Publications of Alexandre GHUYSEN
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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 detailMachine learning algorithms performed no better than regression models for prognostication in traumatic brain injury
Gravesteijn, Benjamin Y.; Nieboer, Daan; Ercole, Ari et al

in Journal of Clinical Epidemiology (2020), 122

Objective: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting: We performed ... [more ▼]

Objective: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting: We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. Results: In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. Conclusion: ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations. © 2020 The Authors [less ▲]

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See detailEmergency Department Crowding: why do patients walk-in?
BRASSEUR, Edmond ULiege; GILBERT, Allison ULiege; Servotte, Jean-Christophe ULiege et al

in Acta Clinica Belgica (2019)

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See detailPharmacothérapie des formes sévères du sevrage éthylique en milieu hospitalier
GENSBURGER, Mathieu ULiege; Ghuysen, Alexandre ULiege

in Revue Medicale de Liege (2019), 74(5-6), 365-372

Acute alcohol withdrawal is a frequent medical condition among hospitalized patients. Severe forms are associated with significant morbidity and mortality, which can be sharply reduced with proper drug ... [more ▼]

Acute alcohol withdrawal is a frequent medical condition among hospitalized patients. Severe forms are associated with significant morbidity and mortality, which can be sharply reduced with proper drug therapy. A good understanding of the pathophysiology as well as the pharmacokinetic and pharmacodynamic properties of the various drug used is paramount. The medications must target the imbalance between inhibitory and excitatory neurotransmitter systems responsible for the clinical picture. Proper drug therapy allows not only rapid symptomatic relief but also limit disease progression and complications while diminishing resource use, notably invasive ventilation and stay duration in the intensive care unit. GABA agonist drugs are the first line treatment, notably benzodiazepines and barbiturates. Other class, such as alpha-2 adrenoreceptor agonists may be used to control the dysautonomic features of the disease but are at best adjunctive. © 2019 Revue Medicale de Liege. All rights reserved. [less ▲]

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See detailTriage for out-of-hours primary care calls: a reliability study of a new French-language algorithm, the SALOMON rule
BRASSEUR, Edmond ULiege; Servotte, Jean-Christophe ULiege; Donneau, Anne-Françoise ULiege et al

in Scandinavian Journal of Primary Health Care (2019)

Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON ... [more ▼]

Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON (Syst eme Algorithmique Li egeois d’Orientation pour la M edecine Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance of the algorithm using simulated PCP calls. Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON’s inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2). Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 (p<0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively. Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting. [less ▲]

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See detailTime to Embrace Simulation in Vascular Surgical Training: Little Things Matter
Boyle, Jonathan Robert; Ghuysen, Alexandre ULiege; D'Orio, Vincenzo ULiege et al

in European Journal of Vascular and Endovascular Surgery (2019), 58(2), 161-162

[No abstract available]

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See detailEfficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department
Servotte, Jean-Christophe ULiege; Bragard, Isabelle ULiege; Szyld, Demian et al

in Western Journal of Emergency Medicine (2019), 20(6),

Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such ... [more ▼]

Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived selfefficacy, the BBN process, and communication skills. [less ▲]

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See detailCorrection to: Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study.
van Essen, Thomas A.; den Boogert, Hugo F.; Cnossen, Maryse C. et al

in Acta Neurochirurgica (2019), 161(3), 451-455

The collaborator names are inverted.

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See detailFatigue‐related risk management in the emergency department: a focus‐group study
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; GHUYSEN, Alexandre ULiege et al

in Internal and Emergency Medicine (2018)

Fatigue has major implications on both patient safety and healthcare practitioner’s well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a ... [more ▼]

Fatigue has major implications on both patient safety and healthcare practitioner’s well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue. Our purpose is to investigate individual proofing and reduction strategies used by emergency physicians to manage fatigue-related risk. 25 emergency physicians were recruited for the study. Four focus groups were formed which consisted of an average of six individuals. Qualitative data were collected using a semi-structured discussion guide unfolding in two parts. First, the participants were asked to describe how on-the-job fatigue a ected their e ciency at work. A mind map was progressively drawn based upon the participants’ perceived effects of fatigue. Second, participants were asked to describe any strategies they personally used to cope with these effects. We used inductive qualitative content analysis to reveal content themes for both fatigue effects and strategies. Emergency physicians reported 28 fatigue effects, 12 reduction strategies and 21 proofing strategies. Content analysis yielded a further classification of proofing strategies into self-regulation, task re-allocation and error monitoring strategies. There is significant potential for the development of more formal processes based on physicians’ informal strategies. [less ▲]

