Investigating the Impact of 'Admission-Discharge-Family Follow-up' Health Education on Insulin Injection Effectiveness and Compliance in Diabetes Patients.

Objective: To investigate the impact of comprehensive health education on insulin therapy outcomes in diabetic patients. Methods: A total of 130 diabetes mellitus patients admitted to our hospital between January 2020 and January 2023 were enrolled. We used a randomization method to divide participants into two groups, one of which received the "admission-discharge-home follow-up" comprehensive health education program and the other which did not. They were randomly divided into an observation group and a control group (65 patients in each). The control group received conventional education, while the observation group received additional one-stop health education involving "admission-discharge-family follow-up." Various parameters, including 2-hour postprandial blood glucose (2hPG), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), insulin injection compliance, insulin standard injection mastery, and quality of life (assessed using the Insulin Therapy Related Quality of Life Questionnaire, ITR-QOL-CV), were compared between the two groups. Results: The study's key findings highlight the significant effects of a comprehensive health education program on key outcomes such as improving insulin injection compliance, improving glycemic control, and improving quality of life in patients with diabetes. Before the intervention, 2hPG, FPG, and HbA1c levels were similar in both groups (P > .05). Following the intervention, these indicators decreased in both groups, with significantly lower levels observed in the observation group (P < .05). Insulin injection compliance was comparable between the groups before the intervention (P > .05), but it increased in both groups post-intervention, with higher compliance observed in the observation group (P < .05). Similarly, scores from the insulin standard injection mastery questionnaire and ITR-QOL-CV were enhanced in both groups after the intervention, with higher scores in the observation group compared to the control group (P < .05). Conclusion: The implementation of one-stop health education involving "admission-discharge-family follow-up" led to improved insulin injection effectiveness, blood glucose control, compliance, insulin standard injection mastery, and overall quality of life in diabetic patients. These significant improvements have important clinical implications for patients with diabetes, as more efficient and consistent use of insulin injections will help to better control blood sugar levels, reducing patients' symptoms and risk of complications. For health care providers, these findings underscore the importance of providing comprehensive health education programs to improve outcomes and overall care for patients with diabetes.

IRIS: Integrated Robotic Intraocular Snake.

Retinal surgery is one of the most technically challenging surgical disciplines. Many robotic systems have been developed to enhance the surgical capabilities. However, very few of them provide the surgeon the dexterity within the patient's eye to enable more flexible, more advanced surgical procedures. This paper presents a sub-millimeter intraocular dexterous robot, the Integrated Robotic Intraocular Snake (IRIS). The variable neutral-line mechanism is used to provide very high dexterity with a very small form factor. The IRIS distal dexterous unit is 0.9 mm in diameter and about 3 mm in length. It enables two rotational degrees of freedom at the distal end of the ophthalmic instruments. The analysis on contact mechanics provides a reference for the adjustment of the wire pretension. Redundant actuation is implemented by using one motor for each wire. A motion scaling transmission is developed to overcome the suboptimal resolution of the motors. A scale-up model of the IRIS is built for initial experimental evaluation. Preliminary results show that the scale-up IRIS can provide large range of motion. For given bending angle, the kinematic model can estimate the desired wire translation when the friction is not significant. The first prototype of the actual-scale IRIS is assembled and tested.

FBG-based sensorized light pipe for robotic intraocular illumination facilitates bimanual retinal microsurgery.

In retinal surgery, microsurgical instruments such as micro forceps, scissors and picks are inserted through the eye wall via sclerotomies. A handheld intraocular light source is typically used to visualize the tools during the procedure. Retinal surgery requires precise and stable tool maneuvers as the surgical targets are micro scale, fragile and critical to function. Retinal surgeons typically control an active surgical tool with one hand and an illumination source with the other. In this paper, we present a "smart" light pipe that enables true bimanual surgery via utilization of an active, robot-assisted source of targeted illumination. The novel sensorized smart light pipe measures the contact force between the sclerotomy and its own shaft, thereby accommodating the motion of the patient's eye. Forces at the point of contact with the sclera are detected by fiber Bragg grating (FBG) sensors on the light pipe. Our calibration and validation results demonstrate reliable measurement of the contact force as well as location of the sclerotomy. Preliminary experiments have been conducted to functionally evaluate robotic intraocular illumination.

Development of A Miniaturized 3-DOF Force Sensing Instrument for Robotically Assisted Retinal Microsurgery and Preliminary Results.

