Digital Education for the Management of Chronic Wounds in Health Care Professionals: Protocol for a Systematic Review by the Digital Health Education Collaboration.

BACKGROUND: Digital education is "the act of teaching and learning by means of digital technologies." Digital education comprises a wide range of interventions that can be broadly divided into offline digital education, online digital education, digital game-based learning, massive open online courses (MOOCs), psychomotor skills trainers, virtual reality environments, virtual patient simulations, and m-learning. Chronic wounds pose an immense economic and psychosocial burden to patients and the health care system, as caring for them require highly specialized personnel. Current training strategies face significant barriers, such as lack of time due to work commitments, distance from provider centers, and costs. Therefore, there is an increased need to synthesize evidence on the effectiveness of digital education interventions on chronic wounds management in health care professionals. OBJECTIVE: Our main objective is to assess the effectiveness of digital education as a stand-alone approach or as part of a blended-learning approach in improving pre- and postregistration health care professionals' knowledge, attitudes, practical skills, and behavior in the management of chronic wounds, as well as their satisfaction with the intervention. Secondary objectives are to evaluate patient-related outcomes, cost-effectiveness of the interventions, and any unfavorable or undesirable outcomes that may arise. METHODS: This systematic review will follow the methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions. As our systematic review is one of a series of reviews on digital education for health professionals' education, we will use a previously developed search strategy. This search includes the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library), MEDLINE (Ovid), Embase (Ovid), Web of Science, the Educational Resource Information Centre (ERIC) (Ovid), PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), the ProQuest Dissertation and Theses database, and trial registries. Databases will be searched for studies published from January 1990 to August 2018. Two independent reviewers will screen the library for included studies. We will describe the screening process using a flowchart as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will extract the data using a previously developed, structured data extraction form. Included studies will be quality-assessed using the Risk of Bias tool from Cochrane. We will narratively summarize the data and, if possible, we will conduct a meta-analysis. We will use Cochrane's RevMan 5.3 software for data analysis. RESULTS: We have completed the screening of titles and abstracts for this systematic review and are currently selecting papers against our inclusion and exclusion criteria through full-text revision. We are expecting to complete our review by the end of April 2019. CONCLUSIONS: This systematic review will provide an in-depth analysis of digital education strategies to train health care providers in the management of chronic wounds. We consider this topic particularly relevant given the current challenges facing health care systems worldwide, including shortages of skilled personnel and a steep increase in the population of older adults as a result of a prolonged life expectancy. TRIAL REGISTRATION: PROSPERO CRD42018109971; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=109971. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12488.

[Application and benefit evaluation of tiered health risk assessment approach on site contaminated by benzene].

The procedures of implementing tiered health risk assessment approach were introduced in detail, and took a large-scale site polluted by benzene in Beijing as an example, the difference on the remediation target of benzene in soil, as well as the corresponding soil remediation volume and costs, were compared. The results indicate that the benzene concentration in soil within 1.5 m in depth and the one below should be remediated to 0.26 mg x kg(-1) and 0.15 mg x kg(-1), respectively, in order to keep the cumulative carcinogenic health risk below 1 x 10(-6) based on tiered II assessment. However, according to tiered III assessment result, which is based on the benzene in soil gas within the contaminated areas in the investigated site, the soil in the corresponding depth should only be remediated to 2.6 mg x kg(-1) and 1.5 mg x kg(-1), respectively. That means the soil remediation volume delimited on tiered III assessment result is less than the one on tiered II by 139 537 m3 and the corresponding remediation costs will be reduced by 57 million Yuan, meaning the enormous economic benefits compared to the costs (around 100 thousands Yuan) spent to carry out tiered III assessment in the site.

(5Z,7Z)-6,8-Dimethyl-9H-tetra-zolo[1,5-b][1,2,4]triazepine.

The mol-ecule of the title compound, C(6)H(8)N(6), is approximately planar, with a maximum deviation from planarity of 0.099 (1) Å. In the crystal, mol-ecules are linked to each other via pairs of N-H⋯N hydrogen bonding, forming inversion dimers. The crystal structure is further stabilized by π-π stacking inter-actions, with a centroid-centroid distance of 3.419 (1) Å.

N-(5-Amino-1H-tetra-zol-1-yl)formamide.

In the title compound, C(2)H(4)N(6)O, the planar [maximum deviation = 0.006 (2) Å] amino-tetra-zole group makes a dihedral angle of 83.65 (8)° with the formamide unit. In the crystal structure, inter-molecular N-H⋯N, N-H⋯O and C-H⋯N hydrogen bonds are responsible for the formation of a three-dimensional network.

1-Isopropyl-ideneamino-1H-tetra-zol-5-amine.

The mol-ecule of the title compound, C(4)H(8)N(6), assumes an approximately planar structure, the methyl C atoms and the C atom to which they are bonded being out of the mean tetrazole ring plane by 0.108 and 0.139, and 0.144 Å, respectively. π-π stacking between parallel tetra-zole rings [centroid-centroid distance = 3.4663 (11) Å] is observed in the crystal structure. Inter-molecular N-H⋯N hydrogen bonding further helps to stabilize the crystal structure.

N-(1-Diacetyl-amino-1H-tetra-zol-5-yl)acetamide.

In the crystal structure of the title compound, C(7)H(10)N(6)O(3), there are N-H⋯O, N-H⋯N and C-H⋯O inter-actions, generating a three-dimensional supra-molecular network structure. A short intermolecular O⋯C contact of 2.8994 (18) Šis alsopresent in the crystal structure, but no π-π contacts are observed.