Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Preliminary investigation of relations between young students' self-regulatory strategies and their metacognitive experiences

The present study investigated second-graders' self-regulative behavior during task engagement and its relations to performance and to students' on-line metacognitive experiences. Participants were 25 individually examined Greek second graders (13 boys and 12 girls; M age: 7.6 yr., SD = 0.2). Students' use of cognitive, metacognitive, and motivational regulatory strategies while performing a cognitive task were directly observed and recorded by two independent observers. Students' task-specific performance was also evaluated. Finally, students' feeling of satisfaction with the solution produced, their estimate of effort expenditure, and estimate of the solution's correctness were assessed. Analysis showed these second grade students' use of self-regulatory strategies and feeling of satisfaction were significantly associated with their performance. However, metacognitive experiences reported after the solution were only slightly related to the students' actual self-regulative behavior during the task, implying that the relations of students' regulatory efforts with their metacognitive processes are still developing at such a young age. © Psychological Reports 2005

Participation motives in physical education: An expectancy-value approach

This study applied an expectancy-value approach in examining participation motives of students in physical education. As predicted outcome expectancy, a variable formed by the combination of outcome value and outcome likelihood correlated significantly higher with motivational indices than these two factors

Teaching mathematics with selfregulation and for self-regulation: Teachers' reports

The aim of this study was to investigate whether elementary school teachers' reported use of self-regulatory instructional strategies regarding mathematics corresponds to the different aspects of the construct of self-regulatory teaching described in literature. Two hundred and ninety two Greek teachers responded to two questionnaires assessing: (a) the strategies they use themselves to plan, monitor, and evaluate mathematics instruction, i.e., teaching with self-regulation, and (b) the strategies they use to activate and enhance students' self-regulated learning in mathematics, i.e., teaching for self-regulation. Confirmatory factor analysis showed that teachers' reported use of self-regulatory teaching is explained by factors of various levels of generality. Teaching with and teaching for self-regulation emerged as distinct conceptual factors. In addition, the cyclic model of self-regulation (Zimmerman, 2000) was confirmed regarding promotion of students' self-regulated learning in mathematics (i.e., strategies enacted before, during, and after learning) but not regarding teachers' self-regulatory instruction. Associations between teachers' gender, teaching experience, and age, and their reported self-regulatory strategy use were also investigated. Gender differences in favour of women teachers were found with regard to the use of strategies for planning learning and instruction. The results are discussed within the frame of teachers' professional growth and students' improvement of mathematics learning

Assessing maternal behaviors that support children's self-regulated learning

The aim of the present study was to adapt a measure of maternal scaffolding of children's learning and to examine its relationships with children's self-regulated learning (SRL) skills and cognitive performance in different cognitive domains, such as visual-spatial and language tasks. Thirty-five pairs of mothers-preschool children participated in joint problem solving. Maternal supportive behaviors were examined by means of a structured observation form tapping mothers' Cognitive and Metacognitive Support, Emotional- Motivational Support, and Autonomy Support. The children's actual SRL skills and cognitive performance in the two different cognitive domains were also assessed. The maternal scaffolding instrument's inter-rater reliability was confirmed. A developing and dynamic network of relations emerged between maternal scaffolding behaviors, children's SRL skills and cognitive performance; the cognitive domain of the tasks differentiated these relations. Maternal promotion of children's autonomy was positively associated with children's actual use of cognitive strategies, and with their planning and monitoring skills in both cognitive domains. The implications of the findings for promoting children's SRL in different cognitive domains are discussed

The effects of instructional and motivational self-talk on students' motor task performance in physical education

Objective: The aim of the study was to examine the effects of instructional and motivational self-talk on students' motor task performance in a chest pass and a modified push-ups test in physical education. Design: The design involved one between-groups factor, the group with three levels (instructional, motivational, no self-talk), and two within-groups factors, the task (chest pass, modified push-ups) and the time (pre-test, post-test). Method: Participants were 54 fifth and sixth grade students who were randomly assigned to two experimental groups (instructional self-talk, motivational self-talk) and one control group. Students were pre-tested in a chest pass and in a modified push-ups test, were instructed to use the respective self-talk type and were post-tested in the two tests. Results: Results showed that both self-talk groups surpassed control group in both tasks. Instructional and motivational self-talk were equally effective in the chest pass test, but motivational self-talk was more effective compared to instructional self-talk in the modified push-ups test. Conclusions: Self-talk was an effective technique for motor task performance enhancement in physical education. These results were discussed with reference to the task-demand-oriented matching hypothesis. (C) 2010 Elsevier Ltd. All rights reserved

Self-regulated learning and students’ metacognitive feelings in physical education

The aim of this study was to examine students’ self-regulated learning and metacognitive feelings regarding a sport skill in elementary physical education. Participants were 88 fifth-and sixth-grade students who were assigned to four groups and practised basketball shooting at different levels of self-regulated learning (i.e. observation, emulation, self-control, and self-regulation). Students were pre- and post-tested in basketball shooting performance and their knowledge regarding technical aspects of the basketball shooting. They also reported their metacognitive feelings of effort, difficulty, and correctness regarding basketball shooting before and after the practice. Results showed that students who experienced both observational learning and emulative practice (i.e. practice with social feedback) improved their knowledge regarding technical aspects of the basketball shooting. However, no differences were found among groups in basketball shooting performance. Moreover, students’ post-test basketball shooting performance was negatively correlated with students’ feelings of difficulty and positively correlated with students’ feelings of correctness. Results are discussed with reference to social cognitive models of self-regulated learning. The role of metacogitive feelings in the process of self-regulated learning of a sport skill is also discussed. © 2015 International Society of Sport Psychology

Self-regulatory teaching in mathematics: relations to teachers' motivation, affect and professional commitment

The purpose of this study was to examine the relationships between teachers' reports on self-regulatory strategy use in mathematics instruction and individual motivational and affective factors. Two hundred and ninety-two Greek primary school teachers responded to two questionnaires assessing (a) the strategies they use themselves to plan, monitor and evaluate mathematics instruction and (b) the strategies they use to activate and enhance students' self-regulated learning in mathematics. Path analysis showed that teachers' self-regulation strategies both for their own teaching and for enhancing students' self-regulation in mathematics were predicted by their self-efficacy beliefs in teaching mathematics, the value they attribute to mathematics and their emotional commitment to their profession. Teachers' enjoyment of mathematics teaching did not directly predict their reported use of self-regulatory instructional strategies. The implications of the study are related to the development of teachers' training programmes in self-regulated instruction

Relations between young students' strategic behaviours, domain-specific self-concept, and performance in a problem-solving situation

This study aimed at investigating the relations between students' strategic behaviour during problem solving, task performance and domain-specific self-concept. A total of 167 first- and second-graders were individually examined in tasks involving cubes assembly and in academic self-concept in mathematics. Students' cognitive, metacognitive, and Motivational/Volitional Strategic Behaviours were video-recorded and rated by two independent observers. Structural equation modelling showed that the cognitive and Metacognitive Strategic Behaviours were explained by a cognitive self-regulation factor which correlated with the Motivational/Volitional Strategic Behaviour factor. The importance of the cognitive self-regulation factor for task performance and the association of domain-specific self-concept with Motivational/Volitional Strategic Behaviour were shown. (c) 2008 Elsevier Ltd. All rights reserved