Lack of force sensing is one of the most formidable technical challenges in retinal microsurgery. Incorporating high sensitivity force sensing into the ophthalmic tools has the potential to provide the surgeon useful force feedback and to enable safe robotic assistance. This paper presents a new design of a three degrees of freedom force sensing instrument based on fiber Bragg grating sensors. A new flexure is developed to achieve high axial force sensing sensitivity and low crosstalk noise. The force sensing segment of the tool, located directly proximal to the tool tip, is ø0.9×8 mm. An extensive calibration shows that the force sensor can measure the transverse and axial force up to 21 mN with 0.5 mN and 3.3 mN accuracy, respectively. The new flexure design demonstrates the potential to improve axial force sensing. Analysis of the experiment results suggests improvements for the future iteration.

A Multi-Function Force Sensing Instrument for Variable Admittance Robot Control in Retinal Microsurgery.

Robotic systems have the potential to assist vitreoretinal surgeons in extremely difficult surgical tasks inside the human eye. In addition to reducing hand tremor and improving tool positioning, a robotic assistant can provide assistive motion guidance using virtual fixtures, and incorporate real-time feedback from intraocular force sensing ophthalmic instruments to present tissue manipulation forces, that are otherwise physically imperceptible to the surgeon. This paper presents the design of an FBG-based, multi-function instrument that is capable of measuring mN-level forces at the instrument tip located inside the eye, and also the sclera contact location on the instrument shaft and the corresponding contact force. The given information is used to augment cooperatively controlled robot behavior with variable admittance control. This effectively creates an adaptive remote center-of-motion (RCM) constraint to minimize eye motion, but also allows the translation of the RCM location if the instrument is not near the retina. In addition, it provides force scaling for sclera force feedback. The calibration and validation of the multi-function force sensing instrument are presented, along with demonstration and performance assessment of the variable admittance robot control on an eye phantom.

Toward robotically assisted membrane peeling with 3-DOF distal force sensing in retinal microsurgery.

Retinal microsurgery requires steady and precise manipulation of delicate eye tissues in a very small space. Physiological hand tremor and lack of force sensing are among the main technical challenges, limiting surgical performance. We present a system that consists of the cooperatively controlled Steady-Hand Eye Robot and a miniaturized 3-DOF force sensing instrument to address these limitations. While the robot can effectively suppress hand tremor, enable steady and precise tissue manipulation, the force sensing instrument can provide three dimensional force measurements at the tool tip with submillinewton resolution. Auditory sensory substitution is used to give the user real time force information. Evaluation experiments are conducted using artificial and biological membrane peeling phantoms. Experimental results show that the robotic assistance and force-to-audio sensory substitution can effectively control the magnitude of the tool-to-tissue force. The direction profiles of the membrane peeling forces reflect the different delaminating strategies for different membrane phantoms.

A submillimetric 3-DOF force sensing instrument with integrated fiber Bragg grating for retinal microsurgery.

Vitreoretinal surgery requires very fine motor control to perform precise manipulation of the delicate tissue in the interior of the eye. Besides physiological hand tremor, fatigue, poor kinesthetic feedback, and patient movement, the absence of force sensing is one of the main technical challenges. Previous two degrees of freedom (DOF) force sensing instruments have demonstrated robust force measuring performance. The main design challenge is to incorporate high sensitivity axial force sensing. This paper reports the development of a submillimetric 3-DOF force sensing pick instrument based on fiber Bragg grating (FBG) sensors. The configuration of the four FBG sensors is arranged to maximize the decoupling between axial and transverse force sensing. A superelastic nitinol flexure is designed to achieve high axial force sensitivity. An automated calibration system was developed for repeatability testing, calibration, and validation. Experimental results demonstrate a FBG sensor repeatability of 1.3 pm. The linear model for calculating the transverse forces provides an accurate global estimate. While the linear model for axial force is only locally accurate within a conical region with a 30° vertex angle, a second-order polynomial model can provide a useful global estimate for axial force. Combining the linear model for transverse forces and nonlinear model for axial force, the 3-DOF force sensing instrument can provide sub-millinewton resolution for axial force and a quarter millinewton for transverse forces. Validation with random samples show the force sensor can provide consistent and accurate measurement of 3-D forces.

Miniature fiber-optic force sensor for vitreoretinal microsurgery based on low-coherence Fabry-Pérot interferometry.

