EVALUATING THE EFFICACY OF FREE STYLE LIBRE FLASH GLUCOSE MONITORING IN THE OLDER POPULATION

Background and Aims: Background: Frailty associated with older age increases the risk of complications for diabetes and its treatment, in particular hypoglycaemia. Free Style Libre is a form of flash glucose monitoring that has been commissioned for use in people living with type 1 diabetes who meet NHS criteria and can reduce hypoglycaemia. Aims: Evaluate whether patients ≥65-years-old across Birmingham Heartlands Hospital (BHH) and Solihull Hospital (SOL) are meeting AATD time in range CGM targets. Methods: BHH and SOL patients ≥65-years-old using Free-Style Libre until June 2021 were included in the study population. Patient data such as average scans per day, TIR, TAR, TBR and time <3.0mmol/L were transferred from Libreview. Demographic and HbA1c data were retrieved from electronic patient records. Results: 65 patients were identified, 44 were eligible for inclusion. 68.2% (30/44) met the TIR target of >50%, 45.5% (20/ 44) met the TAR target of <10% and 18.2% (8/44) met the TBR target of <1%. Further analysis of TBR, comparing patients to the AATD recommendation for younger people, found that 75% (33/ 44) spent <4% of time below range. 18.2% (8/44) spent <1% in hypoglycaemia (<3mmol/L) and 81.8% (36/44) spent ≥1% in hypoglycaemia. Conclusions: Despite using Free Style Libre, older patients remain at significant risk of hypoglycaemia. This risk should be managed in outpatient clinics using hypo-awareness and frailty scores. Free Style Libre data can be used as per the ABCD risk stratification criteria for triaging these patients with high risk hypoglycaemia during the COVID-19 recovery phase.

Validation of the French ADNM-20 in the assessment of emotional difficulties resulting from COVID-19 quarantine and outbreak.

BACKGROUND: Multiple psychological consequences of the COVID-19 outbreak and quarantine have been described. However, there is a lack of global conceptualization. We argue that the stressful aspects of the situation, the multiple environmental consequences of the outbreak, and the diversity of symptoms observed in such a situation, suggest that Adjustment disorder (AD) is a promising way to conceptualize the psychological consequences of the outbreak and quarantine. The first aim of the study was to validate the French version of the ADNM. The second aim was to set out adjustment difficulties resulting from COVID-19 outbreak and quarantine. METHOD: We recruited 1010 (840 women, 170 men) who consented online to participate. They filled out the French ADNM, visual analogic scales, HADS, IES, and the COPE, to evaluate coping strategies. RESULTS: We confirmed the factor structure of the ADNM and we found good psychometric properties. We found that 61.3% of participants presented an adjustment disorder related to COVID-19 outbreak. We found multiple risk factors and protective factors to AD due to quarantine and outbreak. We also identified the coping strategies negatively and positively associated with AD. CONCLUSION: Adjustment disorder is a relevant concept to understand psychological manifestations caused by quarantine and outbreak. The French ANDM has good psychometric properties to evaluate such manifestations. The association between coping strategies and AD symptoms suggest that CBT may be the best intervention to help people suffering from AD.

Work team identification associated with less stress and burnout among front-line emergency department staff amid the COVID-19 pandemic

Background: The COVID-19 pandemic has exposed front-line healthcare workers to unprecedented risks and stressors threatening both physical and mental health. Prior work in the military has found that team identification, or the sense that one was a part of a team, can help reduce stress and prevent burnout during prolonged stress. Methods: We conducted repeated cross-sectional surveys embedded within emergency department workflow to understand whether team identification was associated with reduced reports of stress and burnout among front-line workers. Results: During the 10-week study which spanned the first wave of COVID-19, 327 of 431 (76%) front-line healthcare workers responded to at least one round of the survey. Higher team identification was associated with significantly less work stress (B=-0.60, 95% CI -0.84 to to -0.40, p<0.001) and burnout (B=-12.87, 95% CI -17.73 to -8.02, p<0.001) in cross-sectional analyses. Further evidence of the protective effect of team identification for work stress (B=-0.36, 95% CI -0.76 to 0.05, p=0.09) and burnout (B=-13.25, 95% CI -17.77 to -8.73, p<0.001) was also found in prospective longitudinal evidence. Conclusion: This work suggests work team identification is a key buffering factor against feelings of stress and burnout. Efforts to promote team identification may offer a promising way for leaders to support front-line healthcare workers' well-being during the COVID-19 pandemic. These results can inform ongoing COVID-19 operational and quality improvement initiatives. © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.