13 research outputs found
Attentes du personnel infirmier de la relĂšve envers lâemployeur pour favoriser lâengagement professionnel : un premier jalon pour la conception dâinterventions organisationnelles au QuĂ©bec (Canada)
Introduction : Les conditions de travail difficiles compromettent la qualitĂ© des emplois infirmiers, accentuent le roulement ainsi que lâattrition, et ce, particuliĂšrement pour le personnel infirmier de la relĂšve. La comprĂ©hension des perspectives du personnel infirmier sur lâengagement professionnel est essentielle pour Ă©laborer des interventions organisationnelles innovantes et adaptĂ©es en ce sens.
Objectifs : LâĂ©tude vise Ă 1- dĂ©finir les attentes du personnel infirmier de la relĂšve face Ă lâemployeur pour favoriser lâengagement professionnel et 2- identifier les actions organisationnelles prioritaires pour favoriser lâengagement professionnel.
MĂ©thodes : Suivant un devis de recherche mixte selon une dĂ©marche de cartographie conceptuelle, des infirmiĂšres et infirmiĂšres auxiliaires de la relĂšve (N=14) dans un centre intĂ©grĂ© de santĂ© et de services sociaux (CISSS) semi-urbain du QuĂ©bec (Canada) ont Ă©tĂ© invitĂ©es Ă rĂ©pondre Ă la question : « Que peut faire lâemployeur pour favoriser lâengagement professionnel? ». Des analyses statistiques dâĂ©chelonnement multidimensionnel et en grappe ont permis dâorganiser les 49 Ă©noncĂ©s formulĂ©s par le personnel infirmier. ParallĂšlement, les participantes ont Ă©tabli les actions prioritaires en cotant « lâimportance » et « la probabilitĂ© de succĂšs dâimplantation » de chaque Ă©noncĂ©.
RĂ©sultats : Les attentes du personnel infirmier envers leur employeur sont : des conditions de travail attractives, un leadership positif, des conditions de pratique sĂ©curitaires, le soutien au dĂ©veloppement professionnel et un cheminement personnalisĂ©. Plus prĂ©cisĂ©ment, les actions prioritaires pour lâemployeur consistent Ă : dĂ©montrer du respect, offrir un environnement sain et Ă©viter les dĂ©placements dans des dĂ©partements non souhaitĂ©s.
Discussion et conclusion : Les rĂ©sultats suggĂšrent plusieurs pistes dâactions pour favoriser lâengagement professionnel du personnel infirmier de la relĂšve, en contexte semi-urbain au QuĂ©bec, notamment : lâoffre de ressources humaines et matĂ©rielles, lâimplantation dâune culture organisationnelle positive et lâexercice dâun leadership bienveillant. Â
Attentes du personnel infirmier de la relĂšve envers lâemployeur pour favoriser lâengagement professionnel : un premier jalon pour la conception dâinterventions organisationnelles au QuĂ©bec (Canada)
Introduction: Poor work conditions jeopardize the quality of nursing jobs and increase turnover and attrition rates, especially for early career nurses and licensed practical nurses. Understanding perspectives of the nursing staff on work engagement is essential to develop innovative and responsive organizational interventions.
Objectives: 1- Define the expectations of early career nursing staff with respect to their workplace in order to support work engagement 2- Identify priority actions to support work engagement at organizational level.
Methods: A mixed-methods research design based on a conceptual mapping approach was used. Early career nurses and licensed practical nurses (N=14) working in a semi-urban integrated health and social services center in Quebec (Canada) were asked the following question: âWhat can the workplace do to promote work engagement?â Multidimensional scaling and cluster analysis were used to organize the 49 statements provided by the nursing staff. At the same time, participants prioritized actions by rating the âimportanceâ and âprobability of a successful implementationâ of each statement.
Results: Nursing staffsâ expectations toward their workplace in order to support work engagement were: attractive working conditions, positive leadership, safe working conditions, professional development opportunities, and personalized career path. More specifically, the priority actions identified were: showing respect, providing a healthy environment and avoiding transfer to unwanted departments.
Discussion and conclusion: The results suggest several actions to promote work engagement of early career nursing staff working in semi-urban settings in Quebec, including providing human and material resources, implementing a positive organizational culture, and exercising benevolent leadership. Introduction : Les conditions de travail difficiles compromettent la qualitĂ© des emplois infirmiers, accentuent le roulement ainsi que lâattrition, et ce, particuliĂšrement pour le personnel infirmier de la relĂšve. La comprĂ©hension des perspectives du personnel infirmier sur lâengagement professionnel est essentielle pour Ă©laborer des interventions organisationnelles innovantes et adaptĂ©es en ce sens.
Objectifs : LâĂ©tude vise Ă 1- dĂ©finir les attentes du personnel infirmier de la relĂšve face Ă lâemployeur pour favoriser lâengagement professionnel et 2- identifier les actions organisationnelles prioritaires pour favoriser lâengagement professionnel.
MĂ©thodes : Suivant un devis de recherche mixte selon une dĂ©marche de cartographie conceptuelle, des infirmiĂšres et infirmiĂšres auxiliaires de la relĂšve (N=14) dans un centre intĂ©grĂ© de santĂ© et de services sociaux (CISSS) semi-urbain du QuĂ©bec (Canada) ont Ă©tĂ© invitĂ©es Ă rĂ©pondre Ă la question : « Que peut faire lâemployeur pour favoriser lâengagement professionnel? ». Des analyses statistiques dâĂ©chelonnement multidimensionnel et en grappe ont permis dâorganiser les 49 Ă©noncĂ©s formulĂ©s par le personnel infirmier. ParallĂšlement, les participantes ont Ă©tabli les actions prioritaires en cotant « lâimportance » et « la probabilitĂ© de succĂšs dâimplantation » de chaque Ă©noncĂ©.
RĂ©sultats : Les attentes du personnel infirmier envers leur employeur sont : des conditions de travail attractives, un leadership positif, des conditions de pratique sĂ©curitaires, le soutien au dĂ©veloppement professionnel et un cheminement personnalisĂ©. Plus prĂ©cisĂ©ment, les actions prioritaires pour lâemployeur consistent Ă : dĂ©montrer du respect, offrir un environnement sain et Ă©viter les dĂ©placements dans des dĂ©partements non souhaitĂ©s.
Discussion et conclusion : Les rĂ©sultats suggĂšrent plusieurs pistes dâactions pour favoriser lâengagement professionnel du personnel infirmier de la relĂšve, en contexte semi-urbain au QuĂ©bec, notamment : lâoffre de ressources humaines et matĂ©rielles, lâimplantation dâune culture organisationnelle positive et lâexercice dâun leadership bienveillant.  
Low-value clinical practices in adult traumatic brain injury : an umbrella review
Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last 3 decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. We present data on methodological quality (Assessing the Methodological Quality of Systematic Reviews), reported effect sizes, and credibility of evidence (I to IV). The only clinical practice with evidence of benefit was therapeutic hypothermia (credibility of evidence II to IV). However, the most recent meta-analysis on hypothermia based on high-quality trials suggested harm (credibility of evidence IV). Meta-analyses on platelet transfusion for patients on antiplatelet therapy were all consistent with harm but were statistically non-significant. For the following practices, effect estimates were consistently close to the null: computed tomography (CT) in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality, and most included studies had a high risk of bias
Visuo-motor and visuo-perceptual skill learning in patients with parkinson's disease or with lesions to the cerebellum : effects of task difficulty, stimulus repetition and severity of the disease
Cette thĂšse avait pour but d'Ă©valuer, Ă l'aide de trois Ă©tudes, l'influence de trois facteurs mĂ©thodologiques dans l'apprentissage d'habiletĂ©s visuo-motrice et visuo-perceptuelle chez des patients atteints de la maladie de Parkinson ou porteurs d'une lĂ©sion au cervelet, soit, a) le niveau de difficultĂ© de la tĂąche, b) la rĂ©pĂ©tition des stimuli, et c) la sĂ©vĂ©ritĂ© de la maladie. Dans la premiĂšre Ă©tude, des groupes de patients au Stade 1 (PD[1]) ou aux Stades 2-3 (PD[2-3]) de la maladie de Parkinson, un groupe de patients porteurs d'une lĂ©sion au cervelet (CER - sĂ©parĂ©s en deux sous-groupes selon la sĂ©vĂ©ritĂ© des symptĂŽmes), ainsi que deux groupes de sujets tĂ©moins ont Ă©tĂ© comparĂ©s sur une tĂąche de dessin-miroir comprenant des figures avec une marge de 1.5cm ("facile") ou de 1.0cm ("difficile") entre les bordures. Dans la seconde Ă©tude, de nouveaux groupes de patients (PD[1], PD[2-3] et CER), et de sujets tĂ©moins, ont complĂ©tĂ© une tĂąche de lecture-miroir oĂč les mots Ă©taient prĂ©sentĂ©s pendant l 600ms ("facile") ou I 000ms ("difficile"). Dans la troisiĂšme Ă©tude, les sujets de la deuxiĂšme Ă©tude ont rĂ©alisĂ© une tĂąche de dessin-miroir dans laquelle les figures Ă©taient soient "rĂ©pĂ©tĂ©es" ou "uniques" Ă chaque essai. Les rĂ©sultats de ces Ă©tudes ont dĂ©montrĂ© que les patients du groupe PD(1) avaient un dĂ©ficit d'apprentissage uniquement dans les conditions "difficile" et "rĂ©pĂ©tĂ©" de la tĂąche de dessin-miroir, alors que les patients du groupe PD(2-3) Ă©taient dĂ©ficitaires dans toutes les conditions des tĂąches de dessin-miroir et de lecture-miroir. Bien qu'ils Ă©taient plus lents et moins prĂ©cis dans l'exĂ©cution des tĂąches, les patients du groupe CER ont dĂ©montrĂ© un apprentissage normal des deux habiletĂ©s. Ces donnĂ©es suggĂšrent qu'une lĂ©sion du striatum altĂšre la capacitĂ© d'acquĂ©rir une habiletĂ© visuo-motrice et visuo-perceptuelle. Au niveau visuo-moteur, ce dĂ©ficit semble liĂ© au degrĂ© de difficultĂ© de la tĂąche ainsi qu'Ă la rĂ©pĂ©tition des stimuli. Dans les deux tĂąches, le dĂ©ficit varie selon la sĂ©vĂ©ritĂ© de la maladie (lĂ©sion unilatĂ©rale ou bilatĂ©rale). Ces rĂ©sultats sont discutĂ©s en fonction de l'impact mĂ©thodologique et thĂ©orique qu'ils peuvent avoir sur la recherche traitant de l'apprentissage d'habiletĂ©s. Une dissociation par rapport Ă la participation du striatum et celle du cervelet dans la rĂ©-organisation et le contrĂŽle des processus moteurs et perceptuels de type "boucle-ouverte" est proposĂ©e. Trois Ă©tudes ont Ă©tĂ© rĂ©alisĂ©es afin d'Ă©valuer l'influence de trois facteurs mĂ©thodologiques dans l'apprentissage d'habiletĂ©s visuo-motrice et visuo-perceptuelle chez des patients atteints de la maladie de Parkinson ou porteurs d'une lĂ©sion au cervelet, soit, a) le niveau de difficultĂ© de la tĂąche, b) la rĂ©pĂ©tition des stimuli, et c) la sĂ©vĂ©ritĂ© de la maladie. Les rĂ©sultats ont dĂ©montrĂ© que, contrairement aux patients porteurs d'une lĂ©sion au cervelet, les patients atteints de la maladie de Parkinson avaient un dĂ©ficit d'apprentissage sur des tĂąches de dessin-miroir et de lecture-miroir. Dans la premiĂšre tĂąche, ce dĂ©ficit semble liĂ© au degrĂ© de difficultĂ© de la tĂąche ainsi qu'Ă la rĂ©pĂ©tition des stimuli. Dans les deux tĂąches, le degrĂ© du dĂ©ficit varie selon le niveau de sĂ©vĂ©ritĂ© de la maladie. L'impact mĂ©thodologique et thĂ©orique de ces donnĂ©es est discutĂ© dans le cadre de la contribution respective du striatum et du cervelet dans l'apprentissage d'habiletĂ©s
Advanced Lung Cancer Patients’ Use of EGFR Tyrosine Kinase Inhibitors and Overall Survival: Real-World Evidence from Quebec, Canada
EGFR tyrosine kinase inhibitors (EGFR-TKIs) are breakthrough palliative treatments for advanced lung cancer patients with tumors harboring mutations in the EGFR gene. Using healthcare administrative data, three cohorts were created to describe the use of three EGFR-TKIs that are publicly funded in Quebec for specific indications (i.e., 1st-line gefitinib, 1st-line afatinib, and post-EGFR-TKI osimertinib). The main objective was to compare overall survival (OS) among patients receiving these treatments to those in previous experimental and real-world studies. The patients who received EGFR-TKIs for indications of interest between 1 April 2001, and 31 March 2019 (or 31 March 2020, for post-EGFR-TKI osimertinib) were included to estimate the Kaplan-Meier-based median OS for each cohort. An extensive literature search was conducted to include comparable studies. For the gefitinib 1st-line (n = 457), the afatinib 1st-line (n = 80), and the post-EGFR-TKI osimertinib (n = 119) cohorts, we found a median OS (in months) of 18.9 (95%CI: 16.3–21.9), 26.6 (95%CI: 13.7-NE) and 19.9 (95%CI: 17.4-NE), respectively. Out of the 20 studies that we retained from the literature review and where comparisons were feasible, 17 (85%) had similar OS results, which further confirms the value of these breakthrough therapies in real-world clinical practice
Head CT overuse in children with a mild traumatic brain injury within two Canadian emergency departments
Background:â
The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs).
Methods:â
We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied.
Results:â
One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (â„2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03).
Conclusion:â Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation
Adherence to the PECARN pediatric head injury rule in two canadian emergency settings
BACKGROUND
Head computerized tomography (CT) increases the risk of cancer in children and should be carefully prescribed to paediatric patients with head injury. The Pediatric Emergency Care Applied Network (PECARN) validated a rule to identify children at risk of a clinically important traumatic brain injury (TBI) needing a head CT.
OBJECTIVES
The objective was to evaluate adherence to the PECARN rule as a function of CT overuse (defined as a prescribed CT when not recommended by the rule) and underuse rates (no CT performed when recommended) in two Canadian emergency departments (EDs).
DESIGN/METHODS
We conducted a retrospective chart review of children under 17 years of age seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma center. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with a head trauma. Mandatory inclusion criteria were (1) that the head trauma occurred in the 24 hours prior to arrival to the ED, (2) a GCS over 13 and (3) and at least one sign or symptom of minor TBI. Patients with a special condition that could have influenced the decision to order a head CT were automatically excluded. When a patient did not receive a head CT when recommended by the rule, we reviewed medical records to determine if the patient has returned to the ED after his discharge within the next 30 days.
RESULTS
1546 eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%) respectively from sites 1 and 2 had a head CT performed. For the younger group (< 2), both overuse and underuse rates were below 3%. For the older group, overuse rates were higher in site 2 (9.3% (95%CI:4.8â17%) vs. 1.2% (95%CI:0.2â6.5%) (P=.03)) and there was no difference in underuse rates (22% (95%CI:6.3â55%) vs 39% (95%CI:18â65%) (P=.65)). For children who did not receive a head CT when recommended, none returned to the ED for a related complication.
CONCLUSION
Overall, even if there may be slightly more overuse of head CTs in the Level II trauma center, results showed an excellent agreement with the PECARN rule when CT was not recommended. However, results also showed a deviation when CT was recommended, where a higher portion of patients than expected did not receive a head CT. Reasons to explain this behaviour will need further exploration
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Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study.
BackgroundVariations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity.ObjectivesTo estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use.MethodsWe conducted a retrospective cohort study including â„16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f2. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals.ResultsWe included 32,411 patients. Median costs per admission were 11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICCâ=â5% [4-6]), particularly for the OR (28% [20-40]).ConclusionsResource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, in-hospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting