A multi-modal approach to computer-assisted deep brain stimulation trajectory planning

Purpose

Both frame-based and frameless approaches to deep brain stimulation (DBS) require planning of insertion trajectories that mitigate hemorrhagic risk and loss of neurological function. Currently, this is done by manual inspection of multiple potential electrode trajectories on MR-imaging data. We propose and validate a method for computer-assisted DBS trajectory planning.

Method

Our framework integrates multi-modal MRI analysis (T1w, SWI, TOF-MRA) to compute suitable DBS trajectories that optimize the avoidance of specific critical brain structures. A cylinder model is used to process each trajectory and to evaluate complex surgical constraints described via a combination of binary and fuzzy segmented datasets. The framework automatically aggregates the multiple constraints into a unique ranking of recommended low-risk trajectories. Candidate trajectories are represented as a few well-defined cortical entry patches of best-ranked trajectories and presented to the neurosurgeon for final trajectory selection.

Results

The proposed algorithm permits a search space containing over 8,000 possible trajectories to be processed in less than 20 s. A retrospective analysis on 14 DBS cases of patients with severe Parkinson’s disease reveals that our framework can improve the simultaneous optimization of many pre-formulated surgical constraints. Furthermore, all automatically computed trajectories were evaluated by two neurosurgeons, were judged suitable for surgery and, in many cases, were judged preferable or equivalent to the manually planned trajectories used during the operation.

Conclusions

This work provides neurosurgeons with an intuitive and flexible decision-support system that allows objective and patient-specific optimization of DBS lead trajectories, which should improve insertion safety and reduce surgical time.

     

A non-parametric approach for co-analysis of multi-modal brain imaging data: application to Alzheimer's disease

We developed a new flexible approach for a co-analysis of multi-modal brain imaging data using a non-parametric framework. In this approach, results from separate analyses on different modalities are combined using a combining function and assessed with a permutation test. This approach identifies several cross-modality relationships, such as concordance and dissociation, without explicitly modeling the correlation between modalities. We applied our approach to structural and perfusion MRI data from an Alzheimer's disease (AD) study. Our approach identified areas of concordance, where both gray matter (GM) density and perfusion decreased together, and areas of dissociation, where GM density and perfusion did not decrease together. In conclusion, these results demonstrate the utility of this new non-parametric method to quantitatively assess the relationships between multiple modalities.     

Suicide prevention: A public health approach

This article proposes a model for developing a national or regional suicide prevention strategy. Suicide is examined from the perspectives of stress, coping behaviours, lethality and multiple causation. Public health concepts of primary, secondary and tertiary prevention are applied to suicide with minor modifications. This exercise facilitates clarity with respect to planning strategies. Conceptual clarity may improve prospects for success but ultimately evaluation will elucidate the outcome.     

Barriers to quality health care for the transgender population

The transgender community is arguably the most marginalized and underserved population in medicine. A special issue focusing on men's health would be incomplete without mention of this vulnerable population, which includes those transitioning to and from the male gender. Transgender patients face many barriers in their access to healthcare including historical stigmatization, both structural and financial barriers, and even a lack of healthcare provider experience in treating this unique population. Historical stigmatization fosters a reluctance to disclose gender identity, which can have dire consequences for long-term outcomes due to a lack of appropriate medical history including transition-related care. Even if a patient is willing to disclose their gender identity and transition history, structural barriers in current healthcare settings lack the mechanisms necessary to collect and track this information. Moreover, healthcare providers acknowledge that information is lacking regarding the unique needs and long-term outcomes for transgender patients, which contributes to the inability to provide appropriate care. All of these barriers must be recognized and addressed in order to elevate the quality of healthcare delivered to the transgender community to a level commensurate with the general population. Overcoming these barriers will require redefinition of our current system such that the care a patient receives is not exclusively linked to their sex but also considers gender identity.     

A storefront approach to health promotion

Peace Arch Hospital's Wellness Centre in White Rock, British Columbia, represents a unique model that allows a hospital to bring health and wellness activities to the community in a coordinated and exciting way. Sponsored by the hospital and funded by the hospital global budget, the Wellness Centre has passed its eighth anniversary and recently implemented a three-year strategic plan that will carry this visionary outreach program to the next millennium.     

