Impact d'un guide d'antibioprophylaxie chirurgicale pour les cholécystectomies et les hystérectomies en établissement de santé
Bibliographic record
Abstract
Resume Il s’agit d’une etude quasi experimentale de type pre et post qui evalue l’impact de l’implantation d’un nouveau guide d’utilisation des antibiotiques en prophylaxie pour l’hysterectomie et la cholecystectomie. L’etude a permis de recruter 663 sujets, dont 601 ont ete inclus dans notre analyse. On observe que le recours a l’antibioprophylaxie, selon les recommandations proposees, est conforme dans 54 % des cas dans le groupe preintervention contre 66 % dans le groupe postintervention, une difference statistiquement significative (p = 0,003). Parmi les patients ayant recu des antibiotiques (n = 270), on note que la conformite globale (c’est-a-dire pour les quatre criteres combines, soit le choix, la dose, le delai et le lieu) passe de 31 % avant l’implantation du guide a 39 % apres (p = 0,15). De meme, aucune difference significative n’est observee entre les taux de conformite pour chacun des criteres entre le groupe pre et le groupe post. Le taux de conformite global est plus eleve pour les cholecystectomies (59 %) que pour les hysterectomies (27 %) (p < 0,001). Au niveau des couts, on observe une reduction significative de la moyenne des couts pour l’ensemble des patients inclus dans l’etude entre le groupe controle (n = 301 – cout moyen 3,03 $ ± 2,16) et le groupe experimental (2,56 $ ± 2,18) (p = 0,01, test de t). La difference n’est toutefois plus significative quand on considere uniquement les patients ayant recu une antibioprophylaxie entre le groupe controle (n = 121 – cout moyen 3,75 $ ± 6,22) et le groupe experimental (n = 149 – 2,63 $ ± 3,32) (p = 0,06, test de t). Bien que l’utilisation d’antibiotiques en prophylaxie chirurgicale ait ete largement etudiee, on observe un taux de conformite limite par rapport aux lignes directrices publiees. Meme si nous n’avons pas observe de differences quant a tous les parametres de conformite a la suite de l’implantation du protocole, une intervention ponctuelle des pharmaciens peut contribuer a ameliorer globalement la conformite de l’antibioprophylaxie en etablissement de sante. Abstract This pre-post quasi-experimental study assesses the impact of the implementation of a new guide on prophylactic antibiotics use for hysterectomy and cholecystectomy. 663 subjects have been recruited, from which 601 have been included in our analysis. Antibioprophylaxis is used in accordance with the suggested guidelines in 54% of cases in the preintervention group, compared to 66% in the postintervention group, a statistically significant difference (p = 0.003). Among patients that have been treated with antibiotics (n = 270), global conformity (combination of the four criteria: choice, dose, administration time and place) goes from 31% before implementation of the guide to 39% afterwards (p = 0.15). Likewise, among pre and post groups, no statistically significant difference was noted between conformity rates for each of the criteria. Global conformity rate is higher for cholecystectomies (59%) than for hysterectomies (27%) (p < 0.001). As for costs, we note a significant decrease of the average cost as a whole between the control group (n = 301 – average cost $3.03 ± 2.16) and the experimental group ($2.56 ± 2.18) (p = 0.01, t-test). However, this difference is no longer significant if we only take into account patients who have received antibioprophylaxis, between the control group (n = 121 – average cost $3.75 ± 6.22) and the experimental group (n = 149 – average cost $2.63 ± 3.32) (p = 0.06, t-test). Although the use of antibiotics in surgical prophylaxis has been widely studied, we observe a limited conformity rate in relation to published guidelines. Despite the fact that we have not noticed any difference as to all conformity parameters following protocol implementation, a punctual intervention by the pharmacists may contribute to improve global conformity to antibioprophylaxis in healthcare facilities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".