Antoine Duclos

• MD, PhD
• Professor (Full) at Claude Bernard University Lyon 1

Large Language Models (LLMs) have shown remarkable potential in various fields. This study explores their application in solving multi-objective combinatorial optimization problems–surgery scheduling problem. Traditional multi-objective optimization algorithms, such as the Non-dominated Sorting Genetic Algorithm II (NSGA-II), often require domain e...

Background Medical students face a demanding workload, stressful situations, and irregular sleep patterns, which can lead to elevated sleep disturbances and high fatigue levels. These difficulties may be further associated with a major decline in well-being, quality of life, performance, and health. Thus, these struggles must be addressed to reduce...

Objective To investigate whether the cumulative operative time spent by a surgeon operating on patients on the same day prior to starting a new procedure was associated with surgical outcomes. Background The impact of daily operating room workload on a surgeon’s performance and patient outcomes is uncertain. Methods All elective patients, operate...

Background Medical students face highly competitive stressful situations throughout their curriculum, which can lead to elevated stress levels and a major decline in quality of life, well-being, learning abilities, and health. It is crucial to assist medical students in coping with these stressful situations during their curriculum. Methods The PR...

Recognizing the growing capabilities of large language models (LLMs) and their potential in healthcare, this study explores the application of LLMs in healthcare resource allocation using Prompt Engineering, Retrieval-Augmented Generation (RAG), and Tool Utilization. It addresses both optimizable and non-optimizable challenges in allocating operati...

Background Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons’ physical activity habits and their stress, assessed as heart rate variability, at the start of surgery. Materials and methods This multispecialty prosp...

Background The inverse relationship between increased surgical team familiarity and reduced operative time is established, but its effect on patient outcomes remains uncertain. Materials and methods A prospective cohort study including operations by attending surgeons between 1 November 2020 and 31 December 2021 across fourteen surgical department...

Objectives Refeeding syndrome (RS) defines the deleterious clinical and metabolic changes occurring during nutritional support of severely malnourished patients. Pediatric guidelines to prevent and treat RS are scarce and highly variable. This study aimed to evaluate the effectiveness and safety of an enteral refeeding protocol in severely undernou...

Importance Surgeon stress can influence technical and nontechnical skills, but the consequences for patient outcomes remain unknown. Objective To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications. Design, Setting, and Participants This multicenter prospective coh...

Importance Amid escalating mental health challenges among young individuals, intensified by the COVID-19 pandemic, analyzing postpandemic trends is critical. Objective To examine mental health care utilization and prescription rates for children, adolescents, and young adults before and after the COVID-19 pandemic. Design, Setting, and Participan...

Abstract Purpose Objective Structured Clinical Examination (OSCE) is a stressful exam assessing medical competencies. Stress coping strategies are expected to enhance students’ performance during OSCE. The objective was to determine the effect of short preventive coping interventions on performance of medical students. Materials and methods Double...

Background/objectives The large number and heterogeneity of causes of uveitis make the etiological diagnosis a complex task. The clinician must consider all the information concerning the ophthalmological and extra-ophthalmological features of the patient. Diagnostic machine learning algorithms have been developed and provide a correct diagnosis in...

Background Handoffs are a major determinant of patient’s safety but their implementation remains heterogeneous and non-standardized. Organizational factors, including the order in which individual cases are handled within the handoff, may play a role in their quality. We aimed to confirm the existence of the portfolio effect (e.g. a decrease in dur...

To improve patient safety, surgeons can continually monitor the surgical outcomes of their patients. To this end, they can use statistical process control tools, which primarily originated in the manufacturing industry and are now widely used in healthcare. These tools belong to a broad family, making it challenging to identify the most suitable me...

Background Prior work evaluated clinician work-related physical activity and found it does not meet recommended requirements. We aimed to assess more fully daily surgeon physical activity and compare it to self-reported activity. Methods This multispecialty prospective cohort study included attending surgeons from 14 surgical departments within fo...

Large Language Model (LLM) have recently been widely used in various fields. In this work, we apply LLMs for the first time to a classic combinatorial optimization problem—surgery scheduling—while considering multiple objectives. Traditional multi-objective algorithms, such as the Non-Dominated Sorting Genetic Algorithm II (NSGA-II), usually requir...

