[COV IMPACT: Stress exposure analysis among hospital staff in 2 hospitals in France during the COVID-19 pandemic]. / COV IMPACT : analyse des différents facteurs de stress du personnel hospitalier dans 2 centres hospitaliers en France lors de la pandémie COVID-19.

The COVID-19 pandemic has swept through our hospitals which have had to adapt as a matter of urgency. We are aware that a health crisis of this magnitude is likely to generate mental disorders particularly affecting exposed healthcare workers. Being so brutal and global, this one-of the kind pandemic has been impacting the staff in their professional sphere but also within their private circle. The COV IMPACT study is an early assessment survey conducted for 2 weeks in May 2020, of the perception by all hospital workers of the changes induced in their professional activity by the pandemic. The study was carried out by a survey sent to the hospital staff of Béziers and Montfermeil. The readjusted working conditions were source of increased physical fatigue for 62 % of the respondents. Moral exhaustion was reported by 36 %. It was related to the stress of contracting the infection (72 %) but above all of transmitting it to relatives (89 %) with a broad perception of a vital risk (41 %). This stress affected all socio-professional categories (CSP) and was independent of exposure to COVID. Change in organisation, lack of information and protective gear and equipment were major factors of insecurity at the start of the epidemic. Work on supportive measures is necessary. It should focus on the spread of information, particularly towards the youngest, as well as bringing more psychological support and a larger amount of medical equipment, beyond healthcare workers and the COVID sectors.

[Practical implementation and usefulness of guidelines for the management of syncope: a professional practice study]. / Application pratique et intérêt des recommandations de prise en charge des syncopes : évaluation de pratiques professionnelles.

AIMS: To assess the practical implementation of international guidelines and their impact on syncope management in a 500-bed general hospital. PATIENTS AND METHODS: Three groups of 63 consecutive patients admitted for syncope to the emergency care unit (ECU) were studied: group 1, before the guidelines delivered to the practitioners, group 2 immediately after the diffusion of guidelines and group 3, one year later. The study evaluates the mean duration of stay (MDS) and the relevance of the diagnostic strategy. RESULTS: In group 1 compared to group 2, MDS were respectively 6.8±5.5 and 5.4±2.8 days (P=0.07) and the unexplained syncope number respectively 22% and 24% (P=0.8). The search of orthostatic hypotension became more systematic (13% versus 86% in group 1 and 2 respectively, P<0.001). The agreement (kappa coefficient) between initial and final diagnostic increased in 0.34 to 0.44. One year later MDS in group 3 was 7.1±4.7 days (P=0.8 versus group 1 and P=0.015 versus group 2) with only 6.3% systematic search for orthostatic hypotension (P<0.001). CONCLUSIONS: Guidelines optimize the syncope management in the ECU and the agreement between the emergency and discharge diagnostic without change of unexplained syncope and. MDS tend to be shorter when guidelines are actively implemented. Nevertheless, the positive impact of guidelines implementation is of limited duration.

[Atrial flutter ablation: initial experience in a general hospital]. / Ablation de flutter atrial: experience initiale d'un centre hospitalier general.

BACKGROUND: Right atrial flutter has a relatively high incidence. It is often symptomatic and can have a poor outcome particularly in case of thrombo-embolic events. AIM OF STUDY: We evaluate the results of radiofrequency catheter ablation for right atrial flutter since the introduction of this technique inour hospital. METHODS: The 28 first patients referred in our institution for atrial flutter and relevant for cavo-tricuspid isthmus ablation were enrolled. Ablation used a 8 mm tip electrode catheter and one or two conventional diagnostic catheters. The goal of ablation was complete bidirectional isthmus block. RESULTS: The first-line success rate was 96 percent with 4 percent early flutter recurrence. The mean duration of radiofrequency current applications was 652 +/- 409 seconds. No complication was observed. CONCLUSION: This results are comparable with the published data and encourage the development of basic ablation procedures and maintenance of rhythmic competence in general hospital inside medical network.

Is a cooled tip catheter the solution for the ablation of the cavotricuspid isthmus?

To test the theoretical superiority of irrigated tip catheters to achieve complete cavotricuspid isthmus block, a 4-mm cooled tip catheter was compared to a conventional 8-mm tip catheter with a double temperature sensor in the cavotricuspid isthmus (CTI) ablation. The study prospectively enrolled 60 patients (47 men, mean 65 +/- 10 years) with common flutter divided in group 1 (n = 30) assigned to an 8-mm tip catheter versus group 2 (n = 30), assigned to an internal circuit, irrigated tip catheter. Linear radiofrequency applications were performed in a point-by-point protocol to achieve complete CTI block. Complete CTI block was achieved in 29 patients in each group. Mean durations of procedure and fluoroscopy were 91 versus 90 and 40 versus 33 minutes in group 1 versus 2, respectively, (NS). The mean number/patient of RF pulses to interrupt atrial flutter was four in group 1 and eight in group 2 (P = 0.034), and 11 and 13, respectively, to interrupt CTI conduction (NS). The total energy delivered was similar in both groups (29,237 vs 23,236 W/s, NS). CTI ablation with a conventional 8-mm tip catheter versus an irrigated tip catheter was associated with similar success rates, procedure duration, and fluoroscopic exposure. The technical complexity of the cooled tip catheter renders it less competitive.