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Article ; Online: Qualitative analysis of the organisational response of a university hospital during the first wave of the COVID-19 crisis.

Harkouk, Hakim / Castel, Patrick / Hervouët, Lucile / Fletcher, Dominique

BMJ open quality

2022 Volume 11, Issue 2

Abstract: Background: The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure.: Methods: At a single French university hospital, we performed a ... ...

Abstract	Background: The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure. Methods: At a single French university hospital, we performed a sociological analysis of management adaptation by medical and administrative leaders during the first wave of the COVID-19 crisis. Two sociologists performed interviews with representative members of staff from all the structures involved in managing the crisis to analyse adaptation and the solutions found during this period. Results: The answers collected during interviews were classified into three main topics describing the organisational adaptations of the hospital staff during the COVID-19 crisis: (1) exceptional mobilisation and collaboration; (2) crisis management based primarily on the principle of subsidiarity; and (3) survival of the administrative structure with interventions to support caregivers. Conclusion: This study, focusing on a single hospital, identified a number of factors associated with successful mobilisation in the very specific conditions of this viral pandemic.
MeSH term(s)	COVID-19 ; Hospitals, University ; Humans ; Pandemics ; Personnel, Hospital
Language	English
Publishing date	2022-06-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2022-001817
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Qualitative analysis of the organisational response of a university hospital during the first wave of the COVID-19 crisis

Hakim Harkouk / Dominique Fletcher / Patrick Castel / Lucile Hervouët

BMJ Open Quality, Vol 11, Iss

2022 Volume 2

Keywords	Medicine (General) ; R5-920
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mastering Sedation and Associated Respiratory Events through Simulation-Based Training: A Randomised Controlled Trial Involving Non-Anaesthesiology Residents.

Evain, Jean-Noël / Do, Tran / Harkouk, Hakim / Drolet, Pierre / Perron, Roger / Georgescu, Mihai / Robitaille, Arnaud / Tanoubi, Issam

European journal of investigation in health, psychology and education

2024 Volume 14, Issue 3, Page(s) 463–473

Abstract: Non-anaesthetists commonly administer procedural sedation worldwide, posing the risk of respiratory events that can lead to severe complications. This study aimed to evaluate whether simulation-based learning could lead to enhancements in the clinical ... ...

Abstract	Non-anaesthetists commonly administer procedural sedation worldwide, posing the risk of respiratory events that can lead to severe complications. This study aimed to evaluate whether simulation-based learning could lead to enhancements in the clinical proficiency of non-anaesthesiology residents in managing sedation and related respiratory complications. Following the evaluation of baseline clinical performance through a pre-test simulation, 34 residents were randomly allocated to either participate in an innovative simulation-based learning module (intervention group) or view a brief self-learning video (control group). After a one-month period, their clinical performance was assessed again in a post-test simulation involving respiratory arrest during procedural sedation. Two independent assessors rated each resident's performance using video recordings and a scoring tool with scores ranging from 0 to 19/19. The two assessments were averaged for each performance, and the pre- to post-test change was calculated for each resident. While baseline clinical performance was similar, mean (SD) increase in clinical performance was significantly greater in the intervention group than in the control group (+2.4 (1.6) points versus +0.8 (1.3) points, respectively;
Language	English
Publishing date	2024-02-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	3041279-1
ISSN	2254-9625 ; 2174-8144
ISSN (online)	2254-9625
ISSN	2174-8144
DOI	10.3390/ejihpe14030031
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Opioid-Free Anesthesia Benefit-Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Salomé, Arthur / Harkouk, Hakim / Fletcher, Dominique / Martinez, Valeria

Journal of clinical medicine

2021 Volume 10, Issue 10

Abstract: Opioid-free anesthesia (OFA) is used in surgery to avoid opioid-related side effects. However, uncertainty exists in the balance between OFA benefits and risks. We searched for randomized controlled trials (RCTs) comparing OFA to opioid-based anesthesia ( ...

Abstract	Opioid-free anesthesia (OFA) is used in surgery to avoid opioid-related side effects. However, uncertainty exists in the balance between OFA benefits and risks. We searched for randomized controlled trials (RCTs) comparing OFA to opioid-based anesthesia (OBA) in five international databases. The co-primary outcomes were postoperative acute pain and morphine consumption at 2, 24, and 48 h. The secondary outcomes were the incidence of postoperative chronic pain, hemodynamic tolerance, severe adverse effects, opioid-related adverse effects, and specific adverse effects related to substitution drugs. Overall, 33 RCTs including 2209 participants were assessed. At 2 h, the OFA groups had lower pain scores at rest MD (0.75 (-1.18; -0.32)), which did not definitively reach MCID. Less morphine was required in the OFA groups at 2 and 24 h, but with very small reductions: 1.61 mg (-2.69; -0.53) and -1.73 mg (
Language	English
Publishing date	2021-05-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10102069
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery.