Objective To determine the influence of operating room familiarity on surgeon stress. Background Regulating surgeon stress may improve patient safety. This study evaluated how assisting surgeon and operating room familiarity influence intraoperative heart rate variability among surgeons. Methods Attending surgeons from seven specialties within fo...

Background A surgeon’s daily performance may be affected by operating room organizational factors, potentially impacting patient outcomes. The aim of this study was to investigate the link between a surgeon’s exposure to delays in starting scheduled operations and patient outcomes. Methods A prospective observational study was conducted from 1 Nov...

Moral injury, initially blamed on the profiteering structure of US healthcare, is increasingly recognized alongside burnout as an independent category of distress, including in countries with publicly funded systems. How countries choose to distribute healthcare resources – the structural determinants of health – and who decides, is a common driver...

Background A previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France. The primary objective was to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hosp...

Background and Objectives Teriflunomide is a disease‐modifying therapy (DMT) for multiple sclerosis (MS). This post authorisation safety study assessed risks of adverse events of special interest (AESI) associated with teriflunomide use. Methods Secondary use of individual data from the Danish MS Registry (DMSR), the French National Health Data Sy...

Background Unlike standard methods for the analysis of acid-base disturbances, the Stewart approach allows for a precise quantification of unmeasured anions (strong ion gap, SIG). The prognostic value of these unmeasured anions has been reported in various clinical situations in the intensive care unit (ICU), but not specifically in septic shock. T...

Background To prevent the medical students from a deleterious psychophysiological activation, it is necessary to provide them a large variety of stress management techniques. The primary aim was to assess the efficacy of a short Mindfulness-Based Intervention (MBI) to reduce state-rumination following an exam (Objective Structured Clinical Examinat...

Objective structured clinical examination (OSCE) is a valid method to evaluate medical students’ competencies. The present cross-sectional study aimed at determining how students’ coping and health-related behaviors are associated with their psychological well-being and performance on the day of the OSCE. Fourth-year medical students answered a set...

Background Statistical Process Control (SPC) tools providing feedback to surgical teams can improve patient outcomes over time. However, the quality of routinely available hospital data used to build these tools does not permit full capture of the influence of patient case-mix. We aimed to demonstrate the value of considering time-related variables...

Objective Length of stay (LOS) is an important metric for the organization and scheduling of care activities. This study sought to propose a LOS prediction method based on deep learning using widely available administrative data from acute and emergency care and compare it with other methods. Patients and Methods All admissions between January 1,...

Background Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate further investigation. Met...

Objective structured clinical examination (OSCE) is a valid method to evaluate medical students’ competencies. The present study aimed at determining how students’ coping and health-related behaviors are associated with their psychological well-being and performance on the day of the OSCE. Fourth-year medical students answered a set of standardized...

Objective The Hospital Frailty Risk Score (HFRS) can be applied to medico-administrative datasets to determine the risks of 30-day mortality and long length of stay (LOS) in hospitalized older patients. The objective of this study was to compare the HFRS with Charlson and Elixhauser comorbidity indices, used separately or combined. Design A retros...

Due to the COVID-19 pandemic, hospitals are facing an overload of staff and medical equipment. To uphold the interests of surgeons, patients, and hospitals, it is crucial to allocate medical resources effectively and rationally. This study optimizes the operating room (OR) and intensive care unit (ICU) modules collaboratively, dynamically integrati...

Due to the impact of COVID-19, a significant influx of emergency patients inundated the intensive care unit (ICU), and as a result, the treatment of elective patients was postponed or even cancelled. This paper studies ICU bed allocation for three categories of patients (emergency, elective, and current ICU patients). A two-stage model and an impro...

A new law was voted in France in 2016 to increase cooperation between public sector hospitals. Hospitals were encouraged to work under the leadership of local referral centers and to share their support functions (e.g., information systems) with newly created hospital groups, called “Regional Hospital Groups.” The law made it compulsory for each pu...

Importance Surgical complications represent a considerable proportion of hospital expenses. Therefore, interventions that improve surgical outcomes could reduce healthcare costs. Objective Evaluate the effects of implementing surgical outcome monitoring using control charts to reduce hospital bed-days within 30 days following surgery, and hospital...

BACKGROUND A previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France. OBJECTIVE We aimed to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hospital m...

