Objectives:Due to the persistent primary care physicians shortage and the substantial increase in... more Objectives:Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings. Methods:In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered. Results:10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively. Conclusion:SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.
Ob s e rvat i O n c l i n i q u e Un homme de 68 ans est admis au service des urgences pour un ta... more Ob s e rvat i O n c l i n i q u e Un homme de 68 ans est admis au service des urgences pour un tableau de douleurs abdominales diffuses, crampoïdes, accompagnées de vomissements. Il signale un arrêt des selles et des gaz depuis 48h. L'examen clinique est marqué par un ballonnement abdominal, un transit aboli et, à la palpation abdominale, des douleurs diffuses sans défense, ni contracture. Dans les antécédents, on relève principalement une péritonite sur appendicite aiguë dans l'enfance et, trois mois avant l'épisode qui nous intéresse, une cure de hernie inguinale gauche avec mise en place d'une plaque prothétique de renforcement pariétal extra-péritonéal. L'analyse sanguine révèle un syndrome inflammatoire isolé sans hyperleucocytose. Une tomodensitométrie abdominale avec injection de contraste est réalisée et permet la mise en évidence d'une occlusion grêle dont l'étiologie n'est pas formellement établie, mais attribuée à une probable bride ou adhérence. Un traitement médical conservateur est instauré mais, devant l'absence d'amélioration clinique après 48 heures, une laparotomie est réalisée. De manière assez inattendue, le problème occlusif se situe non pas dans les régions
Aims Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after hea... more Aims Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after heart surgery. Despite limited accuracy, serum creatinine is widely used to estimate glomerular filtration rate (GFR). Cystatin C is more accurate for assessing GFR. The aim of the present study was to assess associations between GFR estimated from serum cystatin C levels before heart surgery and hospital mortality, hospital morbidity, and 1 year mortality. Methods and results In a prospective single-centre observational study, clinical risk factors for morbidity and mortality were recorded and serum creatinine and cystatin C levels were measured in patients admitted for heart surgery. Hospital mortality and morbidity and 1 year mortality were recorded. Over an 8 month period, 499 patients were screened, among whom 376 (74.5%) were included in the study. Hospital mortality was 5.6% (21 patients) and 1 year mortality was 10.2%. Hospital morbidity, defined by a length of stay above the 75th percentile, was 22.1% (83 patients). In the multivariable analysis, GFR estimated from serum cystatin C, but not GFR estimated from serum creatinine, was an independent risk factor for hospital morbidity/mortality (odds ratio per 10 mL/min of GFR decrease, 1.20 (1.07-1.34), P ¼ 0.001) and for 1 year mortality (hazards ratio per 10 mL/min of GFR decrease, 1.26 (1.09-1.46), P ¼ 0.002). Conclusion Pre-operative GFR estimation from serum cystatin C may provide a better risk assessment than pre-operative GFR estimation from serum creatinine in patients scheduled for heart surgery.
Computer Methods in Biomechanics and Biomedical Engineering, 2005
Rapid restoration of coronary blood flow following a period of myocardial ischemia (due to corona... more Rapid restoration of coronary blood flow following a period of myocardial ischemia (due to coronary occlusion) is mandatory to preserve the cardiac muscle. Reperfusion, however, not necessarily restores cardiac function, and cellular damage of the cardiac muscle cells following reperfusion (reperfusion injury) is well documented. The aim of this study was to investigate the effects of reperfusion on left ventricular (LV) hemodynamics and on left ventriculo-arterial (VA) coupling in acutely ischemic pigs.
Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implem... 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.
American Journal of Respiratory and Critical Care Medicine, 2001
... Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 338-339 Prevention of Vent... more ... Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 338-339 Prevention of Ventilator-associated Pneumonia by Oral Decontamination Just Another SDD Study? Didier Pittet, MS, Philippe Eggimann, MD, and Bina Rubinovitch, MD. ...
