Infectious disease hotlines to provide advice to general practitioners: a prospective study

BACKGROUND

Telephone hotlines in infectious diseases (ID) are part of antimicrobial stewardship programs designed to provide support and expertise in ID and to control antibiotic resistance. The aim of the study was to characterize the activity of the ID hotlines and estimate their usefulness for general practitioners (GPs).

METHODS

This was a multicenter prospective observational study in different French regions. ID teams involved in antimicrobial stewardship with a hotline for GPs were asked to record their advice from April 2019 to June 2022. In these regions, all GPs were informed of the ID hotline's operating procedures. The main outcome was usage rate of the hotlines by GPs.

RESULTS

Ten volunteer ID teams collected 4138 requests for advice from 2171 GPs. The proportion of GPs using the hotline varied pronouncedly by region, from 54% in the Isere department, to less than 1% in departments with the lowest usage. These differences were associated with the number of physicians in ID teams and with the age of the hotline. These results highlighted the value of working time as a means of ensuring the permanence of expertise. The main reasons for calling were: a diagnostic question (44%); choice of antibiotic (31%). The ID specialist provided advice on antibiotic therapy (43%) or a proposal for specialized consultation or hospitalization (11%).

CONCLUSIONS

ID hotlines could help to strengthen cooperation between primary care and hospital medicine. However, the deployment and perpetuation of this activity require reflection concerning its institutional and financial support.

Management of Long COVID—The CoviMouv' Pilot Study: Importance of Adapted Physical Activity for Prolonged Symptoms Following SARS-CoV2 Infection

Context

After a COVID-19 infection, some patients have persistent symptoms, the most common is fatigue. To prevent it from becoming chronic (post-COVID-19 syndrome), early management before 3 months could be useful. Exercise and education are recommended.

Objective

To assess fatigue in patients with prolonged symptoms after COVID-19 infection and who received a mixed program of remote adapted physical activity and therapeutic education. The secondary objective was to evaluate the efficacy and safety of this training method thanks to aerobic and anaerobic parameters.

Methods

“CoviMouv': From Coaching in Visual to Mouv in real” is a nonrandomized controlled pilot study. Patients in telerehabilitation followed 12 remote exercise sessions and 3 therapeutic education workshops. Patients on traditional rehabilitation followed their program with a community-based physiotherapist.

Results

Fatigue was reduced after the one-month intervention in both groups (p = 0.010). The majority of aerobic parameters were significantly improved, e.g., maximal oxygen uptake (p = 0.005), walking distance (p = 0.019) or hyperventilation values (p = 0.035). The anaerobic parameter was not improved (p = 0.400). No adverse event was declared.

Discussion

Telerehabilitation is a good alternative when a face-to-face program is not possible. This care at an early stage of the disease could help prevent the chronicity of post-COVID-19 symptoms and the installation of vicious circles of physical deconditioning. A larger study would be necessary.

COVID-19 outpatient management: Shorter time to recovery in Healthcare workers according to an electronic daily symptoms assessment

Objectives

Our aim is to compare the course of the disease between healthcare workers (HCWs) and non-HCWs suffering from covid-19 and eligible for outpatient management.

Methods

Single-center prospective cohort of outpatients with covid-19, diagnosed between the 10th March and the 2nd April, 2020 with a daily collection of symptoms by an on-line auto-questionnaire.

Results

A total of 186 patients were included (median age, 41 years [interquartile range, 19–78 years]; 74.2% female), of whom 132 (71%) were HCWs. The median follow-up after symptom onset was 14 (min 4–max 24) days. HCWs were significantly younger than non-HCWs (median age 40.3 years vs. 47.2 years [P < 0.005]), and 81.8% were women. Four patients (2.2%) were hospitalized including one HCW. The median time to recovery was 9 days after symptom onset (95% CI 8-11) in the global population and respectively 8 (95% CI 8–9) and 13 (95% CI 11–15) days in HCWs and in non-HCWs (P < 0.005). After adjusting for age, co-morbidities, and gender, the instantaneous risk ratio for symptom absence in HCWs was 1.76 compared with non-HCWs (95% CI [1.16–2.67], P = 0.037).

Conclusion

HCWs suffering from covid-19 had favorable outcomes and had a shorter time to recovery than non HCWs.

COVID-19 : les soignants sont-ils de véritables super-héros ?

Introduction

Une grande partie des connaissances en cours concernant la COVID-19 est basée sur les données des patients hospitalisés. Notre objectif est de décrire l’évolution au jour le jour de la COVID-19 dans les cas admissibles à une prise en charge ambulatoire.

Matériels et méthodes

Cohorte prospective monocentrique de patients présentant une infection par le SARS-CoV-2 confirmée virologiquement et présentant des symptômes modérés, admissibles à une prise en charge ambulatoire, entre le 10 mars et le 2 avril 2020. Les symptômes quotidiens ont été recueillis au moyen d’un auto-questionnaire en ligne. Nous avons considéré qu’un patient était guéri lorsqu’aucun des trois symptômes principaux (fièvre, dyspnée et douleur thoracique) n’était signalé après les derniers symptômes connus via l’application en ligne.

Résultats

Un total de 186 patients ont été inclus (âge médian, 41 ans [intervalle interquartile, 19–78 ans] ; 74,2 % de femmes), dont 132 (71 %) étaient des professionnels de santé. Treize patients (7 %) souffraient d’hypertension artérielle (la comorbidité la plus courante) et le suivi médian après l’apparition des symptômes était de 14 jours (min 4–max 24). Les professionnels de santé étaient significativement plus jeunes que les autres (âge médian de 40,3 ans contre 47,2 ans [p < 0,005]), et 81,8 % étaient des femmes. Quatre patients (2,2 %) ont été hospitalisés, dont un professionnel de santé. Le délai médian de guérison était de 9 jours après l’apparition des symptômes (IC95 % : 8–11) dans notre population globale et de 8 jours (IC95 % : 8–9) et 13 jours (IC95 % : 11–15) chez les professionnels de santé et les non-professionnels de santé (p < 0,005), respectivement. Après ajustement sur l’âge, le sexe, les comorbidités et le seuil de détection de la PCR SARS-CoV-2, le rapport de risque instantané pour l’absence de symptômes chez les professionnels de santé était de 1,76 par rapport aux non-professionnels de santé (IC95 % [1,16–2,67], p = 0,037).

Conclusion

La grande majorité de cette cohorte de personnes atteintes d’une infection par la COVID-19 a guéri spontanément. Les professionnels de santé souffrant de la COVID-19 ont eu des résultats favorables et ont eu un temps de récupération plus court que les non-professionnels de santé. Des études supplémentaires sont nécessaires pour mieux comprendre ces différences.