The present disclosure generally relates to medical devices, and more particularly to communications between medical devices in a multi-device system.
Various active implantable devices are available or in development for treating and/or diagnosing numerous ailments. Some examples include cardiac assist devices, pacemakers, defibrillators, cardiac monitors, neurostimulation and neuromodulation systems, drug and medication pumps, and others. A patient may have multiple implanted devices and may benefit in some circumstances by enabling such devices to communicate with one another. Because these implantable devices are often reliant on battery power, communication between devices should be designed for efficiency and to limit power consumption.
The present disclosure relates generally to systems and methods for managing communication strategies with temporal optimization relative to one or more identified conditions in the body.
A first example is a first medical device comprising: means for communicating with a second implantable medical device; means for identifying a first characteristic having a possible impact on communication success; means for selecting a first condition of the first characteristic on which to trigger an attempt at communication; means for determining that the first condition of the first characteristic is present and attempting communication with the second implantable medical device; means for assessing whether the attempted communication was successful; and means for associating the first condition and first characteristic with a reduced likelihood of communication success if the attempted communication was not successful.
A second example takes the form of the first medical device of the first example wherein the means for communicating is configured for communication by conducted communication. A third example takes the form of a first medical device as in either of the first two examples wherein the first medical device is configured as an implantable medical device. A fourth example takes the form of a first medical device of any of the first three example, further comprising means for associating the first condition and first characteristic with an improved likelihood of communication success if the attempted communication was successful.
A fifth example takes the form of a first medical device of any of the first four examples further comprising optimization means for selecting multiple conditions of the first characteristic and repeatedly operating the means for determining, means for assessing and means for associating for each of multiple conditions of the first characteristic to determine whether the first characteristic can be used to determine a likelihood of communication success.
A sixth example takes the form of a first medical device of any of the first to fifth examples further comprising means for identifying a second characteristic, wherein the means for determining, means for assessing and means for assessing are operable to test at least a first condition of the second characteristic to determine whether the second characteristic can be used to determine a likelihood of communication success.
A seventh example takes the form of a first medical device of any of the first to sixth examples wherein the first characteristic is a detected status of a cardiac cycle, and the first condition is the occurrence of one of a cardiac R-wave or a cardiac T-wave. An eighth example takes the form of a first medical device of any of the first to sixth examples wherein the first characteristic is a detected status of a cardiac cycle, and the first condition is the occurrence of a pacing pulse. A ninth example takes the form of a first medical device of any of the first to sixth examples wherein the first characteristic is a detected status of a respiration cycle, and the first condition is the occurrence of one of an exhale or an inhale. A tenth example takes the form of a first medical device of any of the first to sixth examples wherein the first characteristic is a detected a transthoracic impedance, and the first condition is the occurrence of one of a maximum impedance or a minimum impedance. An eleventh example takes the form of a first medical device of any of the first to sixth examples wherein the first characteristic is a cyclic biological phenomenon and the first condition is the occurrence of a recurring event in the cyclic biological phenomenon.
A twelfth example takes the form of an implantable medical device system comprising a first medical device as of any of the first to eleventh examples and a second implantable medical device configured for communication with the first medical device, wherein the first medical device is an intracardiac pacing device, and the second implantable medical device is a subcutaneous defibrillator.
A thirteenth example takes the form of an implantable medical device system comprising a first medical device as in any of the first to eleventh examples, and a second implantable medical device configured for communication with the first medical device, wherein the first medical device is a subcutaneous defibrillator, and the second implantable medical device is an intracardiac pacing device.
A fourteenth example is a first medical device comprising means for communicating with a second medical device; means for determining a first condition of a first characteristic is present; and means for modifying communication with the second implantable medical device based on the determination; wherein at least one of the first and second medical devices is implantable. A fifteenth example takes the form of a first medical device as in the fourteenth example wherein the first characteristic is a cyclic biological phenomenon and the first condition is the occurrence of a recurring event in the cyclic biological phenomenon.
A sixteenth example is a first medical device comprising a communication module for communicating with a second implantable medical device and a controller operatively coupled to the communication module for at least one of receiving or transmitting messages, the controller configured to optimize communication by: identifying a first characteristic having a possible impact on communication success; selecting a first condition of the first characteristic on which to trigger an attempt at communication; determining that the first condition of the first characteristic is present and attempting communication with the second implantable medical device; assessing whether the attempted communication was successful; and if the attempted communication was not successful, associating the first condition and first characteristic with a reduced likelihood of communication success.
A seventeenth example takes the form of the first medical device of the sixteenth example wherein the communication module is configured for communication by conducted communication. An eighteenth example takes the form of the first medical device of either the sixteenth or seventeenth examples wherein the first medical device is configured as an implantable medical device. A nineteenth example takes the form of the first medical device of any of the sixteenth to eighteenth examples, wherein the controller is further configured to associate the first condition and first characteristic with an improved likelihood of communication success if the attempted communication was successful. A twentieth example takes the form of the first medical device of any of the sixteenth to nineteenth examples, wherein the controller is configured to further optimize communication by selecting multiple conditions of the first characteristic and repeating the determining and assessing steps for each of multiple conditions of the first characteristic to determine whether the first characteristic can be used to determine a likelihood of communication success. A twenty-first example takes the form of the first medical device of any of the sixteenth to twentieth examples, wherein the controller is configured to identify a second characteristic and test at least a first condition of the second characteristic to determine whether the second characteristic can be used to determine a likelihood of communication success.
A twenty-second example takes the form of the first medical device of any of the sixteenth to twenty-first examples wherein the first characteristic is a detected status of a cardiac cycle, and the first condition is the occurrence of one of a cardiac R-wave or a cardiac T-wave. A twenty-third example takes the form of the first medical device of any of the sixteenth to twenty-first examples wherein the first characteristic is a detected status of a cardiac cycle, and the first condition is the occurrence of a pacing pulse. A twenty-fourth examples takes the form of the first medical device of any of the sixteenth to twenty-first examples wherein the first characteristic is a detected status of a respiration cycle, and the first condition is the occurrence of one of an exhale or an inhale. A twenty-fifth example takes the form of the first medical device of any of the sixteenth to twenty-first examples wherein the first characteristic is a detected a transthoracic impedance, and the first condition is the occurrence of one of a maximum impedance or a minimum impedance. A twenty-sixth examples takes the form of the first medical device of any of the sixteenth to twenty-first examples wherein the first characteristic is a cyclic biological phenomenon and the first condition is the occurrence of a recurring event in the cyclic biological phenomenon.
A twenty-seventh example takes the form of an implantable medical device system comprising a first medical device as in any of the sixteenth to twenty-sixth examples and a second implantable medical device configured for communication with the first medical device, wherein the first medical device is an intracardiac pacing device, and the second implantable medical device is a subcutaneous defibrillator. A twenty-eighth example takes the form of an implantable medical device system comprising a first medical device as in any of the sixteenth to twenty-sixth examples, and a second implantable medical device configured for communication with the first medical device, wherein the first medical device is a subcutaneous defibrillator, and the second implantable medical device is an intracardiac pacing device.
A twenty-ninth example is a first medical device comprising a communication module for communicating with a second medical device and a controller operatively coupled to the communication module messages, the controller configured to optimize communication by: determining a first condition of a first characteristic is present; and modifying communication with the second implantable medical device based on the determination; wherein at least one of the first and second medical devices is implantable.
A thirtieth example takes the form of the first medical device of the twenty-ninth example wherein the first characteristic is a cyclic biological phenomenon and the first condition is the occurrence of a recurring event in the cyclic biological phenomenon. A thirty-first example takes the form of the first medical device of the thirtieth example wherein the cyclic biological phenomenon is one of a respiration cycle or a cardiac cycle.
A thirty-second example is a method of communication with an implantable medical device comprising: identifying a characteristic having a possible impact on communication success; selecting a condition of the characteristic on which to trigger an attempt at communication; attempting communication based on the condition of the characteristic occurring; and assessing whether the communication was likely successful.
A thirty-third example takes the form of a method as in the thirty-second example, further comprising: if the communication was successful, associating the characteristic and condition with an improved likelihood of communication success; or if the communication was not successful, associating the characteristic and condition with a reduced likelihood of communication success.
A thirty-fourth example takes the form of a method as in either of the thirty-second or thirty-third examples wherein the characteristic is a cyclic biological phenomenon and the condition is the occurrence of a recurring event in the cyclic biological phenomenon. A thirty-fifth example takes the form of a method as in the thirty-fourth example wherein the cyclic biological phenomenon is one of a respiration cycle or a cardiac cycle.
The above summary is not intended to describe each embodiment or every implementation of the present disclosure. Advantages and attainments, together with a more complete understanding of the disclosure, will become apparent and appreciated by referring to the following description and claims taken in conjunction with the accompanying drawings.
The disclosure may be more completely understood in consideration of the following description of various illustrative embodiments in connection with the accompanying drawings, in which:
While the disclosure is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit aspects of the disclosure to the particular illustrative embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure.
The following description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The description and the drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the disclosure.
Other devices could be substituted for those shown in
In some embodiments an implanted device may be in communication with one or more extracorporeal devices. The extracorporeal device(s) may be affixed to the patient in a wearable configuration. The extracorporeal device(s) may provide a therapy, for example a nerve stimulation therapy, muscle simulation therapy and/or respiration therapy (e.g. continuation positive airway pressure therapy). Additionally or alternatively the extracorporeal device may provide a diagnostic function, for example a cardiac monitoring function or/and a respiratory monitoring function. Additionally or alternatively the extracorporeal device may serve as a communication link between an implanted device and a device not in physical contact with the patient (i.e. remote from the body). In some embodiments one or more parts/elements of a device or system may be implanted and other portions may be extracorporeal (e.g. a drug pump or a continuous glucose monitor).
These various systems may be interrogated by an external device or a “programmer” 28, which may optionally use one or more skin electrodes 30 to assist with communication to an implanted device. Skin electrodes 30 may be used for conducted communication with an implantable device. Conducted communication is communication via electrical signals which propagate via patient tissue and are generated by more or less ordinary electrodes. By using the existing electrodes, conducted communication does not rely on an antenna and an oscillator/resonant circuit having a tuned center frequency common to both transmitter and receiver.
For other communication approaches such as RF or inductive communication, the programmer 28 may instead use a programming wand or may have an antenna integral with the programmer 28 housing for communication. Though not shown in detail, the programmer 28 may include any suitable user interface, including a screen, buttons, keyboard, touchscreen, speakers, and various other features widely known in the art.
It is unlikely a single patient 10 would have all of the different systems implanted as shown in
The processing block 52 will generally control operations in the device 50 and may include a microprocessor or microcontroller and/or other circuitry and logic suitable to its purpose. Processing block 52 may include dedicated circuits or logic for device functions such as converting analog signals to digital data, processing digital signals, detecting events in a biological signal, etc. The memory block may include RAM, ROM, flash and/or other memory circuits for storing device parameters, programming code, and data related to the use, status, and history of the device 50. The power supply 56 typically includes one to several batteries, which may or may not be rechargeable depending on the device 50. For rechargeable systems there would additionally be charging circuitry for the battery (not shown).
The I/O circuitry 58 may include various switches or multiplexors for selecting inputs and outputs for use. I/O circuitry 58 may also include filtering circuitry and amplifiers for pre-processing input signals. In some applications the I/O circuitry will include an H-Bridge to facilitate high power outputs, though other circuit designs may also be used. Therapy block 60 may include capacitors and charging circuits, modulators, and frequency generators for providing electrical outputs. For devices such as insulin and drug pumps the therapy circuit 60 may include a pump or pump actuator coupled to a delivery system for outputting therapeutic material, rather than using the I/O circuitry 58 as would be typical for systems that generate an electrical therapy output.
Communications circuitry 62 may include a frequency generator/oscillator and mixer for creating output signals to transmit via the antenna 74. Some devices 50 may include a separate ASIC for the communications circuitry 62, for example. For devices using an inductive communication output, an inductive coil may be included. Devices may also use optical or acoustic communication approaches, and suitable circuits, transducers, generators and receivers may be included for these modes of communication as well or instead of those discussed above.
As those skilled in the art will understand, additional circuits may be provided beyond those shown in
In several embodiments, the present invention is directed toward the management and optimization of conducted communication between two implanted medical devices. For example, an LCP may communicate with an SICD. The LCP may, for example, provide a detected heartbeat rate to the SICD in order to assist the SICD in making a therapy determination. In another example, the SICD may request status from the LCP or may direct the LCP to deliver pacing pulses.
Other combinations of systems may use conducted communication between devices for various reasons. For example, if a patient has both a drug pump and a spinal cord stimulator, the drug pump may communicate to the spinal cord stimulator that it is in need of servicing, such that both systems may use their internal annunciating mechanisms to alert the patient that the drug pump requires service. As integrated systems develop, it may become possible to develop simplified devices that omit, for example, standard telemetry or annunciator circuits, and instead use conducted communication to another device that includes full telemetry and annunciator circuits. If telemetry and/or annunciator circuits are omitted in one or more devices, the devices may become smaller and power consumption may be reduced. Thus conducted communication optimization may facilitate development of smaller and/or longer lasting devices in addition to facilitating inter-device coordination for therapy purposes.
The phrase “data packet” is used for convenience and should be understood as generically including any type of message sent from one device to another. No particular message/frame structure, type of data, size or other meaning should be implied.
In
A detail view of pacing pulse 130 is shown below, and it is seen at 142 that the shape of the pacing pulse 130 includes amplitude modulation embedding a data packet. Other approaches to embedding information in a pacing pulse can be used; the illustration is simplified in
Device A is designed to recognize the data 142 embedded in the pacing pulse 130. In this example, Device A responds with a data packet after some delay such that data packet 134 follows the end of the QRS complex of beat 132. In an alternative, Device A could sent data packet 134 and Device B would respond with a message embedded in pacing pulse 136.
The signals for conducted communication are generally intended to have amplitudes that will not cause cardiac or skeletal muscle contraction, with the exception of the case in which the conducted communication is embedded in a stimulus signal, such as pacing pulse 130 with data 132. The patient should not be aware of the conducted communication signal.
In
One approach to delivering data packet 134 would be to call for a fixed delay after the conclusion of the pacing pulse 130, such as a 300 millisecond delay allowing for the (typically wide) paced QRS complex for beat 132 to be finished. Another approach would be to sense the ECG 120 for termination of the QRS. Each approach has limitations, however. A fixed period may not account for other portions of the ECG, such as the T-wave and/or S-T segment, which can vary in amplitude between patients and even within a patient based on the patient's posture, activity level, etc. Detecting the end of the QRS can be highly dependent on the location of the electrodes used to sense the ECG 120. Moreover, it may be more effective if both Device A and Device B know when the data packet 134 is expected. Thus a temporal optimization may be highly useful to enhance communication reliability.
As used in the present disclosure, the ECG represents the electrical state of the patient's heart, and is a “characteristic” of the patient. The occurrence of a QRS complex, or other event, in the ECG represents a “condition” of the ECG characteristic. Other characteristics and conditions of characteristics are discussed below.
As a result, in this embodiment, the method includes delivering the next packet 180, both outside of the QRS complex of ECG 162, but also at a point where the transthoracic impedance 160 is low as shown at 184. This time, the data packet 180 is received by device B, generating an acknowledgement or other responsive output at 182. Analysis of the observed characteristic (impedance), suggests that the condition of low transthoracic impedance at 184 may have positively impacted the success of data packet 180. The illustrative system may record one or both of the success and failure as indicating a likely connection between transthoracic impedance and communication success. Reviewing
The QRS complex is not the only condition which may arise within the ECG characteristic; the T-wave and P-wave, for example, or S-T segment elevation, are also potential conditions that may impact communication success. In
Device A attempts communication at 210, but the communication fails to be observed by Device B, which does not reply at 212 as expected. Closer review of the ECG 200 indicates that the QRS complex is followed by a prominent T-wave shown at 214. Either of Device A or Device B may assess the ECG and the failed communication attempt and identify a likely relationship, and make an adjustment to the timing of a later communication attempt.
In an alternative example, Device A may not identify whether there is a prominent T-wave; it simply knows that the communication attempt at 210 was not acknowledged. Therefore Device A can adjust the delay after the R-wave detection, shown at 216, by increasing or decreasing the delay. Here, Device A adjusts such that the next attempt in which data packet 220 is sent occurs with a greater delay 226. This time, the T-wave 224 is missed, and the data packet 220 is received and acknowledged by Device B at 222. As illustrated by
For purposes herein, the ECG, transthoracic impedance, and status of the respiration cycle are three possible characteristics. Another characteristic may include posture, which may be determined by use of an accelerometer or through analysis of some other signal such as skeletal muscle activity, the shape or amplitude of a respiration signal, or ECG morphology from one or more sensing vectors. If the patient is exercising, there may be a detectable cycle associated with motion artifacts generated with the patient's stride. For example, at each foot-strike if the patient is running, a monitored biological electrical signal or a monitored accelerometer output, for example, may demonstrate a motion artifact. Testing communication success relative to the detected motion artifact may be useful in determining whether and how communication success can be ensured when the artifact is identified. In some examples, the QRS and to cardiac signal may actually not be of significant importance to communication success, and other factors may be deemed more likely to create marginal or poor communication, such as those non-ECG items just noted.
