Détection précoce du cancer du sein : étude de l'impact sociotechnique d'un soutien-gorge «â€ˆintelligent ¼.

INTRODUCTION: The SBra (Smart Bra) project aims to develop an intelligent bra, combining sensors for measuring skin temperature and the electrical impedance of breast tissue, which could be used for breast cancer screening. The objective of this study is to anticipate both the hindrances to usage and acceptability of SBra with respect to the breast cancer screening practices of healthcare professionals and patients, and then to propose ways to modify the shape and functions of the device to facilitate its potential insertion into the healthcare system. METHODS: A qualitative survey was conducted between September 2019 and December 2020, consisting of a series of interviews conducted with hospital and private healthcare professionals (N = 22) working in Burgundy-Franche-Comté and related to breast cancer, and with women aged 38 to 74 years old living in Burgundy-Franche-Comté and Auvergne-Rhône-Alpes (N = 21) who have or have not had breast cancer, and who either practice or refuse screening. RESULTS: If patients say they are ready to use such a device, at most once a year, and subject to its usability, the majority of them prefer an examination in the office, performed by a gynecologist or a general practitioner. Health professionals point out that this option generates institutional (remuneration and cost of the procedure) and organizational needs, which are both material and human. DISCUSSION: The study highlights the need to pluralize the system in order to respond to the multiplicity of local situations.

Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise.

OBJECTIVES: To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA. METHODS: Thirteen sonographers analysed 75 images for the presence/absence of elementary lesions (binary scoring) and for grading synovitis, synovial hypertrophy, effusion and Doppler signals. Static US images of the second metacarpophalangeal joint (MCP-II), wrist, elbow, knee and ankle in JIA patients at different ages and different disease stages were collected with standardized scanning by two experienced sonographers. Intra- and inter-reader reliability were analysed with kappa coefficients. RESULTS: Intra-reader reliability was good for binary scoring (Cohen's kappa 0.62, range 0.47-0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66-0.86; 0.76, 0.61-0.84; and 0.87, 0.77-0.94, respectively); and moderate for effusion (0.55, 0.24-0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light's kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54-0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40-0.60, respectively). We obtained the best scores for the knee (0.71, 0.54-0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children. CONCLUSIONS: This is the first study establishing the reliability of the OMERACT paediatric US synovitis definitions and scoring system in the five most commonly affected joints in JIA. The reliability was good among a large group of sonographers. These results support the applicability of these definitions and scoring system in clinical practice and multicentre studies.

Does joint effusion influence the clinical response to a single Hylan GF-20 injection for hip osteoarthritis?

OBJECTIVE: To evaluate the influence of a joint effusion on the clinical response to a single injection of Hylan GF-20 for hip osteoarthritis. METHOD: We prospectively included patients scheduled for intraarticular Hylan GF-20 injection to treat hip osteoarthritis. Disease severity was assessed based on the Kellgren-Lawrence radiological grade. Ultrasonography was performed to look for a joint effusion. The pain score on a visual analog scale, Lequesne algofunctional index, and WOMAC scores were recorded at baseline and 1, 3, and 6 months postinjection. The proportions of patients who met OARSI response criteria and who achieved Patient Acceptable Symptom State (PASS) thresholds were determined in the overall population and in the groups with and without a joint effusion at baseline. RESULTS: Of 55 included patients, 24 (44%) had an effusion at baseline. The baseline Lequesne index was significantly higher in the group with an effusion (11.9+/-3.6 versus 8.4+/-4.5) (p=0.003). The proportions of OARSI responders in the overall population were 31.8%, 39.4%, and 14.8% after 1, 3, and 6 months, respectively. The proportions of patients who achieved the PASS for pain and function were 52.4% and 50.0% after 1 month, 67.7% and 54.5% after 3 months, and 60.0% and 50.0% after 6 months, respectively. Presence of an effusion at baseline had no effect on any of the clinical response parameters. CONCLUSION: Presence of a joint effusion is associated with worse pain and functional impairment at baseline but has no influence on the clinical response to Hylan GF-20 in patients with hip osteoarthritis.