Severe illness getting noticed sooner - SIGNS-for-Kids: developing an illness recognition tool to connect home and hospital.

Background: Delays to definitive treatment for time-sensitive acute paediatric illnesses continue to be a cause of death and disability in the Canadian healthcare system. Our aim was to develop the SIGNS-for-Kids illness recognition tool to empower parents and other community caregivers to recognise the signs and symptoms of severe illness in infants and children. The goal of the tool is improved detection and reduced time to treatment of acute conditions that require emergent medical attention. Methods: A single-day consensus workshop consisting of a 17-member panel of parents and multidisciplinary healthcare experts with content expertise and/or experience managing children with severe acute illnesses was held. An a priori agreement of ≥85% was planned for the final iteration SIGNS-for-Kids tool elements by the end of the workshop. Results: One hundred percent consensus was achieved on a five-item tool distilled from 20 initial items at the beginning of the consensus workshop. The final items included four child-based items consisting of: (1) behaviour, (2) breathing, (3) skin, and (4) fluids, and one context-based item and (5) response to rescue treatments. Conclusions: Specific cues of urgent child illness were identified as part of this initial development phase. These cues were integrated into a comprehensive tool designed for parents and other lay caregivers to recognise the signs of serious acute illness and initiate medical attention in an undifferentiated population of infants and children. Future validation and optimisation of the tool are planned.

3-D ultrasound guidance of surgical robotics: a feasibility study.

Laparoscopic ultrasound has seen increased use as a surgical aide in general, gynecological, and urological procedures. The application of real-time, three-dimensional (RT3D) ultrasound to these laparoscopic procedures may increase information available to the surgeon and serve as an additional intraoperative guidance tool. The integration of RT3D with recent advances in robotic surgery also can increase automation and ease of use. In this study, a 1-cm diameter probe for RT3D has been used laparoscopically for in vivo imaging of a canine. The probe, which operates at 5 MHz, was used to image the spleen, liver, and gall bladder as well as to guide surgical instruments. Furthermore, the three-dimensional (3-D) measurement system of the volumetric scanner used with this probe was tested as a guidance mechanism for a robotic linear motion system in order to simulate the feasibility of RT3D/robotic surgery integration. Using images acquired with the 3-D laparoscopic ultrasound device, coordinates were acquired by the scanner and used to direct a robotically controlled needle toward desired in vitro targets as well as targets in a post-mortem canine. The rms error for these measurements was 1.34 mm using optical alignment and 0.76 mm using ultrasound alignment.

Real-time stereo 3D ultrasound.

Real-time 3D ultrasound was developed at Duke University in 1991 and has since been used with a variety of transducers and shown effectiveness in clinical applications and in vivo animal imaging studies. Methods for displaying the 3D pyramid of data acquired by the system include selecting 2D image slices or integrating data into a volume rendered view. A third method, real-time stereo 3D imaging, is discussed here. The clinical commercial 3D system has been modified in our laboratory to display a real-time stereo image pair on the scanner display to be viewed through a stereoscope. This merges the pair into a single image, with a sensation of depth. Stereoscopic displays have previously been demonstrated to provide benefits, including improved depth judgments and increased perception of image quality in other applications. Previously-saved volumes of ultrasound data are shown in stereo 3D using the new system.