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The increasing prevalence of aortic stenosis (AS) and the increasing number of patients indicated for transcatheter aortic valve implantation (TAVI) can lead to increased hospital constraints. This study aimed to compare, from the hospital perspective, the costs, resource use, and 30-day clinical outcomes of patients who underwent TAVI under an optimized or standard clinical pathway. A single-center, retrospective study was conducted among patients with native AS who underwent TAVI between January 2018 and March 2021. Patients who underwent optimized lean TAVI were propensity-score matched 1:1 to those who underwent standard TAVI. In-hospital costs and 30-day clinical outcomes were compared between the 2 groups. A total of 182 patients (91 in each group) were included in the final analysis. Baseline covariates were well balanced after matching. Patients who underwent lean TAVI had shorter length of stay (median [interquartile range] 3.0 days [2.0 to 6.0] vs 6.0 days [5.0 to 9.0], p0.001). Patients in the lean TAVI group incurred lower total costs than did those in the standard TAVI group (mean ± SD: $41,346 ± 10,062 vs $50,471 ± 15,115, p = 0.002). There was no between-group difference in 30-day all-cause mortality (2.2% vs 1.1%, p = 0.573) and pacemaker implantations (5.5% vs 6.6%, p = 0.788). Rates of procedural complications were comparable between groups. In conclusion, lean TAVI leads to hospital efficiencies without compromising patient safety. Efforts to streamline the TAVI procedure should be encouraged to improve access to TAVI for patients with AS, amid resource constraints.

Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore.We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbAFrom 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P 0.001). The proportion of patients with HbAMedication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.背景: 使用降糖药物治疗是对抗2型糖尿病(T2DM)的重要组成部分。在过去的十年中，治疗指南发生了显著的变化。我们报告了在新加坡的一个三级转诊中心里，T2DM患者的药物使用、血糖控制以及严重低血糖发生率随着时间的变化趋势。 方法: 我们分析了36924名从2007至2017年间在新加坡综合医院就诊的T2DM患者数据。每年按年龄、性别以及种族-标准化后的患者比例使用logistic回归进行分析，纳入分析的患者包括(a)所处方的每类降糖药物，(b)正在使用的各种降糖治疗方案，以及(c)HbA1c小于6%、6%至小于7%、7%至小于8%、8%至小于9%，或者9%至更高水平。采用泊松回归法来评估严重低血糖的标准化发生率。 结果: 从2007至2017年，二甲双胍(从45.9%至59.6%)与胰岛素(从24.4%至57.9%)的使用率增加了，而磺脲类药物的使用率下降了(从52.0%至44.9%)(全部P0.001)。从2008至2017年与从2012至2017年，二肽基肽酶-4抑制剂(从1.2%至31.2%)与钠-葡萄糖共转运体-2抑制剂(从0.5%至7.4%)的使用率也增加(全部P0.001)。有更多比例(从17.3%至46.0%)的患者处方是联合使用胰岛素与口服药物治疗(P0.001)。HbA1c大于等于8%的患者比例(从33.7%至36.0%)增加了(P0.001)。严重低血糖的发生率也升高了(从5.0至8.4次/每100名患者/年，P0.001)。 结论: 在过去的11年中，药物的使用模式发生了显著的变化，变得愈来愈倾向于选择新的治疗药物。血糖控制情况保持稳定，但是严重低血糖的发生率有所上升。在推断因果关系之前需要进一步的分析。.

Background Periventricular leukoaraiosis may be an important pathological change in postural instability gait disorder (PIGD), a motor subtype of Parkinson's disease (PD). Clinical diagnosis of PIGD may be challenging for the general neurologist. Purpose To evaluate 1) the utility of a fully automated volume‐based morphometry (Vol‐BM) in characterizing imaging diagnostic markers in PD and PIGD, including, 2) novel deep gray nuclear lesion load (GMab), and 3) discriminatory performance of a Vol‐BM model construct in classifying the PIGD subtype. Study Type Prospective. Subjects In all, 23 PIGD, 21 PD, and 20 age‐matched healthy controls (HC) underwent MRI brain scans and clinical assessments. Field Strength/Sequence 3.0T, sagittal 3D‐magnetization‐prepared rapid gradient echo (MPRAGE), and fluid‐attenuated inversion recovery imaging (FLAIR) sequences. Assessment Clinical assessment was conducted by a movement disorder neurologist. The MR brain images were then segmented using an automated multimodal Vol‐BM algorithm (MorphoBox) and reviewed by two authors independently. Statistical Testing Brain segmentation and clinical parameter differences and dependence were assessed using analysis of variance (ANOVA) and regression analysis, respectively. Logistic regression was performed to differentiate PIGD from PD, and discriminative reliability was evaluated using receiver operating characteristic (ROC) analysis. Results Significantly higher white matter lesion load (WMab) (P