Background: Few studies have investigated real-world healthcare costs following a myocardial infarction (MI) and, to our knowledge, none after an ST-elevation MI (STEMI) specifically. Producing such data is important in order to help evaluate the economic burden of STEMI, but also to feed economic evaluation models and eventually show the economic...

Introduction: Anticipatory stress response can impact well-being, performance and health. Understanding factors that influence stress responsiveness is necessary to promote individualized stress management training. While a large body of literature has shown that personality traits influence the level of stress response during the confrontation wit...

Backround: The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay. Methods: The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma...

Recent years have seen the emergence and application of artificial intelligence (AI) in diagnostic decision support systems. There are approximately 80 etiologies that can underly uveitis, some very rare, and AI may lend itself to their detection. This synthesis of the literature selected articles that focused on the use of AI in determining the di...

Background: Preventive measures applied during the COVID-19 pandemic have modified the age distribution, the clinical severity and the incidence of Respiratory Syncytial Virus (RSV) hospitalisations during the 2020/21 RSV season. The aim of the present study was to estimate the impact of these aspects on RSV-associated hospitalisations (RSVH) cost...

Background: We aimed to analyze the impact of timing of implantation (strategy-outcome relationship) and volume of procedures (volume-outcome relationship) on survival of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock complicating acute myocardial infarction (AMI). Methods: We conducted an observational retrosp...

This Viewpoint describes how surgeons can optimize performance with methods for continuous performance improvement used by athletes.

Background: Thyroid cancer incidence in France has increased rapidly in recent decades. Most of this increase has been attributed to overdiagnosis, the major consequence of which is overtreatment. We aimed to estimate the cost of thyroid cancer management in France and the corresponding cost proportion attributable to the treatment of overdiagnose...

PurposeThe mobilization of most available hospital resources to manage coronavirus disease 2019 (COVID-19) may have affected the safety of care for non-COVID-19 surgical patients due to restricted access to intensive or intermediate care units (ICU/IMCUs). We estimated excess surgical mortality potentially attributable to ICU/IMCUs overwhelmed by C...

Objectives: The control chart is a graphical tool for data interpretation that detects aberrant variations in specific metrics, ideally leading to the identification of special causes that can be resolved. A clear assessment of control chart utilization and its potential impact in surgery is required to justify recommendations for its disseminatio...

Backround The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay. Methods The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma cen...

Unlabelled: To determine the influence of hospital bed turnover rate (BTR) on the occurrence of complications following minor or major digestive surgery. Background: Performance improvement in surgery aims at increasing productivity while preventing complications. It is unknown whether this relationship can be influenced by the complexity of sur...

The present study aimed at investigating the influence of personality on both anticipatory stress vulnerability and the effectiveness of coping strategies in an occupational stressful context. Following assessment of individual personality traits (Big Five Inventory), 147 volunteers were exposed to the anticipation of a stressful event. Anxiety and...

Objectives We evaluated the contribution of lung lesion quantification on chest CT using a clinical Artificial Intelligence (AI) software in predicting death and intensive care units (ICU) admission for COVID-19 patients. Methods For 349 patients with positive COVID-19-PCR test that underwent a chest CT scan at admittance or during hospitalization...

Rationale: Nurse-to-nurse familiarity at work should strengthen the components of team working and enhance its efficiency. However, its impact on patient outcomes in critical care remains poorly investigated. Objectives: To explore the role of nurse-to-nurse familiarity on inpatient deaths during intensive care unit stay. Methods: Retrospectiv...

It remains unknown to what degree resource prioritization toward SARS-CoV-2 (2019-nCoV) coronavirus (COVID-19) cases had disrupted usual acute care for non-COVID-19 patients, especially in the most vulnerable populations such as patients with schizophrenia. The objective was to establish whether the impact of the COVID-19 pandemic on non-COVID-19 h...

Objective: The NASA Task Load Index is a questionnaire widely used in aviation. This index might help for attesting the quality of a scenario in high-fidelity simulation in healthcare. The main purpose of this study was to observe whether NASA Task Load Index for critical care-simulated scenarios, designed for residents, was consistent with the li...

Objective: The stress level of participants in high-fidelity simulation stems from various factors but may result in anticipatory anxiety causing sleep disturbances during the night prior to simulation. The objective of this survey was to determine the change in sleep quality of residents during the night prior to the simulation. Methods: The su...

