![]() This could potentially facilitate management upon arrival at a healthcare facility and improve outcomes 3-5. As previously demonstrated, clinical assessment of patients in rural areas can be supported by secondary care specialists while en route to the hospital with live transmission of audio and video data. Patients who live in remote and rural areas are at particularly high risk of not receiving reperfusion therapy due to long transport times and lack of opportunities for direct access to diagnostic imaging facilities. Thrombectomy can currently only be provided in specialised centres with dedicated neurointerventional facilities, and correct identification of patients that would benefit from direct transfer would optimise clinical outcomes cost-effectively. However, only 10% of patients actually receive thrombolysis 1 due to various pre-hospital and intra-hospital delays 2. Reperfusion therapy with intravenous thrombolysis and mechanical thrombectomy are optimal treatments for the most common type of stroke, acute brain ischaemia, but both must be delivered within hours of symptom onset. Patients suspected of having had an acute stroke require rapid assessment with brain imaging to guide further management. Novice, Scotland, TCD, training, transcranial, ultrasonography. This could potentially be used by medical staff working in remote and rural areas to facilitate acute care for stroke patients, but further work with a larger sample is needed. It was also suggested that further follow-up training, with possible supervision, would be useful to retain the acquired skills.Ĭonclusions: Transcranial ultrasound scans of a quality to allow expert interpretation can be acquired by inexperienced transcranial ultrasound operators after receiving a brief training. All participants gave positive feedback on the provided training and time allocated for each session. Generally, volunteers thought that operating the ultrasound machine and the probe simultaneously was difficult. There was agreement between the trainer and the participants on rating the quality of scans as assessed using a visual analogue scale. The correct labelling rate for the middle cerebral artery was 73% (8/11), and 64% (7/11) for the anterior and posterior cerebral arteries. Participants demonstrated a good performance in detecting major intracranial vessels. The brain midline and cerebral peduncles were correctly labelled by 64% (7/11) and 91% (10/11) of volunteers, respectively. ![]() The average time to complete transcranial ultrasound assessment was approximately 40 minutes. Results: A total of 11 volunteers were recruited in the current pilot study. ![]() Qualitative analysis of the anonymised feedback from participants on the training experience and its potential application was also performed. ![]() Transcranial greyscale and colour-coded duplex sonography was performed to visualise midline structures and major intracranial vessels, and to measure blood flow velocity in the middle cerebral artery, followed by an unsupervised assessment. Participants received three 1-hour training sessions combining theoretical aspects and hands-on practice on healthy volunteers provided by a qualified neurologist with more than 2 years of experience in transcranial ultrasound. Volunteer clinicians and students of nursing or medicine with no practical experience in transcranial ultrasound were recruited. Methods: A pilot training project was set up in a university setting in Inverness, Scotland. A 3-hour training package for novice transcranial ultrasound users has been piloted on a small group of volunteers to investigate whether they could acquire transcranial ultrasound images and video clips to potentially allow remote interpretation and optimise pre-hospital management of acute stroke. Basic brain imaging assessing blood flow in the major intracranial arteries could facilitate such care in remote settings. People with suspected acute stroke living long distances from a hospital are unlikely to receive time-critical reperfusion therapy for these reasons. Introduction: Emergency care delivery to patients in remote and rural areas is limited by diagnostic restrictions and long transport times to major centres of care.
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