Impact du confinement, lors de la pandémie de COVID-19, sur le suivi de l'hémoglobine glyquée des diabétiques de type 2, dans le département des Deux-Sèvres

Background: Lockdown from 17 March to 11 May 2020, during the COVID-19 pandemic, had an impact on the follow-up of patients with type 2 diabetes. In this context, health workers and patients adapted. The reorganization of general medical practices and the development of teleconsultation helped to limit the spread of SARS-CoV-2 and protect patients at risk. Sedentary has been strengthened and life habits could have changed, including diet and physical activity. Lockdown could have effects on mental health, patient's obervance and access to care. The main objective of our study is to evaluate the impact of lockdown on glycated haemoglobin monitoring in Deux-Sèvres department. Methods: A descriptive observational study was conducted on type 2 diabetic patients in Deux-Sèvres department. Patients with type 2 diabetes complicated or not, well-controlled or not, regardless of the treatment, benefiting or not from an ASALEE nurse's follow-up, and without age limit were included. The data collection concerned glycated haemoglobin before and after lockdown, patients' age and gender. The last value of pre-containment glycated haemoglobin (from 1st January to 17 March 2020 included) and the first value of post-containment glycated haemoglobin (after 11 May 2020 to 31 October included) were collected. Data from 787 patients were collected (734 patients followed by an ASALEE nurse, and 53 patients not followed by an ASALEE nurse). The main statistical analysis focused on the change in glycated haemoglobin before and after containment. Subanalyses of change in glycated haemoglobin pre and post-containment were conducted on the basis of gender and age. Results: In our study, patients are on average 70 years old and are mostly men. Glycated haemoglobin of type 2 diabetics decreased significantly after containment, with an average pre and post-containment difference of 0,16%. We find, in particular, a significant decrease in type 2 diabetics followed by an ASALEE nurse. Improvement of glycated haemoglobin is significant for both genders of all type 2 diabetics studied. Furthermore, we do not find a significant correlation between age and the change in glycated haemoglobin pre and post-containment. Conclusion: Our study highlights an improvement in glycated haemoglobin after lockdown in type 2 diabetic patients, in Deux-Sèvres department. However, the results must be apprehended with caution. Many factors can influence values of glycated haemoglobin. It appears interesting to explore the subject with studies on larger samples. We could enhance our containment approach by studying effects on other aspects of type 2 diabetics' follow-up, on possible delays in managing micro and macroangiopathic complications, or on other chronic diseases including cardiovascular ones.Introduction : Le confinement du 17 mars au 11 mai 2020, lors de la pandémie de COVID-19, a eu un impact sur le suivi des patients diabétiques de type 2. Dans ce contexte, les professionnels de santé et les patients se sont adaptés. La réorganisation des cabinets en médecine générale et le développement de la téléconsultation ont contribué à limiter la propagation du SARS-CoV-2, et à protéger les patients à risque. La sédentarité s'est renforcée et les habitudes de vie ont pu être modifiées, notamment l'alimentation et l'activité physique. Le confinement a pu également avoir des répercussions sur la santé mentale des patients, l'observance et l'accès aux soins. L'objectif principal de notre étude est d'évaluer l'impact du confinement sur le suivi de l'hémoglobine glyquée des diabétiques de type 2, dans le département des Deux-Sèvres. Méthode : Nous avons mené une étude observationnelle descriptive chez les patients diabétiques de type 2 du département des Deux-Sèvres. Ont été inclus, sans limites d'âge, les patients présentant un diabète de type 2 compliqué ou non, équilibré ou non, quel que soit le traitement suivi, et bénéficiant ou non d'un suivi par une infirmière ASALEE. Le recueil de données a concerné les hémoglobines glyquées pré et post-confinement, l'âge et le sexe des patients. La dernière valeur de l'hémoglobine glyquée pré-confinement (soit du 1er janvier au 17 mars 2020 inclus) et la première valeur de l'hémoglobine glyquée post-confinement (soit après le 11 mai jusqu'au 31 octobre 2020 inclus) ont été recueillies. Les données de 787 patients ont été recueillies (734 patients suivis par une infirmière ASALEE et 53 patients non suivis par une infirmière ASALEE). L'analyse statistique principale a porté sur l'évolution de l'hémoglobine glyquée pré et post-confinement. Des sous analyses de la variation de l'hémoglobine glyquée pré et post-confinement en fonction de l'âge et du sexe ont également été réalisées. Résultats : Dans notre étude, les patients sont en moyenne âgés de 70 ans, et majoritairement des hommes. L'hémoglobine glyquée des patients diabétiques de type 2 a diminué de manière significative après le confinement avec une différence pré et post-confinement en moyenne de 0,16%. Nous retrouvons notamment une diminution significative chez les diabétiques de type 2 suivis par une infirmière ASALEE. Sur l'ensemble de la population étudiée, l'amélioration de l'hémoglobine glyquée est significative chez les femmes et les hommes diabétiques de type 2. Nous ne constatons, par ailleurs, pas de corrélation significative entre l'âge et la variation d'HbA1c pré et post-confinement. Conclusion : Notre étude met en évidence une amélioration de l'hémoglobine glyquée post-confinement chez les diabétiques de type 2, dans le département des Deux-Sèvres. Toutefois, les résultats sont à appréhender avec prudence. De nombreux facteurs peuvent influencer les valeurs de l'hémoglobine glyquée. Il apparaît intéressant d'approfondir le sujet avec des études sur de plus grands échantillons. Nous pourrions enrichir notre approche du confinement en étudiant ses effets sur d'autres aspects du suivi du diabète de type 2, sur d'éventuels retards de prise en charge de complications micro/macroangiopathiques, ou sur d'autres pathologies chroniques notamment cardiovasculaires