Objective:. To characterize quantitative studies on coaching interventions for professional surgeons to understand how surgical coaching is defined; examine how different coaching programs are designed, implemented, and evaluated; and identify any relevant research gaps. Background:. Surgical coaching is gaining attention as an approach that could...

Objective: The present study aimed at investigating the influence of personality on both anticipatory stress vulnerability and effectiveness of coping strategies in a real-life context. Methods: Following assessment of individual personality traits (Big Five Inventory), 147 volunteers were exposed to the anticipation of a stressful event. Anxiety a...

Background Active participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation. Methods This randomized pilot stud...

The patient transfer from hospitals to followup care and rehabilitation facilities is an important aspect for maintaining the continuity of medical care. In order to achieve flexible healthcare within the field of Internet of Vehicles (IoVs) in terms of secure patient transfer and ambulance transport, the whole organization of patients' discharge a...

Introduction: Robot-assisted surgery is spreading worldwide, accounting for more than 1.2 million procedures in 2019. Data are sparse in the literature regarding the surgeon's mechanisms that mediate risk-taking during a procedure, especially robot-assisted. This study aims to describe and understand the behaviour of the surgeons during robot-assi...

Introduction La relation volume-résultat en chirurgie a été largement investiguée au cours des dernières décennies. Le volume est un proxy qui ne permet pas de mesurer précisément la productivité des hôpitaux. Nous souhaitions déterminer l'influence du turnover de patient par lit d'hospitalisation (TO) sur la survenue d’évènements indésirables maje...

Introduction Prédire correctement la durée des séjours dans chaque unité médicale est essentiel pour en gérer efficacement les lits, organiser le planning des équipes de soins, mieux planifier la sortie des patients, et par conséquent améliorer leur prise en charge. L'objectif de cette étude était de proposer une méthode originale de prédictions de...

Introduction Interpréter la qualité de la prise en charge des établissements de santé en utilisant leurs taux de réhospitalisations évitables nécessite de pouvoir ajuster ces taux sur des facteurs sur lesquels les établissements ne peuvent agir. L'objectif de notre étude est de réaliser un modèle prédictif du risque de réhospitalisation non program...

Introduction L'adéquation entre les ressources en personnel et les besoins des patients est essentielle pour maintenir la sécurité des soins en réanimation. Notre objectif était d’étudier l'influence de la composition des équipes en infirmiers et aides-soignants sur la mortalité des patients en réanimation. Méthodes En combinant les données des re...

Background: Undernutrition has been previously identified as a deleterious factor in acute infections. In covid-19 infection, obesity is a risk-factor of severe evolution, but initial undernutrition has not been evaluated yet. Methods: We retrospectively analyzed correlation between nutritional status at admission and severe outcomes (intensive...

Background Morbidity and Mortality conference provides the necessary improvement measures for patient safety. However, they are an underused resource mainly because the conclusions to be drawn from the discussion and their implications for practice are not always well integrated by inpatient care teams. We therefore propose in this study two interv...

Background In France, the number of emergency department (ED) admissions doubled between 1996 and 2016. To cope with the resulting crowding situation, redirecting patients to new healthcare services was considered a viable solution which would spread demand more evenly across available healthcare delivery points and render care more efficient. The...

The annual prevalence of metastatic neuroendocrine tumours (mNETs) is rising, leading to significant healthcare costs. The present study aimed to describe healthcare resource use (HRU) and the corresponding costs among patients with mNETs, according to primary tumour location, functioning status and type of treatments. The LyREMeNET study included...

Objective This study aimed to assess the performance improvement for machine learning-based hospital length of stay (LOS) predictions when clinical signs written in text are accounted for and compared to the traditional approach of solely considering structured information such as age, gender and major ICD diagnosis. Methods This study was an obse...

Objective: How the checklist is executed in routine practice may reflect the teamwork and safety climate in the operating room (OR). This cross-sectional study aimed to identify whether the presence of a fully completed checklist in medical records was associated with teams' safety attitudes. Methods: Data from 29 French hospitals, including 567...

Background The COVID-19 sanitary crisis inflicted different challenges regarding the reorganization of the human and logistic resources, particularly in intensive care unit (ICU). Interdependence between regional pandemic burden and individual outcome remains unknown. The study aimed to assess the association between ICU bed occupancy and case fata...

