Intérêt d'outils digitaux dans le maintien d'un parcours de soins obésité dans le contexte épidémique Covid-19. Retour de l'expérimentation article 51 Espace Médical Nutrition et Obésité

L'épidémie de Covid-19, au-delà de mettre en évidence l'obésité comme facteur pronostique important, modifie grandement la prise en charge de cette maladie chronique. L'expérimentation article 51 Espace médical nutrition et obésité (EMNO) a dû intégrer des outils numériques pour maintenir les parcours de soins. Cette démarche a également été enrichie par l'apport d'un outil d'éducation thérapeutique digital. L'ensemble du processus de prise en charge a ainsi été réalisé malgré la situation, avec un retour très positif des patients inclus dans l'expérimentation. En contexte épidémique, le maintien des parcours de soins d'une maladie chronique comme l'obésité peut ainsi être assuré avec l'apport du numérique tout en dépassant le simple cadre de la téléconsultation et du suivi en y associant une approche pédagogique digitale.Alternate :The Covid-19 outbreak has not only brought evidence for obesity as an important prognostic factor, it also modifies this chronic disease management. The Article 51 Espace Médical Nutrition et Obésité (EMNO) experiment has had to include digital tools to ensure care pathway maintenance. The response of patients included in the experiment is, in this context, very positive. The procedure has also been enriched with the contribution of a digital therapeutic education tool. The care process has been maintained, despite the situation, with a positive response from patients. In the epidemic context, the maintenance of care pathways for a chronic disease such as obesity can be done with the contribution of digital tools, going beyond teleconsultations or tracking, by adding a digital education approach.

Dietary preparation for bariatric surgery via video conferencing during the COVID-19 health crisis and perspectives

