Comportement du pied et de la cheville au cours de la marche de sujets asymptomatiques

Lower limb amputee gait evaluation is allowed by kinematic and ground reaction force analysis. Motion capture is a non invasive means of gait evaluation. A protocol taking account of the foot and lower limb joints has been proposed. Thirty-five subjects participated in this study. Stride parameters and spatiotemporal parameters were recorded in a database. Correlations were established between the metatarsophalangeal joint, the walking speed and the propulsive forces. These correlations underline the functional significance of feet in the propulsion phase. This study aims at comparative analysis between lower limb amputees and sound people and at prosthetic feet evaluation.     

Implication du personnel infirmier dans la sécurité transfusionnelle : évaluation des connaissances et de la pratique à l''institut Gustave-Roussy

BACKGROUND: A first survey on nurses transfusion practices at our Hospital revealed poor knowledge. Good Transfusion Practices were written, a training program was implemented and a second survey was carried out two years later. STUDY DESIGN AN METHODS: We conducted the second survey in which 4 of the questions were identical to those in the first survey in order to assess the impact of this training strategy. The 4 questions were on blood sample identification, checking patient identification, checking "use by date" on blood product bag and the pre-transfusion bedside compatibility test. Behaviours were evaluated by checking the pre-transfusion procedures, including interpretation of bedside compatibility tests. We investigated the impact of attendance at the training course, the period of employment, day versus night shift and attempted to correlate these factors with the results of the second survey. RESULTS: A significant improvement was observed in knowledge of Good Practices between the first and the second survey (P = 10(-4)). However, the multivariate analysis showed that the impact of training was heterogeneous. Pre-transfusion protocol checks have improved significantly (P = 0.05) as well as pre-transfusion bedside compatibility test interpretation of ABO compatibility (P = 0.007). CONCLUSION: In our study, the implementation of Good practices has significantly improved nurses' knowledge about transfusion safety requirements but it is essential to continue and adapt the training and cheek regularly the impact of these implementations.     

Le CIT de Rennes : une opération pilote entre le CHU de Rennes et l'université de Rennes-I

Rennes CITH has a double objective innovative and evaluative functions of health technologies. More specifically, multivariate monitoring system and active prosthesis allowing the exploration, the evaluation and the treatment of the cardiovascular, nervous and respiratory functions. This paper describes briefly its origin, the partnerships and some technological activities developed since 2001.     

Quantification des propriétés mécaniques du système musculotendinoarticulaire chez l'homme : de la recherche à la valorisation

The article presents an innovative and original ergometer device allowing the characterization of the mechanical properties of skeletal muscles crossing a joint in terms of contractile and elastic properties. The different tests, which can be used, and the methods of quantification will be focused on the elastic properties. Research studies, which were conducted in different applications, will show the usefulness of such measurements, as well as, the interest of these measurements in clinical research, physical medicine and rehabilitation or sports application.     

Problématique de la mise en place d''une unité de métrologie dans le futur centre de biologie du CHRU de Lille

Regional and University Hospitals of Lille holds many of analysis laboratories with a great diversity of biology specialities. To date, a great biology center is building to accommodate there all these laboratories at the beginning of 2007. In this biology center, a room of metrology is foreseen where will be carried out the update of the metrological checks on the equipment concerned and the metrological traceability. The analysis laboratories of medical biology must have a perfect control of their equipment within the framework of the analytical process in order to ensure the quality of their results. This first work is a reflection on the failures of the metrology function within the laboratories from the biomedical point of view. Finally, the objective will be to provide to the laboratories of a coherent and homogeneous metrology tool to all the specialities of the biology of the CHRU of Lille to the service of their quality assurance.     

Fibroscan : un outil non invasif de mesure de la dureté du foie par élastométrie

Fibroscan^® is a new medical device that measures liver stiffness noninvasively. The method is based on one-dimensional transient elastography. Ultrasound signals (3,5 MHz) are used to follow the propagation of a low-frequency shear elastic wave (50 Hz) that propagates at a velocity that depends on liver stiffness. Measurement is performed on the right lobe of the liver using a probe that is placed on the skin surface. Result is obtained at the end of examination that takes about 5 minutes. Pilot and multicentre studies have shown that liver stiffness is strongly correlated to fibrosis stage obtained from liver biopsy on patients with chronic hepatitis C. Fibroscan^® could be used to improve the evaluation of patients with liver chronic diseases by reducing the number of liver biopsies and by allowing the following of treatments.     

