ROS-IGTL-Bridge: an open network interface for image-guided therapy using the ROS environment

Purpose

With the growing interest in advanced image-guidance for surgical robot systems, rapid integration and testing of robotic devices and medical image computing software are becoming essential in the research and development. Maximizing the use of existing engineering resources built on widely accepted platforms in different fields, such as robot operating system (ROS) in robotics and 3D Slicer in medical image computing could simplify these tasks. We propose a new open network bridge interface integrated in ROS to ensure seamless cross-platform data sharing.

Methods

A ROS node named ROS-IGTL-Bridge was implemented. It establishes a TCP/IP network connection between the ROS environment and external medical image computing software using the OpenIGTLink protocol. The node exports ROS messages to the external software over the network and vice versa simultaneously, allowing seamless and transparent data sharing between the ROS-based devices and the medical image computing platforms.

Results

Performance tests demonstrated that the bridge could stream transforms, strings, points, and images at 30 fps in both directions successfully. The data transfer latency was <1.2 ms for transforms, strings and points, and 25.2 ms for color VGA images. A separate test also demonstrated that the bridge could achieve 900 fps for transforms. Additionally, the bridge was demonstrated in two representative systems: a mock image-guided surgical robot setup consisting of 3D slicer, and Lego Mindstorms with ROS as a prototyping and educational platform for IGT research; and the smart tissue autonomous robot surgical setup with 3D Slicer.

Conclusion

The study demonstrated that the bridge enabled cross-platform data sharing between ROS and medical image computing software. This will allow rapid and seamless integration of advanced image-based planning/navigation offered by the medical image computing software such as 3D Slicer into ROS-based surgical robot systems.

     

Design and Evaluation of a new mechatronic platform for assessment and prevention of fall risks

ABSTRACT: BACKGROUND: Studying the responses in human behaviour to external perturbations during daily motor tasks is of key importance for understanding mechanisms leading balance control and for investigating the functional response of targeted subjects. Experimental platforms as far developed entail a low number of perturbations and, only in few cases, have been designed to measure variables used at run time to trigger events during a certain motor task. METHODS: This work introduces a new mechatronic device, named SENLY, that provides balance perturbations while subjects carry out daily motor tasks (e.g., walking, upright stance). SENLY mainly consists of two independently-controlled treadmills that destabilize balance control perturbing the walkway in horizontal directions. It is also provided with force sensors, which can be used at run time to identify and trigger events along the gait cycle. The paper also describes the customized procedures adopted to calibrate the platform and the first testing trials aimed at evaluating its performance. RESULTS: SENLY allows measure both vertical ground reaction forces and their related location more precisely and more accurately than other platforms of the same size. Moreover, kinematic and kinetic performance of the platform meet all required specifications. CONCLUSION: This paper presents the design and development of a new perturbing platform able to reproduce different slipping paradigms while measuring GRFs at run time in order to enable the asynchronous triggering during the gait cycle. Calibration procedures and pilot tests show that SENLY allows to suitably estimate the dynamical features of the load and to standardize experimental sessions, improving the efficacy of functional analysis.     

Nursing informatics. Issues for critical care medicine.

The demands of today's health care arena have forced the issue of automation and computerization. Nursing, as the major stakeholder in the collecting, managing, processing, transforming, and communicating of information regarding the patient, has developed a new approach to these tasks. Nursing informatics, which is the application of computer science and information science, is being used to manage and process the data, information, and knowledge necessary in the discipline. Although still in its infancy, nursing informatics has started to have a major effect on health care information gathering and clinical practice despite the multiple barriers to its advancement. Critical care is a data-rich environmental that can benefit from better management and processing of the data derived from the critically ill patient. Nursing and medical informatics joining together to organize the data, coupled with the introduction of good DSS and the addition of information retrieval systems at the bedside and the on-line medical record, will have a positive effect on the critical care environment and on the critical care patient outcomes.     

