Portable Sensory Room for the West Orange County Consortium for Special Education

This report discusses the development of a Portable Sensory Room to be used at Newland Elementary School in Huntington Beach. Newland Elementary has an exceptional Special Needs program that teaches the children with the most severe cases of autism in its school district. People with autism typically also have sensory processing disorders, which can be extremely disruptive for a child’s development and can make it difficult for a child to be able to concentrate long enough to gain necessary life skills. The idea behind a Sensory Rooms is to create a place to calm the students and to expose them to new stimuli to explore and learn in a calm and non-threatening environment. There are three different Special Needs classrooms that the Portable Sensory Room will be moved between in a single day. The teachers at Newland Elementary also desired a swing element and a pressure applying device. Both of these components are used regularly in Occupational Therapy with children with autism and have been proven to help children develop necessary skills in life. The design of the Portable Sensory Room, which was composed of several brainstorming sessions and decision matrices, lasted several months from Fall 2015 to midway through the Winter 2016 quarter. The final design consists of seven different components - five of the components act as the structure of the room and can easily connect to one another to achieve a uniform enclosure and two are separate from the room structure. All of these components have interactions on their faces that either comfort or challenge the children and all contribute to a calming sea theme throughout. The components are all on locking casters which makes transportation of the assembly easy. The five components of the room structure are: the tactile wall, the bookshelf, the tactile station, the fabric panels, and the LED panels. The tactile wall focuses on helping the children gain fine motor skills by use of tracks that the children can move fish along, a moveable gear set, and a whiteboard. The bookshelf is filled with activities for fine motor skills as well, and provides extra storage for the teachers to arrange according to their desires. The tactile station is a dresser with calming light effects at the top. The drawers can be completely removed and put on the floor, where the children can play with tactile interactions in an enclosed space to avoid a mess. The fabric panels provide tactile sensations using several swatches of fabric that range from calming to challenging. The LED panels have a calming ocean mural and also allow children to observe the notion of cause-and-effect via a control box that changes the light display. The other two components are the swing structure and the pressure applicator, which can either be used in the room or separately from the room depending on the teachers’ preferences. The swing structure was purchased from Amazon and allows for a 360 degree rotation. The pressure applicator was built by the team and is comprised of two horizontal rollers that the child can slide in between. The addition of rubber bands allows the child/teacher to choose how much pressure will be exerted on the child. The build phase of the project lasted from the end of Winter 2016 quarter to the end of Spring 2016 quarter. All of the components were made from lumber and sanded down in order to avoid any sharp edges. Testing was performed to verify that the teachers would not have to exert an enormous effort to move all of the components, as well as to determine the tipping loads for each of the components. The tipping loads were below the desired specification; in order to mitigate this, two adults will be required to move each component. When the room is assembled together, the entire structure is quite stable and does not pose a tipping hazard. The final product will be delivered to Newland Elementary School on June 17th, 2016

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

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London