Background Both medication and non-medication therapies are effective approaches to control blood pressure (BP) in hypertension patients.However,the association of joint changes in antihypertensive medication use and ...Background Both medication and non-medication therapies are effective approaches to control blood pressure (BP) in hypertension patients.However,the association of joint changes in antihypertensive medication use and healthy lifestyle index (HLI)with BP control among hypertension patients is seldom reported,which needs to provide more evidence by prospective intervention studies.We examined the association of antihypertensive medication use and HLI with BP control among employees with hypertension in China based on a workplace-based multicomponent intervention program.Methods Between January 2013 and December 2014,a cluster randomized clinical trial of a workplace-based multicomponent intervention program was conducted in 60 workplaces across 20 urban areas in China.Workplaces were randomly divided into intervention (n=40) and control (n=20) groups.Basic information on employees at each workplace was collected by trained professionals,including sociodemographic characteristics,medical history,family history,lifestyle behaviors,medication status and physical measurements.After baseline,the intervention group received a 2-year intervention to achieve BP control,which included:(1) a workplace wellness program for all employees;(2) a guidelines-oriented hypertension management protocol.HLI including nonsmoking,nondrinking,adequate physical activity,weight within reference range and balanced diet,were coded on a 5-point scale (range:0-5,with higher score indicating a healthier lifestyle).Antihypertensive medication use was defined as taking drug within the last 2 weeks.Changes in HLI,antihypertensive medication use and BP control from baseline to 24 months were measured after the intervention.Results Overall,4655 employees were included (age:46.3±7.6 years,men:3547 (82.3%)).After 24 months of the intervention,there was a significant improvement in lifestyle[smoking (OR=0.65,95%CI:0.43-0.99;P=0.045),drinking (OR=0.52,95%CI:0.40-0.68;P<0.001),regular exercise (OR=3.10,95%CI:2.53-3.78;P<0.001),excessive intake of fatty food (OR=0.17,95%CI:0.06-0.52;P=0.002),restrictive use of salt (OR=0.26,95%CI:0.12-0.56;P=0.001)].Compare to employees with a deteriorating lifestyle after the intervention,those with an improved lifestyle had a higher BP control.In the intervention group,compared with employees not using antihypertensive medication,those who consistent used (OR=2.34;95%CI:1.16-4.72;P=0.017) or changed from not using to using antihypertensive medication (OR=2.24;95%CI:1.08-4.62;P=0.030) had higher BP control.Compared with those having lower HLI,participants with a same (OR=1.38;95%CI:0.99-1.93;P=0.056) or high (OR=1.79;95%CI:1.27~2.53;P<0.001) HLI had higher BP control.Those who used antihypertensive medication and had a high HLI had the highest BP control (OR=1.88;95%CI:1.32-2.67,P<0.001).Subgroup analysis also showed the consistent effect as the above.Conclusion These findings suggest that adherence to antihypertensive medication treatment and healthy lifestyle were associated with a significant improvement in BP control among employees with hypertension.展开更多
Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hyp...Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.展开更多
Ketamine is a dissociative anaesthetic.It is listed by the World Health Organisation[1]in its Model List of Essential Medicines,which are basic drugs required for any health-care system.Indeed,clinically ketamine poss...Ketamine is a dissociative anaesthetic.It is listed by the World Health Organisation[1]in its Model List of Essential Medicines,which are basic drugs required for any health-care system.Indeed,clinically ketamine possesses hypnotic,analgesic and amnesic effects.It is commonly used as induction展开更多
We have a scarcity of health care professionals in the rural areas and therefore we can offer medical services from a distance to the underserved rural population.