Objectives: Primary care treatable visits in the Emergency Department (ED) are part of the differ... more Objectives: Primary care treatable visits in the Emergency Department (ED) are part of the different factors leading to the overcrowding. Their triage and diversion to alternative care centers could potentially help manage the increasing E inflow provided the establishment of an advanced triage to ensure patients' safety. We aim to suggest a new triage tool, PERSEE, and prove its feasibility, safety and performance.Methods: All self-referrals presented to the ED were triaged with the PERSEE algorithm: first, patients were classified with a five-level ED acuity scale and then evaluated by algorithms to determine their appropriate category (ED or Primary Care). Patients were eligible for a redirection if they were triaged by the acuity scale as level 3 or lower, considered as ambulatory patients and finally categorized as primary care patients. We defined appropriate redirections as patients requiring less than three emergency resources, no emergency-specific treatment and no hospitalization.Results: During the study, 1999 patients were admitted to the ED. Among those, 1333 patients were self-referred (66.9%) of whom 1167 patients were triaged as level 3 or below (58.6%) and 775 patients triaged as ambulatory (39.0%). Among the 775 patients, 200 patients were categorized as primary care treatable (10.0%) and thereby, as potentially eligible for a redirection. We noticed an error rate of 7%, sensitivity of 24.06% and specificity of 97.6%. The redirection rate reached 15% of the self-referrals.Conclusion: These results indicate that PERSEE triage could lead to a safe redirection and could be an efficient tool to reduce ED crowding provided several adjustments.
known in folklore medicine for its varied therapeutic potential. petroleum ether, benzene, ethyl ... more known in folklore medicine for its varied therapeutic potential. petroleum ether, benzene, ethyl acetate, methanol and ethanol extract of leaf of mysorense superoxide, ABTS and reducing power. The scavenging effect increases with the concentration of standard and samples. Among the solvent tested, ethanol extract exhibited highest DPPH (116.33% inhibition), hydroxyl (101.84%) scavenger activity. Methanol extract of aim and purpose of this study is to show the significant free radical scavenging potential of mysorense ailments. Key This article is distributed under the terms of the and redistribution provided that the original author and source are credited.
Objectives: For years, general practitioners (GP) shortage and patients' increasing demand for ac... more Objectives: For years, general practitioners (GP) shortage and patients' increasing demand for acute care have been associated with Emergency Department (ED) crowding. Indeed, EDs admissions for non-emergency care seem to constantly increase. Surprisingly, the rationale for patients own decision to directly reach EDs over primary care have been poorly investigated to date. Methods: We conducted a study on patients admitted in two University EDs during nine consecutive days. Patients were asked to answer a survey about their frames for coming and if they were self-referred, referred by a GP, a specialist or after calling the Emergency Number. Results: During the study period, 68.0% of patients were self-referred, 17.0% referred by their GP, 8.5% by a specialist and 7% after an emergency call. 51.0% of the self-referrals thought EDs were the appropriate location to deal with their health problem and 24.0% because of a better accessibility. We noticed that 15.0% of the incomings looked for specialized care and 4.22% reported that the stress had motivated them. Of note, 4.6% of the patients were attracted by the hospital reputation. Financial concerns represented less than 1.0% of the motives invocated. Conclusion: We found that patients' self-perceived severity of illness is the predominant frame to each the ED when they face needs for acute care. EDs' accessibility as compared with other facilities also seems to encourage patients to come to the ED. Other factors such as the hospital reputation or patients' stress tend to influence ED attendance but to a much lesser extent.
Although electrical networks are used with increasing insistence in both clinical and experimenta... more Although electrical networks are used with increasing insistence in both clinical and experimental investigations to describe hemodynamic properties of the arterial vasculafure, the rationale for the selection of a particular model is, however, rarely discussed. In most cases the mathematical procedure is time consuming, highly specific and thereby, reproducible with great difficulties. The aim of the present paper is to provide a rapid method of analysis which supports the identification of parameters together with the choice of the best analog model. Five models with gradual complexity and described by a second order differential equation are considered. Selection and identification is performed through il multiple regression in the time domain.
Background The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant ... more Background The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant morbidities, severe acute respiratory failures and subsequently emergency departments’ (EDs) overcrowding in a context of insufficient laboratory testing capacities. The development of decision support tools for real-time clinical diagnosis of COVID-19 is of prime importance to assist patients’ triage and allocate resources for patients at risk. Methods and principal findings From March 2 to June 15, 2020, clinical patterns of COVID-19 suspected patients at admission to the EDs of Liège University Hospital, consisting in the recording of eleven symptoms (i.e. dyspnoea, chest pain, rhinorrhoea, sore throat, dry cough, wet cough, diarrhoea, headache, myalgia, fever and anosmia) plus age and gender, were investigated during the first COVID-19 pandemic wave. Indeed, 573 SARS-CoV-2 cases confirmed by qRT-PCR before mid-June 2020, and 1579 suspected cases that were subsequently determined to b...
