Knowledge, behaviours, practices, and expectations regarding climate change and environmental sustainability among health workers in France: a multicentre, cross-sectional study.

BACKGROUND: Faced with climate change, hospitals are confronted with a dual challenge. On one hand, they need to embark on a far-reaching ecological transformation to reduce their contribution to greenhouse gas emissions and other environmental impacts; on the other hand, they need to limit the effects of climate change on their activities. We aimed to evaluate the knowledge, behaviours, practices, and expectations of health workers in French hospitals regarding climate change and environmental sustainability. METHODS: This multicentre, cross-sectional study was carried out in six French hospitals from June 1, 2021 to Dec 31, 2022. All health workers at the hospitals were eligible to participate and were recruited through internal publicity. We designed a structured questionnaire consisting of five parts: participant characteristics, knowledge and perceptions of climate change, pro-environmental behaviours, practices concerning environmental sustainability actions, and expectations. A multilevel logistic regression model was used to evaluate associations between the knowledge, behaviours, and practices of health workers and the characteristics of the health workers and hospitals. FINDINGS: Of 57 034 health workers across the six hospitals, 4552 (8·0%) participated in the study. Of those for whom gender data were available, 3518 (78·2%) participants were women and 979 (21·8%) were men. Participants considered energy consumption (71·0%) and waste and discharges related to medical activities (55·6%) and non-medical activities (50·2%) to be the three activities with the greatest environmental impact. On a scale of 1 (not a priority) to 10 (high priority), the median rating attributed by the participants to the commitment of their hospitals to ecological transformation was 5·0 (IQR 3·0-6·0). 1079 (23·7%) of 4552 participants had already initiated at least one environmental sustainability action in their hospital. Barriers reported by participants to the implementation of environmental sustainability-related projects were the lack of dedicated time (40·4%), hierarchical support (32·5%), methodological support (28·9%), and access to training (23·7%). The presence of a sustainable development steering committee, especially one with more than 5 years of activity, was positively associated with health workers feeling better informed about the ecological transformation of their hospital (adjusted odds ratio 1·78 [95% CI 1·29-2·45]), having better knowledge of the environmental impacts of their hospital (1·83 [1·32-2·53]), and initiating a larger number of environmental sustainability actions (1·74 [1·33-2·29]). INTERPRETATION: We showed that health workers in French hospitals seem to be committed to the ecological transformation of their workplaces, and identified some drivers and barriers to further support these essential transformations. There is an urgent need to bolster training for all health workers, enhance structural frameworks within hospitals, and encourage future interdisciplinary research on the vulnerability of health-care facilities to climate change. FUNDING: The University Hospital of Poitiers.

[Role and missions of the mobile wound healing team]. / Rôle et missions de l'équipe mobile plaies et cicatrisation.

The actions carried out by the mobile wounds and cicatrisation team of Bordeaux university hospital help to harmonise professional practices, with benefits for the hospital, the caregivers and the patients. Within the team, this "mentoring system" also strengthens the expertise of individual nurses. The results obtained over the last two years show that the scheme provides real added value in terms of the quality of care, in a context of a constant search for efficiency.

Can continuous glucose monitoring systems predict glycemia?

BACKGROUND: We investigated whether the arrow on a continuous glucose monitoring system (CGMS) screen predicts the course of the capillary glucose level 15 min later. SUBJECTS AND METHODS: Twenty-three patients with type 1 diabetes (age, 40±13 years; diabetes duration, 19±12 years; hemoglobin A1c, 8.5±1.5%) admitted for education in the use of a CGMS performed 242 observations: the arrow was noted at time 0, and the interstitial and capillary glucose levels were noted at time 0 and 15 min later. RESULTS: The capillary glucose courses were -15±28 mg/dL after a descending arrow (n=55), +1±23 mg/dL after a stable arrow (n=147) (P<0.001 vs. descending), and +2±23 mg/dL after an ascending arrow (n=40) (P<0.01 vs. descending), with similar findings for the 67 observations after an interstitial glucose level <100 mg/dL. There were 4.5% grossly erroneous arrows: six descending with later increasing and five ascending with later decreasing capillary glucose. CONCLUSIONS: Although there is a large room for improvement, the arrow on the CGMS screen does predict the decline in capillary glucose 15 min later.

[Insulin injection technique, practices observed by patients and nurses]. / La technique d'injection de l'insuline, pratiques observées par les patients et les infirmières.

A study was carried out in 2008-2009 on the practices of patients with diabetes with regard to insulin self-injection techniques. The results highlight in particular the importance of patient education.