Dtsch Arztebl Int
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Observational Study
Over- and Undertreatment With Levothyroxine—Findings of the Population-Based Rhineland Study.
Levothyroxine is a very commonly prescribed drug, and treatment with it is often insufficient or excessive. Nonetheless, there have been only a few reports on the determinants of inadequate levothyroxine treatment. ⋯ Levothyroxine intake was high in our sample, and suboptimal despite monitoring. Our findings underscore the need for careful dosing and for due consideration of deintensification of treatment where appropriate.
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Review
Patients With Artificial Heart Valves-the Prophylaxis, Diagnosis, and Treatment of Endocarditis.
In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising. ⋯ Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.
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Review
Mediation Analysis in Medical Research—Part 31 of a Series on Evaluation of Scientific Publications.
Mediation analysis addresses the question of the mechanisms by which an exposure causes an outcome. This article is intended to convey basic knowledge of statistical mediation analysis. ⋯ By decomposing the overall exposure effect into indirect and direct components, a mediation analysis can reveal not just whether an exposure causes an outcome, but also how. For a mediation analysis to be valid, however, multiple assumptions must be satisfied that cannot easily be checked, potentially compromising such analyses as compared to the estimation of an overall effect.