Introduction: The health crisis linked to COVID-19 led to the containment of the general population in order to limit the spread of the virus. With the emergence of this new disease, it was necessary to mobilise in order to limit the transmission of the virus to our obese population, at risk of developing a severe form of COVID-19. To do this, we proposed to carry out our TPE workshops by videoconference to all patients included in the TPE "bariatric surgery"programme. Objectives: The aim of this study is to identify the benefits and drawbacks of this group distance TVE format, their efficiency in terms of learning and behavioural changes, and the different resources of the programme that facilitate their learning for the pre- and post-surgery course. Methods: This is a two-phase mixed-methods study. The first phase of the study consisted of an exploratory qualitative study using semi-directive interviews with 18 patients who had followed the distance TPE from March 2020 to May 2020, to explore their experiences of the different educational sessions. In a second phase, the exploratory study made it possible to draw up a questionnaire to gather the views of all the patients educated from March 2020 to May 2021. The analysis of the answers mobilised the theory of capabilities to identify the positive or negative conversion factors of the programme for the patients'learning. Results: Of the 70 patients included, 43 responded to the questionnaire. This video conferencing TPE enabled the scheduling of surgical procedures to be maintained. Patients reported time savings due to the absence of travel. Patients with low digital literacy were able to access this programme. Participants stressed the importance of continuity of connection with caregivers. Patients reported self-care skills acquired through this distance learning and an average weight loss of 7 kg. Both positive and negative learning factors were identified. Discussion: The results of this study demonstrate the interest in developing e-TPE programmes for several reasons: the difficulties in bringing these patients to the hospital, the geographical inequalities in access to TPE, the absence of reimbursement for transport tickets and the lack of dedicated spaces available. It therefore seems important to train professionals and patients in the digital tool. Conclusion: This study of a population of obese patients who participated in a TVE programme by videoconference during a pandemic and a period of confinement shows the perceived quality of this distance education. In view of the different programmes transposed into distance format, it would be interesting to promote research crossing the experiences of patients and professionals to propose the best educational format to the health authorities. © 2023 SETE. Introduction : La crise sanitaire liée au Covid-19 a engendré un confinement de la population générale afin de limiter la propagation du virus. Dans l'émergence de cette nouvelle maladie, il a fallu se mobiliser afin de limiter la transmission du virus auprès de notre population d'obèses, à risque de développer une forme grave au Covid-19. Pour cela, nous avons propos de réaliser nos ateliers ETP par visioconférence à l'ensemble des patients inclus dans le programme ETP « chirurgie bariatrique ». Objectifs : L'objectif de cette étude est de dégager les bénéfices et inconvénients de ce format d'ETP distanciel en collectif, leur efficience au regard des apprentissages et des changements de comportement, et les différentes ressources du programme facilitant leurs apprentissages pour le parcours pré et post chirurgie. Méthodes : Il s'agit d'une étude mixte en deux phases. La première phase de l'étude consiste en une étude qualitative exploratoire par entretiens semi-directifs auprès de 18 patients ayant suivi l'ETP en distanciel de mars 2020 à mai 2020, pour explorer leur vécu des différentes sessions éducatives. L'étude exploratoire a permis d'élaborer dans une deuxième phase un questionnaire pour recueillir le point de vue de l'ensemble des patients éduqués de mars 2020 à mai 2021. L'analyse des réponses a mobilisé la théorie des capabilités pour identifier les facteurs de conversion positifs ou négatifs du programme pour les apprentissages des patients. Résultats : Sur l'ensemble des 70 patients inclus quarante-trois personnes ont répondu au questionnaire... Cette ETP en visioconférence a permis de maintenir la programmation des interventions chirurgicales. Les patients ont rapporté un gain de temps lié à l'absence de déplacement. Des patients avec une faible littératie numérique ont pu accéder à ce programme. Les participants ont souligné l'importance de la continuité du lien avec les soignants. Les patients ont rapporté des compétences d'auto-soins acquises à travers cette ETP à distance ainsi qu'une perte de poids de 7 kg en moyenne. Des facteurs positifs et négatifs au regard des apprentissages ont été mis en évidence. Discussion : Les résultats de cette étude démontrent l'intérêt de développer des programmes e-ETP pour plusieurs raisons : les difficultés à faire venir ces patients à l'hôpital, les inégalités géographiques d'accès à l'ETP, l'absence de remboursement des titres de transport et d'espaces disponibles dédiés. Il parait donc important de former les professionnels et les patients à l'outil numérique. Conclusion : Cette étude auprès de la population de patients obèses ayant participé à un programme d'ETP par visioconférence en période de pandémie et de confinement témoigne de la qualité perçue de cette éducation en distanciel. Au regard des différents programmes transposés sous format distanciel, il serait intéressant de promouvoir des recherches croisant les expériences des patients et des professionnels pour proposer aux autorités de santé le meilleur format éducatif. © 2022 EDP Sciences. All rights reserved.

The pandemic effect: The outlook of lung transplantation.

Lung transplant (LT) is a life-saving treatment for patients with end-stage lung disease. In the setting of COVID-19-associated acute respiratory distress syndrome (ARDS), LT emerged as a therapeutic option for select cases. It is challenging to determine the extent of the knowledge and interest the United States (US) general population has on LT as salvage therapy during and following the COVID-19 pandemic. It is the authors' opinion that patient therapeutic education (PTE) can directly influence established practices by creating an open channel of communication based on needs and expectations for healthcare services. This perspective is a cursory reflection of the nuances between healthcare providers, their services, the interests and expectations of the general population, specifically on LT following COVID-19. The main endpoint of this study is to analyze the US general population's interest in LT as COVID-19 salvage therapy via the Google Trends (GT) web-kit tool.

Feasibility of Real-Time Continuous Glucose Monitoring Telemetry System in an Inpatient Diabetes Unit: A Pilot Study.

