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BACKGROUND: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide. METHODS: GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries. FINDINGS: A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE ± DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %). INTERPRETATION: GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population. ispartof: THROMBOSIS RESEARCH vol:222 pages:31-39 ispartof: location:United States status: published

Background Parenteral anticoagulants and vitamin K antagonists (VKAs) have constituted the cornerstone of venous thromboembolism (VTE) treatment. Meanwhile, direct oral anticoagulants (DOACs) provide physicians with an alternative. The Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE observes real-world treatment practices. Objectives Describe initial anticoagulation (AC) treatment patterns in VTE patients who received parenteral AC, VKAs, and/or DOACs within ±30 days of diagnosis. Methods VTE patients were categorized into parenteral AC only, parenteral AC with transition to VKA, VKA only, parenteral AC with transition to DOAC, and DOAC only. Results A total of 9647 patients were initiated on AC treatment alone. 4781 (49.6%) patients received DOACs ± parenteral ACs; 3187 (33.0%), VKA ± parenteral ACs; and 1679 (17.4%) parenteral ACs alone. Rivaroxaban was the most frequently used DOAC (79.4%). DOACs were more frequently used in North America/Australia (58.1%), Europe (52.2%), and Asia (47.6%) than in Latin America (29.7%) and the Middle East/South Africa (32.5%). In patients with suspected VTE, most received parenteral AC monotherapy (67.7%). Patients with deep vein thrombosis were more likely to receive DOACs alone than those with pulmonary embolism with or without deep vein thrombosis (36.2% vs 25.9%). Active cancer patients received parenteral AC alone (58.9%), with 25.5% receiving DOAC ± parenteral AC and 12.8% parenteral AC and VKA. A total of 46.5% of pregnant patients received parenteral AC monotherapy, 34.0% were treated with VKA ± parenteral AC, and 19.5% received a DOAC (± parenteral AC). Conclusion AC treatment patterns vary by patient population, geographic region and site of VTE. Guidelines for AC therapy are not always adhered to.

Resume Objectif Nous avons recherche les elements de personnalite dans une population ayant une incontinence urinaire. Une correlation entre les resultats du questionnaire de personnalite Minimult et les resultats de l’ICIQ-UI-SF (International Consultation Incontinence Questionnaire Urinary Incontinence Short Form) a ete realisee. Le but du travail est d’objectiver la fiabilite et la sincerite des reponses des patients et de rechercher les elements permettant d’etablir qu’un trouble de personnalite pourrait etre implique dans la physiopathologie de l’incontinence urinaire. Materiels et methodes Nous avons realise une etude prospective observationnelle. Un questionnaire informatise comprenant une double presentation des trois questions scorees de l’ICIQ-UI-SF parmi les 71 questions du Minimult a ete propose a 47 patients. Resultats Sur 37 patients inclus, le test non parametrique Wilcoxon-Mann-Whitney a conforte la concordance des deux questionnaires ICIQ-UI-SF avec p = 0,1792. Parmi ceux-ci, l’inventaire Minimult a permis de selectionner 23 patients dont le score de l’echelle de validite F (avec F 70 correspond a une personne « qui accentue ses symptomes » ou peut etre significatif d’un trouble de l’attention ce qui justifie l’exclusion de ces patients. Nous avons compare la difference des scores de l’ICIQ-UI-SF lors des test et re-test aux scores obtenus sur l’echelle de validite F, indicateur de surcharge, du questionnaire Minimult en utilisant l’analyse ROC. Les resultats ont demontre une AUC de 0,559 avec une sensibilite de 78,6 % et une specificite de 43,5 %. Parmi cette population valide de 23 patients, aucun score L n’etait superieur a 70 ce qui indique l’absence de mensonge delibere. L’analyse de personnalite de cette meme population n’a detecte aucun trouble de personnalite dans 9 cas. Elle a demontre six cas presentant une valeur elevee sur l’echelle d’hypochondrie, cinq une valeur elevee dans l’echelle de depression, quatre une valeur elevee dans l’echelle d’hysterie. Cette triade nevrotique a ete retrouvee dans deux cas. La deviation psychopathique (Pd) relative a un registre antisocial etait retrouvee dans cinq cas tandis que l’echelle paranoia ainsi que l’echelle d’hypomanie etaient elevees dans un cas mais aucune association entre ces traits de personnalite n’etait observee ce qui permettait de conclure en l’absence de problemes de comportement. Le profil psychotique associant schizophrenie, paranoia, depression et hypomanie n’a ete retrouve dans aucun cas. Le tableau psychasthenie qui correspond a des traits de personnalite phobo-obsessionnels etait retrouve dans pres de la moitie des cas valides. Conclusion Nous concluons qu’une correlation entre les resultats d’un questionnaire de personnalite et les resultats de l’ICIQ-UI-SF est realisable. Cette etude comparative objective la fiabilite des reponses des patients tandis que la sincerite de celles-ci est determinee par l’absence de mensonge delibere recherche par le Minimult. Nous confirmons et precisons les donnees de la litterature sur les differents tableaux cliniques de la personnalite des patients incontinents en soulignant l’importance du tableau psychasthenie qui correspond a une personne anxieuse victime d’un important ressenti de son probleme. Ces elements permettent de suspecter qu’un trouble de personnalite pourrait etre implique dans la physiopathologie de l’incontinence urinaire. Niveau de preuve 4.

Objectif : notre objectif a ete de demontrer la valeur ajoutee de l’infirmier(e) referent(e) dans une consultation generale en urologie.Methodes : notre etude prospective evaluative porte sur une population ambulatoire de 135 patients (40 femmes, 95 hommes) inclus. Les troubles de la fonction urinaire ont ete definis par la Classification internationale du fonctionnement, du handicap et de la sante (CIF) de l’Organisation mondiale de la sante (OMS). La composante activite – participation a ete analysee dans le domaine de la communication avant et apres la consultation chez l’urologue. Nous avons utilise les resultats obtenus sur base d’une echelle visuelle analogique (EVA). L’EVA a egalement determine un pourcentage qualifiant le facteur facilitateur de l’environnement cree par l’infirmiere specialisee. L’analyse statistique comporte une etude de la population ainsi qu’une comparaison par analyse de la variance (ANOVA) de la composante activite-participation.Resultats : la population etait âgee de 4 ans et 10 mois a 96 ans (m = 63,29 ; ecart-type (ET) = 19,71). Le code qualificatif median du trouble urologique observe etait de 2 (modere). L’analyse de la variance de la composante activite-participation a objective une difference significative avant et apres la consultation (F = 6,4172 ; p < 0,001). La troisieme question posee qualifiait le facteur facilitateur de l’environnement cree par l’infirmiere sur base d’une EVA avec une moyenne de 97,79 % (ET = 4,67).Conclusion : notre travail prospectif s’est porte sur l’evaluation de l’impact qualitatif d’une infirmiere specialisee dans le decours d’une consultation ambulatoire urologique a caractere general. Le caractere qualitatif d’environnement facilitateur d’un personnel paramedical specialise est important dans le cadre participatif de la communication et de la comprehension du message medical.

Aims A urinary incontinence impairment rating must be a highly accurate, non-invasive exploration of the condition using International Classification of Functioning (ICF)-based assessment tools. The objective of this study was to identify the best evaluation test and to determine an impairment rating model of urinary incontinence. Methods In performing a cross-sectional study comparing successive urodynamic tests using both the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the 1-hr pad-weighing test in 120 patients, we performed statistical likelihood ratio analysis and used logistic regression to calculate the probability of urodynamic incontinence using the most significant independent predictors. Subsequently, we created a template that was based on the significant predictors and the probability of urodynamic incontinence. Results The mean ICIQ-UI-SF score was 13.5 ± 4.6, and the median pad test value was 8 g. The discrimination statistic (receiver operating characteristic) described how well the urodynamic observations matched the ICIQ-UI-SF scores (under curve area (UDA):0.689) and the pad test data (UDA: 0.693). Using logistic regression analysis, we demonstrated that the best independent predictors of urodynamic incontinence were the patient's age and the ICIQ-UI-SF score. The logistic regression model permitted us to construct an equation to determine the probability of urodynamic incontinence. Using these tools, we created a template to generate a probability index of urodynamic urinary incontinence. Conclusions Using this probability index, relative to the patient and to the maximum impairment of the whole person (MIWP) relative to urinary incontinence, we were able to calculate a patient's permanent impairment. Neurourol. Urodynam. 32: 974–979, 2013. © 2012 Wiley Periodicals, Inc.

