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4.
Vasc Med ; 26(4): 426-433, 2021 08.
Article in English | MEDLINE | ID: covidwho-1166685

ABSTRACT

Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received PERT consultations in March and April 2020, compared to historical controls from the same period in 2019. Clinical data were abstracted from the electronic medical record. The primary study endpoints were inpatient mortality and GUSTO moderate-to-severe bleeding. The frequency of PERT utilization was nearly threefold higher during March and April 2020 (n = 74) compared to the same period in 2019 (n = 26). During the COVID-19 pandemic, there was significantly less PERT-guided invasive treatment (5.5% vs 23.1%, p = 0.02) with a numerical but not statistically significant trend toward an increase in the use of systemic fibrinolytic therapy (13.5% vs 3.9%, p = 0.3). There were nonsignificant trends toward higher in-hospital mortality or moderate-to-severe bleeding in patients receiving PERT consultations during the COVID-19 period compared to historical controls (mortality 14.9% vs 3.9%, p = 0.18 and moderate-to-severe bleeding 35.1% vs 19.2%, p = 0.13). In conclusion, PERT utilization was nearly threefold higher during the COVID-19 pandemic than during the historical control period. Among patients evaluated by PERT, in-hospital mortality or moderate-to-severe bleeding were not significantly different, despite being numerically higher, while invasive therapy was utilized less frequently during the COVID-19 pandemic.


Subject(s)
COVID-19/therapy , Health Resources/trends , Health Services Needs and Demand/trends , Patient Care Team/trends , Practice Patterns, Physicians'/trends , Pulmonary Embolism/therapy , Thrombolytic Therapy/trends , Venous Thromboembolism/therapy , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , Female , Hemorrhage/etiology , Hemorrhage/mortality , Hospital Mortality , Humans , Male , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/mortality , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Venous Thromboembolism/diagnosis , Venous Thromboembolism/etiology , Venous Thromboembolism/mortality
5.
Addict Sci Clin Pract ; 16(1): 13, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1102352

ABSTRACT

BACKGROUND: We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul's Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. EXPERIENCES: ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. RECOMMENDATIONS FOR THE FUTURE: We believe that ACS were essential to hospitals' readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/trends , Patient Admission/trends , Substance-Related Disorders/epidemiology , Substance-Related Disorders/rehabilitation , Telemedicine/trends , British Columbia , Buprenorphine/therapeutic use , Connecticut , Cross-Cultural Comparison , Forecasting , Health Plan Implementation/trends , Health Services Accessibility/trends , Humans , Massachusetts , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/rehabilitation , Oregon , Patient Care Team/trends , Patient Discharge/trends , Remote Consultation/trends
7.
J Thromb Thrombolysis ; 52(1): 308-314, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-813352

ABSTRACT

Hamad General Hospital Anticoagulation Clinic is one of the largest collaborative-practice clinics of its type in Qatar. The patients being followed at this clinic are typically complex and vulnerable. During the coronavirus disease 2019 pandemic, measures were implemented at the clinic to minimize the exposure of patients and healthcare providers to the acute respiratory syndrome coronavirus-2 and to promote social distancing. These measures included extending INR-recall period, transitioning to direct oral anticoagulant drugs whenever feasible, home visits to elderly and immunocompromised patients for INR testing, establishing an anticoagulation hotline, and relocation of warfarin dispensing from the main pharmacy to the anticoagulation clinic. In addition, the clinic shifted its multidisciplinary team meetings onto an online platform using Microsoft Teams. Telehealth consultations were extensively utilized to closely follow up with the patients and ensure that anticoagulation efficacy and safety remained optimal. The aim of this paper is to share our experience and describe the measures adopted by the clinic as part of the Hamad Medical Corporation response to the emerging situation.


Subject(s)
Anticoagulants/administration & dosage , Blood Coagulation/drug effects , COVID-19 , Drug Monitoring/trends , Hospitals, General/trends , International Normalized Ratio/trends , Outpatient Clinics, Hospital/trends , Telemedicine/trends , Administration, Oral , Aged , Anticoagulants/adverse effects , Drug Substitution/trends , Female , House Calls/trends , Humans , Male , Middle Aged , Patient Care Team/trends , Predictive Value of Tests , Qatar , Time Factors
12.
Oncologist ; 25(6): 463-467, 2020 06.
Article in English | MEDLINE | ID: covidwho-66231

ABSTRACT

Italy and the rest of the world are experiencing an outbreak of a novel beta-coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this context, in Italy, we reorganized the National Health System and prioritized the clinical cancer care scenario, balancing risk of SARS-CoV-2 transmission versus the magnitude of clinical benefit deriving from a specific therapeutic approach. As initial actions, we recommended that routine screening be suspended and that patients with early and advanced cancer be treated as outpatients as much as possible and at the nearest medical center. Patients who need to be hospitalized for cancer treatment were protected from potential SARS-CoV-2 infection by creating a dedicated diagnostic and therapeutic internal pathway for cancer treatment. We implemented reorganization of the hospital networks, based on a hub-and-spoke design. Stronger personal protection was made available for patients with cancer. Because of the extreme burden created by COVID-19, antitumor treatment was initiated only after considering patient performance status, comorbidities, biology of disease, and the likely impact of treatment on outcome. Treatment strategies were discussed in the context of a multidisciplinary tumor board. Treatment decision making balanced risk and benefits of treatment in the context of the specific pandemic level, on a case-by-case basis.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Medical Oncology/organization & administration , Neoplasms/therapy , Patient Care , Pneumonia, Viral/epidemiology , COVID-19 , Clinical Decision-Making , Coronavirus Infections/transmission , Coronavirus Infections/virology , Hospitalization , Humans , Infection Control/organization & administration , Infection Control/standards , Infection Control/trends , Italy/epidemiology , Mass Screening/organization & administration , Mass Screening/standards , Mass Screening/trends , Medical Oncology/standards , Medical Oncology/trends , Pandemics , Patient Care Team/organization & administration , Patient Care Team/standards , Patient Care Team/trends , Patient Selection , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2
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