Harkouk, Hakim / Fletcher, Dominique / Martinez, Valeria

Regional anesthesia and pain medicine

2021 Volume 46, Issue 3, Page(s) 251–257

Abstract: Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta- ...

Abstract	Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. We searched Medline, Embase, CENTRAL, Database of Abstracts of Reviews of Effects, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for studies comparing PVB with control for CPSP prevention after BCS, from inception to April 2020. The primary outcome was CPSP at 6 months, and the secondary outcomes were CPSP at 3 and 12 months, chronic postsurgical neuropathic pain (CPSNP) at 6 months, and PVB-related complications. Data were pooled and analyzed with a random-effects model, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the certainty of evidence. A total of 12 studies were included in the study; data for the 6-month time point from 7 studies (2161 patients) were analyzed, and no difference was found between PVB and control in terms of efficacy in preventing CPSP after BCS (risk ratio (RR) 0.82 (95% CI 0.62 to 1.08)), with a moderate quality of evidence according to the GRADE system. Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.
MeSH term(s)	Breast Neoplasms/surgery ; Chronic Pain ; Female ; Humans ; Mastectomy ; Nerve Block ; Pain, Postoperative
Language	English
Publishing date	2021-01-07
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1425299-5
ISSN	1532-8651 ; 1098-7339 ; 0146-521X
ISSN (online)	1532-8651
ISSN	1098-7339 ; 0146-521X
DOI	10.1136/rapm-2020-102040
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Article ; Online: Urgent development of an anaesthesiology-based intensive care unit for critical COVID-19 infected patients.

Harkouk, Hakim / Jacob, Chantal / Fletcher, Dominique

Anaesthesia, critical care & pain medicine

2020 Volume 39, Issue 3, Page(s) 359–360

MeSH term(s)	Anesthesiologists/statistics & numerical data ; Anesthesiologists/supply & distribution ; Anesthesiology/organization & administration ; Bed Conversion ; Bed Occupancy ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Critical Care/methods ; Critical Care/organization & administration ; France/epidemiology ; Hospital Bed Capacity/statistics & numerical data ; Hospitals, University/organization & administration ; Hospitals, University/statistics & numerical data ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/supply & distribution ; Medical Staff, Hospital/statistics & numerical data ; Nurse Anesthetists/statistics & numerical data ; Nurse Anesthetists/supply & distribution ; Nursing Staff, Hospital/statistics & numerical data ; Pandemics ; Patient Care Team ; Patient Transfer ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Respiratory Therapy/methods ; Resuscitation/statistics & numerical data ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-05-04
Publishing country	France
Document type	Letter
ISSN	2352-5568
ISSN (online)	2352-5568
DOI	10.1016/j.accpm.2020.04.011
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Opioid-Free Anesthesia Benefit–Risk Balance

Arthur Salomé / Hakim Harkouk / Dominique Fletcher / Valeria Martinez

Journal of Clinical Medicine, Vol 10, Iss 2069, p

A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 Volume 2069

Abstract	Opioid-free anesthesia (OFA) is used in surgery to avoid opioid-related side effects. However, uncertainty exists in the balance between OFA benefits and risks. We searched for randomized controlled trials (RCTs) comparing OFA to opioid-based anesthesia (OBA) in five international databases. The co-primary outcomes were postoperative acute pain and morphine consumption at 2, 24, and 48 h. The secondary outcomes were the incidence of postoperative chronic pain, hemodynamic tolerance, severe adverse effects, opioid-related adverse effects, and specific adverse effects related to substitution drugs. Overall, 33 RCTs including 2209 participants were assessed. At 2 h, the OFA groups had lower pain scores at rest MD (0.75 (−1.18; −0.32)), which did not definitively reach MCID. Less morphine was required in the OFA groups at 2 and 24 h, but with very small reductions: 1.61 mg (−2.69; −0.53) and −1.73 mg ( p < 0.05), respectively, both not reaching MCID. The reduction in PONV in the OFA group in the PACU presented an RR of 0.46 (0.38, 0.56) and an RR of 0.34 (0.21; 0.56), respectively. Less sedation and shivering were observed in the OFA groups with an SMD of −0.81 (−1.05; −0.58) and an RR of 0.48 (0.33; 0.70), respectively. Quantitative analysis did not reveal differences between the hemodynamic outcomes, although severe side effects have been identified in the literature. No clinically significant benefits were observed with OFA in terms of pain and opioid use after surgery. A clear benefit of OFA use was observed with respect to a reduction in PONV. However, more data on the safe use of OFAs should be collected and caution should be taken in the development of OFA.
Keywords	opioid-free anesthesia ; adverse effect ; anesthesia ; analgesia ; systematic review ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Chronic postsurgical pain: A European survey.

