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The educational psychologist as a pedagogue for pupils with social, emotional and behavioural difficulties
This thesis reflects my personal and professional journey from teacher to educational psychologist through significant periods in the education of children with Social Emotional and Behavioural Difficulties (SEBDs) in the UK. It also draws of on lessons learnt from my experience working in North America in the early years of my career.
The main aims of my research were to: (1) Appraise the contribution an educational psychologist could make in assessing the learning potential of children and young people with SEBDs, and (2) Consider the „added value‟ that an educational psychologist might bring to enable these children as better learners and teachers as better teachers of children with SEBDs.
45 Children and young people with Social Emotional Behavioural Difficulties and their parents and teachers participated in the research. A mixed methods approach was employed to undertake three related case studies and a reflexive and narrative analysis was employed.
Main outcomes of the research were (i) SEBDs were almost always accompanied by often unrecognised learning difficulties; (ii) A cognitive assessment by an educational psychologist had an added value in understanding the needs of the child; (iii) When parents and teachers of children who participated in an especially designed intervention, it changed their views of their children‟s behaviours. They reported significant improvement in their children‟s social skills and behaviour.
I conclude the thesis by considering the implications of findings for the benefit of children with SEBDs. It is crucial that teachers identify and assess learning difficulties in all children and young people and clearly differentiate these from matters of and interventions for behaviour difficulties.
Teachers and parents can be empowered to deal with their children‟s behavioural difficulties by involving the Educational Psychologist as a pedagogue, sitting as he or she does at the crossroads of education and psychology
Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study
Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society