Navigating the clinical and research landscape of lung transplantation in Canada: Insights from a National Survey and JLA Priority-Setting Partnership
Notice bibliographique
Résumé
Lung transplantation (LTx) is a complex and life-saving intervention for patients with end-stage lung disease. While advancements in surgical techniques, immunosuppression, and post-transplant care have significantly improved outcomes, considerable variability in clinical practices persists across transplant centers. This variability suggests a state of equipoise, uncertainty or lack of consensus about the most effective approaches, highlighting the need for new or higher quality evidence and evidence-based guidelines. Although much patient-centered research exists, there remains uncertainty about which aspects of care require further study to fill the knowledge gaps that exist in practice. This thesis aims to address these challenges by exploring two dimensions of uncertainty in LTx. First, it investigates the extent of variability in clinical practices among Canadian LTx centers, which may indicate gaps in evidence or consensus regarding optimal care. Second, it seeks to identify the most pressing areas for future research from the perspective of diverse stakeholders, including patients, caregivers, and healthcare professionals, using a structured, stakeholder-driven James Lind Alliance (JLA) approach. The overarching aim is to identify areas where clinical equipoise may exist and prioritize research topics that could guide future research and lead to more evidence-based LTx practices. Objective: The objectives of this thesis are: 1. to assess the average clinical practice in Canada as well as the variability both within and between centers 2. to identify research priorities in LTx according to patients, caregivers, and clinicians. Methods Project 1: A digital survey was conducted targeting all physicians and surgeons involved in LTx at Canadian transplant centers. The survey included both surgical centers (performing LTx and managing pre- and post-operative care) and non-surgical centers (providing pre- and post-transplant care without performing the surgeries). Survey responses captured clinical practices related to key areas such as infection prophylaxis, immunosuppression, surgical care, perioperative management, and candidate selection. Variability was analyzed both across and within centers using Fishers exact test or Pearson chi-square tests for categorical data and Mann Whitney U test or Kruskal-Wallis test, and interquartile ranges for continuous variables. Project 2: The James Lind Alliance (JLA) methodology was employed to identify priorities for future LTx research. An initial survey engaged a broad range of stakeholders: patients, caregivers, and clinicians to generate potential research questions, addressing uncertainties in the LTx process. These responses were consolidated into "indicative" questions. A second, interim prioritization survey asked stakeholders to rank the importance of these questions using a Likert scale. A systematic literature search ensured that the top-ranked questions had not been adequately addressed by existing research. Finally, a virtual, two-half day workshop using a modified nominal group technique facilitated a consensus-driven prioritization of the Top 10 research questions. Conclusion i. Significant variability exists in various areas of LTx clinical practices across Canada. ii. Key research priorities were identified to address gaps in LTx literature. These findings will guide future research funding and efforts, aiming to enhance LTx research and improve outcomes for all stakeholders.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,030 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,011 |
| Études des sciences et des technologies | 0,014 | 0,003 |
| Communication savante | 0,007 | 0,002 |
| Science ouverte | 0,002 | 0,005 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».