China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health ...China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,展开更多
AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tol...AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODSThe Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTSSeventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (±14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P<0.001, P<0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSIONSLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.展开更多
The United States is in the throes of a severe opioid overdose epidemic,primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine,a veterinary sedative often mixed with fentanyl.The high po...The United States is in the throes of a severe opioid overdose epidemic,primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine,a veterinary sedative often mixed with fentanyl.The high potency and long duration of fentanyl is compounded by the added risks from xylazine,heightening the lethal danger faced by opioid users.Measures such as enhanced surveillance,public awareness campaigns,and the distribution of fentanylxylazine test kits,and naloxone have been undertaken to mitigate this crisis.Fentanyl-related overdose deaths persist despite these efforts,partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies.A multifaceted approach is imperative in effectively combating the opioid overdose epidemic.This approach should include expansion of treatment access,broadening the availability of medications for opioid use disorder,implementation of harm reduction strategies,and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.展开更多
Objective:This study aimed to describe patients with melanoma initiating treatments with dabrafenib plus trametinib(Dab+Tram)or encorafenib plus binimetinib(Enco+Bini)in a real-world setting in Japan.Methods:Data were...Objective:This study aimed to describe patients with melanoma initiating treatments with dabrafenib plus trametinib(Dab+Tram)or encorafenib plus binimetinib(Enco+Bini)in a real-world setting in Japan.Methods:Data were extracted from the Japanese Medical Data Vision(MDV)insurance claims database.Patients diagnosed with melanoma between 2012 and 2021 and prescribed with Dab+Tram or Enco+Bini were included in three cohorts:non-adjuvant Dab+Tram,adjuvant Dab+Tram,and Enco+Bini.Data were extracted on patient characteristics at treatment initiation.During follow-up,all changes in melanoma treatments were documented.Treatment adherence was determined as the proportion of prescription days covered(PDC)and treatment dose intensity as the relative dose intensity(RDI).Results:Sixty-seven patients were included in the non-adjuvant Dab+Tram cohort(55 first-line treatments),seven in the adjuvant Dab+Tram cohort(six first-line treatments),and 16 in the Enco+Bini cohort(four firstline treatments).The mean age was 61.3±13.5 years and 56.1%were men.Twenty-seven patients with non-adjuvant Dab+Tram or Enco+Bini in first line(45.8%)switched to a second line.The median treatment duration was 11.8 months for Dab+Tram and 8.1 months for Enco+Bini.A PDC≥80%was observed for 85.7%of patients with adjuvant Dab+Tram,68.7%for non-adjuvant Dab+Tram,and 75.0%for Enco+Bini.Median RDI was 1.0 for adjuvant Dab+Tram,0.9 for non-adjuvant Dab+Tram,and 0.6 for Enco+Bini.Conclusion:Dab+Tram is used consistently with clinical practice guidelines in the adjuvant setting,but adherence in the non-adjuvant setting is suboptimal,as is the prescribed dose of Enco+Bini.Prescribers should ensure that these therapies are used in an optimal way to improve outcomes in melanoma.展开更多
A series of completely sealed standing-wave (SW) accelerator guides was developed and installed on 3,4, 6, 9 and 14 MeV home-made electron linacs for medical and industrial uses. In the development of these SW guides,...A series of completely sealed standing-wave (SW) accelerator guides was developed and installed on 3,4, 6, 9 and 14 MeV home-made electron linacs for medical and industrial uses. In the development of these SW guides, various subjects, including particle dynamics, microwave properties etc, were studied. The fsctors influencing the transverse motion were considered analytically and using a simulation code, TRSV. The problem of electron backbombardment in SW linac was analyzed by a 3-dimensional trace code, SB. Simultaneously decreasing the length of the first cavity and the injection voltage can reduced the electron backbombarding power. The code PPDW based on equivalent circuit theory was developed to analyze many microwave characteristics of arbitrarily composed coupled cavity chains. This research contributed to the successful development of the 3, 4, 6, 9 and 14MeV SW accelerator guides. For example, in the recently developed 14MeV SW guide, the beam passes smoothly through a 1.45 m long guide with a beamhole (diameter of 7 mm) without using a focusing solenoid.展开更多