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See detailPlace de la simulation et de la réalité virtuelle dans la formation : développement d’un environnement de réalité virtuelle en médecine de catastrophe
Servotte, Jean-Christophe ULiege; Ghuysen, Alexandre ULiege; Goosse, Manon ULiege et al

Conference (2018, March 17)

cette communication vise à présenter la place de la réalité virtuelle en simulation ainsi que le développement d'un environnement en médecine de catastrophe

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See detailPregnant women in ED : a new specific triage algorithm
JOBE, Jérôme ULiege; POISMANS, Gaëlle ULiege; GHUYSEN, Alexandre ULiege

Poster (2018, January 20)

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See detailReliability of the computerized version of the ELISA scale at the University Hospital of Liège.
JOBE, Jérôme ULiege; Dewalque, Amélie; GHUYSEN, Alexandre ULiege

Conference (2018, January 20)

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See detailSécurité d’administration des médicaments : comparaison de l’impact d’une formation par simulation et des stages cliniques
Servotte, Jean-Christophe ULiege; Bragard, Isabelle ULiege; Galerin, Catherine et al

Poster (2018, January 20)

Introduction : La probabilité de subir au moins une erreur médicamenteuse est un problème quotidien pour le patient hospitalisé (Donaldson et al., 2017 ; IOM, 2006), qui touche, dans deux tiers des cas ... [more ▼]

Introduction : La probabilité de subir au moins une erreur médicamenteuse est un problème quotidien pour le patient hospitalisé (Donaldson et al., 2017 ; IOM, 2006), qui touche, dans deux tiers des cas, l’administration intra-veineuse (Ross et al., 2000 ; Gissinger, 2010, Ross et al., 2000). Pareilles erreurs entrainent une surmortalité et un accroissement considérable des coûts des soins de santé (Goodstone & Goodstone, 2013). Les infirmiers récemment diplômés étant particulièrement exposés au risque de commettre ce type erreur (Cloete, 2015), nous nous sommes dès lors interrogés sur l’impact potentiel d’une formation à la sécurité d’administration des médicaments intraveineux utilisant les modalités de la simulation, en comparaison avec le stage seul. Matériels et méthodes : L’ensemble des étudiants infirmiers de deuxième année (n=99), de la Haute Ecole Namur-Liège-Luxembourg, ont été répartis de manière aléatoire en deux groupes : formé (GF, n = 49) ou non (GC, n = 50). Les deux groupes ont été évalués à deux reprises, au début et à la fin d’un stage de quatre semaines. La formation incluait un carnet de préparation (bases théoriques et calculs de débit) et une séance de simulation de trois heures utilisant des patients standardisés dans 5 scénarii. L’évaluation comportait un exercice structuré ayant pour thème la modification des débits de perfusions et de pousses-seringues. Des questionnaires ont collecté des données sociodémographiques et évalué les connaissances ainsi que le sentiment d’auto-efficacité des participants. Résultats : Le sentiment d’auto-efficacité s’est amélioré uniquement dans le GF (gain : 19% ; p < 0,001). Les connaissances se sont améliorées dans le GC (+ 45%) et le GF (+150%), et la différence d’amélioration est significative (p<0,001). Les compétences se sont améliorées également davantage pour le GF (+128,5%) que pour le GC (+47,2%) avec une différence significative (p < 0,001). Discussion et Conclusions : La formation utilisant la simulation offre des perspectives intéressantes en matière de sécurité d’administration des médicaments intraveineux. Elle semble être plus efficace que la formation traditionnelle des étudiants en soins infirmiers. Des études complémentaires sont actuellement en cours afin de vérifier son impact réel sur le terrain. [less ▲]

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