It should be noted in this context that an implantable medical device communication system may have multiple reasons for communicating. Some communication is not urgent, as for example, a periodic device status check communication. Other communication is urgent, as for example, a request that a device deliver therapy or prepare to have therapy delivered by a second device. A specific example would be the combination of an LCP and SICD, where the SICD may non-urgently request battery status from the LCP periodically (i.e. weekly), and may on occasion urgently request that the LCP provide a beat rate measurement confirmation prior to the SICD delivering a high power defibrillation shock to the patient, where the LCP rate measurement confirmation would be used to prevent inappropriate shocks due to malsensing.
For another example, an SICD used in combination with a spinal cord stimulator (SCS) may use an urgent communication to allow the SICD to warn the SCS that a high energy defibrillation shock, which could overwhelm the SCS sensing circuitry inputs, is about to be delivered so that the SCS can suspend sensing or isolate its sensing circuitry during the shock. Temporal optimization may be performed using the non-urgent communication requests, to give greater confidence that an urgent request will be received successfully.
While several examples rely on electrical signals (myopotential or neuropotential, for example) and potential interference with conducted communication, other combinations are possible. For example, an acoustic communication system may consider heart sounds or respiratory sounds, rather than myopotentials.
Using the assessment at 256, an association can be generated at 258. Steps 252, 254 and 256 may be repeated for other conditions, as indicated at 260, of the same characteristic. In an additional loop indicated at 262, other characteristics may also be assessed. If desired, further combinations of characteristics and conditions may be concatenated for testing as well. Optionally, a probability map may be generated, as indicated at 264. Such a map may include possible communication pathways (such as links and configurations of devices) and sets of probabilities of success given particular parameters, for example. A probability map may be used by an individual device or system to plot out communication strategies, or it may be exported for diagnostic and system design purposes. In addition, as indicated at 266, settings for the system under test may also be generated, including, for example, if-then type rules for planning communication timing relative to identified conditions and characteristics.
For example, the ECG may be identified as a characteristic at 250, and a condition in which the ECG is above a threshold amplitude may be identified, with testing performed at 254 by attempting to communicate a data packet with the ECG at certain amplitude levels, using a looping approach indicated by block 260. Attempts may be made, for example, with the ECG showing an R-wave as one condition, a T-wave as another condition, and being near baseline during the interval between a T-wave and a subsequent P-wave as yet another condition. The attempts are assessed at 256, and an association is constructed at 258. A probability map can be generated at 264. The system can be appropriately set at 266 to provide temporal optimization such that communication attempts occur at times within the ECG cycle selected to maximize the chance of success. As part of the setting step at 266, or the mapping at 264, data may be communicated to other implanted devices regarding the settings to be applied.
If desired and available, variations on the communication signal may also be applied, for example, if variable output signal amplitude or data rate are available, different communication variations may also be applied to assess their effect on communication success. For example, a system may determine whether reducing the data rate or increasing signal amplitude can affect the likelihood of communication success. The same characteristic and condition can be repeatedly tested with different configurations of the communication signal.
The illustration of
As an example, with a patient who exercises, there may be a cyclic motion artifact in a detected biological signal associated with the patient's stride, or swim stroke, or other repetitive motion. An attempt at communication is made at 270 and fails at 272. It is then determined at 274 how the failed communication attempt related, in time, to the motion artifact. The motion artifact may be determined by sensing the communication channel or by observing a separately sensed channel. A correlation is presumed at 276 and stored for later reference, and plans are made at 278 to ensure that a subsequent attempt at communication will occur with a different temporal relationship to the motion artifact (if such an artifact is observed). The plan at 278 may then be communicated throughout the system, if desired.
As an example, the respiratory cycle of a patient may be observed by tracking transthoracic impedance over time. A communication attempt may be made and characteristics observed in relation to the communication attempt would be measured in block 300. The status of the respiration cycle is observed using block 302, and mapping of the probability of communication success based on the point in the respiration cycle at which communication is attempted can be generated at 304. Then communication attempts for future use can be configured in block 306.
