Le niveau d’adhérence aux pratiques exemplaires des équipes interprofessionnelles avec et sans infirmières praticiennes spécialisées en soins aux adultes en contexte de chirurgie cardiaque : une étude observationnelle rétrospective
Bibliographic record
Abstract
Background: Past qualitative studies suggested that the presence of acute care nurse practitioners (ACNP) in interprofessional teams is associated with a high level of adherence to best-practice guidelines. However, no extraction tool has been developed to measure the level of adherence to best-practice guidelines by interprofessional teams with and without ACNPs in post-operative cardiac surgery. Objectives: The aim of this doctoral project was to 1) develop and pilot-test an extraction tool to measure the level of adherence to best-practice guidelines by interprofessional teams in post-operative cardiac surgery in Québec; and 2) compare the level of adherence to best-practice guidelines of teams with and without ACNPs. Method: To complete a retrospective observational study, a research project was conducted in three steps. 1) A systematic review of randomized controlled trials (RCT) focusing on advanced practice nursing roles in cardiac surgery was conducted to develop the extraction tool. 2) The extraction tool was submitted to a content validation with an expert committee (n=10), a criterion validation, and a pilot-test (n=30 patients). 3) An observational retrospective study was conducted to complete the validation and testing of the extraction tool. Data collection: A retrospective cohort of patients was created. A total of 240 patients hospitalized in a post-operative cardiac surgery unit of an acute care center between January 1st, 2019, and January 31st, 2020, were followed during their entire hospital stay. Data were extracted from patients’ health records and electronic databases. Statistical analysis: A multivariate linear regression model and a multivariate logistic regression model were computed and adjusted for several influencing variables. Findings: Step 1: A total of 13 RCTs were retrieved. Step 2: The extraction tool includes 12 best-practice guidelines, divided into the following three categories: 1) prescription and management of the pharmacotherapy, 2) prescription and management of laboratory tests, and 3) the assessment of the patient post-operative condition. Also, 15 influencing variables, including 13 variables related to patients and two variables related to interprofessional team characteristics are included in the tool. Step 3: Most of the patients of the cohort were male, underwent a coronary artery bypass graft procedure, and stayed on average 10 days at the hospital. Patients under the care of teams with ACNPs were 1.72 (p=0.04) more likely to achieve scores of 80% and above of the level of adherence of best-practice guidelines and 2.29 (p=0.007) more likely to be in the highest quartile of the scores compared to patients under the care of teams without ACNPs. Conclusion: These findings highlight the important contribution of ACNPs in interprofessional teams and the benefits of their practice for patients, families, clinicians, and healthcare organizations. The development and validation of the extraction tool will allow for the comparison of the practice of interprofessional teams with ACNPs at the national and international level
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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 | 0.011 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".