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

ELT-HIRES, the high resolution spectrograph for the ELT: results from the Phase A study

We present the results from the phase A study of ELT-HIRES, an optical-infrared High Resolution Spectrograph for ELT, which has just been completed by a consortium of 30 institutes from 12 countries forming a team of about 200 scientists and engineers. The top science cases of ELT-HIRES will be the detection of life signatures from exoplanet atmospheres, tests on the stability of Nature's fundamental couplings, the direct detection of the cosmic acceleration. However, the science requirements of these science cases enable many other groundbreaking science cases. The baseline design, which allows to fulfil the top science cases, consists in a modular fiber- fed cross-dispersed echelle spectrograph with two ultra-stable spectral arms providing a simultaneous spectral range of 0.4-1.8 μm at a spectral resolution of 100,000. The fiber-feeding allows ELT-HIRES to have several, interchangeable observing modes including a SCAO module and a small diffraction-limited IFU

Observational retrospective study on the effectiveness of sequential graduated intermittent pneumatic compression therapy of lower limbs edema

The main aim of the study is to evaluate the effectiveness of sequential graduated intermittent pneumatic compression (SGIPC) therapy of lower limbs edema, regardless of its etiology. A retrospective observational study is conducted to determine the effectiveness of a regimen of sequential gradient SGIPC in treating edema of lower limbs. The study is carried out on 90 patients affected by different stages of edema and evaluated at a Wound Care Clinic for one month. Medical records data have been collected after the first, the third, and the fifth hour-long treatment session. The inclusion criteria are: (1) presence of edema to one limb, at least, regardless of etiology, (2) presence of both pain and feeling of heaviness (or tiredness) of the limb, (3) non-use of bandages or elastic stocking/knee socks, and (4) availability of complete data about the edema size monitoring. The exclusion criteria are: (1) presence of infected wounds, (2) severe arteriosclerosis or other ischemic vascular diseases, (3) severe congestive cardiac failure, (4) known or suspected acute deep vein thrombosis (DVT), (5) thrombophlebitis or Pulmonary Embolism (PE), and (6) hypertension (Systolic Pressure greater than 170mmHg). The following parameters are considered as grade of improvement: the decrease of the limb circumference in at least two measurement points between the foot, ankle, and calf; the disappearance of at least one of the symptoms of pain and feeling of heaviness of the limb; improved mobility. A Flowtron ACS 900 system is used, for the treatment, consisting of a pump, connected to two (calf and thigh) brace with individual tubes, applying a pneumatic compression, graduated in the air chamber, with sequential cycle in three compartments (one at the calf level and two at the thigh level), at a pressure of 45mmHg, with inflation cycles intermittent alternating. Inflation time 12s, time of deflation 48s. In addition, braces corresponding to limb size have been used (automatically recognized by the system). In a sample of 90 patients (95.6% women and 4.4% men) with edema of the lower limbs (37.8% at stage 1, 43.3% at stage 2, 15.6% at stage 3, and 3.3% at stage 4), a successful treatment has been found, from the first session. A circumference decrease greater than 3mm in at least two measuring points between the foot, ankle, and calf, of 77.8% after the first session, 90% after the third session, 90% after the fifth session, on average for both limbs. The disappearance of pain at the end of the session has been found in 85.6% of cases after the first session and 100% after the third and fifth, respectively. The feeling of heaviness of the limb has disappeared in 100% of cases at the end of the sessions. For the stages 3 and 4, it is generally observed an improvement of mobility in 58.9% of cases at the end of the first session and equal to 100% after the third and fifth session. A good compliance in patients who have rejected the manual lymph drainage has been found. Moreover, a good applicability has been found in patients with critical issues such as dermatoporosis and capillary fragility, and bariatric patients. In general, the patients have underestimated the edema, specifically only 21% of patients at a stage greater or equal to 2 have recognized the edema as a clinical problem

Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models

Background: To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. Aims: (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. Methods: A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0–24 years) with chronic conditions were included. Results: Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. Conclusions: By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable

Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians

The role played by nurses in caring for children in pediatricians' officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0-14 years living in the community. This study aimed to describe Italian primary care pediatricians' opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians' offices