Publications of Alexandre GHUYSEN
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See detailCan video-assistance improve the quality of pediatric dispatcher-assisted cardiopulmonary resuscitation? (IN PROGRESS)
PETERS, Michaël ULiege; Stipulante, Samuel ULiege; Cloes, Véronique et al

in Pediatric Emergency Care (in press)

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See detailUsing simulation to assess patient's self-triage for unscheduled urgent care : the ODISSEE Platform
GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege; François, Sophie et al

Conference (2021, April 14)

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See detailAsthma and COPD Are Not Risk Factors for ICU Stay and Death in Case of SARS-CoV2 Infection
CALMES, Doriane ULiege; Graff, Sophie ULiege; MAES, Nathalie ULiege et al

in Journal of Allergy and Clinical Immunology: In Practice (2021), 9(1), 160-169

BACKGROUND: Asthmatics and patients with chronic obstructive pulmonary disease (COPD) have more severe outcomes with viral infections than people without obstructive disease. OBJECTIVE: To evaluate if ... [more ▼]

BACKGROUND: Asthmatics and patients with chronic obstructive pulmonary disease (COPD) have more severe outcomes with viral infections than people without obstructive disease. OBJECTIVE: To evaluate if obstructive diseases are risk factors for intensive care unit (ICU) stay and death due to coronavirus disease 2019 (COVID19). METHODS: We collected data from the electronic medical record from 596 adult patients hospitalized in University Hospital of Liege between March 18 and April 17, 2020, for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. We classified patients into 3 groups according to the underlying respiratory disease, present before the COVID19 pandemic. RESULTS: Among patients requiring hospitalization for COVID19, asthma and COPD accounted for 9.6% and 7.7%, respectively. The proportions of asthmatics, patients with COPD, and patients without obstructive airway disease hospitalized in the ICU were 17.5%, 19.6%, and 14%, respectively. One-third of patients with COPD died during hospitalization, whereas only 7.0% of asthmatics and 13.6% of patients without airway obstruction died due to SARS-CoV2. The multivariate analysis showed that asthma, COPD, inhaled corticosteroid treatment, and oral corticosteroid treatment were not independent risk factors for ICU admission or death. Male gender (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.1-3.2) and obesity (OR: 8.5; 95% CI: 5.1-14.1) were predictors of ICU admission, whereas male gender (OR 1.9; 95% CI: 1.1-3.2), older age (OR: 1.9; 95% CI: 1.6-2.3), cardiopathy (OR: 1.8; 95% CI: 1.1-3.1), and immunosuppressive diseases (OR: 3.6; 95% CI: 1.5-8.4) were independent predictors of death. CONCLUSION: Asthma and COPD are not risk factors for ICU admission and death related to SARS-CoV2 infection. [less ▲]

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See detailGestion des admission aux urgences durant la pandémie de COVID-19 au sein du CHU de Liège : Apport d'un centre de tri avancé
GILBERT, Allison ULiege; PIAZZA, Justine ULiege; SZECEL, Julien ULiege et al

in Revue Médicale de Liège (2020), 75(Supplement), 11-17

résumé : La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institu- tions hospitalières à une série de réorganisations singulières soutenues par ... [more ▼]

résumé : La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institu- tions hospitalières à une série de réorganisations singulières soutenues par l’activation du Plan d’Urgence Hospitalier. Cet article a pour objet de décrire l’expérience du Centre Hospitalier Universitaire de Liège (CHU de Liège) durant la pandémie de COVID-19 et de relater l’efficience de la mise en place d’un centre de tri avancé en amont des services d’urgences pour la gestion des admissions hospitalières. Méthodes : dès le 2 Mars 2020, le CHU de Liège a mis en place une infrastructure d’accueil des patients suspects d’infection par le SARS-CoV-2. D’abord initiée au sein de l’institution hospitalière, la nécessité d’une infrastructure indépendante s’est rapidement révélée indispensable et a, dès lors, vu le jour dès la fin du mois de mars, sur les deux sites hospitaliers universitaires. Du 2 mars au 3 mai 2020, l’ensemble des données relatives aux visites au sein des centres de tri avancé ont été collectées (nombre d’ad- missions, motif des visites, examens complémentaires et évolutions cliniques). Résultats : sur la période de l’étude, 3.094 patients ont transité par les centres de tri du CHU de Liège. Cette fréquentation était constituée d’un volume global de 3.431 contacts dont 337 représentaient des réad- missions. La sensibilité et la spécificité des centres de tri en regard de la nécessité d’une hospitalisation étaient, respectivement, de 87,9 % et 93,4 %. Conclusion : notre expérience suggère une efficience optimale des centres de tri avancé, en amont des structures hospitalières tradi- tionnelles, pour orienter de manière appropriée le flux des patients suspects d’infection par le SARS-CoV-2. [less ▲]

