27 research outputs found
A toolkit for the identification and assessment of new and emerging health technologies
No full textThe first toolkit for the identification and assessment of new and emerging health technologies was developed by members of the EuroScan International Network and published in 2009. Five years later this revised toolkit continues to focus on methods that are integral to an early awareness and alert (EAA) system. It is once again a collaborative piece of work to which all members have contributed with new information based on their experiences being added.
The main stages involved in EAA systems continue to be: identification of information on new and emerging technologies (horizon scanning); filtration and prioritisation of the identified information; and assessment of the technology or group of technologies. The toolkit provides guidance on these stages and highlights the various approaches that can be taken at each of these stages depending on the context of the EAA system and resources available
THE EUROSCAN STUDY
No full textThe Euroscan group was created to undertake a study across
Europe on the feasibility of routine ultrasound scanning for
congenital malformations, and to evaluate the prenatal detection
rate of all congenital malformations in an unselected
population using data collected by congenital malformation
registries
Evaluation of prenatal diagnosis of cleft lip with or without cleft palate and cleft palate by ultrasound: experience from 20 European registries. EUROSCAN study group.
No full textUltrasound scans in the mid-trimester of pregnancy are now a routine part of antenatal care in most European countries. Using data from registries of congenital anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of cleft lip with or without cleft palate (CL(P)) and cleft palate (CP). All CL(P) and CPs suspected prenatally and identified at birth in the period 1996-98 were registered from 20 Congenital Malformation Registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK, Ukraine. These registries followed the same methodology. A total of 709,027 births were covered; 7758 cases with congenital malformations were registered. Included in the study were 751 cases reported with facial clefts: 553 CL(P) and 198 CP. The prenatal diagnosis by transabdominal ultrasound of CL(P) was made in 65/366 cases with an isolated malformation, in 32/62 cases with chromosomal anomaly, in 30/89 cases with multiple malformations and in 21/36 syndromic cases. The prenatal diagnosis of CP was made in 13/198 cases. One hundred pregnancies were terminated (13%); in 97 of these the cleft was associated with other malformations
Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries.
No full textObjectives To evaluate prenatal diagnosis of congenital heart
diseases by ultrasound investigation in well-defined European
populations.
Design Data from 20 registries of congenital malformations
in 12 European countries were included. The prenatal ultrasound
screening programs in the countries ranged from no
routine screening to three ultrasound investigations per patient
routinely performed.
Results There were 2454 cases with congenital heart disease
with an overall prenatal detection rate of 25%. Termination
of pregnancy was performed in 293 cases (12%). There was
considerable variation in prenatal detection rate between
regions, with the lowest detection rates being in countries
without ultrasound screening (11%) and in Eastern European
countries (Croatia, Lithuania and Ukraine; 8%). In Western
European countries with ultrasound screening, detection rate
ranged from 19–48%. There was a significant difference in
prenatal detection rate and proportion of induced abortions
between isolated congenital heart disease and congenital heart
disease associated with chromosome anomalies, multiple
malformations and syndromes (P < 0.0001). There were
1694 cases with isolated congenital heart disease of which
16% were diagnosed prenatally. Malformations affecting
the size of the ventricles were detected prenatally in half of
the cases.
Conclusions Prenatal detection rate of congenital heart
disease varies significantly between countries even with the
same screening recommendations. The presence of associated
malformations significantly increases the prenatal detection
rate
Early identification and assessment of new and emerging health technologies: Actions, progress, and the future direction of an international collaboration—EuroScan
No full textObjectives: To report on a workshop, and subsequent discussions, that reviewed the achievements and progress of the EuroScan collaboration since its establishment in 1999 to share information on the methods and results of early identification and assessment of new and emerging health technologies; considered challenges to the collaboration; and discussed its possible future direction.Methods: A workshop was held in Stockholm in September 2006, with thirty-two participants from ten countries and representatives from EuroScan member agencies, policy makers involved in policy or decision making relating to new technologies, and invited external commentators from international HTA networks. The workshop used a mix of presentations, panel and audience discussions, and small group work to consider the achievements and challenges put forward.Results: EuroScan has developed as a sustainable network, and has made progress on all tasks in its initial action plan, with the EuroScan information sharing database on new and emerging technologies being one of the collaboration's key achievements. Identified immediate concerns for the network included consideration of the impact of its current name and membership model; acknowledgement and publication of the full range of benefits of membership; contribution to and development of the database to encourage increased information sharing; and EuroScan's ongoing interaction with the wider HTA world.Conclusions: The workshop was a useful mechanism for reviewing the work of EuroScan and for creating a platform to take the collaboration forward. The workshop affirmed the benefits of the network to individual members; posed some significant challenges to the network to consider; and acted as a stimulus for an interim name change to better represent the global membership, and a major review of the EuroScan database of identified and assessed emerging health technologies
Anorectal anomalies associated with or as part of other anomalies.
