More Myself: Exploring Students\u27 Perceptions of Self-Authorship Development

Increasingly, the challenges of modern adult life include the responsibility for ambiguous tasks, the need to work as a team with diverse others and the expectation to make important decisions in the face of competing interests. Research suggests that individuals able to meet these challenges demonstrate self-authorship, a way of knowing that allows them to exert control over their lives. Existing research provides insight into college students’ self-authorship and the influence of situational, environmental and personal factors on self-authorship development. However, the literature has yet to explore students’ own understanding of their self-authorship development. The purpose of this study was to explore the ways students make meaning of their self-authorship and self-authorship development. This study utilized a qualitative approach and a narrative inquiry design to collect data from recent college graduates. Eleven graduates from a public, comprehensive university in the southeast participated in the study. Participants represented a variety of ethnic backgrounds, ages, and academic disciplines. Each participated in two in-depth, semi-structured interviews. The study utilized a constant comparative approach to analysis, and open, axial, and selective coding, to identify themes that would inform the findings of the study. The findings of the study include the following: (1) nine of the eleven participants demonstrated self-authored perspectives and processes, (2) participants viewed their self-authorship development not as a series of developmental experiences or transitions, but as a singular experience of continuous development, (3) participants made meaning of their self-authorship in the context of their independence and purpose, and (4) participants’ understanding of their development provided new insight into self-authorship and its development

Exploratory Analysis of Preoperative and Postoperative Risk Stratification Tools to Identify Acute Kidney and Myocardial Injury in Patients Undergoing Surgery for Chronic Subdural Haematoma.

Perioperative statistical risk stratification is widespread. Such tools inform intraoperative and postoperative care as part of the National Emergency Laparotomy Audit (NELA)1. Patients with chronic subdural haematomas (cSDH) are often elderly with significant comorbidity2. Despite this, there is a paucity of literature pertaining to risk stratification models in this cohort3. At our centre, as part of a multidisciplinary improvement initiative (the ‘Improving Care in Elderly Neurosurgery Initiative’ (ICENI)4) (Project ID:PRN7705) we demonstrated a significant association between postoperative complications and length of stay2. As a further analysis within this cohort of operated cSDH, we explore the potential of using retrospective electronic health record (EHR) data to generate prognostic statistical models for the identification of two end-organ complications (myocardial injury –troponin above the upper limit of normal and acute kidney injury (AKI) –a rise in serum creatinine of ≥ 1.5 times baseline). Outcomes were chosen based on data availability and veracity as well as clinical relevance. The integrated nature of our EHR permitted incorporation of variables reflecting intraoperative management. This enabled an exploratory analysis of models that, analogous to NELA, could be used preoperatively and updated postoperatively

Integrated care pathways in neurosurgery: A systematic review.

IntroductionIntegrated care pathways (ICPs) are a pre-defined framework of evidence based, multidisciplinary practice for specific patients. They have the potential to enhance continuity of care, patient safety, patient satisfaction, efficiency gains, teamwork and staff education. In order to inform the development of neurosurgical ICPs in the future, we performed a systematic review to aggregate examples of neurosurgical ICP, to consider their impact and design features that may be associated with their success.MethodsElectronic databases MEDLINE, EMBASE, and CENTRAL were searched for relevant literature published from date of inception to July 2020. Primary studies reporting details of neurosurgical ICPs, across all pathologies and age groups were eligible for inclusion. Patient outcomes in each case were also recorded.ResultsTwenty-four studies were included in our final dataset, from the United States, United Kingdom, Italy, China, Korea, France, Netherlands and Switzerland, and a number of sub-specialties. 3 for cerebrospinal fluid diversion, 1 functional, 2 neurovascular, 1 neuro-oncology, 2 paediatric, 2 skull base, 10 spine, 1 for trauma, 2 miscellaneous (other craniotomies). All were single centre studies with no regional or national examples. Thirteen were cohort studies while 11 were case series which lacked a control group. Effectiveness was typically evaluated using hospital or professional performance metrics, such as length of stay (n = 11, 45.8%) or adverse events (n = 17, 70.8%) including readmission, surgical complications and mortality. Patient reported outcomes, including satisfaction, were evaluated infrequently (n = 3, 12.5%). All studies reported a positive impact. No study reported how the design of the ICP was informed by published literature or other methods.ConclusionsICPs have been successfully developed across numerous neurosurgical sub-specialities. However, there is often a lack of clarity over their design and weaknesses in their evaluation, including an underrepresentation of the patient's perspective

Physical Activity Levels in Children with Sensory problems: Cross-sectional Analyses from the Millennium Cohort Study

Background: Hearing and vision impairments/problems are associated with increased risk of premature mortality in adulthood. One potential pathway explaining this association is reduced levels of physical activity. Reductions in activity levels due to sensory impairments may commence earlier in life; however, associations between sensory impairments/problems and activity levels in childhood are not well understood. Objective: The objective of this study was to examine associations between hearing and vision problems and objectively measured activity levels in a representative sample of British children. Methods: Data were drawn from sweep 4 of the Millennium Cohort Study, a prospective cohort study among children aged 7. Child hearing and vision problems were reported by parents in a postal survey. Children were also invited to have their physical activity measured objectively via accelerometry. A total of 6410 children had valid accelerometry data accompanied by complete survey data on the variables of interest. The main outcomes were objectively measured moderate-to-vigorous physical activity, steps and sedentary time. Adjusted linear regression was used to examine associations between vision and hearing problems and objectively measured activity levels. Results: In this sample of 7-year old children, 16.7% (n = 1068) had a reported vision problem and 11.6% (n = 745) had a hearing problem. Reported vision problems in both eyes, but not one eye, was associated with 2 fewer minutes of moderate-to-vigorous physical activity per day (B = −2.1 95% Confidence Intervals [CI] −3.9 to −0.4) and almost 200 fewer steps per day (B = −198.4 95% CI, −398.4 to 1.6). Hearing problems were not associated with activity levels in either one or both ears. Conclusion: Children with visual problems affecting both eyes, but not one eye, are likely to have lower levels of physical activity. Strategies to promote physical activity in children with visual problems are warranted