A holistic-existential approach to health promotion

Health promotion seems to be implicit in many nursing theories, but the theoretical and philosophical basis of health promotion in nursing is not always explicitly stated. The interpretation of health promotion is closely related to the interpretation of man, health, illness and nursing. There is a need to clarify, refine and redefine health promotion in nursing because the concept is partly nonspecific and has not been used to identify a distinctive nursing focus. The aim of this study was to formulate a stipulative definition of health promotive nursing with a holistic-existential approach. A philosophical frame of reference in combination with conceptual analysis and theoretical synthesis were used as the methodological approach. The philosophical framework served as a basis in selecting the nursing theories and influenced the analysis. Two nursing theories and one nursing model were selected due to their influence on Norwegian nursing and because of their philosophical basis. Through analysis and synthesis of the selected nursing theories, the concepts man, health, illness/disease and nursing were analysed. The paper proposes a stipulative definition of health promotion in nursing based on a holistic-existential approach, supported by five necessary conditions. The definition and conditions needs to be further investigated by both empirical studies and by comparing with other relevant nursing theories, in order to formulate theoretical statements. The proposed definition may be the first step in a process of developing a theoretical framework of health promotive nursing with a holistic-existential approach.     

Integration of military and veteran health in a psychiatric mental health BSN curriculum: A mindful analysis

The military and veteran populations in the U. S. state of Hawaii have a strong presence in the local communities. It was this substantial presence that provided the impetus to integrate military and veteran health into a Bachelor's of Science in Nursing (BSN) curriculum. This exploratory study investigated the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students' understanding of the many facets of military veterans' health. The concepts related to military and veterans' health was infused in didactic, seminar, simulation and clinical instruction. Examples of approaches to teaching include guest speakers from military clinical partners, inclusion of military/military families in simulation, the reading of evidence-based articles focusing on the military and veteran population, use of identification of problem based learning and clinical placements in hospital(s) and community agencies specific to servicing military and veterans and their families. Students were encouraged to record their reflections which provided some insight on the value of integration of this important segment into the curriculum. Classroom discussions and reflections were analyzed using an exploratory method of inquiry by categorizing themes which revealed some biases about the military and veteran population and how working with this population helped students to understand their health needs. Although the data is limited, it an important foundation for further exploration into the significance of the integration of military and veterans' health in a psychiatric mental health BSN nursing curriculum. The recommendation is to further include military and veterans' health across the curriculum in order to help future nursing graduates understand and evaluate their role in working with this distinctive population, recognize challenges and opportunities in working with this population and identify available evidence-based resources to inform their practice.     

Ethics education for health professionals: A values based approach

It is now widely accepted that ethics is an essential part of educating health professionals. Despite a clear mandate to educators, there are differing approaches, in particular, how and where ethics is positioned in training programmes, underpinning philosophies and optimal modes of assessment. This paper explores varying practices and argues for a values based approach to ethics education. It then explores the possibility of using a web-based technology, the Values Exchange, to facilitate a values based approach. It uses the findings of a small scale study to signal the potential of the Values Exchange for engaging, meaningful and applied ethics education.     

Integration of oral healthcare into undergraduate health professional educational programs: A scoping review

BackgroundOral disease affects 3.5 billion people worldwide and despite this, it is not known the extent to which oral health education has been integrated into undergraduate health professional programs.AimTo explore the pedagogical approaches used to integrate and deliver oral health education across nursing and other non-dental health disciplines.Review methodsA scoping review was conducted following the PRISMA-ScR extension guidelines in January 2021. CINAHL, Ovid MEDLINE, SCOPUS, Education Research Complete, ERIC, Nursing and Allied Health Database, PUBMED, NDLTD, and OHNEP were searched and screened, yielding 5,781 references with 18 studies eligible for inclusion. Findings were synthesised and presented as narratives and tables.FindingsWhile an interdisciplinary learning approach of simultaneously teaching students from multiple disciplines was adopted in only three studies, the use of subject matter experts was reported in more than half of the studies. Delivery of learning material occurred in varied settings and the assessment of learning outcome effectiveness focused on changes in knowledge, attitude, confidence, and skills competence.DiscussionAlthough only a few studies reported using interdisciplinary learning approaches, the use of subject matter experts in over half of the studies was a recognition of the importance of interdisciplinary collaboration. Nevertheless, the superiority of any one approach remains unclear, due to the heterogeneity in learning outcome measures.ConclusionOral healthcare has been embedded in a small number of undergraduate educational programs, using a diverse range of pedagogical approaches. The use of subject matter experts should be commonplace when developing oral healthcare curricula.