Vitreoretinal surgery requires delicate manipulation of retinal tissue. However, tool-to-tissue interaction forces in the order of sub-millinewton are usually below the human sensory threshold. A surgical force sensor (FS) compatible with conventional surgical tools may significantly improve the surgery outcome by preventing tissue damage. We have designed and built a miniature FS for vitreoretinal surgery using a fiber-optic common-path phase-sensitive optical coherence tomography (OCT) system where the distal end of the fiber probe forms a low-finesse Fabry-Pérot (FP) cavity between the cleaved tip of the lead-in single mode fiber and the polished back surface of a stainless steel surgical tool tip. To accurately measure the change of the FP cavity length, the cavity is interrogated by the fiber-optic common-path phase-sensitive OCT. The FP cavity was illuminated with a broadband light source, and the interferometric signal was detected using a broadband spectrometer. The phase of the interferometric signal, which is proportional to the cavity length change as well as the exerted force, was extracted. We have conducted calibration experiments to characterize our one dimensional FS. Our result shows that the FS responses linearly to force in axial direction with force sensitivity better than 0.25 millinewton.

A force-sensing microsurgical instrument that detects forces below human tactile sensation.

PURPOSE: To test the sensitivity and reproducibility of a 25-gauge force-sensing micropick during microsurgical maneuvers that are below tactile sensation. METHODS: Forces were measured during membrane peeling in a "raw egg" and the chick chorioallantoic membrane models (N = 12) of epiretinal membranes. Forces were also measured during posterior hyaloid detachment and creation of retinal tears during vitrectomy in live rabbits (n = 6). RESULTS: With the raw egg model, 0.5 ± 0.4 mN of force was detected during membrane peeling. In the chorioallantoic membrane model, delaminating the upper membrane produced 2.8 ± 0.2 mN of force. While intentionally rupturing the lower membrane to simulate a retinal tear, 7.3 ± 0.5 mN (range, 5.1-9.2 mN; P < 0.001) of force was generated while peeling the upper membrane. During vitrectomy, the minimum force that detached the posterior hyaloid was 6.7 ± 1.1 mN, which was similar to the force of 6.4 ± 1.4 mN that caused a retinal tear. The rate of force generation, as indicated by the first derivative of force generation, was 3.4 ± 1.2 mN/second during posterior hyaloid detachment, compared with 7.7 ± 2.4 mN/second during the creation of a retinal tear (P = 0.04). CONCLUSION: Force-sensing microsurgical instruments can detect forces below tactile sensation, and importantly, they can distinguish the forces generated during normal maneuvers from those that cause a surgical complication.

A Novel Dual Force Sensing Instrument with Cooperative Robotic Assistant for Vitreoretinal Surgery.

Robotic assistants and smart surgical instruments have been developed to overcome many significant physiological limitations faced by vitreoretinal surgeons, one of which is lack of force perception below 7.5 mN. This paper reports the development of a new force sensor based on fiber Bragg grating (FBG) with the ability to sense forces at the tip of the surgical instrument located inside the eye and also provide information about instrument interaction with the sclera. The sclera section provides vital feedback for cooperative robot control to minimize potentially dangerous forces on the eye. Preliminary results with 2×2 degree-of-freedom (DOF) sensor and force scaling robot control demonstrate significant reduction of forces on the sclera. The design and analysis of the sensor is presented along with a simulated robot assisted retinal membrane peeling on a phantom with sclera constraints and audio feedback.

Miniature fiber-optic force sensor based on low-coherence Fabry-Pérot interferometry for vitreoretinal microsurgery.

During vitreoretinal surgery, the surgeon manipulates retinal tissue with tool-to-tissue interaction forces below the human sensory threshold. A force sensor (FS) integrated with conventional surgical tools may significantly improve the surgery outcome by providing tactile feedback to the surgeon. We designed and built a surgical tool integrated with a miniature FS with an outer diameter smaller than 1 mm for vitreoretinal surgery based on low-coherence Fabry-Pérot (FP) interferometry. The force sensing elements are located at the tool tip which is in direct contact with tissue during surgery and the FP cavity length is interrogated by a fiber-optic common-path phase-sensitive optical coherence tomography (OCT) system. We have calibrated the FS's response to axial and lateral forces and conducted experiments to verify that our FS can simultaneously measure both axial and lateral force components.