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See detailCOVID-19 pneumonia and acute pulmonary embolism: a case report
SZECEL, Julien ULiege; GILBERT, Allison ULiege; GHUYSEN, Alexandre ULiege et al

in International Journal of Medical Reviews and Case Reports (2020)

Since December 2019, a novel coronavirus (SARS-Cov2) disease emerged in China with the evidence of multiple cases of severe pneumonia. Since then, various clinical findings and complications related to ... [more ▼]

Since December 2019, a novel coronavirus (SARS-Cov2) disease emerged in China with the evidence of multiple cases of severe pneumonia. Since then, various clinical findings and complications related to that infection have been described. Recently, studies reported various cases of thrombotic events complicating SARS-Cov2 infections. Particularly, the incidence of pulmonary embolism appears to be higher in patients with the novel coronavirus disease. In the presence of clinical and/or biological evocative findings, pulmonary embolism has to be excluded. Recent arguments tend to prone thromboprophylaxis early in specific populations. [less ▲]

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See detailCONTRIBUTION A LA VALIDATION D’UN PROTOCOLE 112 D’ASSISTANCE A LA MISE EN PLACE D’UN GARROT ARTERIEL : UNE ETUDE CONTROLEE ET RANDOMISEE
Poncin, Elodie; Stipulante, Samuel ULiege; Losfeld, Xavier et al

Conference (2020, March 31)

Detailed reference viewed: 28 (2 ULiège)
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See detailSALOMON, un modèle coopératif entre la première et la seconde ligne de soins pour les appels d'urgence nocturnes
BRASSEUR, Edmond ULiege; GILBERT, Allison ULiege; Servotte, Jean-Christophe ULiege et al

in Revue Médicale de Liège (2020), 75(2), 83-88

L’objectif de notre étude est d’apporter une réponse originale à la problématique de la permanence médicale de première ligne liée au vieillissement médical et à la charge de travail croissante. Nous ... [more ▼]

L’objectif de notre étude est d’apporter une réponse originale à la problématique de la permanence médicale de première ligne liée au vieillissement médical et à la charge de travail croissante. Nous proposons, à cet effet, la mise en place d’une interface de régulation des appels en période critique (nuit profonde) au moyen d’un outil algorithmique original dénommé SALOMON («Sys- tème Algorithmique Liégeois d’Orientation pour la Méde- cine Omnipraticienne Nocturne»). En fonction du degré de gravité supputé, la plateforme propose l’orientation opti- male du patient parmi quatre options possibles : renvoi de la demande vers le centre d’appel unifié 112 et prise en charge par les moyens de l’Aide Médicale Urgente (AMU), orientation du malade vers un service d’urgence spécialisé (SUS) de son choix pour une Mise Au Point Hospitalière (MAPH), mise en Contact avec le Médecin Généraliste de garde (CMG) ou enfin prise en charge par une Visite Diffé- rée (VD) via le médecin de famille. Après une description de l’outil, nous présentons l’étude de faisabilité qui a porté sur une période de 12 mois. Cette étude préliminaire était destinée à vérifier la robustesse de SALOMON avant de prévoir, le cas échéant, sa diffusion au sein d’une zone plus vaste. Les résultats préliminaires suggèrent une grande fiabilité de SALOMON. Nous avons également observé que son utilisation était associée à un réel état de satis- faction de l’ensemble des acteurs impliqués, qu’ils aient été infirmiers dispatcheurs ou médecins généralistes. Sous réserve d’une étude à plus grande échelle, les bénéfices actuellement notés en matière d’épargne de ressources humaines durant la garde de première ligne ont rapidement entraîné la fusion de deux zones de garde. [less ▲]

