Collaborative development of the Arrowsmith two node search interface designed for laboratory investigators.

Arrowsmith is a unique computer-assisted strategy designed to assist investigators in detecting biologically-relevant connections between two disparate sets of articles in Medline. This paper describes how an inter-institutional consortium of neuroscientists used the UIC Arrowsmith web interface http://arrowsmith.psych.uic.edu in their daily work and guided the development, refinement and expansion of the system into a suite of tools intended for use by the wider scientific community

Experience of a tutor centric model for sonography training of emergency department registrars in an Australian urban emergency department 2009–2012

Purpose: To assess the impact of a regular sonographer proctored training program for emergency medicine trainees in the use of Emergency Department bedside ultrasound Methods: Emergency Department (ED) Registrars in the Swan District Hospital ED were provided with proctored instruction in bedside ultrasound in performance of extended focused assessment sonography in trauma (eFAST) and abdominal aortic aneurysm (AAA) detection. Training was conducted by credentialed sonographers for individual trainees in a 1:1 or 1:2 setting for 1 hour on a weekly basis. Registrars who trained in the Department between Jan 2009 to Dec 2012 were invited to participate in a survey conducted between June-August 2013 designed to assess the impact of training on their confidence and use of bedside sonography. Results: Registrars reported increased perception of their skill level in AAA and eFAST post-training. High levels of confidence in their ability to adjust machine settings for image optimization, recognition of free fluid in the abdomen and ability to recognise an AAA were also reported. The participants that completed at least 10 hours of training and at least 20 scans showed significantly greater improvement in their perception of skill and confidence levels than those with less time. Registrars reported training was of significant benefit, improving their confidence in obtaining good quality images and their understanding of the equipment, which contributed to them obtaining accreditation. Benefits were ongoing and 50% of participants reported using ultrasound in clinical practice at least 3 times per week and a further 30% at least weekly after leaving ED. Conclusion: Proctored training in the clinical context for ED registrars resulted in improvement in skills, confidence and willingness to maintain skills through practice in the clinical context over the long-term

Context-aware learning for robot-assisted endovascular catheterization

Endovascular intervention has become a mainstream treatment of cardiovascular diseases. However, multiple challenges remain such as unwanted radiation exposures, limited two-dimensional image guidance, insufficient force perception and haptic cues. Fast evolving robot-assisted platforms improve the stability and accuracy of instrument manipulation. The master-slave system also removes radiation to the operator. However, the integration of robotic systems into the current surgical workflow is still debatable since repetitive, easy tasks have little value to be executed by the robotic teleoperation. Current systems offer very low autonomy, potential autonomous features could bring more benefits such as reduced cognitive workloads and human error, safer and more consistent instrument manipulation, ability to incorporate various medical imaging and sensing modalities. This research proposes frameworks for automated catheterisation with different machine learning-based algorithms, includes Learning-from-Demonstration, Reinforcement Learning, and Imitation Learning. Those frameworks focused on integrating context for tasks in the process of skill learning, hence achieving better adaptation to different situations and safer tool-tissue interactions. Furthermore, the autonomous feature was applied to next-generation, MR-safe robotic catheterisation platform. The results provide important insights into improving catheter navigation in the form of autonomous task planning, self-optimization with clinical relevant factors, and motivate the design of intelligent, intuitive, and collaborative robots under non-ionizing image modalities.Open Acces

Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA) for patients with an asymptomatic abdominal aortic aneurysm (AAA) to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation) and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS). Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision makin

Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

PURPOSE: The in situ fenestration of a standard endograft is currently limited by difficulties in targeting the fenestration site under fluoroscopic control and by the lack of a safe method to perforate the graft. Evidence in the literature suggests the use of a 3 D electromagnetic navigator to accurately guide the endovascular instruments to the target and a laser to selectively perforate the graft. The aim of this work is to provide design guidelines to develop a sensorized catheter to guide the laser tool to the fenestration site and conduct preliminary testing of the feasibility of the proposed solution. Matherials and methods: Different catheter designs were delineated starting from engineering considerations, then prototypes were preliminarily tested to collect surgeon opinions and to steer the design process toward the preferred solution reported by the user. Finally, mechanical simulations were performed with CathCAD, a design software system for the development of composite tubing for endovascular catheters. RESULTS: Based on surgeon feedback, a 9-French steerable catheter with a stabilization system was designed. CathCAD simulations allowed us to define the construction parameters (e.g., materials and geometric constrains) for the fabrication of composite tubes with mechanical properties (flexural, axial, and torsional rigidities) compatible with target values in the literature for guiding catheters. CONCLUSION: The presented results preliminarily demonstrate the clinical reasonability and feasibility of the designed tool in terms of mechanical properties. Further mechanical tests and extensive in vitro clinical trials are required prior to animal testing

Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement

Importance: An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. Most AAAs are asymptomatic until they rupture. Although the risk for rupture varies greatly by aneurysm size, the associated risk for death with rupture is as high as 81%. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening. Population: This recommendation applies to asymptomatic adults 50 years or older. However, the randomized trial evidence focuses almost entirely on men aged 65 to 75 years. Evidence Assessment: Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit. The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit. The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA. The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits. Recommendations: The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. (C recommendation) The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA. (I statement)

BioPARR:A software system for estimating the rupture potential index for abdominal aortic aneurysms

An abdominal aortic aneurysm (AAA) is a permanent and irreversible dilation of the lower region of the aorta. It is a symptomless condition that, if left untreated, can expand until rupture. Despite ongoing efforts, an efficient tool for accurate estimation of AAA rupture risk is still not available. Furthermore, a lack of standardisation across current approaches and specific obstacles within computational workflows limit the translation of existing methods to the clinic. This paper presents BioPARR (Biomechanics based Prediction of Aneurysm Rupture Risk), a software system to facilitate the analysis of AAA using a finite element analysis based approach. Except semi-automatic segmentation of the AAA and intraluminal thrombus (ILT) from medical images, the entire analysis is performed automatically. The system is modular and easily expandable, allows the extraction of information from images of different modalities (e.g. CT and MRI) and the simulation of different modelling scenarios (e.g. with/without thrombus). The software uses contemporary methods that eliminate the need for patient-specific material properties, overcoming perhaps the key limitation to all previous patient-specific analysis methods. The software system is robust, free, and will allow researchers to perform comparative evaluation of AAA using a standardised approach. We report preliminary data from 48 cases