Impact of rural hospital environments on patients and nurses

Rural hospitals provide life-saving acute care from a consistent group of care providers. Rural hospitals with financial difficulties operate under tight margins as an attempt to prevent closure, which could contribute to not completing repairs needed to the hospital building. This paper explores an ethical dilemma for rural hospital nurse administrators, which is, “Is it better for a rural hospital building is disrepair to remain open so that it can provide a place for some degree of acute care services to be offered in the rural community–or–if a hospital building has structural problems that could lead to harm, should hospital operations cease until a solution is found?" To illustrate this dilemma, I will discuss the challenges of rural hospital administrators and a first-hand experience I had as a bedside nurse who experienced a dangerous near miss related to the built environment. Rural hospitals operating in a built environment in disrepair might need to consider nontraditional, even unusual, solutions to provide safer care given financial constraints. Rural businesses and institutions could consider sharing their building space to provide a safer built environment for nurses and patients while also not placing hospitals at further risk of financial distress.     

Using protocols to improve the outcomes of mechanically ventilated patients. Focus on weaning and sedation.

The use of nonphysician-directed protocols and guidelines for the management of sedation and weaning has been shown to reduce the duration of mechanical ventilation for patients with acute respiratory failure when compared with conventional physician-directed practices. Practitioners in ICUs frequently are needed to perform multiple tasks and to evaluate numerous elements of clinical information in the care of the critically ill. In this complex environment, protocols and guidelines are one strategy for ensuring that specific tasks are carried out in a timely manner. Simple-to-employ methods for facilitating changes and improvements in the care of hospitalized patients recently have been proposed. These methods emphasize the importance of developing a culture of cooperation within the ICU so protocols and guidelines can be implemented successfully. Such a culture should embrace changes in medical practices in the ICU if they are associated with improved clinical outcomes. The results of studies evaluating the use of protocols and guidelines have important implications for general critical care practices, because many ICUs do not have physicians who are constantly at the patient's bedside. The need for effective communication from the bedside caregiver (e.g., nurse, respiratory therapist, pharmacist, technician) to the physician, so that treatment orders can be changed appropriately, usually results in some delay in the implementation of treatment changes. Protocols are one method for potentially reducing those delays and ensuring that medical care is administered in a more standardized and efficient manner.     

Chronic stroke patients show early and robust improvements in muscle and functional performance in response to eccentric-overload flywheel resistance training: a pilot study

Myoelectric control has been used for decades to control powered upper limb prostheses. Conventional, amplitude-based control has been employed to control a single prosthesis degree of freedom (DOF) such as closing and opening of the hand. Within the last decade, new and advanced arm and hand prostheses have been constructed that are capable of actuating numerous DOFs. Pattern recognition control has been proposed to control a greater number of DOFs than conventional control, but has traditionally been limited to sequentially controlling DOFs one at a time. However, able-bodied individuals use multiple DOFs simultaneously, and it may be beneficial to provide amputees the ability to perform simultaneous movements. In this study, four amputees who had undergone targeted motor reinnervation (TMR) surgery with previous training using myoelectric prostheses were configured to use three control strategies: 1) conventional amplitude-based myoelectric control, 2) sequential (one-DOF) pattern recognition control, 3) simultaneous pattern recognition control. Simultaneous pattern recognition was enabled by having amputees train each simultaneous movement as a separate motion class. For tasks that required control over just one DOF, sequential pattern recognition based control performed the best with the lowest average completion times, completion rates and length error. For tasks that required control over 2 DOFs, the simultaneous pattern recognition controller performed the best with the lowest average completion times, completion rates and length error compared to the other control strategies. In the two strategies in which users could employ simultaneous movements (conventional and simultaneous pattern recognition), amputees chose to use simultaneous movements 78% of the time with simultaneous pattern recognition and 64% of the time with conventional control for tasks that required two DOF motions to reach the target. These results suggest that when amputees are given the ability to control multiple DOFs simultaneously, they choose to perform tasks that utilize multiple DOFs with simultaneous movements. Additionally, they were able to perform these tasks with higher performance (faster speed, lower length error and higher completion rates) without losing substantial performance in 1 DOF tasks.     

An audiosystem for teaching pulmonary auscultation.

We have developed and tested a portable audiosystem that will allow as many as 14 persons to listen simultaneously to pulmonary and cardiac sounds when an instructor places a central stethomicrophone on a patient's chest. This system facilitates the teaching and learning of chest auscultation on the clinical setting because it (1) helps to ensure that the student hears what the instructor intends, (2) minimizes patient discomfort by allowing everyone in the group to listen simultaneously rather than in groups of two or three in succession, and (3) provides a means of effectively recording sounds at the bedside for future educational purposes.     