Background: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While ... more Background: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While mitigating unnecessary crowding in hospitals is favourable to reduce viral transmission, it is more important to prevent readmissions with impaired clinical status due to initially inappropriate level of care. A validated predictive tool to assist clinical decisions for patient triage and facilitate remote stratification is of critical importance. Methods: We conducted a retrospective study in patients with confirmed COVID-19 stratified into two levels of care, namely ambulatory care and hospitalization. Data on socio-demographics, clinical symptoms, and comorbidities were collected during the first (N ¼ 571) and second waves (N ¼ 174) of the pandemic in Belgium (2 March to 6 December 2020). Univariate and multivariate logistic regressions were performed to build and validate the prediction model.
European Journal of Case Reports in Internal Medicine, 2019
Parsonage-Turner syndrome, also known as neuralgic amyotrophy, is a rare disorder characterized b... more Parsonage-Turner syndrome, also known as neuralgic amyotrophy, is a rare disorder characterized by painful clinical manifestations mainly involving the upper limbs. This syndrome seems to be triggered, among other factors, by some viral infections, although its pathophysiology remains unclear. Moreover, it has rarely been related to hepatitis E virus infection. We report the case of a 33-year-old man who was diagnosed with Parsonage-Turner syndrome following acute hepatitis E infection.
3. Maintain and improve physical conditioning through early exercise and mobility. 21-28 [level C... more 3. Maintain and improve physical conditioning through early exercise and mobility. 21-28 [level C] 4. Elevate the head of bed (HOB) to 30º to 45º unless clinically contraindicated in patients receiving mechanical ventilation, as well as patients at high risk for aspiration. 29-32 [level C] 5. Minimize pooling of secretions above the endotracheal tube cuff by using an endotracheal tube with subglottic suction capability in patients with anticipated intubation greater than 48 to 72 hours. 33-39 [level C] 6. Change ventilator circuits only if visibly soiled; do not change ventilator circuits routinely. 40-43
Canadian journal of veterinary research = Revue canadienne de recherche vétérinaire, 1995
Forty-one and 55 records of right-sided and systemic arterial pressures, cardiac output, and end-... more Forty-one and 55 records of right-sided and systemic arterial pressures, cardiac output, and end-diastolic and end-systolic right ventricular volumes were collected from a group of 6 conventional and 6 double-muscled calves, respectively. In each group, the mean right ventricular pressure-volume loop was constructed. Global cardiac performance was significantly lower in the double-muscled than in the conventional calves. The right ventricular end-diastolic and end-systolic volumes, as well as the diastolic portion of the mean pressure-volume loop, were similar in the 2 groups. Those results suggest that the reduced cardiac performance of double-muscled calves is not due to a lowered ventricular preload and that diastolic properties of their myocardium are similar to those of conventional calves. When expressed on a body weight basis, however, the right ventricular end-diastolic and end-systolic volumes were lower in the double-muscled than in conventional calves. When expressed as a...
Although reperfusion after coronary occlusion is mandatory for myocardial salvage, reperfusion ma... more Although reperfusion after coronary occlusion is mandatory for myocardial salvage, reperfusion may trigger a cascade of harmful events (reperfusion injury) adding to myocardial injury. We investigated effects of reperfusion on left ventricular (LV) haemodynamics and ventriculoarterial (VA) coupling in pigs following acute myocardial ischaemia induced by coronary artery occlusion. Experiments were performed in six animals, with measurements of cardiac and arterial function at baseline, after 60 min of ischaemia (T60) and after 2 (T180) and 4 h of reperfusion (T300). Ventriculo-arterial coupling was assessed using the ventriculo-arterial elastance ratio of paper, as well as using a 'stiffness coupling' and 'temporal coupling' index. Reperfusion following ischaemia (T180 versus T60) induced a progressive decline in cardiovascular function, evidenced by a decrease in mean arterial blood pressure, cardiac output and ejection fraction which was not restored at T300. Although reperfusion also induced an increase in slope of the end-systolic pressure-volume relationship (ESPVR), the ESPVR curve shifted to the right, associated with a depression of contractile function. Histology demonstrated irreversible myocardial damage at T300. The ventriculo-arterial elastance ratio and the 'stiffness coupling' index were unaffected throughout the protocol, but the 'temporal coupling' parameter indicated a relative shift between heart period and the time constant of the arterial system. It is unlikely that these alterations are attributable to ischaemic injury alone. The combination of both the stiffness and temporal coupling index may provide more information when studying ventriculo-arterial coupling than the more commonly used ventricular end-systolic stiffness/effection arterial elastance (E es /E a ) ratio.