In landmark-based image registration, estimating the landmark correspondence plays an important role. In this letter, a novel landmark correspondence estimation technique using mean shift algorithm is proposed. Image ...In landmark-based image registration, estimating the landmark correspondence plays an important role. In this letter, a novel landmark correspondence estimation technique using mean shift algorithm is proposed. Image corner points are detected as landmarks and mean shift iterations are adopted to find the most probable corresponding point positions in two images. Mutual information between intensity of two local regions is computed to eliminate mis-matching points to improve the stability of corresponding estimation correspondence landmarks is exact. The proposed experiments of various mono-modal medical images. Multi-level estimation （MLE） technique is proposed Experiments show that the precision in location of technique is shown to be feasible and rapid in the展开更多
Objective Diabetes remission has emerged as an achievable treatment goal,shifting the focus of care from increasing medication use to restoring metabolic health.While clinical trials show that remission is possible in...Objective Diabetes remission has emerged as an achievable treatment goal,shifting the focus of care from increasing medication use to restoring metabolic health.While clinical trials show that remission is possible in controlled settings,evidence remains limited regarding its implementation in routine care within middle-income,rice-based dietary contexts.This study aims to explore healthcare provider experiences with implementing diabetes remission services in Thailand,focusing on dietary strategies,deprescription practices and patient management in routine care settings.Design Qualitative study using semi-structured,in-depth interviews,supplemented by structured questionnaires and programme documents.Setting Thirteen healthcare facilities across six Thai regions and two national-level professional or policy organisations.Participants 17 key informants purposively sampled for regional,institutional and professional diversity,including physicians,nurses,dietitians and national programme leaders.Data were collected and analysed iteratively until no new insights emerged.Thematic content analysis was conducted in QDA Miner Lite v3.0 with investigator triangulation.Result Five major themes emerged:key strengths,success factors,nutritional approaches and lifestyle modification,implementation challenges,and development strategies.Multidisciplinary teamwork,personalised care plans and regular monitoring facilitated service delivery.Culturally adapted dietary strategies,such as low-carbohydrate Thai-style meals and intermittent fasting,were widely used.Challenges included unclear clinical guidelines,limited staffing and technological disparities.Medication deprescription varied across sites due to the absence of standardised protocols.Healthcare providers emphasised the need for community engagement and policy support to enable scale-up.Real-world implementation of diabetes remission services is feasible but challenged by systemic constraints and contextual variability.Flexible,culturally tailored approaches,empowered care teams and supportive policy frameworks are essential for sustainability.展开更多
基金supported by grant 2011BAI11B01 from the Projects in the Chinese National Science and Technology Pillar Program during the 12th Five-year Plan Periodby grant 2017-I2M-1-004 from the Chinese Academy of Medical Science Innovation Fund for Medical Sciencesby the Major science and technology special plan project of Yunnan Province (202302AA310045)。
文摘Background Both medication and non-medication therapies are effective approaches to control blood pressure (BP) in hypertension patients.However,the association of joint changes in antihypertensive medication use and healthy lifestyle index (HLI)with BP control among hypertension patients is seldom reported,which needs to provide more evidence by prospective intervention studies.We examined the association of antihypertensive medication use and HLI with BP control among employees with hypertension in China based on a workplace-based multicomponent intervention program.Methods Between January 2013 and December 2014,a cluster randomized clinical trial of a workplace-based multicomponent intervention program was conducted in 60 workplaces across 20 urban areas in China.Workplaces were randomly divided into intervention (n=40) and control (n=20) groups.Basic information on employees at each workplace was collected by trained professionals,including sociodemographic characteristics,medical history,family history,lifestyle behaviors,medication status and physical measurements.After baseline,the intervention group received a 2-year intervention to achieve BP control,which included:(1) a workplace wellness program for all employees;(2) a guidelines-oriented hypertension management protocol.HLI including nonsmoking,nondrinking,adequate physical activity,weight within reference range and balanced diet,were coded on a 5-point scale (range:0-5,with higher score indicating a healthier lifestyle).Antihypertensive medication use was defined as taking drug within the last 2 weeks.Changes in HLI,antihypertensive medication use and BP control from baseline to 