Exploring barriers and facilitators of primary care physicians towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group: a qualitative study in Singapore.

Objectives: To explore the perspectives of primary care physicians with regard to the barriers and facilitators towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group.

Design: Qualitative descriptive study.

Setting: Four polyclinics in a public primary care institution in Singapore.

Missed diagnosis or misdiagnosis: Common pitfalls in genetic testing.

Genetic testing has the power to identify individuals with increased predisposition to disease, allowing individuals the opportunity to make informed management, treatment and reproductive decisions. As genomic medicine continues to be integrated into aspects of everyday patient care and the indications for genetic testing continue to expand, genetic services are increasingly being offered by non-genetic clinicians. The current complexities of genetic testing highlight the need to support and ensure non-genetic professionals are adequately equipped with the knowledge and skills to provide services.

Muscle injury causes long-term changes in stem-cell DNA methylation.

Injury to muscle brings about the activation of stem cells, which then generate new myocytes to replace damaged tissue. We demonstrate that this activation is accompanied by a dramatic change in the stem-cell methylation pattern that prepares them epigenetically for terminal myocyte differentiation. These de- and de novo methylation events occur at regulatory elements associated with genes involved in myogenesis and are necessary for activation and regeneration.

Development and pilot testing of a decision aid for navigating breast cancer survivorship care.

Background: The predominant oncologist-led model in many countries is unsustainable to meet the needs of a growing cohort of breast cancer survivors (BCS). Despite available alternative models, adoption rates have been poor. To help BCS navigate survivorship care, we aimed to systematically develop a decision aid (DA) to guide their choice of follow-up care model and evaluate its acceptability and usability among BCS and health care providers (HCPs).

General practitioners' (GPs) experience, attitudes and needs on clinical genetic services: a systematic review.

Objective: The proliferation and growing demands of genetic testing are anticipated to revolutionise medical practice. As gatekeepers of healthcare systems, general practitioners (GPs) are expected to play a critical role in the provision of clinical genetic services. This paper aims to review existing literature on GPs' experience, attitudes and needs towards clinical genetic services.

Implementing a community-based shared care breast cancer survivorship model in Singapore: a qualitative study among primary care practitioners.

Background: The adaptability of existing recommendations on shared care implementation to Asian settings is unknown. This qualitative study aims to elicit public- and private-sectors primary care practitioners' (PCPs) perspectives on the sustainable implementation of a shared care model among breast cancer survivors in Singapore.

Methods: Purposive sampling was employed to engage 70 PCPs from SingHealth Polyclinics, National University Polyclinics, National Healthcare Group Polyclinics, and private practice.

How practice setting affects family physicians' views on genetic screening: a qualitative study.

Background: Genetic screening (GS), defined as the clinical testing of a population to identify asymptomatic individuals with the aim of providing those identified as high risk with prevention, early treatment, or reproductive options. Genetic screening (GS) improves patient outcomes and is accessible to the community. Family physicians (FPs) are ideally placed to offer GS.

Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection.

Background: Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse.

Methods: A multicentre observational study was conducted from August 2016 to February 2017 in the UK.

Transcervical Foley Balloon Plus Vaginal Misoprostol versus Vaginal Misoprostol Alone for Cervical Ripening in Nulliparous Obese Women: A Multicenter, Randomized, Comparative-Effectiveness Trial.

Objective: Nulliparous obese women are at increased risk of labor induction and cesarean delivery (CD). We sought to determine whether the combination of a transvaginal Foley balloon plus misoprostol prostaglandin E1 (PGE1) is superior to misoprostol alone in reducing the risk for CD.

Study Design: We undertook a multicenter, open-label, comparative-effectiveness randomized clinical trial of nulliparous obese women with unfavorable cervix (Bishop's score ≤ 6) undergoing labor induction from January 2016 to June 2018 at three tertiary centers.

Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study.

Background: Breast cancer is prevalent and has high cure rates. The resultant increase in numbers of breast cancer survivors (BCS) may overwhelm the current oncology workforce in years to come. We postulate that primary care physicians (PCPs) could play an expanded role in comanaging survivors, provided they are given the appropriate tools and training to do so.

Kaiso Gene Knockout Promotes Somatic Cell Reprogramming.

Reprogramming of somatic cells is associated with overcoming the established epigenetic barrier. Key events in this process are changes in the DNA methylation landscape and histone modifications. Studying the factors affecting epigenetic plasticity will allow not only to reveal the principles underlying cell reprogramming but also to find possible ways to influence this process.

Campylobacter fetus spondylodiscitis: A case report and review of the literature.

Campylobacter are common zoonotic food borne pathogens but infrequent causes of disseminated human infection. is an unusual cause of human infection and spondylodiscitis. We describe a case of infection in a 72-year-old woman who presented with indolent onset lumbar spondylodiscitis.

Practitioners' perspectives on community-based breast cancer survivorship care in Singapore: A focus group study.

With the long-term goal of optimising the delivery of breast cancer survivorship care in Singapore, we conducted a qualitative study to gather in-depth descriptions from community practitioners (general practitioners and community pharmacists) about their perceptions of community-based cancer survivorship care in Singapore. Sixteen participants (11 general practitioners and five community pharmacists) participated in four structured focus group discussions between August and November 2016. The focus group discussions were analysed using deductive content analysis.

Acardiac twin fetus with severe hydrops fetalis and bilateral talipes varus deformity.

Twin reversed-arterial-perfusion syndrome (TRAPS) is a rare complication of monochorionic twin pregnancies. TRAPS is characterized by the hemodynamic dependence of a "recipient" twin from a "pump" twin. The "recipient" twin exhibits lethal abnormalities, such as acardia and acephaly.

The correlation of arterial lesions with umbilical artery Doppler velocimetry in the placentas of small-for-dates pregnancies.

The placentas of 14 growth-retarded fetuses with abnormal umbilical artery velocimetry and 15 appropriately grown fetuses with normal waveforms were collected immediately after delivery and analyzed in a blinded fashion. A large percentage of the arterial vessels in the placentas from the former group showed abnormal changes in the vessel wall. The percentage of abnormal arterial vessels in all placentas correlated significantly with the resistance index.

Histometric and electron cytochemical study of muscle in the dystrophic mouse.

A histometric analysis of the alterations at the motor end plate in dystrophic Bar Harbor mice has been performed. In both forms of mouse dystrophy, simplification and focal atrophy of the junctional folds and retraction of the nerve terminal represented the significant changes. The postsynaptic alterations were similar to those described in Duchenne dystrophy.