Optimisation du parc d'échographes à l'hôpital européen Georges-Pompidou : impact de la tarification à l'activité

The choice of an ultrasound remain on medical, technical and budgetary criteria of an establishment. In a hospital configuration in constant change, the step will have to take into account as much as possible, increasingly bonded factors (medical interest, profitability, budgets restricted…), and to set up an acquisition policy of and ultrasound renewal. If clinical specificities and the machine's medical performances remain before the reference criteria in equipment acquisition process, the evolution towards the new hospitals funding methods (with the implementation of tariffing with the activity) imposes more and more the machine's activity like one of the dominating criteria choice process. Nevertheless the machine's activity although necessary, is not enough to operate a judicious choice. Taking charge of certain clinically necessary activities but not very productive is likely to be sacrificed in aid of the profit. In this work, we tried to arbitrate the choices by taking the medical needs and the financial constraints into account, due to the new fashion of financing of the hospital. The optimization of the ultrasounds park within the framework of the equipments renewal can and must integrate the two complementary aspects for a better choice.     

Virus de l''immunodéficience humaine et virus des hépatites virales C et B chez les patients drépanocytaires au CHU Campus de Lomé (Togo)

CONTEXT: The clinical features of sickle cell disease (SCD) are vaso-occlusive and/or hemolytic crises which treatment may require blood transfusions. OBJECTIVE: This study aimed to determine the prevalence of HIV, Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) infections in a population of SCD patients. METHODS: All the samples were analyzed by Elisa technique. We studied 119 sera for HIV using Elisa and a confirmation test in case of positive Elisa. We screened 91 sera for HCV and 119 sera for HBV. RESULTS: The prevalence was 5.04% for HIV, 6.5% for HCV and 20.2% for HBs Ag. Homozygous (SS) patients were more infected than compound heterozygous patients SC, (p < 0.02). 24.6% of the children (0 to 15 years of age) were infected as well as adults (35.5%). The Relative Risk to be contaminated was 7.14 for HIV, 4.29 for HCV and 5.43 for HBV in transfused compared to non transfused SCD patients. CONCLUSIONS: This high infectious risk in SCD patients should lead us to elaborate a better strategy to increase the safety of blood transfusion in Togo.     

Avancées technologiques et intégration de la biologie délocalisée dans les établissements de soins

Practice of Point of Care Testing in medical care centre is very unequal in France despite official guidelines of governmental agencies and laboratory professionals. Last years, a lot of advances in devices technology have been performed particularly in term of connectivity, quality control and traceability with apparition of new global solutions. These possibilities open new perspectives in point of care testing organization in France. We suggest an overall view with the introduction of a coordinator of all point of care testing to coordinate the different actors at every step of the project, from decision to installation of the chosen solutions.     

Un CITH spécialisé dans la technologie pour le handicap moteur : quatre ans d'expérience

The role of the Technological Innovation Center (TIC) in Garches hospital is to promote research and development of new technological aids and to follow developments in the field. This is done in co-operation with users, researchers, manufacturers and professionals in the field. Companies are supported to develop prototypes using new technologies to assist people with disabilities. The TIC carries out evaluations of different assistive technology products, from an ankle prosthesis to new kinds of wheelchairs. Numerous studies have been performed and finally have permitted to improve the usefulness of assistive technology for disabled people.     

« FORSAFE » forceps et capteurs souples bio-inspirés

Living tissues are mainly constituted of soft matter. This so particular state, neither liquid, neither gas, nor solid led to the use, in simulation, of increasingly complicated mathematical models. These tissues are organised in multi-layers, present anisotropic properties and nonlinear behaviour. The evaluation of the interface pressure by traditional rigid sensors leads to errors of measurement. The device FORSAFE performs the measurement of the pressure on the fetal head. It is aimed to limit the risks due to a bad positioning and a too important tightening of the forceps on the head of the new-born, during the childbirth. It is based on an original method bio-inspired reproducing the sense of touch, by micro-palpations. Complications in forceps deliveries are rare but their consequences might be dramatics. This situation could be avoided if the obstetrician knows the information concerning symmetry of the obstetrical forceps position on the fetal head and the related interface pressure. Indeed, forceps delivery is an emergency gesture which is normally not expected. The aims of the FORSAFE device are: first, to prevent instrumented delivery accidents, secondly, to provide a safe training of forceps technique. This paper presents the original method of the interface pressure measurement, the results obtained on a physical model of interface pressure as well as the corrections performed on the probe placed on the forceps.     

