A complicating factor is that TCD screening can be delivered using two types of equipment described as non-imaging or imaging TCD. The absence of a formal training centre outside of the USA contributes to the failure to implement the recommendation. There are a number of reasons why access to TCD services remains a challenge funding is a major issue, but even with adequate funds, issues remain due to a lack of skills and knowledge, particularly with respect to adequately trained TCD operators. A substantial variation in the access to TCD screening has been reported, varying from as low as 90% in children with SCD. Therefore, TCD screening is recommended as a standard of care for children with SCD starting at an age of two years. The TCD technique involves the meticulous interrogation of the basal cerebral arteries, with frequent optimisation of the ultrasound transducer orientation to ensure measurement of the highest blood velocity, which is related to stroke risk. Stroke risk was based on the presence and severity of intracranial stenosis which, was reliably estimated using Transcranial Doppler Ultrasound (TCD). Several countries have organised a specific response in order to meet the needs of the growing number of patients with SCD, including establishing newborn screening and stroke risk screening programmes Ī worldwide SCD stroke risk screening programme was recommended following the Stroke Prevention Trial in Sickle Cell Anemia (STOP) which provided Level 1 evidence of the reduction in primary stroke risk following blood transfusion for children with a high risk of stroke. Establishing clinical services for rare disorders is encouraged, and the importance of identifying areas with poor access to health services is well-recognised. Although considered a “rare disease” due to its global frequency, in the 28 countries of the European Union, SCD is the most common single gene genetic disease in France and the United Kingdom and its frequency is steadily rising in many other countries of central and southern Europe. Recent studies on the impact of migration on the geographical distribution of the HbS allele have highlighted sickle cell disease (SCD) as a global public health issue. Further work is in progress to develop an achievable and reproducible QA program. A quality assurance (QA) system is required to ensure that standards are maintained. Conclusion: The attainment of competency in stroke screening using transcranial Doppler scanning (TCD) in sickle cell disease is more feasible for professionals with an ultrasound imaging background. The same consistency in stroke risk distribution following training was demonstrated with both non-imaging and imaging-TCD data. The stroke risk distribution of children at each centre varied significantly before training ( p < 0.001), but improved after training (Fisher’s Exact: no treatment = 5.6, p = 0.41, treatment = 13.8, p < 0.01). Following training, the TAMMV showed closer agreement between centres for both imaging-TCD and non-imaging TCD. The imaging-TCD TAMMV was also higher in Centre 3 ( p < 0.001). The TAMMV, used to predict stroke risk at each Centre, demonstrated the highest values in Centre 3 ( p < 0.0001) before training. Results: 42% (23/55) of trainees successfully completed the program. The impact of the training programme was evaluated in three European haematology clinics by comparing stroke risk classification and middle cerebral artery time-averaged maximum velocity (TAMMV) obtained from a cohort of 555 patients, before and after training. Methods: Fifty-five practitioners from differing professional backgrounds were recruited to the TCD training program. The present European multi-centre study was designed to promote the standardisation and delivery of effective screening. Nevertheless, less than 50% of children with SCD in Europe receive annual TCD-one of the reasons being a lack of trained personnel. Effective implementation relies on the correct stratification of stroke risk using Transcranial Doppler Ultrasound (TCD), prior to committing children to long-term treatment with transfusion. Background: Effective stroke prevention in sickle cell disease (SCD) is recommended for children with sickle cell anaemia.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |