Le compagnonnage cognitif : une approche pédagogique à explorer pour le développement du raisonnement clinique infirmier? - Cognitive Companionship: a potential pedagogical approach to developing clinical reasoning in nursing?

L’étalage des processus cognitifs et métacognitifs engagés chez les expertes dans des situations authentiques de la pratique est peu exposé ou exploité dans la formation infirmière : les étudiantes y accèdent rarement ou sporadiquement. En d’autres mots, le savoir tacite développé chez les expertes demeure trop souvent silencieux et les étudiantes n’obtiennent pas d’explication, de justification ou d’articulation intentionnelle des hypothèses et des interventions cliniques avancées par les expertes dans des situations authentiques de la pratique professionnelle. Dès lors, comment mieux tirer profit du raisonnement clinique infirmier des expertes et créer un mode d’accompagnement pour l’apprentissage de la compétence ? Le but de cet article est d\u27explorer le compagnonnage cognitif comme approche pédagogique au développement du raisonnement clinique infirmier. Plus précisément, les fondements épistémologiques et théoriques sont explicités afin de saisir les principes pédagogiques qui sous-tendent l’application et la contribution potentielle du compagnonnage cognitif au développement de la compétence. L’apport de cet article repose sur une conceptualisation riche des fondements théoriques qui guident les stratégies pédagogiques à mettre en œuvre dans les programmes de formation infirmière et qui pourraient être contributives au développement du raisonnement clinique infirmier. Différentes stratégies sont énumérées et exemplifiées par les auteurs afin d’outiller les milieux académiques et les milieux cliniques face à l’utilisation du compagnonnage cognitif. Ces stratégies permettent d’illustrer le compagnonnage cognitif dans différentes situations d’apprentissage/enseignement notamment le préceptorat, la simulation clinique ou l’utilisation de supports numériques à l’apprentissage. Ancrées dans une approche sociocognitiviste, ces stratégies sollicitent l’articulation des connaissances, la réflexion ainsi que le dialogue cognitif socialement partagé et lié à une situation authentique de la pratique professionnelle. Le compagnonnage cognitif permet de capter les « savoirs-vivants» des expertes, ces savoirs spécialisés et construits par la pratique, mais qui demeurent difficilement traduits dans les ouvrages de référence. Le compagnonnage cognitif suggère ainsi un accompagnement propice au développement du raisonnement clinique infirmier. Ultimement, cette approche pourrait contribuer à une culture de développement professionnel tout en favorisant l’apport d’une communauté d’apprentissage. Les auteurs proposent la conduite de recherches et d\u27interventions pédagogiques afin d’établir un lien cohérent entre l’approche du compagnonnage cognitif, les stratégies utilisées et le développement de la compétence. Abstract The cognitive and metacognitive processes favoured by experts in real practice situations are rarely evoked or called upon in nursing education. Students, in fact, are only exposed to these concepts very rarely or sporadically, if at all. As a result, the tacit knowledge acquired by experts is too often kept under wraps, effectively preventing students from obtaining explanations, reasons or clear precisions regarding the clinical assumptions and interventions discussed by experts during real practice situations. This begs the question of how to reap the benefits of the clinical reasoning adopted by experts to design a companionship method for improving student learning in the area of nursing competency. This article explores cognitive companionship as an educational approach to developing such clinical reasoning. More specifically, theoretical and epistemological foundations are discussed in detail to allow for a better understanding of the educational principles underlying the application and possible contribution of cognitive companionship to competency development. The content of this article consists of a thorough conceptualization of the theoretical underpinnings of the educational strategies to incorporate into nursing education programs, in the hopes that they will favour the development of clinical reasoning in nursing. The authors have identified and expanded upon various educational strategies for preparing academic and clinical settings for the eventual use of cognitive companionship. These strategies illustrate the uses of cognitive companionship in various learning/teaching situations (specifically, preceptorship programs, clinical simulations or learning through e-learning environments). Rooted in a socio-cognitive approach, they rely on the articulation of knowledge, reflection and a cognitive dialogue that is both socially shared and linked to real practice situations. Cognitive companionship makes it possible to understand the living knowledge of experts, a specialized knowledge that grows with practice, but which is hard to put to paper in reference works. Cognitive companionship also relies on an approach suitable to the development of clinical reasoning in nursing. Ultimately, this approach could foster a professional development culture supported by an entire learning community. The authors suggest carrying out research and academic activities to identify a consistent link between the cognitive companionship approach, the related educational strategies and development of the desired competence

Theoretical foundations of educational strategies used in e-learning environments for developing clinical reasoning in nursing students : a scoping review

E-learning environments expand opportunities for the use of educational strategies that may contribute to the development of clinical reasoning in nursing students. The purposes of this scoping review were the following: 1) to map the principles of cognitive companionship and the theoretical foundations underlying the design and implementation of educational strategies used in e-learning environments for developing clinical reasoning in nursing students; and 2) to identify the types of educational strategies used in e-learning environments for developing or assessing clinical reasoning in nursing students. A scoping review was conducted and was based on the Joanna Briggs Institute Framework. Bibliographical databases were searched for studies published between January 2010 to July 2017. Out of 1202 screened articles, 18 met eligibility criteria and were included in this review. Principles of cognitive companionship in e-learning environments provide key clues from a learning support perspective, such as integrated feedback, interactive group discussion, gaming, and questioning. However, theoretical foundations underlying educational strategies in e-learning environments are poorly documented and insufficiently associated with cognitive learning models. E-learning environments must have solid theoretical foundations to provide support for the development of CR in nursing students

Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial

Background: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes.Methods/design: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters.Discussion: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. © 2013 Iwuji et al.; licensee BioMed Central Ltd

Évaluation objective structurée de l’animation du débriefing (ÉOSAD) : traduction, adaptation et validation d’une rubrique

Contexte : Le débriefing en simulation clinique requiert des habiletés d’animation de la part des formateurs. Bien que des outils d’évaluation validés existent et pourraient servir à leur formation, ils sont uniquement disponibles en anglais et ne sont pas adaptés à la réalité québécoise. But : (1) Traduire une rubrique d’évaluation de la qualité de l’animation du débriefing (Objective Structured Assessment of Debriefing) en français et l’adapter au contexte québécois ; et (2) en tester la validité et la fidélité dans un contexte de formation en sciences infirmières. Méthodes : La rubrique a été traduite et adaptée par trois traducteurs indépendants. Des experts en simulation (n = 11) en ont validé le contenu selon une méthode Delphi modifiée. La rubrique traduite a été mise à l’essai auprès d’animateurs en simulation (n = 10) qui ont évalué la qualité de débriefings filmés (n = 16). Résultats : La rubrique présente une forte validité de contenu selon les experts et une forte validité concomitante en comparaison avec un score d’évaluation générale du débriefing. Les résultats pour les fidélités interjuges et test-retest montrent une variabilité dans l’attribution des scores par les animateurs de débriefing. Conclusion : La rubrique fournit un langage et des critères communs pour évaluer la qualité d’animation des débriefings. Elle pourrait servir de base à la formation des formateurs en précisant des critères de performance et des descripteurs reflétant différents niveaux de performance. Les qualités psychométriques observées suggèrent toutefois qu’une formation plus exhaustive et des modifications dans les descripteurs seraient nécessaires avant que la rubrique ne soit utilisée en contexte de recherche.Context: Educators must be skilled to facilitate debriefing after healthcare simulations. While tools to assess the quality of debriefing exist and could guide educators’ training, they are only available in English and are not adapted to the reality of Quebec. Purpose: (1) To translate a rubric to assess the quality of debriefing (Objective Structured Assessment of Debriefing) in French and adapt it to the context of Quebec; and (2) to test the validity and fidelity of the translated and adapted rubric. Methods: Three independent translators translated and adapted the rubric. Simulation experts (n = 11) validated the rubric’s content through a modified Delphi process. The translated rubric was piloted with a sample of simulation educators (n = 10) whom assessed the quality of recorded debriefings (n = 16). Results: The rubric presented strong content validity according to simulation experts and strong concurrent validity when compared to a general debriefing assessment score. Results for interrater and test-retest reliability showed some variability among educators. Conclusion: The rubric offers a common language and a set of criteria to assess the quality of debriefing. The rubric could guide educators’ training by specifying performance criteria and descriptors reflecting various levels of performance. However, results regarding psychometric properties of the rubric suggest that extensive training and some modification to descriptors are required prior to its use as a research instrument

Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

Introduction: The universal test-and-treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods: The TasP cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 9 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results: 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions: PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART-initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90-90-90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context-specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH-27-0512-3974 (South African National Clinical Trials Register)

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Bioplastics in automotive applications

International audienceNowadays, polymeric materials represent approximately 20 % of the total weight of an automobile, in other words 100 to 150 kg/car