ABSTRACT
Background: Dedicated anticoagulation clinics have demonstrated superior patient outcomes. The COVID-19 pandemic created challenges for patient care including fear of medical appointments due to potential risk of exposure. An innovative approach to anticoagulation management was developed at our center that allows the patient to stay in their vehicle while our anticoagulation advanced practice nurse obtains blood for point-of- care/ INR testing, education and counseling. Objectives: 1. To assess degree of compliance to anticoagulation management pre vs. post drive-through clinic. 2. Assess percentage and time to therapeutic range (TTR), percentage within therapeutic (TR), subtherapeutic, and supratherapeutic INR pre vs. post drive-through clinic. 3. Evaluate bleeding and thrombosis complications during study period. 4. Assess patient/family satisfaction. Methods: Retrospective chart review of patients on warfarin therapy who used the drive-through clinic between April 1 and August 31, 2020. Patient demographics, underlying diagnosis, and target INR range were reviewed. Dates and values for INR, percentage of therapeutic (TR), subtherapeutic, and supratherapeutic INR and degree of compliance (≥1 INR determination per month) were collected for 6 months prior to April 1 and compared to results obtained during drive-through clinic implementation. Data were summarized descriptively and compared using nonparametric statistical methods. Results: A total of 17 patients were evaluated in our drive-through clinic during the study period. Fifty-eight percent were males (n = 10) with a median age of 15 years (range: 3-54). Primary indication for warfarin therapy included: tricuspid valve replacement (n = 1), mitral valve (n = 5), aortic valve (n = 4), Fontan (n = 5), atrial fibrillation (n = 1), and deep vein thrombosis (n = 1). Median TTR was 60.1% (range: 21.1-89.2) with a median cumulative time of anticoagulation of 3.3 years (range: 0.2-6.1 years). Overall compliance pre vs. post drive-through clinic implementation was similar (median pre compliance 100% (95% CI: 83%-100%) vs. 100% post (95% CI: 100%-100%);p = 0.16;Figure 1). Five of six patients who had compliance less than 90% achieved an improvement with the drive-through clinic. The median percentage of INR within TR improved significantly with the drive-through clinic (median pre 50% (95% CI: 33%-67%) vs. median post 80% (95% CI: 57%-100%);p = 0.0103;Figure 2). No bleeding or thrombotic complications were observed. Patients and families reported 100% satisfaction with the drive-through care. Conclusions: A drive-through INR clinic during COVID-19 pandemic allowed patients to access care from their vehicle. A subgroup of patients improved compliance to INR monitoring. The median percentage of INR within TR improved significantly after implementation of the drive-through clinic. Innovative approaches such as this clinic may improve patient compliance and adherence to anticoagulation. (Figure Presented).
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic is a primary health problem globally. In particular, it has caused troubles even to the advanced health systems of Western countrieswho attempted to limit the spread of the infection and manage patients with severe respiratory distress. However, this sudden contingency has had a much higher cost if we also consider the cost of suspending ordinary clinical care or delays in the emergency pathways of non-COVID-19 patients. Furthermore, the policies applied to contain the contagion have exacerbated the socio-economic disparities of the population and isolated fragile patients, making them subject to clinical relapses or aggravation of chronic diseases. For this reason, the various specialist centers have equipped themselves to guarantee an effective therapeutic path. In this brief review, we have outlined some consequent repercussions on the management of acute and chronic cardiovascular and neurovascular diseases and on oncological treatment. In particular, we have described the effects of the current health reorganization on some acute and time-dependent diseases, such as stroke and acute coronary syndromes, in which therapeutic delay is potentially disabling or fatal. Furthermore, we have focused on cancer treatments, whose essential cornerstones are early screening and follow-up. Finally, the suffering of the local health network has led to a lack of continuity of care in fragile patients, such as psychiatric, marginalized, or multiple comorbid patients.
ABSTRACT
A diagnostic algorithm that allows for the rapid identification of sepsis and possibly guides the appropriate antimicrobial therapy application is the cornerstone to obtaining effective treatment and better results. The use of emerging surrogate markers could significantly improve clinical practice, but the validity and clinical utility have been proved only for very few of them, and their availability in clinical routine is limited. For this purpose, numerous scientific evidence has indicated procalcitonin as a marker linked to sepsis and its evolution. This review aims to retrace the main evidence relating to the use of procalcitonin in sepsis. We analyzed the primary studies in the literature and the existing meta-analysis evaluating the behavior of procalcitonin as a marker of bacterial sepsis, its prognostic power, and its ability to influence antibiotic therapy. Recent evidence has suggested that procalcitonin could be an efficient marker for diagnosing sepsis and its therapeutic management in many types of patients. The choice of the appropriate timing to initiate and suspend antibiotic therapy, with obvious clinical advantages, the favorable effects could also include reducing health costs, both avoiding the administration of inappropriate antibiotic therapies, and reducing the duration of hospitalization. Moreover, limited studies reported high procalcitonin levels in coronavirus disease 2019 patients with a worse prognosis. Despite the considerable evidence in favor of the potential of procalcitonin as an index for managing septic patients, there are conflicting data that deserve specific and detailed studies. © 2021 the Author(s).