Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

A multidimensional, person-centred perspective on teacher engagement: evidence from Canadian and Australian teachers

Background Hitherto, little work has examined the proposition that teachers may simultaneously invest varying degrees of their energetic resources in the teaching and learning environment. Aims Drawing on a multidimensional, person-centred perspective, the study aimed to identify profiles of teacher engagement, reflecting distinct configurations of teachers’ energetic investments, and their generalizability across Canadian and Australian teachers. Additionally, we examined teachers’ self-efficacy beliefs as predictors of engagement profile membership and the cross-country generalizability of these relations. We also examined emotional exhaustion (EE) and job satisfaction (JS) as outcomes of profile membership in Canadian and Australian teachers, respectively. Samples The samples comprised 586 Canadian and 595 Australian teachers. Methods Data on teachers’ multidimensional engagement and teacher self-efficacy were collected in both the Canadian and Australian samples. Additionally, data on Canadian teachers’ burnout and Australian teachers’ job satisfaction were collected. Results Latent profile analyses revealed three engagement profiles, representing distinct configurations of teachers’ multidimensional energetic investments, which were found to mostly generalize. Additionally, self-efficacy beliefs were found to predict the likelihood of engagement profile membership equally in Canadian and Australian teachers, and EE in Canadian teachers and JS in Australian teachers were found to differ significantly across the profiles. Conclusions The results of the study constitute among the first evidence that teachers may be differentially engaged in the teaching environment with respect to their distinct energetic investments, and such differential profiles of engagement have differential implications for well-being-related outcomes and can be predicted by their teaching capability beliefs

Relations of science teaching self-efficacy with instructional practices, student achievement and support, and teacher job satisfaction

Conceptual models of the effects of teacher self-efficacy hold that efficacy beliefs are related to important teacher (e.g., well-being) and student (e.g., achievement) outcomes both directly and indirectly via teacher practices. Surprisingly little work, however, has been conducted to test these propositions in integrative models comprising both teacher and student outcomes. Even less work has examined the cross-national generalizability of these relations notwithstanding the centrality of teachers’ national contexts to their beliefs. In the present study, we proposed and tested a model of the associations of teachers’ science teaching self-efficacy with not only their job satisfaction but also students’ science achievement and perceived support during science lessons both directly and indirectly via teachers’ inquiry-based science teaching practices. We tested the model across teachers and their students from the Czech Republic and France, comprising over 400 teachers and over 7500 students in total. Results showed direct positive relations of teachers’ science teaching self-efficacy beliefs with the extent of use of inquiry science teaching practices and job satisfaction. Additionally, inquiry teaching was found to be positively related to classroom levels of science achievement. Although science teaching self-efficacy was not directly linked with classroom-average science achievement, evidence was obtained for an indirect association via inquiry-based science teaching. The proposed model was found to generalize across the Czech and French samples