9 research outputs found
Designing worked examples to teach lower primary school students fractions
Cognitive load theory is an instructional theory which aims to generate innovative instructional methods based on the known characteristics of human cognitive architecture. The worked example effect is a well-established phenomenon in cognitive load theory, indicating advantages of explicit instruction over pure problem-solving activities for novice learners. However, it has been mostly investigated with secondary and high school students rather than younger students, such as lower primary school students. This chapter reviews the worked example effect and provides empirical evidence of applying it in teaching fractions to lower primary school students.</p
Designing worked examples to teach lower primary school students fractions
Cognitive load theory is an instructional theory which aims to generate innovative instructional methods based on the known characteristics of human cognitive architecture. The worked example effect is a well-established phenomenon in cognitive load theory, indicating advantages of explicit instruction over pure problem-solving activities for novice learners. However, it has been mostly investigated with secondary and high school students rather than younger students, such as lower primary school students. This chapter reviews the worked example effect and provides empirical evidence of applying it in teaching fractions to lower primary school students.</p
The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit
Background: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. Methods: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. Results: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P <.001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P <.001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P =.004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. Conclusions: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes
Textbook outcome following oesophagectomy for cancer: international cohort study
Background: Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. Methods: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). Results: Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. Conclusion: Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome
Textbook outcome following oesophagectomy for cancer: international cohort study
Background: Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. Methods: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). Results: Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. Conclusion: Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome
Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study
Background: No evidence currently exists characterising global outcomes
following major cancer surgery, including esophageal cancer. Therefore,
this study aimed to characterise impact of high income countries (HIC)
versus low and middle income countries (LMIC) on the outcomes following
esophagectomy for esophageal cancer.
Method: This international multi-center prospective study across 137
hospitals in 41 countries included patients who underwent an
esophagectomy for esophageal cancer, with 90-day follow-up. The main
explanatory variable was country income, defined according to the World
Bank Data classification. The primary outcome was 90-day postoperative
mortality, and secondary outcomes were composite leaks (anastomotic leak
or conduit necrosis) and major complications (Clavien-Dindo Grade
III-V). Multivariable generalized estimating equation models were used
to produce adjusted odds ratios (ORs) and 95% confidence intervals
(CI95%).
Results: Between April 2018 to December 2018, 2247 patients were
included. Patients from HIC were more significantly older, with higher
ASA grade, and more advanced tumors. Patients from LMIC had almost
three-fold increase in 90-day mortality, compared to HIC (9.4% vs
3.7%, p < 0.001). On adjusted analysis, LMIC were independently
associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p
= 0.015). However, LMIC were not independently associated with higher
rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or
major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to
HIC.
Conclusion: Resections in LMIC were independently associated with higher
90-day postoperative mortality, likely reflecting a failure to rescue of
these patients following esophagectomy, despite similar composite
anastomotic leaks and major complication rates to HIC. These findings
warrant further research, to identify potential issues and solutions to
improve global outcomes following esophagectomy for cancer. (C) 2020
Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and
the European Society of Surgical Oncology. All rights reserved
Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study
Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved
Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study.
BACKGROUND
No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.
METHOD
This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI).
RESULTS
Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI: 0.54-1.32, p = 0.5), compared to HIC.
CONCLUSION
Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer
Textbook outcome following oesophagectomy for cancer: international cohort study
Improvements in centralization, hospital resources (i.e. daily 24-hour
on-call oesophagogastric surgeons and radiologists), access to minimal
access surgery, and adoption of newer techniques for improving lymph
node yield could improve textbook outcome. Understanding how these
individual parameters help improve quality of patient care should be the
focus of future research and will present a strong message globally to
improve outcomes.
Background Textbook outcome has been proposed as a tool for the
assessment of oncological surgical care. However, an international
assessment in patients undergoing oesophagectomy for oesophageal cancer
has not been reported. This study aimed to assess textbook outcome in an
international setting. Methods Patients undergoing curative resection
for oesophageal cancer were identified from the international
Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December
2018. Textbook outcome was defined as the percentage of patients who
underwent a complete tumour resection with at least 15 lymph nodes in
the resected specimen and an uneventful postoperative course, without
hospital readmission. A multivariable binary logistic regression model
was used to identify factors independently associated with textbook
outcome, and results are presented as odds ratio (OR) and 95 per cent
confidence intervals (95 per cent c.i.). Results Of 2159 patients with
oesophageal cancer, 39.7 per cent achieved a textbook outcome. The
outcome parameter `no major postoperative complication' had the greatest
negative impact on a textbook outcome for patients with oesophageal
cancer, compared to other textbook outcome parameters. Multivariable
analysis identified male gender and increasing Charlson comorbidity
index with a significantly lower likelihood of textbook outcome.
Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95
per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per
cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive
oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001),
and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to
2.98; P < 0.001) were independently associated with a significantly
increased likelihood of textbook outcome. Conclusion Textbook outcome is
achieved in less than 40 per cent of patients having oesophagectomy for
cancer. Improvements in centralization, hospital resources, access to
minimal access surgery, and adoption of newer techniques for improving
lymph node yield could improve textbook outcome