The aim of this study was to investigate left ventricular contractility and energetic cost of car... more The aim of this study was to investigate left ventricular contractility and energetic cost of cardiac ejection under conditions of acute increase in aortic compliance. Methods: In six anaesthetized pigs, ascending aortic compliance was increased by adding a volume chamber in parallel to the ascending aorta. Systemic vascular parameters, including characteristic impedance, peripheral resistance, total vascular compliance, and inertance, were estimated with a four-element windkessel model. Arterial elastance was derived from these parameters. Left ventricular systolic function was assessed by end-systolic pressure±volume relationship (end-systolic elastance), and stroke work. Pressure±volume area was used as a measure of myocardial oxygen consumption. Heart rate remained constant during the experimentation. Results: Adding the aortic volume chamber signi®cantly increased vascular compliance from 0.95^0.08 to 1.17^0.06 ml/ mmHg (P , 0:01), while inductance, characteristic impedance, peripheral resistance, and arterial elastance remained statistically at basal values, respectively 0.0020^0.0003 mmHg.s 2 /ml, 0.105^0.009 mmHg.s/ml, 1.27^0.12 mmHg.s/ml, and 2.43^0.21 mmHg/ml. During the same interval, stroke work and pressure±volume area decreased respectively from 2700^242 to 2256^75 mmHg.ml (P , 0:01), and from 3806^427 to 3179^167 mmHg.ml (P , 0:01). Stroke work and pressure±volume area decreased at matched end-diastolic volumes. In contrast, end-systolic elastance, ejection fraction, and stroke volume remained statistically unchanged, respectively at 2.29^0.14 mmHg/ ml, 48.1^2.1 %, and 32.4^1.7 ml. Conclusions: These data suggest that, when facing an increased aortic compliance, the left ventricle displays unchanged contractility, but the energetic cost of cardiac ejection is signi®cantly decreased. These data may be of clinical importance when choosing an arti®cial prosthesis for ascending aortic replacement.
Objectives:Due to the persistent primary care physicians shortage and the substantial increase in... more Objectives:Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings. Methods:In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered. Results:10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively. Conclusion:SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.
Ob s e rvat i O n c l i n i q u e Un homme de 68 ans est admis au service des urgences pour un ta... more Ob s e rvat i O n c l i n i q u e Un homme de 68 ans est admis au service des urgences pour un tableau de douleurs abdominales diffuses, crampoïdes, accompagnées de vomissements. Il signale un arrêt des selles et des gaz depuis 48h. L'examen clinique est marqué par un ballonnement abdominal, un transit aboli et, à la palpation abdominale, des douleurs diffuses sans défense, ni contracture. Dans les antécédents, on relève principalement une péritonite sur appendicite aiguë dans l'enfance et, trois mois avant l'épisode qui nous intéresse, une cure de hernie inguinale gauche avec mise en place d'une plaque prothétique de renforcement pariétal extra-péritonéal. L'analyse sanguine révèle un syndrome inflammatoire isolé sans hyperleucocytose. Une tomodensitométrie abdominale avec injection de contraste est réalisée et permet la mise en évidence d'une occlusion grêle dont l'étiologie n'est pas formellement établie, mais attribuée à une probable bride ou adhérence. Un traitement médical conservateur est instauré mais, devant l'absence d'amélioration clinique après 48 heures, une laparotomie est réalisée. De manière assez inattendue, le problème occlusif se situe non pas dans les régions
Aims Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after hea... more Aims Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after heart surgery. Despite limited accuracy, serum creatinine is widely used to estimate glomerular filtration rate (GFR). Cystatin C is more accurate for assessing GFR. The aim of the present study was to assess associations between GFR estimated from serum cystatin C levels before heart surgery and hospital mortality, hospital morbidity, and 1 year mortality. Methods and results In a prospective single-centre observational study, clinical risk factors for morbidity and mortality were recorded and serum creatinine and cystatin C levels were measured in patients admitted for heart surgery. Hospital mortality and morbidity and 1 year mortality were recorded. Over an 8 month period, 499 patients were screened, among whom 376 (74.5%) were included in the study. Hospital mortality was 5.6% (21 patients) and 1 year mortality was 10.2%. Hospital morbidity, defined by a length of stay above the 75th percentile, was 22.1% (83 patients). In the multivariable analysis, GFR estimated from serum cystatin C, but not GFR estimated from serum creatinine, was an independent risk factor for hospital morbidity/mortality (odds ratio per 10 mL/min of GFR decrease, 1.20 (1.07-1.34), P ¼ 0.001) and for 1 year mortality (hazards ratio per 10 mL/min of GFR decrease, 1.26 (1.09-1.46), P ¼ 0.002). Conclusion Pre-operative GFR estimation from serum cystatin C may provide a better risk assessment than pre-operative GFR estimation from serum creatinine in patients scheduled for heart surgery.
