5 research outputs found
ESTUDIO EXPLORATORIO SOBRE EL DESARROLLO DE LAS HABILIDADES DEL PENSAMIENTO GEOMÉTRICO ESPACIAL EN ESTUDIANTES DE LA EDUCACIÓN PREUNIVERSITARIA
- Publication venue
- University of Las Tunas
- Publication date
- 01/06/2018
- Field of study
Desarrollar el pensamiento geométrico espacial en los estudiantes de la educación preuniversitaria en Cuba, como uno de los componentes del pensamiento matemático, es un imperativo en el proceso de enseñanza-aprendizaje de la asignatura Matemática en este nivel educativo. La mayoría de los estudiantes que promueven al duodécimo grado e incluso los que cursan la educación superior, en no pocas ocasiones, presentan dificultades en demostrar que poseen algún desarrollo de las habilidades relacionadas con el pensamiento geométrico espacial. En este trabajo, a partir del análisis crítico de investigaciones de diferentes autores sobre el tema, así como de la utilización de métodos tales como: analítico-sintético, inductivo-deductivo, encuesta, análisis de frecuencias, dócimas de bondad de ajuste para una población como pruebas de significación estadística; se realizó un estudio exploratorio de la situación actual del desarrollo de las habilidades del pensamiento geométrico espacial en los estudiantes y profesores de la asignatura Matemática del Instituto Preuniversitario Urbano “Mártires del Porvenir” del municipio de Diez de Octubre en la provincia de La Habana. Estos resultados obtenidos permitieron realizar varias reflexiones que arrojaron inconsistencias tanto en estos estudiantes como en sus profesores en el ya mencionado nivel educativo en el Sistema Nacional de Educación en la República de Cuba.
ABSTRACT
Developing spatial geometric thinking in students of Pre-University education in Cuba, as one of the components of mathematical thinking, is an imperative in the teaching-learning process of the mathematics subject at this level educational. The majority of students who promoted to twelfth grade and even those who are studying higher education, not infrequently, present difficulties in demonstrating that they possess some development skills related to spatial geometric thinking. In this work, from the critical analysis of research of different authors on the subject, as well as the use of methods such as: analytical - synthetic, inductive - deductive , survey, analysis of frequency, goodness of fit for a docimas population as tests of statistical significance; was an exploratory study of the current situation of the development of the spatial geometric thinking skills in students and teachers of the subject mathematics of the urban pre-University Institute "Martyrs of el Porvenir" of the municipality of 10 October in the province of Havana. These results allowed to make several reflections which showed inconsistencies in these students and their teachers in the aforementioned level of education in the national education system in the Republic of Cuba.
KEY WORDS: spatial geometric thinking, abilities of spatial geometric thinking, development of skills
PRE-EXPERIMENTO PARA CONSTATAR CAMBIOS AL APLICAR UN RESULTADO CIENTÍFICO. EJEMPLO PRÁCTICO DE UNA METODOLOGÍA PARA MEJORAR EL DESARROLLO DE HABILIDADES DEL PENSAMIENTO GEOMÉTRICO ESPACIAL
- Publication venue
- University of Las Tunas
- Publication date
- 01/09/2018
- Field of study
En el trabajo se exponen algunas características de los diseños experimentales en la investigación educativa. Se explican distintas tipologías de los diseños pre-experimentales, tales como el diseño de solo pos prueba con un grupo, el de pre prueba- pos prueba con un grupo y el de solo pos prueba con dos grupos no equivalentes. Para el diseño pre-experimental de pre prueba- pos prueba con un grupo se presenta un ejemplo práctico con los datos de campo de una investigación educativa aplicada. También se destaca la importancia, en el mencionado ejemplo, de la utilización de herramientas estadísticas tanto descriptivas univariables como la prueba de los signos como dócima de una muestra medida dos veces y obtenida por medio de pares replicados en este tipo de diseño pre-experimental, para poder constatar que la intervención de una metodología elaborada, sustentada en el enfoque desarrollador y en la enseñanza basada en la resolución de problemas, contribuye a provocar cambios positivos al estado actual del desarrollo de las habilidades del pensamiento geométrico espacial en estudiantes de la educación preuniversitaria en la provincia de La Habana
EL DESARROLLO DE LAS HABILIDADES DEL PENSAMIENTO GEOMÉTRICO ESPACIAL: UNA MIRADA DESDE EL ENFOQUE DESARROLLADOR Y LA ENSEÑANZA BASADA EN LA RESOLUCIÓN DE PROBLEMAS
- Publication venue
- 'Universidad Tecnica de Babahoyo'
- Publication date
- 30/06/2018
- Field of study
THE DEVELOPMENT OF SPATIAL GEOMETRIC THINKING SKILLS: A VIEW FROM THE DEVELOPER APPROACH AND TEACHING BASED ON PROBLEM SOLVING
RESUMEN
Los estudiantes de la educación preuniversitaria en Cuba presentan limitaciones en la resolución de problemas geométricos de la geometría del espacio debido al bajo nivel de desarrollo de sus habilidades del pensamiento geométrico. Entre las causas que provocan tales limitaciones está en la insuficiente preparación teórica y didáctica de los profesores de Matemática de esta educación para guiar a sus estudiantes en el desarrollo de las mismas. En este trabajo se analiza y fundamenta cómo desde el enfoque desarrollador y la enseñanza basada en la resolución de problemas, se puede crear esas bases teóricas y didácticas para que los profesores de Matemática conduzcan el proceso de desarrollo de las habilidades del pensamiento geométrico espacial en sus estudiantes de la educación preuniversitaria.