Feature construction can improve diagnostic criteria for high-dimensional metabolic data in newborn screening for medium-chain acyl-CoA dehydrogenase deficiency

BACKGROUND: In newborn screening with tandem mass spectrometry, multiple intermediary metabolites are quantified in a single analytical run for the diagnosis of fatty-acid oxidation disorders, organic acidurias, and aminoacidurias. Published diagnostic criteria for these disorders normally incorporate a primary metabolic marker combined with secondary markers, often analyte ratios, for which the markers have been chosen to reflect metabolic pathway deviations. METHODS: We applied a procedure to extract new markers and diagnostic criteria for newborn screening to the data of newborns with confirmed medium-chain acyl-CoA dehydrogenase deficiency (MCADD) and a control group from the newborn screening program, Heidelberg, Germany. We validated the results with external data of the screening center in Hamburg, Germany. We extracted new markers by performing a systematic search for analyte combinations (features) with high discriminatory performance for MCADD. To select feature thresholds, we applied automated procedures to separate controls and cases on the basis of the feature values. Finally, we built classifiers from these new markers to serve as diagnostic criteria in screening for MCADD. RESULTS: On the basis of chi(2) scores, we identified approximately 800 of >628,000 new analyte combinations with superior discriminatory performance compared with the best published combinations. Classifiers built with the new features achieved diagnostic sensitivities and specificities approaching 100%. CONCLUSION: Feature construction methods provide ways to disclose information hidden in the set of measured analytes. Other diagnostic tasks based on high-dimensional metabolic data might also profit from this approach.     

复旦中山医院胆道外科医护联动学科体系的建设实践

医护一直是以整体的、并适当分工形式共同协作的。本研究通过建设全面的胆道外科医护共建管理体系,构建医护共建医疗平台、医护共建科教平台、医护共建研究平台、医护共建人才培养平台来完成医护联动模式,通过医护双方共同参与、共同合作、资源共享,从而有效的提高医护双方的工作效率,使得患者获益最大化。该医护联动体系涵盖了医疗、科教、研究、培育等多方面,并在中山医院但到外科中进行实践,获得了较好的效果。     

Spiritual care: evangelism at the bedside

News media stories about Christian nurses sharing religious beliefs with patients raise questions about ethical spiritual care and the appropriateness of sharing one's faith at the bedside. The purpose of this article is to explore the ethics of faith sharing in the context of Christian nursing and offer guidance for ethical spiritual care.     

Putting the senior seminar online

A seminar for graduating bachelor of science in nursing students involving discussion of clinical problems was successfully offered online concurrently with their clinical placements, rather than as an in-class course after clinical experience. The author describes the model used to guide discussion, which used a WebCT platform. The Web-based seminar achieved all the objectives of the classroom course while allowing more timely consideration of the issues that students encountered in practice and more considered discussion by students.     

Dual-chamber pacing

Dual-chamber pacing has been available since the early 1980s, yet it is a topic with which critical care nurses consistently have difficulty. New advances in pacemaker technology have built on the principles inherent in dual-chamber pacing, making it imperative that practitioners have a basic understanding of dual-chamber pacemaker function. With dwindling clinical resources, the responsibility of the bedside nurse to evaluate appropriate pacemaker function and identify the patient's response to pacemaker therapy has increased.     

Multi-indices quantification of optic nerve head in fundus image via multitask collaborative learning

