PROOF OF CONCEPT DESIGN FOR A REMOTELY POWERED DEEP BRAIN STIMULATION DEVICE

Parkinson's disease is a neurodegenerative disorder that causes tremor, stiffness, and slowness of movement. The first line of treatment for the disease is the administration of drugs. Over a period of time, these drugs slowly lose their affect to arrest the symptoms associated with Parkinson's disease. Once a patient becomes refractory to drug treatment, one alternative treatment option is Deep Brain Stimulation (DBS). In DBS, a probe is implanted in the basal ganglia area of the brain to administer electric pulses that curb the aforementioned symptoms. Although not fully understood, DBS is becoming a more widely accepted treatment, with various implantable devices currently on the market. These devices, however, require the implantation of a relatively large battery and control pack in the chest with subcutaneous wires threaded up through the neck to the top of the skull. The control pack and wires are a common source of irritation and infection, sometimes necessitating long periods of antibiotics or even removal of the device. Furthermore, the device is susceptible to magnetic interference and has a limited battery life. After the average 3- to 5-year lifespan of an implant's battery, another surgery is required to replace the device. The aim of this research is to design a small remotely powered device capable of driving a DBS probe from directly under the scalp. Successful development and proof of viability will form a basis for the conceptual redesign of currently marketed devices in order to eliminate the intrusive battery pack and wires, as well as the health risks commonly associated with them and the implantation procedure

Multi-depth probe transcranial electrical stimulation modeling in 2-D using finite element method analysis

Multi-depth probe transcranial electrical stimulation yields varying electrical potentials and electrical field values at different probe depths in the head. The purpose of this research was to determine whether a stimulating probe would increase or decrease the voltages required to achieve muscle stimulation via the motor cortex. A finite element model was constructed to analyze the theoretical effects of multi-depth probe transcranial electrical stimulation on a 2-1) circular volume conduction model. Laplace's equation was used to model the electrostatic effects of the system, and boundary conditions were set to reflect realistic tissue, fluid, and bone parameters. A mapping of the electric potentials has been developed to identify changes in electric potential through the various layers of the head and the intracranial region. © 2006 IEEE

Engaging caregivers and providers of children with sickle cell anemia in shared decision making for hydroxyurea: Protocol for a multicenter randomized controlled trial

Background: Sickle cell anemia (SCA) is a genetic blood disorder that puts children at a risk of serious medical complications, early morbidity and mortality, and high health care utilization. Until recently, hydroxyurea was the only disease-modifying treatment for this life-threatening disease and has remained the only option for children younger than 5 years. Evidence-based guidelines recommend using a shared decision-making (SDM) approach for offering hydroxyurea to children with SCA (HbSS or HbS/β0 thalassemia) aged as early as 9 months. However, the uptake remains suboptimal, likely because caregivers lack information about hydroxyurea and have concerns about its safety and potential long-term side effects. Moreover, clinicians do not routinely receive training or tools, especially those that provide medical evidence and consider caregivers\u27 preferences and values, to facilitate a shared discussion with caregivers. Objective: The aim of this study is to understand how best to help parents of young children with sickle cell disease and their clinicians have a shared discussion about hydroxyurea (one that considers medical evidence and parent values and preferences). Methods: We designed our study to compare the effectiveness of two methods for disseminating hydroxyurea guidelines to facilitate SDM: a clinician pocket guide (ie, usual care) and a clinician hydroxyurea SDM toolkit (H-SDM toolkit). Our primary outcomes are caregiver reports of decisional uncertainty and knowledge of hydroxyurea. The study also assesses the number of children (aged 0-5 years) who were offered and prescribed hydroxyurea and the resultant health outcomes. Results: The Ethics Committee of the Cincinnati Children\u27s Hospital Medical Center approved this study in November 2017. As of February 2021, we have enrolled 120 caregiver participants. Conclusions: The long-term objective of this study is to improve the quality of care for children with SCA. Using multicomponent dissemination methods developed in partnership with key stakeholders and designed to address barriers to high-quality care, caregivers of patients with SCA can make informed and shared decisions about their health

Engaging Caregivers and Providers of Children With Sickle Cell Anemia in Shared Decision Making for Hydroxyurea:Protocol for a Multicenter Randomized Controlled Trial

BACKGROUND: Sickle cell anemia (SCA) is a genetic blood disorder that puts children at a risk of serious medical complications, early morbidity and mortality, and high health care utilization. Until recently, hydroxyurea was the only disease-modifying treatment for this life-threatening disease and has remained the only option for children younger than 5 years. Evidence-based guidelines recommend using a shared decision-making (SDM) approach for offering hydroxyurea to children with SCA (HbSS or HbS/β0 thalassemia) aged as early as 9 months. However, the uptake remains suboptimal, likely because caregivers lack information about hydroxyurea and have concerns about its safety and potential long-term side effects. Moreover, clinicians do not routinely receive training or tools, especially those that provide medical evidence and consider caregivers’ preferences and values, to facilitate a shared discussion with caregivers. OBJECTIVE: The aim of this study is to understand how best to help parents of young children with sickle cell disease and their clinicians have a shared discussion about hydroxyurea (one that considers medical evidence and parent values and preferences). METHODS: We designed our study to compare the effectiveness of two methods for disseminating hydroxyurea guidelines to facilitate SDM: a clinician pocket guide (ie, usual care) and a clinician hydroxyurea SDM toolkit (H-SDM toolkit). Our primary outcomes are caregiver reports of decisional uncertainty and knowledge of hydroxyurea. The study also assesses the number of children (aged 0-5 years) who were offered and prescribed hydroxyurea and the resultant health outcomes. RESULTS: The Ethics Committee of the Cincinnati Children’s Hospital Medical Center approved this study in November 2017. As of February 2021, we have enrolled 120 caregiver participants. CONCLUSIONS: The long-term objective of this study is to improve the quality of care for children with SCA. Using multicomponent dissemination methods developed in partnership with key stakeholders and designed to address barriers to high-quality care, caregivers of patients with SCA can make informed and shared decisions about their health. TRIAL REGISTRATION: ClinicalTrials.gov NCT03442114; https://clinicaltrials.gov/ct2/show/NCT03442114 INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/2765