Diabetes education of patients and their entourage: out-of-hospital national study (EDUCATED 2).

AIMS: To determine the contributing factors in the successful diabetes education of patients and their entourage. METHODS: Prospective observational study conducted in a pre-hospital setting by 17 emergency services across France (September 2009-January 2011) included all insulin-treated patients (≥18 years) provided that at least one family member was present on scene. Data were collected from patients and their entourage: (1) personal details including language proficiency and educational attainment, (2) treatments, (3) diabetes-related data (log sheets, glucose meter, glucagon, glycated hemoglobin, prior hypoglycemic episodes); (4) care by diabetologist, general practitioner and/or visiting nurse. The main end points were ability to measure capillary blood sugar (patient) and awareness of hypoglycemia symptoms and ability to administer glucagon (entourage). RESULTS: Overall, 561 patients and 736 family members were included; 343 patients (61%) were experiencing a hypoglycemic episode (<2.5 mmol/L). A total of 141 (75%) patients and 343 (50%) family members could measure capillary blood sugar. They could name a median of 2 [0-3‰] hypoglycemia symptoms although 217 (39%) patients and 262 (39%) family members could name no symptom. Few patients (33%) had glucagon available. In multivariate analyses, the main factor associated with better patient education was care by a diabetologist. Lack of an educational qualification and visits by a nurse were associated with poor patient education, and French mother tongue and care by a diabetologist with better education of the entourage. CONCLUSIONS: In France, diabetic patients and their entourage are inadequately educated. Their education benefits most from care by a diabetologist.

Gender as a risk factor for pulmonary embolism after air travel.

It was the objective of this study to confirm the hypothesis that women experience an increased risk of pulmonary embolism (PE) and/or thromboembolic events after long-distance air travel. We systematically reviewed the records of all patients with confirmed pulmonary embolism after arrival at Roissy-Charles-de-Gaulle (CDG) Airport (Paris, France) during a 13-year period. The incidence of PE was calculated as a function of distance travelled and gender using Bayesian conditional probabilities obtained in part from a control population of long-distance travellers arriving in French Polynesia (Tahiti). A total of 287.6 million passengers landed at CDG airport during the study period. The proportion of male to female long-distance travellers was estimated to be 50.5% to 49.5%. Overall, 116 patients experienced PE after landing [90 females (78%), 26 males (22%)]. The estimated incidence of PE was 0.61 (0.61-0.61) cases per million passengers in females and 0.2 (0.20-0.20) in males, and reached 7.24 (7.17-7.31) and 2.35 (2.33-2.38) cases, respectively, in passengers travelling over 10,000 km. Our study strongly suggests that there is a relationship between risk of PE after air travel and gender. This relationship needs to be confirmed in order to develop the best strategy for prophylaxis.

Use of an automated device for external chest compressions by first-aid workers unfamiliar with the device: a step toward public access?

OBJECTIVE: The objective was to establish the feasibility of using an automated external chest compression (ECC) device among first-aid workers unfamiliar with the device. METHODS: Eighty first-aid workers unfamiliar with the Autopulse ECC device were randomized into three groups. Group 1 was given two explanatory illustrations on device use. Group 2 was given four explanatory illustrations. Group 3 was shown a 5-minute video on the placement and use of the device and allowed to handle the device for 5 minutes. The time taken to place and start the device on a mannequin was recorded. RESULTS: There was no significant difference among the three groups with regard to age, sex ratio, experience, and time elapsed since their last training session. No mistakes in device placement were made by any of the groups. All 80 participants started ECC in less than 160 seconds. There was no significant difference between Groups 1 and 2 in time taken to place or start the device (medians and 25-75 percentiles = 72 [54-112] vs. 86 [46-130] seconds and 154 [103-183] vs. 156 [120-197] seconds, respectively). However, Group 3 first-aid workers obtained significantly better results (19 [16-26] seconds to place and 48 [40-65] seconds to start; p<0.0001). CONCLUSIONS: An automated ECC device can be rapidly placed and used by first-aid workers unfamiliar with the device. In the light of these results, use of the device by the general public can be envisaged.