Analysis of plantar pressure in diabetic type 2 subjects with and without neuropathy

Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy. The most common form of diabetes is type 2 diabetes. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot. The purpose of this study was to examine the plantar pressure distribution in normal, diabetic type 2 with and without neuropathy subjects. Footscans were obtained using the F-Scan (Tekscan USA) in-shoe pressure measurement system. Various pedobarographic parameters such as the total plantar force, total contact area, peak pressures, percentage medial impulse (PMI), load and power ratio (PR, the ratio of high frequency power to the total power in an image) were evaluated. These parameters were subjected to ANOVA (analysis of variance) test with more than 95% confidence interval giving excellent P-values in all the categories.     

Rétention prolongée de TGFβ1 par des hydrogels à base de dextrane fonctionnalisé : synthèse, caractérisation et évaluations biologiques

Due to a short half-life, growth factors, which could be used as therapeutic agents, usually require carriers able to protect their biological activity and to sustain protein delivery in situ. It was shown that water-soluble functionalized dextrans (DMCB) present some heparin-like properties, especially the capacity to interact with Heparin-Binding Growth Factors such as TGFβ₁. In this study, dextran-based hydrogels were synthesized by cross-linking a DMCB with native dextrans to develop a TGFβ₁ release carrier. In vivo, these hydrogels were demonstrated to be biocompatible and to allow good cell invasion. In vitro, functionalized hydrogels retained 50 to 60% of initially loaded growth factor contrary to unfunctionalized hydrogels. The degree of hydrogel functionalization did not influence the amount of entrapped growth factor. Nevertheless, it modulated the prominent type of interactions between TGFβ₁ and hydrogels.     

12th Korea Healthcare Congress 2021; 김치국부터 마시지 말라; The Time for Digital Health is Almost Here

We are now on the cusp of massive adoption of digital health technologies. Medicine is becoming an information science intertwined with technology and data science. This talk aims to describe the current state of digital transformation in healthcare, to identify reasons for enthusiasm and caution, and to provide a framework for thinking about what is necessary for hospitals and health systems to be confident about incorporating these innovations into practice. I have three key recommendations. First, we should buy results, not claims. Those in positions that influence decisions about endorsing or purchasing digital products designed to improve care or outcomes ought to buy results, not claims or intermediate results. Moreover, although analytic validity and clinical validity are important, they sometimes do not reflect the impact of a product in its entirety. Ultimately, we need to know whether patients benefit. Second, we should insist on transparency. The performance of a product cannot be a secret. The basis on which developers make claims about their products should be open to all, including patients. Better yet, data on which experts reach a conclusion should be shared, just as many companies share research data on drugs and devices. Third, we should be aware of unintended adverse consequences. We should evaluate every intervention for unintended adverse consequences. Changes to systems, with all good intentions, can always go awry. In conclusion, insistence on good and evolving evidence is the best way to arrive at our destination: the use of innovations to improve outcomes.     

Nouveau container de prélèvement : rôle dans la réduction de la contamination bactérienne des unités plaquettaires standard

BACKGROUND: Bacterial contamination of unstable blood products constitutes today the most frequent infectious risk transmitted by blood transfusion. Platelet concentrates are often incrimineted. As responsible germs are in general of cutaneous origin, a sample procedure with diversion of the first 20 ml during blood donation is studied. The aim of this study is to evaluate the results of this technique on bacterial contamination rate of standard platelet units prepared at the regional blood transfusion center in Casablanca. STUDY DESIGN AND METHODS: A comparative study of two types of sample pockets is made: 500 Standard Platelet concentrates (CPS) are prepared after collection using standard triple bags (Baxter) (group 1) and 560 pockets of CPS were prepared after collection using triple bags with Sample Diversion Pouch sampling system for elimination of the first 20 ml of donation (Macopharma and Terumo) (group 2). The skin was disinfected in two times with alcohol 70%. The bacteriological study was made in the two groups at the third day of conservation. RESULTS: Six CPS of group 1 were contaminated, of which five were staphylococci coagulase negative and one bacillus sp. Six CPS of group 2 were contaminated, of which five were staphylococci coagulase negative and one staphylococcus aureus. The bacteria isolated were those of cutaneous flora at 100%. Diversion of first 20 ml of blood donation results in a 16.6% reduction in bacterial contamination of CPS (P>0.05). CONCLUSION: The non-significant reduction in the prevalence of the bacterial infection of CP formulates the problem of the indication of the sampling devices with derivation of first 20 ml during blood collection.