No full textAnorectal anomalies occurring with other
anomalies or as part of syndromes were
analyzed to determine how their epidemiological
characteristics differed from those
of isolated anal anomalies. Almost 15% of
cases were chromosomal, monogenic or teratogenic
syndromes, whereas the rest were
of unknown cause including sequences
(9.3%), VACTERL associations (15.4%) and
multiple congenital anomalies (MCA) (60.2%).
Almost half of babies with MCA had one or
two VACTERL anomalies with distribution
frequencies that did not differ significantly
from those in babies with the full VACTERL
association. There were considerable differences
in the frequency of the VACTERL
association among babies with different
types of anorectal anomaly. Babies with
anal anomalies occurring with sequences,
VACTERL or MCA showed the same sex
differences as babies with isolated anal
anomalies, namely male predominance in
anal atresia without fistula or cloaca, no sex
difference in anal atresia with fistula, and
female predominance in ectopic anus and
congenital anal fistula. These anomalies,
however, were associated with significantly
lower mean gestational lengths and birth
weights, and higher frequencies of fetal
death and pregnancy termination than
babies with isolated anal anomalies. Twins
were more frequent in sequences, VACTERL
and MCA than in isolated anomalies, monogenic
syndromes or chromosome anomalies.
Five cases were conjoined twins, representing
15% of all cases of twin pregnancies with
an anal anomaly. Indeterminate sex was
more frequent in babies with anal atresias
without fistula than in those with fistula.
Anal anomalies are defects of blastogenesis
attributable to disorders in expression of
pattern determining genes. The differential
sex involvement in different types of anal
anomaly may be manifestations of expression
of the HY/SRY genes during blastogenesis
or of X-linkag
Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: An analysis of 709,030 births in 12 European countries
No full textThe study was performed to evaluate the prevalence of prenatal ultrasound diagnoses for renal anomalies in 20 registries of 12 European countries, and to compare the different prenatal scanning policies. Standardized data were acquired from 709,030 livebirths, stillbirths, and induced abortions during the study period of 2.5 years and transmitted for central analysis. At least one renal malforruation was diagnosed in 1130 infants and fetuses. Prenatal diagnosis (PD) was given in 81.8% of all cases, 29% of these pregnancies were terminated. The highest detection rate was reported for unilateral multicystic dysplastic kidneys with 97% (102/105). An early diagnosis was documented for exstrophy of bladder at a mean gestational age of 18.5 weeks. Dilatations of the upper urinary tract were seen late in pregnancy at 28.3 weeks. Terminations of pregnancies (TOP) were performed in 67% (58/86) of the detected bilateral renal agenesis/dysgenesis, but only 4% of the unilateral multicystic dysplastic renal malformations (4/102). In about 1/3 of the cases, renal malformations are within the category of associated malformations, which include multiple non-syndromal malformations, chromosomal aberrations, and non-chromosomal syndromes. Renal malformations were detected in 2/3 of the associated category by the first prenatal ultrasound scan. Detection rates vary in the different countries of the European community due to diverse policies, ethical, and religious background. Countries with no routine ultrasound show the lowest rates in detection, and termination of pregnancy. Prenatally detected renal malformations should result in a careful examination for further anomalies. Prenatal ultrasound fulfills the needs of screening examinations and is a good tool in detecting lethal and severe renal malformations. (c) 2005 Elsevier SAS. All rights reserved
Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in Europe.
No full textUltrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996-1998, 709 030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into 'isolated' when only a cardiac malformation was present and 'associated' when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20-24 weeks for the majority of associated cardiac defects
Contribution of ultrasonographic examination to the prenatal detection of chromosomal abnormalities in 19 centres across Europe
No full textThe objective of this study was to evaluate the prenatal detection of chromosomal abnormalities by fetal ultrasonographic examination in a large database provided by 19 Registries of Congenital Anomalies from 11 European countries. This study included 1738 cases of chromosomal abnormalities, liveborn, stillborn or termination of pregnancy regardless of maternal age from a population of 664,340 births during the period 1996 - 1998. The most frequent chromosomal anomalies were Down syndrome (n=1050), trisomy 18 (n=191), Turner syndrome (n=125), trisomy 13 (n=86), and triploidy (n=56). Fetal ultrasonographic examination resulted in the prenatal detection of 37.7% of the chromosomal abnormalities, thereby resulting in a reduction of 28.6% in their prevalence at birth due to terminations of pregnancy. The detection rate by ultrasound examination varied according to local policies of prenatal diagnosis : it was lower in countries where routine scan were not performed and higher in countries in which at least one routine anomaly scan during the second trimester of pregnancy was performed. The ultrasound detection varied according to the specific chromosomal anomaly and was lowest for Klinefelter syndrome (5.7%) and highest for triploidy (78.6%). For Down syndrome it was 26.4%. Termination of pregnancy was performed in 75.9% of the cases. Among the 655 cases detected by ultrasound, the most frequent ultrasound signs by category of chromosomal abnormalities were analysed. This study shows that ultrasound screening is an important tool in the prenatal detection of chromosomal abnormalities in Europe, leading to a significant reduction in the prevalence of livebirth children with chromosomal anomalies