PALABRAS CLAVE: pensamiento geométrico espacial; habilidades; enseñanza basada en problemas; proceso de enseñanza-aprendizaje desarrollador; problemas geométricos.
ABSTRACT
The students of preuniversity education in Cuba have limitations in solving geometric problems of the geometry of the space due to the low level of development of geometric thinking skills. Among the causes that provoke such limitations is in insufficient theoretical and didactic preparation of teachers of mathematics in education to guide students in the development of the same. This study analyzed and based how from a developer perspective and teaching based on problem solving, you can create these theoretical and didactic bases so that teachers of mathematics will lead the process of developing the skills of the spatial geometrical thinking in their students of pre-university education.
KEYWORDS: spatial geometric thinking; abilities of spatial geometric thinking; teaching based on problems; process of teaching - learning developer; geometric problems
Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry
- Author
- A'Court Christine
- Abdel-Qader Muwafeg
- Abe Masahiko
- Abe Masatake
- Abe Mitsunori
- Abe Sumihisa
- Abe Yukihiko
- Abhayaratna Walter
- Accogli Michele
- Adachi Susumu
- Adachi Toru
- Adak Dhriti
- Adam Matthew
- Adriaansen Henk
- Aegerter Emanuel
- Ageta Masato
- Aggarwala Anil
- Agnelli Giancarlo
- AgnieszkaMetzgier-Gumiela AgnieszkaMetzgier-Gumiela
- Ahlmark Hakan
- Ahmad Kamran
- Ahmad Shahid
- Ahmed Fayzal
- Ahn Jung Joo
- Akers Lori
- Akiyama Masahiro
- Al Mahmeed Wael
- Al-Khalili Faris
- Alberts Mark
- Alborough Elizabeth
- Aldegather Jehad
- Aleksandrova Elena
- Alexandre Almeida Carlos
- Ali Amar
- Ali Gholam
- Alia Pilar Montero
- Allasia Bartolomeo
- Alonso Carmela
- Alonso Concepcion
- Altun Armagan
- Alunni Massimo
- Alvarez Garcia Pere
- Alvarez Douglas
- Alvarez Miguel
- Alzogaray Maria Fernanda
- Amarenco Pierre
- Amaro Marisol
- Ambicka Monika
- Ambrosino Pasquale
- Ambrosio Giuseppe
- Amin Joseph
- Amrhein Diana
- Amstutz Daniela
- An Hae Jung
- Andere Natalia
- Andersson Agneta
- Andersson Lisbeth
- Ando Hiroshi
- Ando Shinichi
- Andrzejewski Dariusz
- Angaran Paul
- Ansoult Nadege
- Antonova Petra
- Antonsen Hege
- Aoki Kenji
- Aoyama Takuma
- Appleby Nigel
- Appleby Nigel
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- Arai Hidekazu
- Araminowicz Joanna
- Aras Funda
- Arcocha Torres Maria Fe
- Argena Antonio
- Arima Shinichi
- Armangau Pauline
- Arstall Margaret
- Asafu-Adjaye Nana
- Asano Hiroshi
- Asano Taku
- Ashraf M. Javed
- Assagay Maharajh S.
