Use of anticoagulant drugs in patients with atrial fibrillation. Does adherence to therapy have a prognostic impact?

Anticoagulant therapy represents a pivotal element that strongly influences the thromboembolic risk of non-valvular atrial fibrillation (NVAF) subjects. The main purpose of this review was to identify issues and suggest strategies to improve the oral anticoagulants (OACs) treatment adherence, which is the most important predictor of NVAF outcome. Advantages, efficacy, and impact of these drugs on patients' prognosis were revealed in important clinical trials on large cohorts of patients and are often prescribed nowadays. A real-life data registry, the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) analyzed the profile and outcome of patients diagnosed with NVAF receiving oral antithrombotic treatment. The observations gathered in the registry were crucial for identifying relevant elements that clinicians must improve, such as adherence strategies and predisposing factors that correlated with stroke. Adherence to OACs in AF patients is essential from the viewpoint of clinical efficacy and safety. Major adverse events and negative outcome are correlated with a weak anticoagulation control caused by an ineffective treatment adherence strategy. Solving the issue of oral anticoagulation adherence is possible using new technologies, but future directions should be explored. Mobile phone applications centered on patients' needs, telemedicine programs that evaluate patients' evolution and detect adverse reactions or events, encouraging an adequate management of the event without interruption of OACs, represent perspectives with a major impact on treatment adherence.

Distress in neurocognitive disorders due to Alzheimer's disease and stroke.

Patients with neurocognitive disorders experience subjectively the concept of quality of life; this is the reason why researchers avoid approaching this concept and prefer to focus attention on the emotional profile of the caregivers. Many studies highlight the efforts both emotional and financial made by caregivers in case of patients diagnosed with neurocognitive disorders. The present study shows the differences between the patients diagnosed with neurocognitive disorder due to Alzheimer's disease and patients diagnosed with stroke, as well as the Romanian norms for the short form of Geriatric Depression Scale. The study group consisted of the clinical population (N=45), selected according to the inclusion/exclusion criteria, following the principles of Helsinki Declaration for Ethical Medical Research. The study was conducted at the Neuropsychiatry section of the Municipal Clinical Hospital, Dr Gavril Curteanu, Oradea, Romania. The results showed significant differences between the two types of patients in terms of quality of life, t(43)=-7.99, P=0.001, affective distress, t(43)=5.10, P=0.001 and perceived stress, t(43)=3.81, P=0.001. The internal consistency of the scale is high, the coefficient KR-20 being 0.86.

Orchard management under the effects of climate change: implications for apple, plum, and almond growing.

The authors analyzed certain species and varieties of fruit tree in which applied crop technology is used and also undergoes the effects of climate change. The aim is to extend productive crop varieties, resistant to disease and pests, in order to obtain superior yields. The research was conducted in orchards located in northwestern Romania (on 8.59 ha), intensively cultivated with apple, plum, and almond species. The blooming period of the species and fruit production was studied in 2009, the first year of the farm's commercial production, and then compared to figures from 2016 to see the changes that occurred. Climatic conditions were studied throughout the period of existence of the farm (2002-2016). To determine the influence of the climatic factor on the blooming and production periods, respectively, every year is considered having pre-blooming, blooming, and ripening periods. It was found that climate change influences the annual biological cycle of the trees: the vegetative rest period of the trees shortens, the tree vegetation begins earlier in the spring, and the blooming period is advanced by as much as 10 days compared to normal cultivated varieties. All these factors have direct repercussions on the quantity of production.