BACKGROUND: Hospitalization of persons with diabetes in an inpatient diabetes unit is challenging, notably for patients having different profiles. We aimed to evaluate the feasibility and the benefit of a continuous glucose monitoring (CGM) telemetry system to control glucose excursions in hospitalized patients with diabetes, according to their diabetes type and the reasons for their hospitalization. METHOD: A prospective pilot study was conducted in 53 insulin-requiring diabetes patients hospitalized in the general ward. Glucose was monitored using Guardian Connect (GC, Medtronic) to adopt insulin therapy. The time in range (TIR, target 70-180 mg/dL), the time below range (TBR), and the time above range (TAR) were recorded by GC between the start of hospitalization (SH) and end of hospitalization (EH), and analyzed according to the diabetes type (type 1 diabetes n = 28, type 2 diabetes n = 25) and the reasons for hospitalization (acute complications n = 35, therapeutic education n = 18). Patient and caregiver satisfaction was also assessed. RESULTS: In patients with type 2 diabetes and those hospitalized for acute complications, TIR significantly increased between the SH and EH, from 75.7% (95%CI 48.5-84.6) to 82.2% (95%CI 63.2-91.8) P = 0.043 and from 58.3% (95%CI 46.3-69.7) to 66.4% (95%CI 55.6-75.5) P = 0.031, respectively, and TAR significantly decreased, with no change in TBR. In patients with diabetes hospitalized for therapeutic education, TBR significantly decreased from 3.4% (95%CI 0-9.4) to 0% (95%CI 0-3.8) P = 0.037. Finally, 94% of patients and caregivers deemed the GC system useful. CONCLUSIONS: CGM telemetry system use is feasible and well accepted in patients hospitalized in diabetes care unit and could be useful to improve therapeutic education and metabolic control, especially for specific homogenous populations with diabetes.

[Path of a fighter]. / La désensibilisation allergénique au secours de la récidive.

Allergy is a frequent and often disabling condition for the patients. In the context of allergic rhinitis and asthma or anaphylactic shock to hymenoptera venom, allergenic desensitization can be proposed to limit the symptoms or recurrence of major reactions. Access to this treatment is made difficult by a lack of allergists, a lack of products or, more recently, by the Covid-19 crisis.

Impact of COVID-19 pandemic on access to online therapeutic education programs for children with sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is a lifelong disease for which outcomes may be influenced by patients' self-care knowledge. Therapeutic education (TPE) is a patient-centered teaching instrument based on patient's adaptative processes and needs. TPE was developed in the Paris area by a pediatric health network using interactive face-to-face meetings. The COVID-19 pandemic has impacted the TPE modalities by promoting online training. Our aims were to evaluate the accessibility of patients with SCD to online TPE. METHODS: We compared sessions of TPE before and after the onset of the pandemic: the number of sessions, performed face-to-face or online, individual or in a group. We also recorded the number of participants in each session and their age, school level, and department in France. FINDINGS: We observed an increase in the total number of trained children, but participation varied greatly according to the geographical area of residence, with a decrease from 22.4% to 4.9% in the proportion of attendees living in the most socio-economically deprived French departments. DISCUSSION: Online TPE is feasible for patients with SCD but with unequal access according to socio-economic status. APPLICATION TO PRACTICE: Access to TPE needs to be improved for patients living in socially disadvantaged areas.

Adapting clinical psychological practices for pain during the COVID-19 pandemic

Introduction: Clinical practice with chronic pain patients, shaken by the reorganization of the health care field, has required a rethinking of pain management. In order to continue the psychological support of patients, individual consultations or distance group workshops have been developed. A practice analysis group bringing together psychologists and psychotherapists shared their clinical experiences and experiences of the crisis. Objectives: The objectives of this study are to explore the adaptation of clinical practices for chronic pain subjects;the experience of professionals;and to propose recommendations resulting from the collective reflections. Method: The clinical research methodology was that of a focus group. Three two-hour videoconference meetings were held from September 2020 to May 2021. A thematic analysis of the transcripts was carried out with the NVivo qualitative analysis software. Results: In all, 9 psychologists and psychotherapists participated in the focus group. The thematic analysis revealed three main themes, namely: (1) impact of the health crisis related to COVID-19;(2) adaptation of practices;(3) process of changing clinical practices. Conclusion: Professionals report that the use of digital tools has limited the psychopathological impact of the health crisis on patients. The recommendations resulting from the collective reflections suggest maintaining remote care and relying on the support of the teams, the hierarchy, and peer exchange groups. © 2022 Société Française de Psychologie

Adaptation des pratiques psychologiques en clinique de la douleur durant la pandémie de la COVID-19