Multi-indices quantification of optic nerve head (ONH), measuring ONH appearance with multiple types of indices simultaneously from fundus images, is the most clinically significant tasks for accurate ONH assessment and ophthalmic disease diagnosis. However, no attempt has been reported due to its challenges of the large variation of fundus appearance across patients, heavy overlap and extremely weak contrast between optic nerve head areas. In this paper, we propose a multitask collaborative learning framework (MCL-Net) for multi-indices ONH quantification. The proposed MCL-Net, a two-branch neural network, first obtains expressive shared and task-specific representations with the backbone network and its two branches; then models the feature exchanges and aggregations between two branches with a well-designed feature interaction module (FIM) to promote each other collaboratively. After that, it estimates multiple types of ONH indices under a multitask ensemble module (MEM) that is capable of learning aggregation of multiple outputs automatically. Therefore, the proposed MCL-Net is consisted of the feature representation, inter-task feature interaction, dual-branch task-specific prediction, and multitask quantification ensemble, which establish an effective framework which takes full advantages of segmentation and estimation tasks for multi-indices ONH quantification. Rather than the low-level feature sharing and individual prediction, the proposed MCL-Net collaboratively learns an optimal combination of shared and task-specific representation, as well as the aggregated prediction, therefore leads to accurate quantification of ONH with multiple types of indices.Experimental results on the dataset of 650 fundus images show that MCL-Net successfully delivers accurate quantification of all the three types of ONH indices, with average mean absolute error of 0.98 ± 0.20, 0.97 ± 0.16, 1.19 ± 0.18, as well as average correlation coefficient of 0.699, 0.708 and 0.691, for diameters, whole areas and regional areas, respectively. In addition, the experiments demonstrate that quantitative indices obtained by our method provide more effective glaucoma diagnosis with AUC of 0.8698. This endows our proposed MCL-Net a great potential in clinical assessment from focal to global for ophthalmic disease diagnosis.     

Development of non-agglutination microarray blood grouping

Microarray technology provides an opportunity to monitor multiple parameters simultaneously. High-throughput applications such as blood donation screening could greatly benefit from performing various tests on a single testing platform. Blood grouping represents one part of the donation testing complementing the screening for blood-borne pathogens. Blood group serology traditionally exploited agglutination as the detection method. In this investigation, we have adapted blood grouping reactions to a solid-phase microarray substrate in a non-agglutination reaction format as an initial step in the development of a combined microarray testing platform. We have investigated immobilization of proprietary antibodies on multiple surfaces and monitored their performance under various reaction conditions. For the first time, highly specific blood grouping has been achieved on a planar microarray using directly labelled erythrocytes or a secondary labelled reagent using fluorescent signal end point readout. We have also complemented microarray data with a label-free, surface plasmon resonance-based Biacore platform data and used the real time quantitative measurement to rank anti-A antibodies according to the strength of reaction with the immobilized synthetic blood group antigen A.     

Electronic Task Management System: A Pediatric Institution's Experience

Background  Electronic medical task management systems (ETMs) have been adopted in health care institutions to improve health care provider communication. ETMs allow for the requesting and resolution of nonurgent tasks between clinicians of all craft groups. Visibility, ability to provide close-loop feedback, and a digital trail of all decisions and responsible clinicians are key features of ETMs. An embedded ETM within an integrated electronic health record (EHR) was introduced to the Royal Children''s Hospital Melbourne on April 30, 2016. The ETM is used hospital-wide for nonurgent tasks 24 hours a day. It facilitates communication of nonurgent tasks between clinical staff, with an associated designated timeframe in which the task needs to be completed (2, 4, and 8 hours). Objective  This study aims to examine the usage of the ETM at our institution since its inception. Methods  ETM usage data from the first 3 years of use (April 2016 to April 2019) were extracted from the EHR. Data collected included age of patient, date and time of task request, ward, unit, type of task, urgency of task, requestor role, and time to completion. Results  A total of 136,481 tasks were placed via the ETM in the study period. There were approximately 125 tasks placed each day (24-hour period). The most common time of task placement was around 6:00 p.m. Task placement peaked at approximately 8 a.m., 2 p.m., and 9 p.m.—consistent with nursing shift change times. In total, 63.16% of tasks were placed outside business hours, indicating predominant usage for after-hours task communication. The ETM was most highly utilized by surgical units. The majority of tasks were ordered by nurses for medical staff to complete (97.01%). A significant proportion (98.79%) of tasks was marked as complete on the ETM, indicating closed-loop feedback after tasks were requested. Conclusion  An ETM function embedded in our EHR has been highly utilized in our institution since its introduction. It has multiple benefits for the clinician in the form of efficiencies in workflow and improvement in communication and also workflow management. By allowing collection, tracking, audit, and prioritization of tasks, it also provides a stream of actionable data for quality-improvement activities.     

Medical image registration with partial data

We have developed a general-purpose registration algorithm for medical images and volumes. The transformation between images is modeled as locally affine but globally smooth, and explicitly accounts for local and global variations in image intensities. An explicit model of missing data is also incorporated, allowing us to simultaneously segment and register images with partial or missing data. The algorithm is built upon a differential multiscale framework and incorporates the expectation maximization algorithm. We show that this approach is highly effective in registering a range of synthetic and clinical medical images.     