Martinez, Valeria / Lehman, Thomas / Lavand'homme, Patricia / Harkouk, Hakim / Kalso, Eija / Pogatzki-Zahn, Esther M / Komann, Marcus / Meissner, Winfried / Weinmann, Claudia / Fletcher, Dominique

European journal of anaesthesiology

2024 Volume 41, Issue 5, Page(s) 351–362

Abstract: Background: Chronic postsurgical pain (CPSP) is a clinical problem, and large prospective studies are needed to determine its incidence, characteristics, and risk factors.: Objective: To find predictive factors for CPSP in an international survey.: ...

Abstract	Background: Chronic postsurgical pain (CPSP) is a clinical problem, and large prospective studies are needed to determine its incidence, characteristics, and risk factors. Objective: To find predictive factors for CPSP in an international survey. Design: Observational study. Setting: Multicentre European prospective observational trial. Patients: Patients undergoing breast cancer surgery, sternotomy, endometriosis surgery, or total knee arthroplasty (TKA). Method: Standardised questionnaires were completed by the patients at 1, 3, and 7 days, and at 1, 3, and 6 months after surgery, with follow-up via E-mail, telephone, or interview. Main outcome measure: The primary goal of NIT-1 was to propose a scoring system to predict those patient likely to have CPSP at 6 months after surgery. Results: A total of 3297 patients were included from 18 hospitals across Europe and 2494 patients were followed-up for 6 months. The mean incidence of CPSP at 6 months was 10.5%, with variations depending on the type of surgery: sternotomy 6.9%, breast surgery 7.4%, TKA 12.9%, endometriosis 16.2%. At 6 months, neuropathic characteristics were frequent for all types of surgery: sternotomy 33.3%, breast surgery 67.6%, TKA 42.4%, endometriosis 41.4%. One-third of patients experienced CPSP at both 3 and 6 months. Pre-operative pain was frequent for TKA (leg pain) and endometriosis (abdomen) and its frequency and intensity were reduced after surgery. Severe CPSP and a neuropathic pain component decreased psychological and functional wellbeing as well as quality of life. No overarching CPSP risk factors were identified. Conclusion: Unfortunately, our findings do not offer a new CPSP predictive score. However, we present reliable new data on the incidence, characteristics, and consequences of CPSP from a large European survey. Interesting new data on the time course of CPSP, its neuropathic pain component, and CPSP after endometriosis surgery generate new hypotheses but need to be confirmed by further research. Trial registration: clinicaltrials.gov ID: NCT03834922.
MeSH term(s)	Female ; Humans ; Breast Neoplasms ; Chronic Pain/diagnosis ; Chronic Pain/epidemiology ; Chronic Pain/etiology ; Endometriosis/complications ; Neuralgia/diagnosis ; Neuralgia/epidemiology ; Neuralgia/etiology ; Pain, Postoperative/diagnosis ; Pain, Postoperative/epidemiology ; Pain, Postoperative/etiology ; Quality of Life ; Surveys and Questionnaires ; Male
Language	English
Publishing date	2024-02-27
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0000000000001974
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Urgent development of an anaesthesiology-based intensive care unit for critical COVID-19 infected patients

Harkouk, Hakim / Jacob, Chantal / Fletcher, Dominique

Anaesth Crit Care Pain Med

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #165414
Database	COVID19

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Article ; Online: Urgent development of an anaesthesiology-based intensive care unit for critical COVID-19 infected patients

Harkouk, Hakim / Jacob, Chantal / Fletcher, Dominique

Anaesthesia Critical Care & Pain Medicine

2020 Volume 39, Issue 3, Page(s) 359–360

Keywords	covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ISSN	2352-5568
DOI	10.1016/j.accpm.2020.04.011
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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