Chart Card: feasibility of a tool for improving emergency department care in sickle cell disease.

BACKGROUND: Patients with sickle cell disease (SCD) are concerned with emergency department care, including time to treatment and staff attitudes and knowledge. Providers are concerned about rapid access to patient information and SCD treatment protocols. A software application that stores and retrieves encrypted personal medical information on a plastic credit card-sized Chart Card was designed. OBJECTIVE: To determine the applicability and feasibility of the Chart Card on patient satisfaction with emergency department care and provider accessibility to patient information and care protocols. METHODS: One-half of 44 adults (aged -18 years) and 50 children with SCD were randomized to either the Chart Card or usual care. Patient satisfaction was surveyed pre and post implementation of the Chart Card program, and emergency department staff was surveyed about familiarity with SCD treatment protocols. CONCLUSION: Patient satisfaction with emergency department care and efficacy in health care increased post Chart Card implementation. Providers valued immediate access to patient information and SCD treatment guidelines. The technology has potential for application in the treatment of other illnesses in other settings.

Current issues in blood transfusion for sickle cell disease.

PURPOSE OF REVIEW: Although blood transfusion has been felt to be a beneficial therapy for sickle cell disease (SCD) since the 1950s, associated complications initially limited this therapy for these patients. With advances now reducing the side effects of transfusion and several landmark studies over the last decade clearly defining the efficacy for decreasing sickle cell morbidity, the indications for transfusion have increased. This review will discuss the indications, methods and goals of transfusion as well as complications and recent changes in transfusion therapy for SCD. RECENT FINDINGS: Recently studies have established the efficacy of transfusion for prevention of stroke, treatment of acute chest syndrome and perioperative transfusion management of SCD. Pulmonary hypertension is increasingly recognized as a significant source of morbidity and mortality and is an evolving indication for transfusion therapy. Phenotypically matching transfused blood has been shown to decrease alloimmunization, and genotyping for antigen matching may help match donors to patients in the future. SUMMARY: The increased use of transfusions may ultimately be balanced by hydroxyurea and other newer therapies developed as the complex pathophysiology of SCD is better understood; however, red cell transfusion is currently the most studied and accepted therapy for most acute and many chronic complications of SCD. Physicians caring for patients with sickle cell disease should be aware of the unique complications and transfusion requirements in this population.

Transfusion medicine for the pediatrician.

In the next decade, many of the methodologies and research reviewed in this article will become clinical practice, making the transfusion of blood products safer and more universally available than they are today. NAT will be standard and will surely be performed on each unit of product, PCR testing for pathogens will evolve, and the pathophysiology and immunology of transfusion-related events such as TRALI and immunomodulation will be elucidated. New methods of preservation and early detection of contamination will extend the life of blood products. Red blood cell antigens may be attenuated, making safe products available to more patients. Clinical vigilance at the bedside and in the blood bank will remain key areas for transfusion safety. As I have told many a resident and patient, blood is not saline; there are and will remain risks inherent in this commonly used medical therapy.

Stress reactivity as a moderator of family stress, physical and mental health, and functional impairment for children with sickle cell disease.

OBJECTIVE: To evaluate whether autonomic nervous system (ANS) reactivity modifies the relation between family stress, and physical and mental health, and functional impairment for children with sickle cell disease. METHODS: Thirty-eight 5-to 8-year old children with sickle cell disease completed a 20-minute ANS reactivity protocol measuring respiratory sinus arrhythmia and pre-ejection period during comparison and challenge tasks in social, cognitive, sensory, and emotion domains. Domain-specific reactivity was calculated as the difference between challenge and comparison tasks; overall reactivity was calculated across domains as the mean of the difference scores. ANS profile scores combined the overall respiratory sinus arrhythmia and pre-ejection period reactivity scores. Caregivers completed measures of family stress, child physical and mental health symptoms, and functional impairment. RESULTS: Family stress was associated with child functional impairment whereas overall and cognitive ANS reactivity was associated with co-morbid internalizing and externalizing mental health symptoms. Interaction models showed that children with the classic ANS profile (parasympathetic inhibition and sympathetic activation) in the cognitive and emotion domains were most vulnerable to the effects of stress, with more functional impairment and injuries when family stress was high, controlling for age, sex, and parent education. CONCLUSION: The costs to patients and families in diminished quality of life and to the health care system could be reduced by further exploration of strategies to identify children with sickle cell disease who are most vulnerable under conditions of high family stress and heightened psychobiologic reactivity.