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Abstract: Purpose: Compression ultrasonograpy is the reference test for the diagnosis of distal deep venous thrombosis of lower limbs. However, the ways it is performed and the related treatments are very heterogeneous between various countries. Current knowledge and key points: In USA, Canada and Netherlands, compression ultrasonograpy is restricted to proximal limbs considering that this test is inadequate to explore the distal veins. The strategy consisting of a clinical approach, including the clinical probability and/or a follow-up ultrasonography has demonstrated its efficacy and safety (extension rate to proximal veins of 1.2% at three months and absence of fatal pulmonary embolism). In France, Italy and Spain, lower limb ultrasonograpy testing includes the examination of calf veins in a so called “complete testing”. This procedure leads to the diagnosis of a large number of distal deep venous thrombosis (45–56%) among the 14 to 36% of deep vein thrombosis diagnosed in the setting of clinical suspicion. Recent diagnosis strategy studies have shown that both strategies are effective, but the complete ultrasound strategy doubles the number of anticoagulation treatments. Justification of inappropriate anticoagulation is not evident owing to the relatively low risk of proximal venous-thrombosis extension, the rate of severe hemorrhagic events at three months and the cost excess. Future prospects and projects: Prospective comparative clinical trials are necessary in distal-venous thrombosis and ongoing Cactus study addresses this therapeutic dilemma. [Copyright &y& Elsevier]

Objective: To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)., Research Design and Methods: Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs., Results: Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ∼$1,600 lower with EQW than with placebo ( P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time., Conclusions: Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated., (© 2019 by the American Diabetes Association.)

The Kidney Donor Profile Index (KDPI) was introduced in the United States in 2014 to guide the decision making of clinicians with respect to accepting or declining a donated kidney. To evaluate whether the KDPI can be applied to a European cohort, we retrospectively assessed 580 adult patients who underwent renal transplantation (brain-dead donors) between January 2007 and December 2014 at our center and compared their KDPIs with their short- and long-term outcomes. This led to the observation of two associations: one between the KDPI and the estimated glomerular filtration rate at one year (1-y-eGFR) and the other between the KDPI and the death-censored allograft survival rate (both p < 0.001). Following this, the individual input factors of the KDPI were analyzed to assess their potential to evaluate the quality of a donor organ. We found that a donor's age alone is significantly predictive in terms of 1-y-eGFR and death-censored allograft survival (both p < 0.001). Therefore, a donor's age may serve as a simple reference for future graft function. Furthermore, we found that an organ with a low KDPI or from a young donor has an improved graft survival rate whereas kidneys with a high KDPI or from an older donor yield an inferior performance, but they are still acceptable. Therefore, we would not encourage defining a distinct KDPI cut-off in the decision-making process of accepting or declining a kidney graft.

Introduction: Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work-related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow-up services and participation in social networks and recreational activities., Methods: The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow-up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation., Results: The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow-up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow-up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat-11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment., Conclusions: In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients., (© 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Aim: This paper explores some of the premises of evidence-based design (EBD) and suggests that greater attention to and differentiation of the various purposes of research are needed, along with the development of an ecological theory that reflects the complexity of the health systems studied and more varied ways to communicate with and engage practitioners., Background: Problems with the American healthcare system are well known. For the past 20 years, an intervention that has gained increasing attention has been the physical design of healthcare facilities-hospitals in particular. EBD has been advocated as one means of using research to examine the relationship between design and healthcare to improve patient safety and the quality of care., Conclusions: The concept of integrated healthscape strategies is proposed to focus not only on research "evidence" and the methods used to collect and analyze it, but also on the different purposes research serves, the role of theory, and the use of EBD research in practice.

The pharmacy profession has long used technology to more effectively bring health care to the patient. Navy pharmacy has embraced technology advances in its daily operations, from computers to dispensing robots. Evolving from the traditional role of compounding and dispensing specialists, pharmacists are establishing themselves as vital team members in direct patient care: on the ward, in ambulatory clinics, in specialty clinics, and in other specialty patient care programs (e.g., smoking cessation). An important part of the evolution is the timely access to the most up-to-date information available. Micromedex, Inc. (Denver, Colorado), has developed a number of computer CD-ROM-based full-text pharmacy, toxicology, emergency medicine, and patient education products. Micromedex is a recognized leader with regard to total pharmaceutical information availability. This article discusses the implementation of Micromedex products within the established Composite Healthcare Computer System and the subsequent use by and effect on the international Navy pharmacy community.

An evaluation of the effect on total health care costs of a Medicaid demonstration project to provide coverage for alcoholism and substance abuse was conducted in Illinois in 1985. A pre/post-treatment analysis of expenditures for a subgroup of demonstration clients suggests that the addition of the alcohol and drug benefit did not result in higher total expenditures. [An important policy implication is that, when medical services substitute for one another, costs savings (increases) will not necessarily be realized when benefit packages are cut (expanded).]