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See detailLe cas clinique du mois. Complication hémorragique d’une forme sévère de maladie de moyamoya
ANGELOZZI, Valeria ULiege; GERMAY, Caroline ULiege; GILBERT, Allison ULiege et al

in Revue Médicale de Liège (2020), 75(2), 75-77

La maladie de moyamoya est une vasculopathie cérébrale souvent méconnue. Sa découverte est majoritairement brutale dans les suites de la survenue d’un accident vasculaire ischémique ou, dans certains cas ... [more ▼]

La maladie de moyamoya est une vasculopathie cérébrale souvent méconnue. Sa découverte est majoritairement brutale dans les suites de la survenue d’un accident vasculaire ischémique ou, dans certains cas, hémorragique. L’artériographie est l’examen de choix pour confirmer le diagnostic. Différentes approches thérapeutiques ont été proposées, qu’elles soient médicamenteuses, endoscopiques ou chirurgicales. Nous présentons le cas d’une jeune patiente chez qui un diagnostic de maladie de moyamoya a été posé dans le décours d’une hémorragie cérébrale avec altération rapide de l’état de conscience. [less ▲]

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See detailInformal fatigue-related risk management in the emergency department: A trade-off between doing well and feeling well
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; GHUYSEN, Alexandre ULiege et al

in Safety Science (2020), 122

Emergency physicians are known to be particularly vulnerable to sleep deprivation due to inconsistent shift rotation, extended duty periods and overnight calls. However, naturalistic studies have actually ... [more ▼]

Emergency physicians are known to be particularly vulnerable to sleep deprivation due to inconsistent shift rotation, extended duty periods and overnight calls. However, naturalistic studies have actually failed to systematically demonstrate that sleep deprivation is associated with poorer work performance in emergency physicians. The inconsistency of these results could reside in physicians’ ability to compensate for fatigue-related impairments. Our aim is to assess the effectiveness of informal fatigue proofing (FPS) and reduction (FRS) strategies used by emergency physicians. We conducted a prospective longitudinal study with 28 emergency physicians (mean age 36.89 ± 10.73 years, 11 females) for a total of 182 shifts. At enrollment, participants answered the Maslach Burnout Inventory and the Fatigue Management Survey. During shifts, we measured fatigue-related impairments using the Psychomotor Vigilance Task and work performance using an adapted version of the Physician Achievement Review. Of the four work performance dimensions addressed, patient interaction was the only one associated with decreased reaction time (F = 27.61, p < 0.001). Our findings revealed a significant interaction between reaction time and FPS frequency of use for the patient interaction (F = 4.91, p = 0.03) and self-management subscales (F = 5.92, p = 0.02). However, the frequency of use of FPS were found to be positively associated with early symptoms of burnout (β = 0.79, p < 0.001). Finally, our results show that FRS frequency was associated with decreased reaction time (F = 8.02, p = 0.01) with no associated risk of burnout. We propose further considerations for the implementation and follow-up of a fatigue risk management system in the emergency department. [less ▲]

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See detailFatigue-related risk perception among emergency physicians working extended shifts.
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; Ghuysen, Alexandre ULiege et al

in Applied Ergonomics (2020), 82

There is a growing body of studies indicating that extended shift duration has an adverse effect on fatigue, consequently leading to reduced work performance and higher risk of accident. Following modern ... [more ▼]

