Electrode Placement Accuracy in Robot-Assisted Asleep Deep Brain Stimulation.

Deep brain stimulation (DBS) involves the implantation of electrodes into specific central brain structures for the treatment of Parkinson's disease. Image guidance and robot-assisted techniques have been developed to assist in the accuracy of electrode placement. Traditional DBS is performed with the patient awake and utilizes microelectrode recording for feedback, which yields lengthy operating room times. Asleep DBS procedures use imaging techniques to verify electrode placement. The objective of this study is to demonstrate the validity of an asleep robot-assisted DBS procedure that utilizes intraoperative imaging techniques for precise electrode placement in a large, inclusive cohort. Preoperative magnetic resonance imaging (MRI) was used to plan the surgical procedure for the 128 patients that underwent asleep DBS. During the surgery, robot assistance was used during the implantation of the electrodes. To verify electrode placement, intraoperative CT scans were fused with the preoperative MRIs. The mean radial error of all final electrode placements is 0.85 ± 0.38 mm. MRI-CT fusion error is 0.64 ± 0.40 mm. The average operating room time for bilateral and unilateral implantations are 139.3 ± 34.7 and 115.4 ± 42.1 min, respectively. This study shows the validity of the presented asleep DBS procedure using robot assistance and intraoperative CT verification for accurate electrode placement with shorter operating room times.

Developing the Next Generation of Physicians.

To improve health care, the USA needs to create a longitudinal medical education system that will develop physicians able to lead the transformation of health care toward a focus on the promotion of healthy behaviors aimed at preventing disease. The development of patient-centered care has been an important step in promoting healthy behaviors. However, to truly develop a meaningful relationship with a patient, a physician must first see them as a person, not as a list of diseases. Medical education should develop physicians able to provide person-centered care - moving beyond patient-centered care to focus more broadly on the entirety of the person, for whom being a patient is merely one aspect of their personhood. Restructuring medical education begins with the admission process itself, followed by longitudinal changes at the undergraduate, graduate, and continuing professional development levels that will reinforce the attributes critical for future physicians. The authors view this longitudinal approach through the theoretical framework of situated cognition, exploring personal, environmental, and social factors leading to success; outline several key stages of medical education from matriculation through continuing professional development; and identify potential areas that merit longitudinal efforts to develop future physicians able to promote positive health behaviors.