Background Burnout describes emotional exhaustion (EE), depersonalization (DP), and low personal achievement caused by work and is known to bring about negative consequences to practitioners, patients, and health systems. Various organizational and personal factors, such as organizational strategies and resilience, have been associated with this phenomenon. However, there is a paucity of data describing the prevalence of burnout among pharmacy staff within Singapore and Asia, especially in the pharmacy technician (PT) population. Objectives This study aimed to (1) quantify burnout in PTs in patient-care sectors in Singapore and (2) explore factors that may be associated with burnout. Methods A cross-sectional survey among PTs in patient-care areas in Singapore, which includes hospitals, primary and secondary care institutions, and retail pharmacies, across both public and private sectors was conducted from February to April 2020. The Maslach Burnout Inventory – Human Services Survey and Brief Resilience Scale were used to assess burnout and resilience among participants. Demographic, employment, and well-being information were also collected and summarized. Univariate analysis and multivariate logistic regression were used to assess associations between burnout and potential risk and impact factors. Results Slightly more than half (52.0%) of PTs reported burnout (EE score ≥ 27 or DP ≥ 10 or both). Statistically significant factors associated with burnout include resilience, age, years of experience, ethnicity, marital status, nationality, highest qualifications, pharmacy-related certification, full-time employment status, and work hours. Impact associated with burnout includes intent for job change, job satisfaction, sleep, and presence of mental conditions. Statistically significant reported reasons for burnout and ways to build resilience were also elucidated. Conclusion Burnout affects most PTs in Singapore and is primarily driven by workload and nature of their work, low resilience, and poor social support structures. National and organizational efforts are needed to arrest the vicious cycle that propagates burnout in PTs.

Purpose of review Patient-reported outcome measures (PROMs) and patient registries both play important roles in assessing patient outcomes. However, no study has examined the use of PROMs among registries involving patients with type 2 diabetes mellitus (T2DM). Our objective is twofold: first, to review the range of PROMs used in registry-based studies of patients with T2DM; second, to describe associations between these PROMs, T2DM and its complications. Recent findings The International Consortium for Health Outcomes Measurement (ICHOM) Diabetes Standard Set recommended routine usage of PROMs to assess psychological well-being, diabetes distress, and depression among patients with T2DM. A wide variety of PROMs were used among the 15 studies included in this review. Quality of life, depressive symptoms and treatment adherence were the most common aspects of T2DM that utilised PROMs for assessment. Adoption of PROMs among registries of patients with T2DM remains uncommon, non-routine and with few that are validated before use.

BACKGROUND Primary medication non-adherence (PMN), defined as failure to obtain newly prescribed medications, results in adverse clinical and economic outcomes. We aimed to (a) assess the prevalence of PMN in six common chronic diseases: asthma and/ or chronic obstructive pulmonary disease, depression, diabetes mellitus, hyperlipidaemia, hypertension and osteoporosis; (b) identify and categorise factors associated with PMN; (c) explore characteristics that contributed to heterogeneity between studies. METHODS We performed a systematic search in MEDLINE, Embase, Cochrane Library, CINAHL and PsycINFO. Studies published in English between January 2008 and August 2018 assessing PMN in subjects aged ≥18 years were included. We used the Cochrane risk of bias tool, Newcastle-Ottawa Scale and National Heart, Lung and Blood Institute Quality Assessment Tool to assess the quality of randomised controlled trials, cohort and cross-sectional studies, respectively. Findings were reported using the PRISMA checklist. PMN rates were pooled using a random effects model. We summarised factors associated with PMN descriptively. Subgroup analysis was performed to explore sources of heterogeneity. RESULTS We screened 3083 articles and included 33 (5 randomised controlled trials, 26 cohort and 2 cross-sectional studies, n = 539 156), of which 31 (n = 519 971) were used in meta-analysis. The pooled PMN rate was 17% (95% CI: 15%-20%). Pooled PMN rates were highest in osteoporosis (25%, 95% CI: 7%-44%) and hyperlipidaemia (25%, 95% CI: 18%-32%) and lowest in diabetes mellitus (10%, 95% CI: 7%-12%). Factors commonly associated with PMN include younger age, number of concurrent medications, practitioner specialty and higher co-payment. Type of chronic disease, age, study setting and PMN definition contributed to heterogeneity between studies (all P

Tumor-specific antibody drugs can serve as cancer therapy with minimal side effects. A humanized antibody, PRL3-zumab, specifically binds to an intracellular oncogenic phosphatase PRL3, which is frequently expressed in several cancers. Here we show that PRL3-zumab specifically inhibits PRL3+ cancer cells in vivo, but not in vitro. PRL3 antigens are detected on the cell surface and outer exosomal membranes, implying an ‘inside-out’ externalization of PRL3. PRL3-zumab binds to surface PRL3 in a manner consistent with that in classical antibody-dependent cell-mediated cytotoxicity or antibody-dependent cellular phagocytosis tumor elimination pathways, as PRL3-zumab requires an intact Fc region and host FcγII/III receptor engagement to recruit B cells, NK cells and macrophages to PRL3+ tumor microenvironments. PRL3 is overexpressed in 80.6% of 151 fresh-frozen tumor samples across 11 common cancers examined, but not in patient-matched normal tissues, thereby implicating PRL3 as a tumor-associated antigen. Targeting externalized PRL3 antigens with PRL3-zumab may represent a feasible approach for anti-tumor immunotherapy., Phosphatase of regenerating liver 3 (PRL3) is usually found intracellularly, and is over-expressed in cancer cells. Here the authors show that PRL-3 is also detectable on cell surface, and can be recognized by PRL3-zumab to recruit immune cells into tumor to promote anti-tumor immunity, thereby implicating PRL-3 as a potential tumor antigen.