publication; and (5) full-text, published between January 2006 and December 2014. The quality of the full economic evaluations reviewed was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. Results A total of 2204 articles were screened and 25 studies were selected. These studies were conducted in a community pharmacy (n = 10), a clinic- /hospital-based outpatient facility (n = 8), or others. Pharmacist-managed services included targeted education (n = 24), general pharmacotherapeutic monitoring (n = 21), health screening or laboratory testing services (n = 9), immunization services (n = 2) and pharmacokinetic monitoring (n = 1). Compared with usual care, pharmacist-managed services resulted in cost savings that varied from $7 to $65,000 ($8 to $85,000 in 2014 US dollars) per person per year, and generated higher quality-adjusted life years with lower costs. Benefit-to-cost ratios ranged from 1:1 to 8.5:1. Among the 25 studies reviewed, 11 were full economic evaluations of moderate quality. Conclusions Pharmacist-managed services had a positive return in terms of economic viability. With the expanding role of pharmacists in the healthcare sector, alongside increasing health expenditure, future economic studies of high quality are needed to investigate the cost-effectiveness of these services.

This study investigates the relation between information transparency and idiosyncratic risk with the unique and nonpublic data of listed companies violating the material information disclosure rules in Taiwan. This study employs the violated companies that do not report or delay the disclosure of material information as sample of worse information transparency. The results show that the companies with worse information transparency have higher idiosyncratic risk and total risk than other companies. The negative connection between information transparency and idiosyncratic risk implies that the current regulations of material information disclosure in Taiwan work efficiently.