The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: a quality improvement study

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy

Adaptive Hypermedia Systems design: a method from practice

Adaptive Hypermedia Systems represent a great potential for e-learning; nevertheless instructors and designers find it difficult to develop adaptive application within their framework. This paper presents a map-based visual design method, developed at the AHS atelier in the University of Lugano and tailored for non-technical people, for designing adaptive courseware according to different instructional strategies

Integrating instructional design and hypermedia design

The impact of new technologies in education has brought to the perception that educational Web sites have a more or less standard features in several contexts. Yet, an analysis of the existing literature reveals that the practices of Instructional Design and Hypermedia Design have few if any contact points. We claim that an integration of the two processes – namely learning activities design and hypermedia design – would bring benefits in term of efficiency and effectiveness of the development process and quality of the final application. As a first step in this direction, we propose a general framework that integrates the existing approaches adopted in Instructional Design and Hypermedia Development for both design and requirements analysis

Integrating Instructional Design and Hypermedia Design

Abstract: The impact of new technologies in education has brought to the perception that educational Web sites have a more or less standard features in several contexts. Yet, an analysis of the existing literature reveals that the practices of Instructional Design and Hypermedia Design have few if any contact points. We claim that an integration of the two processes – namely learning activities design and hypermedia design – would bring benefits in term of efficiency and effectiveness of the development process and quality of the final application. As a first step in this direction, we propose a general framework that integrates the existing approaches adopted in Instructional Design and Hypermedia Development for both design and requirements analysis

Solid-State Color Centers for Single-Photon Generation

Single-photon sources are important for integrated photonics and quantum technologies, and can be used in quantum key distribution, quantum computing, and sensing. Color centers in the solid state are a promising candidate for the development of the next generation of single-photon sources integrated in quantum photonics devices. They are point defects in a crystal lattice that absorb and emit light at given wavelengths and can emit single photons with high efficiency. The landscape of color centers has changed abruptly in recent years, with the identification of a wider set of color centers and the emergence of new solid-state platforms for room-temperature single-photon generation. This review discusses the emerging material platforms hosting single-photon-emitting color centers, with an emphasis on their potential for the development of integrated optical circuits for quantum photonics

Multicentre observational study on practice of prehospital management of hypotensive trauma patients: the SPITFIRE study protocol

Introduction Major haemorrhage after injury is the leading cause of preventable death for trauma patients. Recent advancements in trauma care suggest damage control resuscitation (DCR) should start in the prehospital phase following major trauma. In Italy, Helicopter Emergency Medical Services (HEMS) assist the most complex injuries and deliver the most advanced interventions including DCR. The effect size of DCR delivered prehospitally on survival remains however unclear.Methods and analysis This is an investigator-initiated, large, national, prospective, observational cohort study aiming to recruit >500 patients in haemorrhagic shock after major trauma. We aim at describing the current practice of hypotensive trauma management as well as propose the creation of a national registry of patients with haemorrhagic shock. Primary objective: the exploration of the effect size of the variation in clinical practice on the mortality of hypotensive trauma patients. The primary outcome measure will be 24 hours, 7-day and 30-day mortality. Secondary outcomes include: association of prehospital factors and survival from injury to hospital admission, hospital length of stay, prehospital and in-hospital complications, hospital outcomes; use of prehospital ultrasound; association of prehospital factors and volume of first 24-hours blood product administration and evaluation of the prevalence of use, appropriateness, haemodynamic, metabolic and effects on mortality of prehospital blood transfusions. Inclusion criteria: age >18 years, traumatic injury attended by a HEMS team including a physician, a systolic blood pressure <90 mm Hg or weak/absent radial pulse and a confirmed or clinically likely diagnosis of major haemorrhage. Prehospital and in-hospital variables will be collected to include key times, clinical findings, examinations and interventions. Patients will be followed-up until day 30 from admission. The Glasgow Outcome Scale Extended will be collected at 30 days from admission.Ethics and dissemination The study has been approved by the Ethics committee 'Comitato Etico di Area Vasta Emilia Centro'. Data will be disseminated to the scientific community by abstracts submitted to international conferences and by original articles submitted to peer-reviewed journals