- Assouline Serge
- Astridge Penny
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- Atar Dan
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- Avinc Gamze
- Avinc Gamze
- Axthelm Christoph
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- Ayres Bronte
- Azakami Shiro
- Aziz Michael
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- Banfi Elena
- Barbarash Olga
- Barbeira Pablo Saleta
- Barkowski Timothy
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- Barraquer Feu Edelmira
- Barreau Angeline
- Barreda Maria
- Barretto Antonio Carlos Pereira
- Barrow Susan
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- Bartkowiak Radoslaw
- Bartlett Melialoha
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- Becerra Munoz Victor
- Begum Haseena
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- Belenkova Yulia
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- Berardi Mario
- Berg-Johansen Berg-Johansen
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- Bireciklioglu Mustafa Fehmi
- Birhan MEHMET BİRHAN
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- Botha Margo
- Bottarelli Maria Luisa
- Bouzamayor Maria Belen Lage
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- Bronisz Marek
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- Bruin Sandra
- Brusorio Stefania
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- Brzustowska Malgorzata
- Buckley Elizabeth
- Buiks Paul
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- Burke Elizabeth
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- Butter Keith
- Cabrera Ramos Mercedes
- Cabrini Romina
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- Cameron Alex
- Camm A. John
- Camm A. John
- Camm A. John
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- Campo Monica
- Cancho Corchado Gema
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- Capucci Alessandro
- Carlton Lesley
- Carpenedo Monica
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- Cartwright Simon
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- Catanchin Andrei
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- Cervellione Kelly
- Cha James
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- Chandwani Prakash
- Chattranukulchai Pairoj
- Chauhan Kuldeep
- Chauhan Naresh
- Cheewatanakornkul Sirichai
- Chemin Frederic
- Chen Jiyan
- Chen Kangning
- Chen Xiao
- Cheryl Laurie Ferleyko
- Cheung Stephen
- Chi Andwoo Jin
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- Chmielowski Artur
- Cho Amie
- Cho Jeong-Gwan
- Cho Myeong-Chan
- Choi Dong Ju
- Choi Eun A.
- Choi Eun Hee
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- Choi Hee Suk
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- Choudhary Ulka
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- Christoph Marian
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- De Cristofaro Raimondo
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- de Meyer Lorinda
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- Dedek Vratislav
- Dehghani Payam
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- Demir Mesut
- Denis Isabelle
- DePauw Jill
- Deshpande Bhakti
- Dhakrao Priyanka
- Dhillon Ripple
- Di Ancona Torrette
- Di Minno Giovanni
- Diaz Lopez Carlos Maria
- Dichristin Uta
- Diederichs Roelof
- Diercks Deborah
- Dimitri Hany
- Dixon Sue
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- Dolman Marilyn
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- Dominguez Helena
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- Dooldeniya Chaminda
- Dorottya Kanizsai
- Dorsch Wilfried
- Douglas Kevin
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- Drapkina Oksana
- Drasnar Tomas
- Dresser George
- Drexel Heinz
- Drown Jane
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- Dzeletovic Susanna
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- Ebner Karl-Martin
- Eccleston David
- Eden Jane
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- Edin Anton
- Efe Jana
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- Egorova Liudmila
- Egyutt Mihaly
- Eikelboom John
- Eikelboom John
- Eisleben Lutherstadt
- Eissing Volker
- Ekstrand Ann-Britt
- El-Aziz Ahmed Abd
- El-Etreby Adel
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- Elkhadem Magdi
- Ellervik Christina
- Ellis Tania
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- Elorriaga Madariaga Ane
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- Emura Yoko
- Endo Masato
- Engdahl Johan
- Engelbrecht Johannes
- Engelthaler Gabriella
- Epelde Gonzalo Francisco
- Erdle Werner
- Erga Knut
- Ericsson Marianne
- Ersanli Murat
- Eskandari Mehdi
- Eslick Renee
- Espallargas Anna
- Estifanos Salah
- Eto Takuma
- Evans Lorlie
- Evans Paul
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- Fairhead Sue
- Fanelli Raffaele
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- Farquhar Donald
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- Felekoglu Mehmet Ali
- Felpel Susan
- Femiano Claudio
- Feng Shuai
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- Ferkl Richard
- Fernandez Escobar Esther
- Ferreira-Jardim Antonio
- Ferreira-Jardim Antonio
- Ferrer Ana
- Ferrini Piera Maria
- Fetahovic Taufik
- Fielder Debbie
- Figura-Chmielewska Monika
- Figura-Chmielewska Monika
- Fikry Sameh
- Fikry Sameh
- Finlaison Judy Anne
- Fitzmaurice David
- Fitzmaurice David A.