If, for example, the phase of respiration at which the transthoracic impedance is at a minimum shows better communication metrics than the point of maximum transthoracic impedance, then the map of probability at 304 would be used to configure communications to occur while minimum transthoracic impedance is occurring. On the other hand, the probability mapping at 304 may determine from the observed communication metrics that the respiration cycle is not likely to impact communication success or failure. If that is the case, then a different characteristic and condition may instead be assessed, and the system would record data indicating that a configuration based on respiration cycle may not be helpful.
For example, if an SICD is attempting to cause an LCP to deliver antitachycardia pacing (ATP) because the SICD is about to prepare for defibrillation therapy, no retries may be called if the retry interrupts therapy preparation, as the patient may be suffering a life-threatening situation. On the other hand, if the SICD can attempt to call for ATP without interrupting therapy preparations (which may take several seconds as capacitors are charged to therapy levels), one or several retries 406 may be attempted during therapy preparation.
If a non-critical issue is occurring at 404, then an adjustment is made for a physiological condition at 410 and a number of retries may be attempted in a loop between 410 and 412. Upon success, the parameters 414 of a successful communication attempt would be stored for later use. If the number of retries is limited at 412 and the maximum retry limit is reached, then the system may set an error flag or annunciate an error condition 416.
A first non-limiting example takes the form of a first medical device comprising: means for communicating with a second implantable medical device; means for identifying a first characteristic having a possible impact on communication success; means for selecting a first condition of the first characteristic on which to trigger an attempt at communication; means for determining that the first condition of the first characteristic is present and attempting communication with the second implantable medical device; means for assessing whether the attempted communication was successful; and means for associating the first condition and first characteristic with a reduced likelihood of communication success if the attempted communication was not successful.
In this first non-limiting example, the means for communicating may take the form of, for example, the communication subsystem 62 in
Further in the first non-limiting example, the means for selecting a first condition of the first characteristic on which to trigger an attempt at communication may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
In the first non-limiting example, the noted means for assessing whether the attempted communication was successful may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
An extension of this first non-limiting example may further comprise a means for associating the first condition and first characteristic with an improved likelihood of communication success if the attempted communication was successful, which may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
Another extension of this first non-limiting example further comprises optimization means for selecting multiple conditions of the first characteristic and repeatedly operating the means for determining, means for assessing and means for associating for each of multiple conditions of the first characteristic to determine whether the first characteristic can be used to determine a likelihood of communication success, wherein the optimization means may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
Still another extension of this first non-limiting example further comprises a means for identifying a second characteristic, wherein the means for determining, means for assessing and means for assessing are operable to test at least a first condition of the second characteristic to determine whether the second characteristic can be used to determine a likelihood of communication success, wherein the means for identifying a second characteristic may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
A second non-limiting example takes the form of a first medical device comprising means for communicating with a second medical device; means for determining a first condition of a first characteristic is present; and means for modifying communication with the second implantable medical device based on the determination; wherein at least one of the first and second medical devices is implantable.
In this second non-limiting example, the means for communicating may take the form of, for example, the communication subsystem 62 in
Also in this second non-limiting example, the means for determining a first condition of a first characteristic is present may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
Finally in the second non-limiting example, the means for modifying may include an instruction set stored in memory 54 for operation by processing circuitry 52 of
Those skilled in the art will recognize that the present disclosure may be manifested in a variety of forms other than the specific examples described and contemplated herein. For instance, as described herein, various examples include one or more modules described as performing various functions. However, other examples may include additional modules that split the described functions up over more modules than that described herein. Additionally, other examples may consolidate the described functions into fewer modules. Accordingly, departure in form and detail may be made without departing from the scope and spirit of the present disclosure as described in the appended claims.
The present application is a continuation of U.S. patent application Ser. No. 15/058,412, filed Mar. 2, 2016, which claims the benefit of and priority to U.S. Provisional Patent Application No. 62/134,752, filed Mar. 18, 2015, titled COMMUNICATIONS IN A MEDICAL DEVICE SYSTEM WITH TEMPORAL OPTIMIZATION, the disclosures of which are incorporated herein by reference.
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Child | 16033852 | US |