Helping a visually impaired student to improve her social interaction skills at Andrés Bello University, Viña del Mar, Chile : an action research

Tesis (Pedagogía en Inglés)During the last decade, inclusion that is “Something which cannot be done to people, it is something in which people are actively involved” (Norwich, 1999), has been used by different educational institutions to define or highlight their programs and as a matter of promoting a very comprehensive education. That is why an action research was conducted, whose aim is to study and improve the social interaction between a visually impaired student and her professors and peers within the English Pedagogy Program from a university in the city of Viña del Mar. In this thesis project, several people who are part of the daily life of the subject of the study contributed to this thesis project by providing relevant information. These people were professors, previous and current classmates and family members who decided to participate in a voluntarily and active form. In order to collect the information from a qualitative nature, focus groups, semi-structured interviews, questionnaires and observations were used as instruments. Moreover, more support and guidance were delivered by professionals from the educational and medical fields, i.e a psychology and a psychopedagogue. These experts provided techniques in order to reach the objective of this research. In terms of results, these were unexpected because they changed the researchers’ perspectives and helped them to understand a reality that was present but, was not taken into account. After analyzing the results obtained from the strategies applied in the action plan, the researchers came into the conclusion that the subject improved her social interaction skills thanks to the different techniques that we applied with her. However, it was found out that the context played a key role in the interaction between the classmates and the subject because the dysfunctional characteristics of the peers made the student to react different to them as she interacted with the researchers.Durante la última década, inclusión que se refiere a “Una acción la cual no puede ser realizada por personas, es algo en que las personas están activamente envueltas” (Norwich, 1999) (Traducido por Ivette Aguirre, Camila Fernández, Bárbara Melo y Bastián Mendoza), ha sido utilizado por diferentes instituciones educacionales para definir o destacar sus programas como una manera de promover una educación completa. Por esta razón se llevó a cabo una investigación acción la cual pretende investigar y mejorar la interacción social entre un estudiante con dificultades visuales y sus profesores y compañeros en un programa de pregrado de una universidad en la región de Viña del Mar. Varias personas los cuales forman parte activa en el quehacer diario del sujeto de estudio contribuyeron con información relevante para esta investigación. Estos fueron profesores, compañeros, ex compañeros y familiares, quienes aceptaron participar de forma voluntaria y activa. Para recolectar la información de naturaleza cualitativa, se utilizó focos grupales, entrevistas semi-estructuradas, cuestionarios y observaciones como instrumentos. Además, más apoyo y guía fue entregada por parte de profesionales en el área de la educación y la salud como una psicóloga y psicopedagoga. Estas personas aportaron técnicas para el desarrollo del objetivo de nuestra investigación. En tema de resultados, fueron sorprendentes porque cambiaron mucho la perspectiva de los investigadores y ayudaron a entender una realidad que estaba presente pero no se había tomado en cuenta. Después de analizar los resultados obtenidos por las estrategias aplicadas en el plan de acción, los investigadores llegaron a la conclusión de que el sujeto mejoró en sus habilidades de interacción social gracias a las diferentes técnicas que se trabajaron con ella. Aunque, se encontró que el contexto juega un rol principal en la interacción entre los compañeros y la estudiante debido a que las características disfuncionales de los compañeros hicieron que la estudiante reaccionara diferente con ellos as que como interactuó con los investigadores

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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