- Fitzmaurice David A.
- Fitzpatrick Michael
- Fleck Anja
- Fleury Julie
- Flint Kerstin
- Floegel Hildegard
- Floren Karin
- Flynn Ann
- Foechterle Johannes
- Foechterle Johannes
- Fontanillas Maria Teixido
- Foo David
- Fooks Tim
- Foppa Luciano
- Forcignano Fulvio
- Forgo Veronika
- Forshaw Karen
- Fournier Denise
- Fox Beverley
- Fox Keith A. A.
- Fox Robin
- Frankiewicz Anna
- Franklin Simon
- French John
- Frick Marcel
- Fritella Roberta
- Frittella Roberta
- Fudo Tetsuro
- Fujii Masako
- Fujii Yuichi
- Fujiki Rei
- Fujimoto Shunichi
- Fujisawa Akinori
- Fujisawa Yasuaki
- Fujito Tsuneo
- Fujiura Yoshihisa
- Fujiura Yoshitake
- Fukuda Tsuyoshi
- Funda Balci
- Furukawa Nobufusa
- Furukawa Yoshiyuki
- Furumoto Wataru
- Fushtey Ivan
- Gadzinski Andwaldemar
- Galinier Michel
- Galloway Sophia
- Garcia Bermudez Miriam
- Garcia Millan Venesa
- Garcia Jorge
- Garda Riaz
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- Gasior Ewa
- Gaudreault Julie
- Gaudreault Julie
- Gavira Saenz Marga
- Geatch Diane
- Gentry Paula
- Geraghty Richard
- Gerbaulet Uwe
- Gergely Szilvia
- Germini Fabrizio
- Ghezai Beraki
- Gibbs Harry
- Gibbs Harry
- Gibbs Janene
- Gibson Fraser
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- Giles Claire
- Gilliand A.
- Giombolini Angelo
- Girke Friederike
- Girollet Camille
- Gjertsen Erik
- Gladbach Bergisch
- Glanowska Grazyna
- Glanowska Grazyna
- Glatzel Dirk
- Glencross Janet
- Goda Toshihiro
- Goldhaber Samuel Z.
- Goldhaber Samuel Z.
- Goldhaber Samuel Z.
- Goldhaber Samuel Z.
- Goldhaber Samuel Z.
- Golino Paolo
- Gombos Petra
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- Gomez Pajuelo Casimiro
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- Gonzalez Paz
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- Goodwin Daryl
- Goram Jane
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- Goto Shinya
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- Grabek Teresa
- Grande Ruiz Angel
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- Grigorian Lilian
- Grilli Piero
- Groenemeijer B. E.
- Gruchala Marcin
- Grunewald Anneke
- Grytzmann Aileen
- Guazzaloca Giuliana
- Guazzaloca Giuliana
- Gubanov Alexander
- Gudmundsson Sirin
- Guedj-Meynier Dominique
- Guenther Franziska
- Guerra Federico
- Guerra Michele
- Guerrero Molina Alicia
- Guinand Alexandre
- Gujral Jaspal
- Gulliver Wayne
- Gulyas David
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- Gupta Milan
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- Gustavsson Mikael
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- Gutowski Ted
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- Gyorke Eszter Kiralyhazine
- Haas Sylvia
- Haas Sylvia
- Haas Sylvia
- Hacke Werner
- Hagn Claus
- Hahn Mario
- Haideri Abbas
- Hajimirsadeghi Ali
- Hakimi Fatema
- Hallaraker Arne
- Halpin Andrew
- Han Sunhui
- Hanazono Naoto
- Handel Hans
- Hansen Jesper
- Haq Ikram
- Haque Ihsan
- Haraguchi Yoshikuni
- Hargreaves Nick
- Harris Kimberlee
- Hart Nigel
- Hartmann Hermann-Josef
- Hartranft Elise
- Hasegawa Koichi
- Hauk Joachim
- Haverkamp Wilhelm
- Hawkins Benji
- Hayashi Yoshihito
- Hayes Kate
- He Ruhua
- He Shenghu
- Headlee Marsha
- Heart Bryan
- Heath John
- Heeg Ramona
- Hegde Miyar Prathap
- Heinz Afra
- Heinz Gerd-Ulrich
- Henley Lindy
- Henrichsen Svein Hoegh
- Henriette Isberg
- Henriksson Kerstin
- Henson Lynn
- Her KyoungOk
- Heradien Marshall
- Hergdt Gunter
- Hergdt Susanne
- Hermans Walter
- Herrero Maeso Beatriz
- Herrick Christopher
- Herrman Jean-Paul
- Hesketh Leverne
- Heuer Adrienne
- Hevia Rodriguez Eduardo
- Hey Heinz
- Heyvang Nathalie
- Hibino Michitaka
- Hicks Teresa
- Hiczkiewicz Jaroslaw
- Higa Satoshi
- Higashi Takayuki
- Higgs Megan
- Higuchi Koji
- Hines Christine
- Hines Kathleen
- Hintze Marianne
- Hintze Ulrik
- Hiramitsu Shinya
- Hirasawa Kunihiko
- Hirayama Hiroyoshi
- Hirose Makoto
- Hirst Rob
- Hjertesenter Vestfold
- Hlengwa Sipho
- Hoddy Sally-Anne
- Hodgins Ian
- Hole Torstein
- Honda Masaaki
- Honek Jakub
- Hongsuppinyo Siripan
- Honkova Michaela
- Honzawa Tatsuo
- Hoogslag Pieter
- Horak Adrian
- Horejsi Michaela
- Horie Hideki
- Horstmeier Uwe
- Hoshiai Mitsumoto
- Hosokawa Hiroaki
- Hosokawa Hiroshi
- Hot-Bjelak Aida
- Howard Joy
- Hruczkowski Tomasz
- Hu Dayi
- Hu Xiaosheng
- Huang Xingfu
- Huber Kurt
- Hubert Katja
- Hubrich Christl
- Hummelshoj Joan
- Hutayanon Pisit
- Hutchinson Peter
- Hwang Eunjung
- Hwang Gyo-Seung
- I Llibre Joan Bayo
- Iacopino Saverio
- Ido Takahisa
- Igarashi Morio
- Iglesias Alonso Luis Fernando
- Iiji Osamu
- Ikeda Hideo
- Ikeoka Kiyomitsu
- Illingworth Laura
- Imaizumi Mitsuru
- Imamaki Mizuho
- Inagaki Koichi
- Inagaki Masahiko
- Iniguez Romo Andres
- Irvine Gordon
- Isaacs Anna
- Isabel Cotilla Maria
- Iseki Atsushi
- Ishiguro Motoyuki
- Ishioka Norio
- Ismail Siddique
- Ison Rodney
- Ito Kenichiro
- Ito Nobuhisa
- Ivanova Yulia
- Ivashkin Vladimir
- Jackson Ana Maria
- Jackson Daniel
- Jackson Penny
- Jacobs Marc
- Jacobs Polly
- Jacobs Polly
- Jacobson Barry
- Jacobson Barry
- Jacobson Ben
- Jadhav Praveen
- Jaerisch Viola
- Jaguszewska Grazyna
- Jai-Aue Sasivimon
- Jain Dinesh
- Jang Eumi
- Jang Eumi
- Jang Hye-suk
- Jang Sung-Won
- Jansen Suzanne
- Janska Lenka
- Jansky Petr
- Jansson Birgitta
- Jaremczuk-Kaczmarczyk Adriana
- Jarzebowski Artur
- Jasinski Sarah
- Jass Gabriele
- Jaufeerally Fazlur Rehman
- Jawoo Jung
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- Zateyshchikov Dmitry
- Zauzig Heinz-Dieter
- Zdrowotnej Zespol Opieki
- Zecca Cinzia
- Zemlianskaia Oksana
- Zhai Hong
- Zhan Qiong
- Zhang Guoshan
- Zhang Huaiqin
- Zhang Ran
- Zhang Yi
- Zhao Yusheng
- Zhuravleva Evgeniya
- Zidek Milan
- Zidkova Eva
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- Zimmett Leon
- Zimny Hans-Hermann
- Zincke Stephanie
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- Zinka Elzbieta
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- Zubeeva Galina
- Zuber Mathieu
- Zutz Stefan
- Zwenkau Schwarz
- Zyczynska Malgorzata
- Publication venue
- 'American Medical Association (AMA)'
- Publication date
- 01/06/2019
- Field of study
IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