Background France is among the countries showing fastest growth of thyroid cancer (TC) incidence and highest incidence rates in Europe. This study aimed to clarify the temporal and geographical variations of TC in France and to quantify the impact of overdiagnosis. Methods We obtained TC incidence data in 1986–2015, and mortality data in 1976–2015...

Hospital beds management is critical for the quality of patient care, while length of inpatient stay is often estimated empirically by physicians or chief nurses of medical ward. Providing an efficient method for forecasting the length of stay (LOS) is always expected to improve resources and discharges planning, its predicted results should be ac...

Abstract Background About 25% of patients experience adverse drug events (ADE) in primary care, but few events are reported by the patients themselves. One solution to improve the detection and management of ADEs in primary care is for patients to report them to their general practitioner. The study aimed to assess the effect of a booklet designed...

Objective: This systematic review sought to establish a picture of length of stay (LOS) prediction methods based on available hospital data and study protocols designed to measure their performance. Materials and methods: An English literature search was done relative to hospital LOS prediction from 1972 to September 2019 according to the PRISMA...

Objectives: We investigated whether the risk of death among noncoronavirus disease 2019 critically ill patients increased when numerous coronavirus disease 2019 cases were admitted concomitantly to the same hospital units. Design: We performed a nationwide observational study based on the medical information system from all public and private ho...

Pancreatic ductal adenocarcinoma (PDAC) remains a major public health challenge, and faces disparities and delays in the diagnosis and access to care. Our purposes were to describe the medical path of PDAC patients in the real-life setting and evaluate the overall survival at 1 year. We used the national hospital discharge summaries database system...

Background: The Hospital Frailty Risk Score (HFRS) has made it possible internationally to identify subgroups of patients with characteristics of frailty from routinely collected hospital data. Objective: To externally validate the HFRS in France. Design: A retrospective analysis of the French medical information database. Setting: 743 hospi...

Background: Morbidity and Mortality Conferences provides the necessary improvement measures required for patient safety. However, it is an underused resource mainly because the conclusions to be drawn from the discussion and their implications for practice are not always well integrated by inpatient care teams. We therefore propose in this study tw...

Background The NASA Task Load IndeX (NASA-TLX) is a questionnaire widely used in aviation. This index might help for attesting the quality of a scenario in high-fidelity simulation (HFS) in healthcare. The main purpose of this study was to observe whether the score of NASA-TLX for critical care simulated scenarios, designed for residents, was consi...

Objectives The objective of the study is to evaluate the performance of high-dimensional propensity scores (hdPSs) for controlling indication bias as compared with propensity scores (PSs) in surgical comparative effectiveness studies. Study Design and Setting Patients who underwent interventional transcatheter aortic valve implantation (TAVI) or s...

Background: In France, the number of admissions to emergency departments doubled between 1996 and 2016, leading to overcrowding. To cope with the resultant overcrowding, redirecting patients to new healthcare services is a viable solution, to spread demand more evenly across available healthcare delivery points, and render care more efficient. The...

Background: Evaluation of burden and very severe ALRTI RSV-associated hospitalisation (VS-RsvH) in a major metropolitan area is of prime importance to guide future vaccine policies. We aimed to describe (VS-RsvH) incidence, factors associated with VS-RsvH and the prevalence of difficulty of breast-feeding or drinking in the VS-RsvH population. Meth...

Objective: To determine the effect of introducing prospective monitoring of outcomes using control charts and regular feedback on indicators to surgical teams on major adverse events in patients. Design: National, parallel, cluster randomised trial embedding a difference-in-differences analysis. Setting: 40 surgical departments of hospitals ac...

Background: Respiratory syncytial virus (RSV) infection is the predominant cause of lower respiratory tract infection (LRTI) during the first year of life. We aimed to estimate the incidence and the birth variables associated with the risk of Severe RSV LRTI in the paediatric population in a major metropolitan European area. Materials/methods: We...

Background Data about incidence and severity of reoperations up to 6 months after bariatric surgery are currently limited. The aim of this cohort study was to evaluate the incidence and severity of reoperations after initial bariatric surgical procedures and to compare this between the 3 most frequent current surgical procedures (sleeve, gastric by...