The aim of this study was to demonstrate that the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) tool can be applied for a factual score determining urinary incontinence in the Katz-6 Scale, and it is effective to identify score 2 from score 3.Functional capacity of 63 patients (14 M, 49 F aged from 70 to 99 years old) was evaluated with a Mini Mental State Examination (MMSE), Katz Index for Activities of Daily Living, and ICIQ-UI-SF questionnaire. Mean comparative analysis was performed. ICIQ-UI-SF scores were then entered as variables. These data observed in Katz continence item scored 2 and Katz continence item scored 3 were compared in a combined box-and-whisker and dot plot. Sensitivity and specificity of each variable were tested and results were evaluated using a receiver operating characteristic (ROC) curve. The best variable (ICIQ-UI-SF Score) was retained as a breach permitting to distinguish patients to be scored 2 or 3 over continence Katz item.Statistical analysis demonstrated significant difference between the sample of Katz continence item scored 2 and the sample of Katz continence item scored 3 over the ICIQ-UI-SF Score and the Katz global Score, but the difference was not significant concerning the MMSE Score. Using ROC analysis, we compared the discriminant power of the ICIQ-UI-SF Score for continence Katz item Score. Criterion values and coordinates of the ROC curve were studied and the ICIQ-UI-SF score of 13 was considered the best one.We demonstrated that the best variable (ICIQ-UI-SF Score) to retain as a breach permitting to distinguish patients to be scored 2 or 3 over continence Katz item is 13.

This paper presents the results of a prospective study of outpatient urology consultations designed to provide evidence of the benefits of using a specialist nurse to improve quality of care.135 patients (95 men and 40 women) were included in the study. Urinary disorders were defined using the International Classification of Functioning, Disability and Health (ICF), developed by the World Health Organization (WHO). The activity/ participation component was studied from a communication perspective before and after the urology consultation. Scores were obtained using a visual analogue scale (VAS). The VAS was also used to assess the role of the nurse as a facilitator (environmental factors component). A statistical analysis was performed on the population, as was an analysis of variance (ANOVA) of the activity/participation component.The participants were aged between 4years 10 months and 96years (m = 63.29; standard deviation (SD) = 19.71). The median score for the urological disorders was 2. An analysis of variance of the two questions relating to the activity/participation component indicated a significant difference between the two groups (F = 6.4172; p0.001). A third question was used to assess the environmental factors component (nurse as facilitator), with a mean VAS score of97.79% (SD= 4.67).The purpose of this prospective study was to conduct a qualitative assessment of the impact of involving a specialist nurse in outpatient urology consultations. The study demonstrated that the qualitative impact of using a specialist nurse as a facilitator (environmental factors component) is extremely important for the participatory dimension of communication, particularly in terms of understanding medical information.

A splitting technique for solutions of the Navier—Stokes and the energy equations, in Boussinesq approximately, is presented. The equations are first integrated in time using a splitting procedure and then discretized spatially by means of a high‐order spectral element method. The whole technique is validated on the flow in a differentially‐heated cavity at intermediate and transitional Rayliegh numbers. The results are in a very good agreement with other available numerical solutions.

A urinary incontinence impairment rating must be a highly accurate, non-invasive exploration of the condition using International Classification of Functioning (ICF)-based assessment tools. The objective of this study was to identify the best evaluation test and to determine an impairment rating model of urinary incontinence.In performing a cross-sectional study comparing successive urodynamic tests using both the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the 1-hr pad-weighing test in 120 patients, we performed statistical likelihood ratio analysis and used logistic regression to calculate the probability of urodynamic incontinence using the most significant independent predictors. Subsequently, we created a template that was based on the significant predictors and the probability of urodynamic incontinence.The mean ICIQ-UI-SF score was 13.5 ± 4.6, and the median pad test value was 8 g. The discrimination statistic (receiver operating characteristic) described how well the urodynamic observations matched the ICIQ-UI-SF scores (under curve area (UDA):0.689) and the pad test data (UDA: 0.693). Using logistic regression analysis, we demonstrated that the best independent predictors of urodynamic incontinence were the patient's age and the ICIQ-UI-SF score. The logistic regression model permitted us to construct an equation to determine the probability of urodynamic incontinence. Using these tools, we created a template to generate a probability index of urodynamic urinary incontinence.Using this probability index, relative to the patient and to the maximum impairment of the whole person (MIWP) relative to urinary incontinence, we were able to calculate a patient's permanent impairment.

