Improvement of post-stroke outcomes relies on patient adherence and appropriate therapy maintenance by physicians. However, comprehensive evaluation of these factors is often overlooked. This study assesses secondary stroke prevention by differentiating patient adherence to antithrombotic treatments (ATT) from physician-initiated interruptions or switches. We analyzed a population-based retrospective cohort (n = 10,343) of post-stroke patients with atrial fibrillation using the VID database (2010-2017). Secondary prevention was evaluated based on patients' primary and secondary adherence to ATT at two years (percentage of days covered-PDC-and persistence/discontinuation) and physician prescription patterns (initiation, interruption, switching, restart). E-prescription and dispensing data were linked. Three ATT strategies were identified: oral anticoagulants (OAC), antiplatelets (APT), or combination therapy (OAC + APT), prescribed to 54%, 23%, and 17% of patients, respectively. Primary adherence was high for all ATTs (≈90%). OAC discontinuation was highest (16%), but frequently restarted (73.4%). APT treatment was interrupted the most (14%) and restarted the least (38.5%) by physicians, followed by OAC (interrupted in 11%, restarted in 65%). Overall, 17% of patients switched treatments, with OAC + APT being switched the most (76%), mainly to OAC (53.8%). Identifying areas for improvement in secondary stroke prevention requires considering both patient adherence and physician prescription patterns (initiation, interruptions, and restarts).
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JMIR Pediatr Parent
January 2025
General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Background: Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support.
Objective: This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents.
JAMA Netw Open
January 2025
Men's Health Inequities Research Lab, Milwaukee, Wisconsin.
Importance: Research indicates that social drivers of health are associated with cancer screening adherence, although the exact magnitude of these associations remains unclear.
Objective: To investigate the associations between individual-level social risks and nonadherence to guideline-recommended cancer screenings.
Design, Setting, And Participants: This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data from 39 US states and Washington, DC.
Endocrine
January 2025
Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy.
Diabetes mellitus (DM) and neuroendocrine tumors (NET) can exert unfavorable effects on each other prognosis. In this narrative review, we evaluated the effects of NET therapies on glycemic control and DM management and the effects of anti-diabetic therapies on NET outcome and management. For this purpose, we searched the PubMed, Science Direct, and Google Scholar databases for studies reporting the effects of NET therapy on DM as well as the effect of DM therapy on NET.
View Article and Find Full Text PDFCardiol Ther
January 2025
Advocate Aurora Research Institute, Advocate Health, 945 N 12th St, Milwaukee, WI, 53233, USA.
Introduction: Oral anticoagulants (OAC) reduce the risk of stroke among patients with atrial fibrillation (AF). However, adherence remains suboptimal. We focused on primary nonadherence to OAC and its associations with patient characteristics-specifically social determinants of health collected in electronic health records (EHR).
View Article and Find Full Text PDFArch Orthop Trauma Surg
January 2025
Orthopedics Research Center, Mashhad University of Medical Science, Mashhad, Iran.
Introduction: There exist conflicting electrodiagnostic reports between diagnosing mild carpal tunnel syndrome (CTS) and normal results, depending on the interpretation methods used by electrodiagnosticians. This underscores the necessity for precise clinical guidelines. This study aims to assess how the variation between mild and normal electrophysiological reports impacts (1) subsequent clinical outcomes in patients diagnosed with CTS and (2) physicians' decision-making.
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