Résumé Introduction: La pratique clinique auprès de patients douloureux chroniques, ébranlée par la réorganisation du champ sanitaire, a nécessité de repenser la prise en charge psychologique de la douleur. Afin de poursuivre l’accompagnement psychologique des patients, des consultations individuelles ou des ateliers de groupes à distance se sont développés. Un groupe d’échange de pratiques rassemblant des psychologues et psychothérapeutes a partagé ses expériences cliniques et son vécu de la crise. Objectifs: Les objectifs de cette étude sont d’explorer l’adaptation des pratiques cliniques pour les sujets douloureux chroniques, le vécu des professionnels, et de proposer des recommandations issues des réflexions collectives. Méthode: La méthodologie de recherche clinique a suivi celle d’un focus group. Trois réunions en visioconférence de deux heures ont eu lieu de Septembre 2020 à Mai 2021. Une analyse thématique des retranscriptions a été réalisée avec le logiciel d'analyse qualitative NVivo. Résultats: 9 psychologues et psychothérapeutes ont participé au focus group. L'analyse thématique a révélé trois grands thèmes, à savoir: (1) Impact de la crise sanitaire liée à la COVID-19;(2) Adaptation des pratiques;(3) Processus de changement des pratiques cliniques. Conclusion: Les professionnels rapportent que l’usage des outils numériques a permis de limiter l’impact psychologique de la crise sanitaire sur les patients et de maintenir le lien. Des recommandations issues des réflexions collectives suggèrent de maintenir les soins en distanciel et de s’appuyer sur le soutien des équipes, de la hiérarchie, et des groupes d’échanges entre pairs. Introduction: Clinical practice with chronic pain patients, shaken by the reorganization of the health care field, has required a rethinking of pain management. In order to continue the psychological support of patients, individual consultations or distance group workshops have been developed. A practice analysis group bringing together psychologists and psychotherapists shared their clinical experiences and experiences of the crisis. Objectives: The objectives of this study are to explore the adaptation of clinical practices for chronic pain subjects;the experience of professionals;and to propose recommendations resulting from the collective reflections. Method: The clinical research methodology was that of a focus group. Three two-hour videoconference meetings were held from September 2020 to May 2021. A thematic analysis of the transcripts was carried out with the NVivo qualitative analysis software. Results: 9 psychologists and psychotherapists participated in the focus group. The thematic analysis revealed three main themes, namely: (1) Impact of the health crisis related to COVID-19;(2) Adaptation of practices;(3) Process of changing clinical practices. Conclusion: Professionals report that the use of digital tools has limited the psychopathological impact of the health crisis on patients. The recommendations resulting from the collective reflections suggest maintaining remote care and relying on the support of the teams, the hierarchy, and peer exchange groups.

[Impact of confinement on the follow-up of oral immunotherapies: A multicentre study in the Île-de-France region]. / Impact du confinement sur le suivi des immunothérapies orales alimentaires : étude multicentrique dans 3 centres d'Île-de-France.

PURPOSE OF THE STUDY: Several studies have confirmed the impact of confinement on the population, resulting in disruption of care, somatic and psychological effects. Our study looks at adverse effects and problems of adherence to oral immunotherapy therapy (OIT) during this period. PATIENTS AND METHODS: A total of 132 patients, mostly children (95%), with an atopic history (60%) followed for an OIT were included in 3 allergology centers in Île-de-France, during the period of confinement from 03/16 to 05/11/20. The main food allergens used for OIT were peanut (38%), cow's milk (24%), hazelnut (14%), egg (9%), cashew nut and pistachio nut (8%). RESULTS: Adverse effects were found in 13 patients or 10% of the cases. These reactions were mainly grade 1 and 2 according to the Ring and Messmer classification. Three patients had grade 3 reactions and six patients used epinephrine at home. Adherence was correct in 81% of cases with no omissions. Three patients increased their daily dose without medical advice. No significant difference was found in the subgroup analysis comparing age-matched children followed up in OIT in 2019 and 2020 over the same period in the same hospital. CONCLUSION: There was no increase in adverse events in OIT during the confinement period. Therapeutic education during OIT is paramount and helps to reduce the occurrence of adverse events.