Computer Methods in Biomechanics and Biomedical Engineering, 2005
Rapid restoration of coronary blood flow following a period of myocardial ischemia (due to corona... more Rapid restoration of coronary blood flow following a period of myocardial ischemia (due to coronary occlusion) is mandatory to preserve the cardiac muscle. Reperfusion, however, not necessarily restores cardiac function, and cellular damage of the cardiac muscle cells following reperfusion (reperfusion injury) is well documented. The aim of this study was to investigate the effects of reperfusion on left ventricular (LV) hemodynamics and on left ventriculo-arterial (VA) coupling in acutely ischemic pigs.
Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implem... 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.
American Journal of Respiratory and Critical Care Medicine, 2001
... Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 338-339 Prevention of Vent... more ... Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 338-339 Prevention of Ventilator-associated Pneumonia by Oral Decontamination Just Another SDD Study? Didier Pittet, MS, Philippe Eggimann, MD, and Bina Rubinovitch, MD. ...
Objectives: Primary care treatable visits in the Emergency Department (ED) are part of the differ... more Objectives: Primary care treatable visits in the Emergency Department (ED) are part of the different factors leading to the overcrowding. Their triage and diversion to alternative care centers could potentially help manage the increasing E inflow provided the establishment of an advanced triage to ensure patients' safety. We aim to suggest a new triage tool, PERSEE, and prove its feasibility, safety and performance.Methods: All self-referrals presented to the ED were triaged with the PERSEE algorithm: first, patients were classified with a five-level ED acuity scale and then evaluated by algorithms to determine their appropriate category (ED or Primary Care). Patients were eligible for a redirection if they were triaged by the acuity scale as level 3 or lower, considered as ambulatory patients and finally categorized as primary care patients. We defined appropriate redirections as patients requiring less than three emergency resources, no emergency-specific treatment and no hospitalization.Results: During the study, 1999 patients were admitted to the ED. Among those, 1333 patients were self-referred (66.9%) of whom 1167 patients were triaged as level 3 or below (58.6%) and 775 patients triaged as ambulatory (39.0%). Among the 775 patients, 200 patients were categorized as primary care treatable (10.0%) and thereby, as potentially eligible for a redirection. We noticed an error rate of 7%, sensitivity of 24.06% and specificity of 97.6%. The redirection rate reached 15% of the self-referrals.Conclusion: These results indicate that PERSEE triage could lead to a safe redirection and could be an efficient tool to reduce ED crowding provided several adjustments.
known in folklore medicine for its varied therapeutic potential. petroleum ether, benzene, ethyl ... more known in folklore medicine for its varied therapeutic potential. petroleum ether, benzene, ethyl acetate, methanol and ethanol extract of leaf of mysorense superoxide, ABTS and reducing power. The scavenging effect increases with the concentration of standard and samples. Among the solvent tested, ethanol extract exhibited highest DPPH (116.33% inhibition), hydroxyl (101.84%) scavenger activity. Methanol extract of aim and purpose of this study is to show the significant free radical scavenging potential of mysorense ailments. Key This article is distributed under the terms of the and redistribution provided that the original author and source are credited.