Problems in the development of a computerized ward monitoring system for a paediatric intensive care unit

A computerised ward monitoring system based on Archimedes PC's at each bedside is under development for the PICU at Killingbeck Hospital in Leeds. This work was initiated with a view to reducing the amount of paperwork in the unit. The present paper charts have been broken down into sections for the purpose of entry into the computer. The completed charts may be viewed in tabular form. There are several alternative displays. The default display mode illustrates the patients principal cardiovascular variables over the previous six hours. Alternative graphical displays include 12 hour trend curves for the cardiovascular variables, a screen with one hour trend graphs and panels illustrating the latest values of other patient variables, and graphical 12 hour reviews for clear fluid balance, blood volume balance and respiratory variables.The program also serves as a vehicle for testing an alarm generating system and a cardiovascular status index in the paediatric environment. A separate program has been developed which allows the retrospective construction of data bases by using some or all of the data from one or more of the charts for a series of patients.Finally the difficulties encountered in preliminary trials of the system are discussed. At the present time the program is being run at a central station while attempts are being made to surmount these difficulties.     

Increasing Medical Students' Confidence in Procedural Skills Using a Junior Doctor-Delivered Bedside Supervision Program

Clinical procedural skills are formally taught to medical students in clinical skills centers using mannequins. Exposure to procedural skills involving patients and opportunities to practice under the supervision of doctors are limited. Intervention: A bedside supervision program was piloted at a district general hospital in the United Kingdom. The supervision model was chosen as the method to increase medical students' practice in basic procedural skills because it allowed safe practice with patients. Context: The program was an optional component of the medical students' clinical clerkships. Off-duty junior doctors were recruited as voluntary trainers. The trainers obtained requests for procedural tasks from the on-call doctors and ward nurses, following which the trainers supervised medical students performing the basic procedures with patient consent. Outcome: The pilot program was successfully run for 4 weeks. Fourteen students took part, and 9 (64%) completed a postintervention feedback questionnaire. The students' confidence (rating scale = 1–5) in performing procedural skills improved from a mean of 3.0 (SD ± 0.9) to 4.7 (SD ± 0.5) following a supervision session. Although the range of skills was limited to opportunistic encounters, the students reported high satisfaction and felt supervision enabled them to identify areas for improvement. Lessons Learned: It is feasible to implement a junior doctor-delivered bedside program to supplement procedural skills training provided by medical schools. The challenges include reconciling the tension between junior doctors' service work and their teaching commitment, logistical issues such as recruiting a sufficient number of trainers and ensuring adequate coverage of training tasks.     

Bedside ultrasound for the detection of diabetic myonecrosis

Diabetic myonecrosis is an uncommon complication of diabetes mellitus. There are fewer than 50 cases reported in the general medical literature. Patients classically complain of the abrupt onset of diffuse anterior thigh pain with no signs of overlying infection or signs of systemic toxicity.Because of the difficulty in diagnosis, most patients endure multiple medical visits until appropriate imaging modalities are obtained. Currently, magnetic resonance imaging (MRI) or tissue biopsy is considered the gold standard for diagnosis. This is the first case reported in the literature of diabetic myonecrosis detected in the ED by bedside ultrasound. We hope that with the continued use of bedside ultrasound, more physicians will be able to determine abnormal tissue architecture allowing for the early detection of diabetic myonecrosis.     

Hemodynamic management of cardiovascular failure by using PCO2 venous-arterial difference

The difference between mixed venous blood carbon dioxide tension (PvCO(2)) and arterial carbon dioxide tension (PaCO(2)), called ?PCO(2) has been proposed to better characterize the hemodynamic status. It depends on the global carbon dioxide (CO(2)) production, on cardiac output and on the complex relation between CO(2) tension and CO(2) content. The aim of this review is to detail the physiological background allowing adequate interpretation of ?PCO(2) at the bedside. Clinical and experimental data support the use of ?PCO(2) as a valuable help in the decision-making process in patients with hemodynamic instability. The difference between central venous CO(2) tension and arterial CO(2) tension, which is easy to obtain can substitute for ?PCO(2) to assess the adequacy of cardiac output. Differences between local tissue CO(2) tension and arterial CO(2) tension can also be obtained and provide data on the adequacy of local blood flow to the local metabolic conditions.