Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies

Objectives. To document the practice and training opportunities of US-guided arthrocentesis and joint injection (UGAJ) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR). Methods. An English-language questionnaire, containing questions on demographics, clinical and practical aspects of UGAJ, training options in UGAJ for rheumatologists, UGAJ education in the rheumatology training curriculum and other structured education programmes in UGAJ was sent to three different groups: (i) all national rheumatology societies of EULAR; (ii) all national societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB); and (iii) 22 senior rheumatologists involved in EULAR musculoskeletal US training from 14 European countries, who were also asked to circulate the questionnaire among relevant colleagues. Results. Thirty-three (75%) of 44 countries responded to the questionnaire (61.3% of national rheumatology societies, 25% of the national US societies and 100% of expert ultrasonographers). In the majority of countries (85%) 80%) rate of rheumatologists performing conventional joint injection in most of the surveyed countries. The reported variations in practice and the lack of available structured training programmes for trainees in most countries indicates the need for standardization in areas including training guideline

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

A framework for the classification of dexterous haptic interfaces based on the identification of the most frequently used hand contact areas

Conference Code:98366International audienceHaptic interfaces are purposed for the simulation of physical interactions with a virtual environment in a realistic way. Their design is often based on a compromise between the interaction capabilities and mechanical design complexity. This paper is aimed at providing a methodology that helps tuning this trade-off. A survey of both manipulation and exploration taxonomies allows the identification of elementary hand contact areas with their associated frequency of use. The relative importance of these areas is illustrated by the building of an interaction map for the hand. Some combinations of these elementary areas, with their frequency of use, are then organised into a graphical tree as a function of their complexity. This tree allows to review some existing devices and to propose some guidelines for improved designs

A 2-D Infrared Instrumentation for Close-Range Finger Position Sensing

International audienceHaptic interfaces are proposed for enhancing human-computer interfaces through the rendering of interaction forces. Among them, encounter-type haptic displays feature an original way to provide the user with an improved transparency: their end effectors remotely track the fingers of the operator and encounter them only when force rendering is required. These interfaces call for the development of specific position tracking systems. In this paper, a 2-D hollow instrumentation for remote and marker-free close-range finger tracking is proposed. It encloses 16 infrared proximity sensors. Its design specifications are based on a literature review of finger motion and a simulation of the tracking dynamics. Some calibration methods, organized as a function of their complexity level, are also described. The instrumentation performances are experimentally evaluated to assess its adequacy with the targeted application. This design accounts for the demonstration that infrared proximity sensing is a viable solution for close-range sensing of targets as changing as human body parts

Analysis of the directions in which forces are applied on the hand during manual manipulation and exploration

Conference of 10th IEEE World Haptics Conference, WHC 2015 ; Conference Date: 22 June 2015 Through 26 June 2015; Conference Code:116034International audienceHaptic interfaces aim at realistically simulating physical interactions within a Virtual Environment (VE) through the sense of touch. Therefore, they should display both a negligible impedance in free space and high forces and stiffness in contact. These constraints are however difficult to meet simultaneously. While compromises can usually be found when interacting through a handle grasped in hand, this is much more difficult when considering dexterous interactions with manual interfaces or exoskeletons due to the high number of degrees of freedom and limited space available. To ease their design, the authors previously made an analysis of the hand contact areas of interest for the simulation of the majority of interactions in a VE. It was shown that tracking and providing force feedback only on the five fingertips and the side of the index allows interacting naturally within a VE more than 50% of the time. This paper goes a step further and analyses in which directions these forces are applied on each hand area. A new result is that forces are required on the 6 areas of interest only normal to the skin, while tangential forces can be limited to 4 and even 1 area(s) depending on the direction

Evaluation of Tactile Sensors as an Alternative to Force Sensors in an Assistive Haptic Handlebar

International audienceThis paper shows experimental results that confirm that tactile sensors are appropriate to provide information about the caregiver intention in an assistive haptic handlebar. Preliminary tests have been performed to identify possible control inputs. Specifically, experiments have been carried out with a rear handlebar that incorporates tactile sensors and a force/torque sensor mounted on a powered wheelchair. An overall strong correlation is found between variables obtained from the tactile sensors output and those from the force/torque sensor that model the user interaction during driving. This way, an intuitive and easy driving can be achieved with a handlebar based exclusively on tactile sensors, which are a cost-effective alternative to force sensors

Perception of haptic motion is enhanced during conditions of increased postural stability

International audienceBackground: Coupling between postural sway and fingertip displacement has been observed in individuals lightly touching a moving surface. This can be attributed to the central nervous system (CNS) misinterpreting surface motion as self-motion, evoking a compensatory sway response.Research question: Does baseline postural state influence the correct perception of haptic object motion? Methods: Motion perception detection thresholds of index finger displacement at 1 mm.s *1 velocity during light touch were determined for three postural conditions: standing with eyes open (EO) and closed (EC), and sitting with eyes closed. For the standing condition with eyes shut, displacement thresholds were measured using three velocities (1, 2 & 4 mm.s *1).Results: Postural condition had a large influence on motion perception, with a reduction in displacement threshold from 12 ô 6 ô 2 mm during the transition from standing ECô standing EOô sitting EC. A systematic decrease in displacement perception threshold was observed with increasing velocity. This tends to suggest that the increase of the touched object velocity may help overcoming the misinterpretation.Significance: These results suggest that the ability to disambiguate self motion from haptic motion is enhanced during stable postures, and when stimulus velocity is high. Our findings may help to understand the mechanisms underlying the coupling between surface movements and postural sway, reported in the literature