Objectives: For years, general practitioners (GP) shortage and patients' increasing demand for ac... more Objectives: For years, general practitioners (GP) shortage and patients' increasing demand for acute care have been associated with Emergency Department (ED) crowding. Indeed, EDs admissions for non-emergency care seem to constantly increase. Surprisingly, the rationale for patients own decision to directly reach EDs over primary care have been poorly investigated to date. Methods: We conducted a study on patients admitted in two University EDs during nine consecutive days. Patients were asked to answer a survey about their frames for coming and if they were self-referred, referred by a GP, a specialist or after calling the Emergency Number. Results: During the study period, 68.0% of patients were self-referred, 17.0% referred by their GP, 8.5% by a specialist and 7% after an emergency call. 51.0% of the self-referrals thought EDs were the appropriate location to deal with their health problem and 24.0% because of a better accessibility. We noticed that 15.0% of the incomings looked for specialized care and 4.22% reported that the stress had motivated them. Of note, 4.6% of the patients were attracted by the hospital reputation. Financial concerns represented less than 1.0% of the motives invocated. Conclusion: We found that patients' self-perceived severity of illness is the predominant frame to each the ED when they face needs for acute care. EDs' accessibility as compared with other facilities also seems to encourage patients to come to the ED. Other factors such as the hospital reputation or patients' stress tend to influence ED attendance but to a much lesser extent.
Although electrical networks are used with increasing insistence in both clinical and experimenta... more Although electrical networks are used with increasing insistence in both clinical and experimental investigations to describe hemodynamic properties of the arterial vasculafure, the rationale for the selection of a particular model is, however, rarely discussed. In most cases the mathematical procedure is time consuming, highly specific and thereby, reproducible with great difficulties. The aim of the present paper is to provide a rapid method of analysis which supports the identification of parameters together with the choice of the best analog model. Five models with gradual complexity and described by a second order differential equation are considered. Selection and identification is performed through il multiple regression in the time domain.
Background The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant ... more Background The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant morbidities, severe acute respiratory failures and subsequently emergency departments’ (EDs) overcrowding in a context of insufficient laboratory testing capacities. The development of decision support tools for real-time clinical diagnosis of COVID-19 is of prime importance to assist patients’ triage and allocate resources for patients at risk. Methods and principal findings From March 2 to June 15, 2020, clinical patterns of COVID-19 suspected patients at admission to the EDs of Liège University Hospital, consisting in the recording of eleven symptoms (i.e. dyspnoea, chest pain, rhinorrhoea, sore throat, dry cough, wet cough, diarrhoea, headache, myalgia, fever and anosmia) plus age and gender, were investigated during the first COVID-19 pandemic wave. Indeed, 573 SARS-CoV-2 cases confirmed by qRT-PCR before mid-June 2020, and 1579 suspected cases that were subsequently determined to b...
Background: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While ... more Background: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While mitigating unnecessary crowding in hospitals is favourable to reduce viral transmission, it is more important to prevent readmissions with impaired clinical status due to initially inappropriate level of care. A validated predictive tool to assist clinical decisions for patient triage and facilitate remote stratification is of critical importance. Methods: We conducted a retrospective study in patients with confirmed COVID-19 stratified into two levels of care, namely ambulatory care and hospitalization. Data on socio-demographics, clinical symptoms, and comorbidities were collected during the first (N ¼ 571) and second waves (N ¼ 174) of the pandemic in Belgium (2 March to 6 December 2020). Univariate and multivariate logistic regressions were performed to build and validate the prediction model.
European Journal of Case Reports in Internal Medicine, 2019
Parsonage-Turner syndrome, also known as neuralgic amyotrophy, is a rare disorder characterized b... more Parsonage-Turner syndrome, also known as neuralgic amyotrophy, is a rare disorder characterized by painful clinical manifestations mainly involving the upper limbs. This syndrome seems to be triggered, among other factors, by some viral infections, although its pathophysiology remains unclear. Moreover, it has rarely been related to hepatitis E virus infection. We report the case of a 33-year-old man who was diagnosed with Parsonage-Turner syndrome following acute hepatitis E infection.
3. Maintain and improve physical conditioning through early exercise and mobility. 21-28 [level C... more 3. Maintain and improve physical conditioning through early exercise and mobility. 21-28 [level C] 4. Elevate the head of bed (HOB) to 30º to 45º unless clinically contraindicated in patients receiving mechanical ventilation, as well as patients at high risk for aspiration. 29-32 [level C] 5. Minimize pooling of secretions above the endotracheal tube cuff by using an endotracheal tube with subglottic suction capability in patients with anticipated intubation greater than 48 to 72 hours. 33-39 [level C] 6. Change ventilator circuits only if visibly soiled; do not change ventilator circuits routinely. 40-43
Canadian journal of veterinary research = Revue canadienne de recherche vétérinaire, 1995
Forty-one and 55 records of right-sided and systemic arterial pressures, cardiac output, and end-... more Forty-one and 55 records of right-sided and systemic arterial pressures, cardiac output, and end-diastolic and end-systolic right ventricular volumes were collected from a group of 6 conventional and 6 double-muscled calves, respectively. In each group, the mean right ventricular pressure-volume loop was constructed. Global cardiac performance was significantly lower in the double-muscled than in the conventional calves. The right ventricular end-diastolic and end-systolic volumes, as well as the diastolic portion of the mean pressure-volume loop, were similar in the 2 groups. Those results suggest that the reduced cardiac performance of double-muscled calves is not due to a lowered ventricular preload and that diastolic properties of their myocardium are similar to those of conventional calves. When expressed on a body weight basis, however, the right ventricular end-diastolic and end-systolic volumes were lower in the double-muscled than in conventional calves. When expressed as a...