24 months were measured after the intervention.Results Overall,4655 employees were included (age:46.3±7.6 years,men:3547 (82.3%)).After 24 months of the intervention,there was a significant improvement in lifestyle[smoking (OR=0.65,95%CI:0.43-0.99;P=0.045),drinking (OR=0.52,95%CI:0.40-0.68;P<0.001),regular exercise (OR=3.10,95%CI:2.53-3.78;P<0.001),excessive intake of fatty food (OR=0.17,95%CI:0.06-0.52;P=0.002),restrictive use of salt (OR=0.26,95%CI:0.12-0.56;P=0.001)].Compare to employees with a deteriorating lifestyle after the intervention,those with an improved lifestyle had a higher BP control.In the intervention group,compared with employees not using antihypertensive medication,those who consistent used (OR=2.34;95%CI:1.16-4.72;P=0.017) or changed from not using to using antihypertensive medication (OR=2.24;95%CI:1.08-4.62;P=0.030) had higher BP control.Compared with those having lower HLI,participants with a same (OR=1.38;95%CI:0.99-1.93;P=0.056) or high (OR=1.79;95%CI:1.27~2.53;P<0.001) HLI had higher BP control.Those who used antihypertensive medication and had a high HLI had the highest BP control (OR=1.88;95%CI:1.32-2.67,P<0.001).Subgroup analysis also showed the consistent effect as the above.Conclusion These findings suggest that adherence to antihypertensive medication treatment and healthy lifestyle were associated with a significant improvement in BP control among employees with hypertension.
文摘Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.
文摘Ketamine is a dissociative anaesthetic.It is listed by the World Health Organisation[1]in its Model List of Essential Medicines,which are basic drugs required for any health-care system.Indeed,clinically ketamine possesses hypnotic,analgesic and amnesic effects.It is commonly used as induction
文摘We have a scarcity of health care professionals in the rural areas and therefore we can offer medical services from a distance to the underserved rural population.
文摘China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,
文摘AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODSThe Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTSSeventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (±14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P<0.001, P<0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSIONSLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.
文摘The United States is in the throes of a severe opioid overdose epidemic,primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine,a veterinary sedative often mixed with fentanyl.The high potency and long duration of fentanyl is compounded by the added risks from xylazine,heightening the lethal danger faced by opioid users.Measures such as enhanced surveillance,public awareness campaigns,and the distribution of fentanylxylazine test kits,and naloxone have been undertaken to mitigate this crisis.Fentanyl-related overdose deaths persist despite these efforts,partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies.A multifaceted approach is imperative in effectively combating the opioid overdose epidemic.This approach should include expansion of treatment access,broadening the availability of medications for opioid use disorder,implementation of harm reduction strategies,and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.
基金funded by Novartis Japan,which developed and marketed TKIs for the treatment of melanoma.
文摘Objective:This study aimed to describe patients with melanoma initiating treatments with dabrafenib plus trametinib(Dab+Tram)or encorafenib plus binimetinib(Enco+Bini)in a real-world setting in Japan.Methods:Data were extracted from the Japanese Medical Data Vision(MDV)insurance claims database.Patients diagnosed with melanoma between 2012 and 2021 and prescribed with Dab+Tram or Enco+Bini were included in three cohorts:non-adjuvant Dab+Tram,adjuvant Dab+Tram,and Enco+Bini.Data were extracted on patient characteristics at treatment initiation.During follow-up,all changes in melanoma treatments were documented.Treatment adherence was determined as the proportion of prescription days covered(PDC)and treatment dose intensity as the relative dose intensity(RDI).Results:Sixty-seven patients were included in the non-adjuvant Dab+Tram cohort(55 first-line treatments),seven in the adjuvant Dab+Tram cohort(six first-line treatments),and 16 in the Enco+Bini cohort(four firstline treatments).The mean age was 61.3±13.5 years and 56.1%were men.Twenty-seven patients with non-adjuvant Dab+Tram or Enco+Bini in first line(45.8%)switched to a second line.The median treatment duration was 11.8 months for Dab+Tram and 8.1 months for Enco+Bini.A PDC≥80%was observed for 85.7%of patients with adjuvant Dab+Tram,68.7%for non-adjuvant Dab+Tram,and 75.0%for Enco+Bini.Median RDI was 1.0 for adjuvant Dab+Tram,0.9 for non-adjuvant Dab+Tram,and 0.6 for Enco+Bini.Conclusion:Dab+Tram is used consistently with clinical practice guidelines in the adjuvant setting,but adherence in the non-adjuvant setting is suboptimal,as is the prescribed dose of Enco+Bini.Prescribers should ensure that these therapies are used in an optimal way to improve outcomes in melanoma.
