Implementing peer support in our intensive care unit to improve the mental wellbeing of trainees

Introduction: Working on the intensive care unit (ICU) exposes staff to the suffering of patients and their families as a consequence of devastating illnesses and injuries, often leading to psychological trauma. The COVID-19 pandemic has amplified pressures on healthcare staff, resulting in deteriorating mental health and increased incidence of stress and burn out. The Intensive Care Society (ICS) has placed emphasis on peer support to combat this;recognising that working in a 'psychologically safe' environment improves wellbeing, enables safe and compassionate care, and reduces mistakes [1]. The aim of peer support is to improve wellbeing by offering a systematic, strategic approach to sustain staff who are coping well and provide initial support to those who are struggling. Method(s): Staff who have undertaken ICS training, under the supervision of a clinical psychologist, facilitate fortnightly meetings open to all ICU trainees. They also act as an initial contact to provide advice and guidance on addressing the psychological difficulties highlighted above. An anonymous screening questionnaire at the start of each session allows a moment of reflection for trainees prior to discussion. This, in addition to anonymous feedback, provides qualitative data to both audit the programme and inform improvement. Result(s): Participation in peer support is voluntary, nonetheless attendance at meetings has been excellent. Initial qualitative results indicate that most trainees feel 'nervous, anxious or on edge', 'question their capability at work' and are 'unable to stop thinking about work/a significant event at work' at least a few days per week. Feedback from trainees regarding the programme has been intensely positive. Conclusion(s): Anxiety and stress are high amongst ICU trainees which can lead to psychological harm if not addressed. Engagement from trainees in our programme has been good and feedback positive, emphasising the need for peer support in the ICU.

Management of steroid induced hyperglycaemia in patients critically unwell with COVID-19

Introduction: The aim of this study was to improve treatment of corticosteroid induced hyperglycaemia in patients critically unwell with COVID-19. Management with high dose steroids reduces mortality and has become standard practice. However, high dose glucocorticoid therapy impairs glucose metabolism in patients already at risk of insulin resistance and impaired insulin production, resulting in increased incidence of hyperglycaemia [1]. Methods: A retrospective audit was undertaken, collecting data on steroid use, glycaemic control, and insulin treatment in 100 patients admitted to the Royal Cornwall Hospital Intensive Care Unit with COVID-19. A standard operating procedure (SOP) for the treatment of steroid induced hyperglycaemia was created, based on guidelines from the National Inpatient Diabetes COVID-19 Response Group [1]. Results: Of 100 patients, 91 received high dose steroids. The majority (64.8%) experienced glycaemic control issues, defined as one episode of blood sugar > 12 mmol/l. Of the patients treated with 6 mg dexamethasone 52% experienced hyperglycaemia, compared to 71% of those treated with higher steroid doses. There was no significant difference in the highest blood sugar level of either cohort (t54 = - 0.450, p = 0.654). The average time between first episode of hyperglycaemia and commensal of insulin was 76 h. There was a lack of consensus in management of steroid-induced hyperglycaemia-no treatment was administered in 37% of patients. In those who were treated, 19 different combinations of insulin were given. Sliding scale insulin was administered in most patients who experienced no further hyperglycaemia. Conclusions: These results highlight a necessity for consensus management of steroid induced hyperglycaemia. In line with these findings, the devised SOP recommends initial therapy with rapid acting insulin and administration of a sliding scale if hyperglycaemia persists.

Teleconsultation for primary care: An in-depth transformation on how to care

Strongly encouraged by the health law of 2018th which determined the acts of Teleconsultation assumed by Assurance Maladie, the medical consultation has been implemented in practice of general medicine during home confinement and state of health emergencies. The teleconsultation has been useful to avoid any excessive risk taking with COVID-19, to provide monitoring of chronic diseases or to improve accessibility to health services. Day to day, beside these advantages, there are also some hazards of operating mode and inconvenience which must be evaluated. It is important to think about the consequences about the other way to practice medicine with the absence of physical examination and with the modification of the relationship between doctor and patient. © 2021 l'Académie nationale de médecine

Rapport 21-08. La Téléconsultation en médecine générale: une transformation en profondeur dans la façon de soigner*

Résumé Fortement encouragée par les arrêtés de 2018 qui définissent les actes de télémédecine pris en charge par l’Assurance Maladie, la téléconsultation médicale s’est ancrée dans la pratique des médecins généralistes notamment à la faveur du confinement et de l’état d’urgence sanitaire. La téléconsultation a été utile pour éviter des prises de risque vis-à-vis de la COVID -19, pour assurer la surveillance des patients atteints de maladies chroniques ou pour améliorer l’accès aux soins. Au quotidien, à côté de ces avantages, il existe aussi des aléas de fonctionnement et des inconvénients qui méritent d’être évalués. Il faut s’interroger sur les conséquences de « cette autre façon de pratiquer la médecine » avec l’absence de l’examen clinique et la modification de la relation médecin – malade Summary Strongly encouraged by the health law of 2018th which determined the acts of Teleconsultation assumed by Assurance Maladie, the medical consultation has been implemented in practice of general medicine during home confinement and state of health emergencies. The teleconsultation has been useful to avoid any excessive risk taking with COVID-19, to provide monitoring of chronic diseases or to improve accessibility to health services. Day to day, beside these advantages, there are also some hazards of operating mode and inconvenience which must be evaluated. It is important to think about the consequences about the other way to practice medicine with the absence of physical examination and with the modification of the relationship between doctor and patient.