There is a growing body of studies indicating that extended shift duration has an adverse effect on fatigue, consequently leading to reduced work performance and higher risk of accident. Following modern fatigue risk management systems (FRMS), acceptable performance could be maintained by the mobilization of appropriate mitigation strategies. However, the effective deployment of such strategies assume that workers are able to assess their own level of fatigue-related impairments. In this study, we sought to determine whether emergency physicians’ subjective feelings of sleepiness could provide accurate knowledge of actual fatigue-related impairments while working extended shifts. We conducted a prospective observational study with a within-subjects repeated measures component. We collected sleep logs, sleepiness ratings and reaction times on a Psychomotor Vigilance Task (PVT) at different time points during shifts. Our results show that the PVT is sensitive to sleep loss and fatigue, with a 10% increase in mean reaction time across the shift. Subjective sleepiness, however, showed no significant association with time since awakening and was not a significant predictor of PVT performance. Our results are consistent with experimental studies showing that individuals tend to underestimate fatigue-related impairments when sleep deprived or functioning under adverse circadian phase. The discrepancy between subjective sleepiness and actual fatigue-related impairments may give workers the illusion of being in control and hinder the deployment of mitigation strategies. Further research is needed to determine the relative weight of circadian phase shifting and cumulative sleep deprivation in the decline of self-knowledge in extended shifts. [less ▲]

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See detailSyndrome de veine cave supérieure dans un contexte de volumineux sarcome médiastinal Intravasculaire
HAUSS, Sophie ULiege; Ghuysen, Alexandre ULiege

in Revue medicale de Liege (2020), 75(7-8), 532-536

The superior vena cava (SVC) syndrome associates a series of signs and symptoms caused by an obstruction of the superior vena cava. The etiologies are multiple, but the most common cause is external ... [more ▼]

The superior vena cava (SVC) syndrome associates a series of signs and symptoms caused by an obstruction of the superior vena cava. The etiologies are multiple, but the most common cause is external compression of this vein by a tumor process. The present report concerns a young female with SVC syndrome. The etiology has been shown to be extra-skeletal Ewing's sarcoma extending from the right atrium to the left brachiocephalic trunk and right humeral vein. This diagnosis of tumor was delayed in the present clinical case and the patient developed serious iatrogenic complications during the early hospital management.Le syndrome de veine cave supérieure (SVCS) associe une série de manifestations liées à une obstruction de la veine cave supérieure. Les étiologies en sont multiples, mais la cause la plus fréquente de ce syndrome est une compression externe de la veine par un processus tumoral. Le cas rapporté est celui d’une jeune patiente présentant un SVCS pour lequel l’étiologie se révélera être un sarcome d’Ewing extra-squelettique s’étendant de l’oreillette droite au tronc brachio-céphalique gauche et à la veine humérale droite. Ce diagnostic de masse néoplasique ne sera toutefois posé que tardivement et la patiente développera diverses complications iatrogènes graves durant sa prise en charge hospitalière initiale. [less ▲]

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See detailNouvelle approche de régulation de la demande de soins non planifiés: l'application interactive d'auto-triage ODISSEE
GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege; GHUYSEN, Alexandre ULiege et al

in Revue Médicale de Liège (2020)

La régulation de la demande de soins non planifiés fait partie des approches envisagées pour obtenir une meilleure répartition de la demande de soins parmi les différents intervenants de la santé. En ... [more ▼]

La régulation de la demande de soins non planifiés fait partie des approches envisagées pour obtenir une meilleure répartition de la demande de soins parmi les différents intervenants de la santé. En effet, tant la première ligne de soins que les services d’urgence font face à des flux de patients conséquents, saturant fréquemment les ressources qu’ils possèdent pour y répondre. L’apparition de nouvelles technologies et l’entrée dans la pratique courante de la diffusion de l’information médicale se sont révélées être des précurseurs de nouvelles stratégies adaptatives, mais également de nouveaux défis quotidiens. La création d’une application interactive permettant l’auto-triage du patient vers la ligne de soins la plus appropriée fait intervenir ces différents concepts. Nous avons donc développé une plateforme interactive, l’application ODISSEE (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), permettant au patient d’autoévaluer la gravité de son problème et de bénéficier d’un conseil avisé sur le niveau de soins à envisager. Les protocoles utilisés sont directement issus d’un outil créé précédemment dans notre institution et ayant fait ses preuves durant 5 années d’utilisation, l’outil SALOMON (Système Algorithmique Liégeois d’Orientation pour la Médecine Omnipraticienne Nocturne). La création d’un système interactif d’auto-triage du patient le guidant vers le niveau de soins le plus approprié pourrait être une méthode prometteuse pour la régulation de la demande de soins non planifiés. [less ▲]

