"Hatch closed a major chapter in her life. Drifting between everywhere and nowhere, she seeks to find her new path. Like any pathfinder, Hatch cuts through the pain of her past one step at a time. A desperate call from an old friend brings her to Florida's panhandle. Before Hatch can connect, tragedy strikes. A helicopter training accident off the shore of Naval Air Station Pensacola takes the life of her friend and seasoned operator. All she has to go on is the cryptic message, leaving her with more questions than answers. When the pieces of the puzzle don't fit, Hatch must satisfy her own curiosity. There are some who don't want the truth to be exposed and will do everything in their power to stop it from coming to the surface. As Hatch turns every stone, she slips deeper into dark territory. Surrounded by enemies. Hatch must deploy the skills that have made her legend. Follow Hatch down the Fastrope and prepare for yourselves for the hell she brings upon those who force her to once again honor the code instilled by her father. Protect those who can't protect themselves and punish those responsible."--Back

Background Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the international normalised ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time consuming for healthcare professionals. This study reports the first randomised controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT. Methods A prospective, randomised controlled cross-over study was carried out to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control to that provided by an anticoagulation management service (AMS). During the six months of supervised PST, patients measured their INR at home using a portable meter and entered this result along with other information onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms. Results One hundred and sixty two patients were enrolled in the study (61.4% male, mean age 59.6 years), and 132 (81.5%) patients completed both arms. TTR was significantly higher during PST management (median 74%) compared with AMS management (58.6%) (p0.001). Extreme INR values (