- Author
- Aarts Frits
- Ababneh Hazim
- Abad-Motos Ane
- Abaidalla Ahmed
- Abbakar Malaz
- Abd El Aal Ahmed
- Abd-Errazik Mohammad Ahmad
- Abdalradiy Abdalrahmman G
- Abdelkhalek Mohamed
- Abdelkhalek Mostafa
- Abdellatif Ahmed
- Abdellatif Mohamed
- Abdelsaid Kirolas
- Abdou Khaled
- Abdulfatah Mustapha
- Abdullah Mohammad Amer
- Abdullahi Mustapha Miko Mohammed
- Abellán Antonio Melero
- Abeysinghe Nayana
- Abiyere Henry
- Achimas-Cadariu Patriciu Andrei
- Adakaya Sıla
- Adam Nicolas
- Adams Benita
- Adams Ferdinand
- Adegboye Kazeem
- Adeyeye Ademola
- Adra Lama
- Adu-Poku Patricia
- Afuwape Oludolapo
- Afzal Ameer
- Afzal Muhammad Farooq
- Agapov Mihail
- Agara Daniel
- Aggarwal Manisha
- Agger Erika
- Aghadi Ifeanyi Kene
- Ahmed Amjed Yassir
- Ahmed Haleemasahdia
- Ahmed Khalil
- Ahmed Manar
- Ahmed Masood
- Ahmed Safia
- Ahn Hong Min
- Aibe Raquel
- Aigner Felix
- Aissat Abdenour
- Aitbaeva Arai
- Akay Omer
- Akbar Ali
- Akbas Ahmet
- Akçay Özlem
- Akere Abidemi
- Akesen Selcan
- Akgun Erhan
- Akhtar Naseem
- Akın Emrah
- Akova Elif
- Aktas Serhat
- Al Masri Mahmoud
- Al-Alnsi Ahmed
- Al-Hutheifi Roqia'A
- Al-Jarrah Amar
- Al-Naggar Hamza
- Al-Shehari Mohammed
- Alamin Nadeen
- Alawi Raneen
- Alawlaqi Dina
- Alawneh Fade
- Alberola Maria José
- Albers Michael
- Alcolea Natalia González
- Aleem Muhammad
- Alegre Inês
- Alegre Javier Martinez
- Alexandre Flavia
- Alexandrescu Corina
- Alexnder Abelevich
- Alexopoulou Kalliopi
- Alfonso Beatriz Amorós
- Ali Ahmed
- Ali Che Saniati Che
- Ali Danish
- Ali Madeeha
- Ali Mahmoud Abdelwahab
- Ali Manhal Hashim
- Ali Noura Al
- Alikhanli Jhale
- Aliyeva Zumrud
- Aliyu Mohammed
- Aljawder Hasan
- Allen Kate
- Almahmeed Ebrahim
- Alonso Alfredo
- Alonso Javier Etreros
- Alsamneh Muneer
- Alsayadi Ramzi
- Altinel Yuksel
- Altintoprak Fatih
- Altomare Donato F
- Alvarenga Isabella
- Alvarez Laura Jimenez
- Alvarez-Bautista Francisco Emmanuel
- Alvarez-Díez Marcos
- Alves Brenda Chayanny
- Amadigwe Rita
- Amado Andreia
- Amado Fabíola
- Amador Cristina García
- Amanullah Nazli
- Amaral Hélida Aline Tomacheski
- Amaral Luis
- Amin-Tai Hizami
- Aminu Bashiru
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- Yılmaz Gülseren
- Yilmazlar Tuncay
- Yoldas Tayfun
- Yonekura Hiroshi
- Yorkmui Liu
- Yoshino Kenji
- Younes Lina
- Young Trudi
- Yule Michael
- Yusoff Zakiah Mohd
- Zaari Fatimazahraa
- Zabiyaka Mikhail
- Zadrożna Monika
- Zafar Madiha
- Zagaynov Eugeny
- Zaidi Syed-Nadeem
- Zaimis Tilemachos
- Zain Wan Zainira Wan
- Zainy Rhendra Hardy Mohamad
- Zakaria Andee Dzulkarnaen
- Zakaria Maheen
- Zakaria Zaidi
- Zamudio-Bautista Jorge Luis
- Zanc Loredana
- Zanoni Andrea
- Zanus Giacomo
- Zapparoli Alessandro
- Zappone Anna
- Zarzava Eirini
- Zatari Dirar
- Zawadzki Marek
- Zayakov Georgi
- Zaycev Andrey
- Zazo Aya
- Zazo Rama
- Zdravkovic Maja
- Zengin Abdullah Kağan
- Zeringa Georgia
- Zimmerman David D E
- Zuhdy Mohammad
- Zvirych Vitalii
- Zywicka Ewa
- Publication venue
- Publication date
- 01/01/2023
- Field of study
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)