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See detailPatient education in case of Oubreak: Adopt the CEdRIC strategy
Pétré, Benoît ULiege; Margat, Aurore; Servotte, Jean-Christophe ULiege et al

in Western Journal of Emergency Medicine (2020), 21(6), 52-60

The current coronavirus disease 2019 (COVID-19) pandemic is forcing healthcare systems around the word to organise care differently than before. Prompt detection and effective triage and isolation of ... [more ▼]

The current coronavirus disease 2019 (COVID-19) pandemic is forcing healthcare systems around the word to organise care differently than before. Prompt detection and effective triage and isolation of potentially infected and infectious patients are essential to preventing unnecessary community exposure. Since there are as yet no medications to treat or vaccines to prevent COVID-19, prevention focuses on self-management strategies, creating patient education challenges for physicians doing triage and testing. This article describes a five-step process for effectively educating, at discharge, patients who are suspected of being infectious and instructed to selfisolate at home. We are proposing the CEdRIC strategy as a practical, straightforward protocol that meets patient education and health psychology science requirements. The main goal of the CEdRIC process is to give patients self-management strategies aimed at preventing complications and disease transmission. The COVID-19 pandemic is challenging clinicians to rapidly teach their patients self-management strategies while managing the inherent pressures of this emergency situation. The CEdRIC strategy is designed to deliver key information to patients and standardize the discharge process. CEdRIC is currently being tested at triage centres in Belgium. Formal assessment of its implementation is still needed. [less ▲]

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See detailDevelopment and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19.
Servotte, Jean-Christophe ULiege; Welch-Horan, T. Bram; Mullan, Paul et al

in Advances in Simulation (2020), 5(1), 32

BACKGROUND: Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical ... [more ▼]

BACKGROUND: Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic. METHODS: We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10-25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed. RESULTS: During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7-13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%). CONCLUSION: Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE. [less ▲]

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See detailImmersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience
GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege; PETIT, Meredith ULiege et al

in Acta Clinica Belgica (2020)

Objectives: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective ... [more ▼]

Objectives: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective solution proposed in disaster medicine, also works well to manage Emergency Department (ED) flow. The aim of this study was to describe the role of an ED Triage Center for patients with suspected novel coronavirus disease (Covid-19) and character- ize the patient flow. Methods: In March 2020, we established a Covid-19 triage center close to the Liège University EDs. From March 2 to March 23, we planned to analyze the specific flow of patients admitted to this triage zone and their characteristics in terms of inner specificities, work-up and manage- ment. During this period, all patients presented to the ED with symptoms suggestive of Covid- 19 were included in the study. Results: A total amount of 1071 patients presented to the triage center during the study period. 41.50% of the patients presented with flu-like symptoms. In 82.00% of the cases, no risk factor of virus transmission was found. The SARS-Cov2 positive patients represented 29.26% of the screened patients. 83.00% of patients were discharged home while 17.00% were admitted to the hospital. Conclusion: Our experience suggests that triage centers for the assessment and management of Covid-19 suspected patients is an essential key strategy to prevent the spread of the disease among non-symptomatic patients who present to the EDs for care. This allows for a disease- centered work-up and safer diversion of Covid-19 patients to specific hospital units. [less ▲]

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See detailVirtual reality experience: immersion, sense of presence and cybersickness
Servotte, Jean-Christophe ULiege; Goosse, Manon ULiege; Campbell, Suzanne et al

in Clinical Simulation in Nursing (2020)

Detailed reference viewed: 150 (66 ULiège)