Knowledge translation in the management of acute calculous cholecystitis
Notice bibliographique
Résumé
Background Acute calculous cholecystitis (ACC) is a common surgical disease and definitive treatment is cholecystectomy. Despite evidence and international consensus supporting early laparoscopic cholecystectomy as optimal management, variations in practice persist, supporting the existence of an evidence-practice gap. Research objective and methods Knowledge translation (KT) consists in raising knowledge users' awareness of specific clinical evidence to facilitate the use of this evidence in patient care. While implementation of an institutional care pathway for ACC may decrease unwanted variations in practice, prior to implementing any intervention, the KT approach requires identification of factors preventing proper application of knowledge and contributing to an evidence-practice gap. The aim of this thesis was to use the KT approach to identify variability in management of ACC within the McGill Division of General Surgery. To do so, 3 studies were completed. The first study was an institutional survey aiming to identify practice variations in the management of ACC within our division. The second study was a qualitative study using semi-structured interviews aiming to delineate overarching themes driving decision-making in the management of ACC. The third study was a retrospective observational study aiming to identify variables associated with non-operative management of ACC. Results Study #1: From 92 potential respondents, 40 faculty members and 26 senior residents responded to the survey. For mild ACC, 92% of respondents agreed with optimal management of emergency cholecystectomy, but this decreased as case complexity increased. Multivariate analysis showed that patient comorbidities, higher age, increased severity of ACC, longer duration of symptoms and respondent level of training were all significant independent predictors of discordance with optimal management. Study #2: 3 main themes influenced decision-making in the management of ACC: patient factors, surgeon factors and institutional factors. Patient factors included overall clinical status and presentation. Surgeon factors included perceived difficulty of cholecystectomy, comfort with the procedure and threshold to operate. Institutional factors included access to the operating room (OR) and the surgical team's relationship with OR staff Study #3: 374 patients were included. 246 patients underwent operative management with early cholecystectomy. When comparing early cholecystectomy and non-operative management groups, there were no differences in complications during hospitalization, but early cholecystectomy patients had a lower median total length of stay (3 days [2-5] vs 5 [4-9], p<0.001). On multiple logistic regression, higher age, hospital site and higher risk of concurrent choledocholithiasis were significantly associated with non-operative management. Conclusion The presence of an evidence-practice gap in the management of ACC within the McGill Division of General Surgery was successfully identified using a KT approach. The institutional survey identified that patient and respondent factors were independent predictors of discordance with optimal management. The qualitative study demonstrated that patient and surgeon factors are important components of decision-making, but that institutional factors also play a significant role in variability. The retrospective observational study confirmed that patient and institutional factors were associated with non-operative management of ACC. Multiple strategies will be necessary to implement institutional best practices in the management of ACC. More importantly, the KT approach presented in this thesis demonstrates the use of a methodology which can be reproduced and applied to a variety of clinical contexts to identify a potential evidence-practice gap.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».