Management of donations of personal protective equipment in response to the massive shortage during the COVID-19 health crisis: providing quality equipment to health care workers

Abstract Background In the COVID-19 pandemic context, a massive shortage of personal protective equipment occurred. To increase the available stocks, several countries appealed for donations from individuals or industries. While national and international standards to evaluate personal protective equipment exist, none of the previous research studied how to evaluate personal protective equipment coming from donations to healthcare establishments. Our aim was to evaluate the quality and possible use of the personal protective equipment donations delivered to our health care establishment in order to avoid a shortage and to protect health care workers throughout the COVID-19 crisis. Methods Our intervention focused on evaluation of the quality of donations for medical use through creation of a set of assessment criteria and analysis of the economic impact of these donations. Results Between 20th March 2020 and 11th May 2020, we received 239 donations including respirators, gloves, coveralls, face masks, gowns, hats, overshoes, alcohol-based hand rubs, face shields, goggles and aprons. A total of 448,666 (86.3%) products out of the 519,618 initially received were validated and distributed in health care units, equivalent to 126 (52.7%) donations out of the 239 received. The budgetary value of the validated donations was 32,872 euros according to the pre COVID-19 prices and 122,178 euros according to the current COVID-19 prices, representing an increase of 371.7%. Conclusions By ensuring a constant influx of personal protective equipment and proper stock management, shortages were avoided. Procurement and distribution of controlled and validated personal protective equipment is the key to providing quality care while guaranteeing health care worker safety. </jats:sec

Incidence, complications, and costs of peripheral venous catheter-related bacteraemia: a retrospective, single-centre study

International audienceBackground: Peripheral venous catheter (PVC) complications occur on average in approximately half of patients, necessitating premature PVC removal, suspending administration of ongoing therapies, and catheter replacement.Aim: To estimate the current incidence, complications, and costs of bloodstream infection (BSI) attributable to PVCs.Methods: Patients with PVC-related BSI (cases) were matched with patients without PVC-related BSI (controls).Findings: From January 1st, 2018 to March 31st, 2020, a total of 9833 out of 113,068 patients visiting the emergency department (9%) were hospitalized in a medical ward after insertion of a PVC. Among them, 581 (6%) had at least one positive blood culture. Twenty-five (4%) of these were judged as having a PVC-related BSI. Major complications were noted in nine patients. One patient presented severe sepsis requiring admission to intensive care unit for eleven days followed by thoracic (T4-T7) spondylodiscitis requiring prolonged antimicrobial therapy. Another patient developed mitral valve endocarditis also requiring prolonged antimicrobial therapy. One patient developed a pre-sacral abscess three months after initial PVC infection and required hospital readmission for 19 days for drainage. Median (interquartile range) hospital stay costs were €11,597 (8,479-23,759) for cases and €6,789 (4,019-10,764) for controls, leading to median additional costs of €5,587.Conclusion: Though the risk of developing PVC-related BSI in patients admitted to medical wards may seem low, complications of PVC-related BSI are severe, and associated mortality remains high. The financial resources used to treat these complications could be better spent on prevention, including the use of high-quality materials and technologies, and improved training of healthcare providers