Several explicit Taylor-Galerkin-based time integration schemes are proposed for the solution of both linear and non-linear convection problems with divergence-free velocity. These schemes are based on second-order Taylor series of the time derivative. The spatial discretization is performed by a high-order Galerkin spectral element method. For convection-diffusion problems an operator-splitting technique is given that decouples the treatment of the convective and diffusive terms. Both problems are then solved using a suitable time scheme. The Taylor-Galerkin methods and the operator-splitting scheme are tested numerically for both convection and convection-diffusion problems.

Objectif : notre objectif a ete de demontrer la valeur ajoutee de l’infirmier(e) referent(e) dans une consultation generale en urologie.Methodes : notre etude prospective evaluative porte sur une population ambulatoire de 135 patients (40 femmes, 95 hommes) inclus. Les troubles de la fonction urinaire ont ete definis par la Classification internationale du fonctionnement, du handicap et de la sante (CIF) de l’Organisation mondiale de la sante (OMS). La composante activite – participation a ete analysee dans le domaine de la communication avant et apres la consultation chez l’urologue. Nous avons utilise les resultats obtenus sur base d’une echelle visuelle analogique (EVA). L’EVA a egalement determine un pourcentage qualifiant le facteur facilitateur de l’environnement cree par l’infirmiere specialisee. L’analyse statistique comporte une etude de la population ainsi qu’une comparaison par analyse de la variance (ANOVA) de la composante activite-participation.Resultats : la population etait âgee de 4 ans et 10 mois a 96 ans (m = 63,29 ; ecart-type (ET) = 19,71). Le code qualificatif median du trouble urologique observe etait de 2 (modere). L’analyse de la variance de la composante activite-participation a objective une difference significative avant et apres la consultation (F = 6,4172 ; p < 0,001). La troisieme question posee qualifiait le facteur facilitateur de l’environnement cree par l’infirmiere sur base d’une EVA avec une moyenne de 97,79 % (ET = 4,67).Conclusion : notre travail prospectif s’est porte sur l’evaluation de l’impact qualitatif d’une infirmiere specialisee dans le decours d’une consultation ambulatoire urologique a caractere general. Le caractere qualitatif d’environnement facilitateur d’un personnel paramedical specialise est important dans le cadre participatif de la communication et de la comprehension du message medical.

SUMMARY An approximate projection scheme based on the pressure correction method is proposed to solve the NavierStokes equations for incompressible flow. The algorithm is applied to the continuous equations; however, there are no problems concerning the choice of boundary conditions of the pressure step. The resulting velocity and pressure are consistent with the original system. For the spatial discretization a high-order spectral element method is chosen. The high-order accuracy allows the use of a diagonal mass matrix, resulting in a very efficient algorithm. The properties of the scheme are extensively tested by means of an analytical test example. The scheme is Mer validated by simulating the laminar flow over a backward-facing step. The solution of the Navier-Stokes equations for unsteady incompressible fluid flow is still a major challenge in the field of computational fluid dynamics. An overview of the most important aspects with respect to the solution of the incompressible Navier-Stokes equations can be found in References 1-5. The Navier-Stokes equations form a set of coupled equations for both velocity and pressure (or, better, the gradient of the pressure). One of the main problems related to the numerical solution of these equations is the imposition of the incompressibility constraint and consequently the calculation of the pressure. The pressure is not a thermodynamic variable, as there is no equation of state for an incompressible fluid. It is an implicit variable which instantaneously 'adjusts itself' in such a way that the velocity remains divergence-free. The gradient of the pressure, on the other hand, is a relevant physical quantity: a force per unit volume. The mathematical importance of the pressure in an incompressible flow lies in the theory of saddle-point problems (of which the steady Stokes equations are an example), where it acts as a Lagrangian multiplier that constrains the velocity to remain divergence-free. There are numerous approaches to solve the Navier-Stokes equations. For the solution of unsteady Navier-Stokes flow perhaps one of the most successful approaches to date is provided by the class of projection methods.&' Projection methods have been developed as a useful way of obtaining an efficient solution algorithm for unsteady incompressible flow. In this paper, projection methods are considered that are applied to the set of continuous equations, yielding very efficient and simple-toimplement algorithms. By decoupling the treatment of velocity and pressure terms, a set of easier-tosolve equations arises: a convectiondiffusion problem for the velocity, yielding an intermediate velocity which is not divergence-free; and a Poisson equation for the pressure (or a related quantity).