Although reperfusion after coronary occlusion is mandatory for myocardial salvage, reperfusion ma... more Although reperfusion after coronary occlusion is mandatory for myocardial salvage, reperfusion may trigger a cascade of harmful events (reperfusion injury) adding to myocardial injury. We investigated effects of reperfusion on left ventricular (LV) haemodynamics and ventriculoarterial (VA) coupling in pigs following acute myocardial ischaemia induced by coronary artery occlusion. Experiments were performed in six animals, with measurements of cardiac and arterial function at baseline, after 60 min of ischaemia (T60) and after 2 (T180) and 4 h of reperfusion (T300). Ventriculo-arterial coupling was assessed using the ventriculo-arterial elastance ratio of paper, as well as using a 'stiffness coupling' and 'temporal coupling' index. Reperfusion following ischaemia (T180 versus T60) induced a progressive decline in cardiovascular function, evidenced by a decrease in mean arterial blood pressure, cardiac output and ejection fraction which was not restored at T300. Although reperfusion also induced an increase in slope of the end-systolic pressure-volume relationship (ESPVR), the ESPVR curve shifted to the right, associated with a depression of contractile function. Histology demonstrated irreversible myocardial damage at T300. The ventriculo-arterial elastance ratio and the 'stiffness coupling' index were unaffected throughout the protocol, but the 'temporal coupling' parameter indicated a relative shift between heart period and the time constant of the arterial system. It is unlikely that these alterations are attributable to ischaemic injury alone. The combination of both the stiffness and temporal coupling index may provide more information when studying ventriculo-arterial coupling than the more commonly used ventricular end-systolic stiffness/effection arterial elastance (E es /E a ) ratio.
The aim of this study was to investigate left ventricular contractility and energetic cost of car... more The aim of this study was to investigate left ventricular contractility and energetic cost of cardiac ejection under conditions of acute increase in aortic compliance. Methods: In six anaesthetized pigs, ascending aortic compliance was increased by adding a volume chamber in parallel to the ascending aorta. Systemic vascular parameters, including characteristic impedance, peripheral resistance, total vascular compliance, and inertance, were estimated with a four-element windkessel model. Arterial elastance was derived from these parameters. Left ventricular systolic function was assessed by end-systolic pressure±volume relationship (end-systolic elastance), and stroke work. Pressure±volume area was used as a measure of myocardial oxygen consumption. Heart rate remained constant during the experimentation. Results: Adding the aortic volume chamber signi®cantly increased vascular compliance from 0.95^0.08 to 1.17^0.06 ml/ mmHg (P , 0:01), while inductance, characteristic impedance, peripheral resistance, and arterial elastance remained statistically at basal values, respectively 0.0020^0.0003 mmHg.s 2 /ml, 0.105^0.009 mmHg.s/ml, 1.27^0.12 mmHg.s/ml, and 2.43^0.21 mmHg/ml. During the same interval, stroke work and pressure±volume area decreased respectively from 2700^242 to 2256^75 mmHg.ml (P , 0:01), and from 3806^427 to 3179^167 mmHg.ml (P , 0:01). Stroke work and pressure±volume area decreased at matched end-diastolic volumes. In contrast, end-systolic elastance, ejection fraction, and stroke volume remained statistically unchanged, respectively at 2.29^0.14 mmHg/ ml, 48.1^2.1 %, and 32.4^1.7 ml. Conclusions: These data suggest that, when facing an increased aortic compliance, the left ventricle displays unchanged contractility, but the energetic cost of cardiac ejection is signi®cantly decreased. These data may be of clinical importance when choosing an arti®cial prosthesis for ascending aortic replacement.
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Papers by Vincent D'Orio