文摘A series of completely sealed standing-wave (SW) accelerator guides was developed and installed on 3,4, 6, 9 and 14 MeV home-made electron linacs for medical and industrial uses. In the development of these SW guides, various subjects, including particle dynamics, microwave properties etc, were studied. The fsctors influencing the transverse motion were considered analytically and using a simulation code, TRSV. The problem of electron backbombardment in SW linac was analyzed by a 3-dimensional trace code, SB. Simultaneously decreasing the length of the first cavity and the injection voltage can reduced the electron backbombarding power. The code PPDW based on equivalent circuit theory was developed to analyze many microwave characteristics of arbitrarily composed coupled cavity chains. This research contributed to the successful development of the 3, 4, 6, 9 and 14MeV SW accelerator guides. For example, in the recently developed 14MeV SW guide, the beam passes smoothly through a 1.45 m long guide with a beamhole (diameter of 7 mm) without using a focusing solenoid.
基金supported by the National Natural Science Foundation of China under Grant No.60572101
文摘In landmark-based image registration, estimating the landmark correspondence plays an important role. In this letter, a novel landmark correspondence estimation technique using mean shift algorithm is proposed. Image corner points are detected as landmarks and mean shift iterations are adopted to find the most probable corresponding point positions in two images. Mutual information between intensity of two local regions is computed to eliminate mis-matching points to improve the stability of corresponding estimation correspondence landmarks is exact. The proposed experiments of various mono-modal medical images. Multi-level estimation （MLE） technique is proposed Experiments show that the precision in location of technique is shown to be feasible and rapid in the
文摘Objective Diabetes remission has emerged as an achievable treatment goal,shifting the focus of care from increasing medication use to restoring metabolic health.While clinical trials show that remission is possible in controlled settings,evidence remains limited regarding its implementation in routine care within middle-income,rice-based dietary contexts.This study aims to explore healthcare provider experiences with implementing diabetes remission services in Thailand,focusing on dietary strategies,deprescription practices and patient management in routine care settings.Design Qualitative study using semi-structured,in-depth interviews,supplemented by structured questionnaires and programme documents.Setting Thirteen healthcare facilities across six Thai regions and two national-level professional or policy organisations.Participants 17 key informants purposively sampled for regional,institutional and professional diversity,including physicians,nurses,dietitians and national programme leaders.Data were collected and analysed iteratively until no new insights emerged.Thematic content analysis was conducted in QDA Miner Lite v3.0 with investigator triangulation.Result Five major themes emerged:key strengths,success factors,nutritional approaches and lifestyle modification,implementation challenges,and development strategies.Multidisciplinary teamwork,personalised care plans and regular monitoring facilitated service delivery.Culturally adapted dietary strategies,such as low-carbohydrate Thai-style meals and intermittent fasting,were widely used.Challenges included unclear clinical guidelines,limited staffing and technological disparities.Medication deprescription varied across sites due to the absence of standardised protocols.Healthcare providers emphasised the need for community engagement and policy support to enable scale-up.Real-world implementation of diabetes remission services is feasible but challenged by systemic constraints and contextual variability.Flexible,culturally tailored approaches,empowered care teams and supportive policy frameworks are essential for sustainability.
