Impact of Nursing Educational Program on Reducing or Preventing Postoperative Complications for Patients after Intracranial Surgery

Intracranial surgery means any surgery performed inside the skull to treat problems in thebrain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr hole, craniotomy and craniectomy) were included in this study. Their age ranged from18-65 years old, fully conscious after operation. Patients divided into two groups; control group (30 patients who received routine care) and study group (30 patients who received nursing educational program). Three tools were used for data collection; tool I patient assessment sheet, tool II nursing educational program after intracranial surgery and tool III patient evaluation sheet. Results: A good improvement in total knowledge scores of study group patients after application of nursing educational program. Significant reduction and/or prevention of systemic and neurosurgical postoperative complications for study group patients after application of nursing educational program. Conclusion:Improving patients` knowledge in study group had a favorable effect in reducing or preventing systemic and neurosurgical postoperative complications than in control group. Recommendation: Establishment of health care educational center in neurosurgery department to educate patients about their conditions. Keywords: Nursing educational program– Intracranial surgery– Postoperative complications

The Search for a New Theory of Sustainable Architectural Design: Breathing Architecture

To maintain the reduction in fuel consumption and the need to modify the techniques concerning climate change new ideas for example “Parisian worker gardens”, New York’s “community gardens”, and “vegetable squares” of Muscovite, come into the picture. The city aims to produce more clean energy than it consumes within fifteen years for a positive energetic assessment. The city plans to shift more towards renewable energies for example photovoltaic cells, biomass, green architecture such as walls and roofs, etc. The new architecture should also follow these green technologies and methods. Methodology—The methodology of this paper is based on a qualitative research format for findings and results, depending on: Data collection, Data Analysis, Theoretical analysis and analytical cases studies integrating the interdisciplinary fields of green technologies and sustainability. Thus producing a new language of architecture based on the dynamic relation among materials, structures and finally a new spatial idea. Empirical application and study. Besides rational comparisons and conclusions

The Search for a New Theory of Sustainable Architectural Design: Breathing Architecture

To maintain the reduction in fuel consumption and the need to modify the techniques concerning climate change new ideas for example “Parisian worker gardens”, New York’s “community gardens”, and “vegetable squares” of Muscovite, come into the picture. The city aims to produce more clean energy than it consumes within fifteen years for a positive energetic assessment. The city plans to shift more towards renewable energies for example photovoltaic cells, biomass, green architecture such as walls and roofs, etc. The new architecture should also follow these green technologies and methods. Methodology—The methodology of this paper is based on a qualitative research format for findings and results, depending on: Data collection, Data Analysis, Theoretical analysis and analytical cases studies integrating the interdisciplinary fields of green technologies and sustainability. Thus producing a new language of architecture based on the dynamic relation among materials, structures and finally a new spatial idea. Empirical application and study. Besides rational comparisons and conclusions

USING HISTORIC SITES IN DETERMINING PLANT-SOIL INTERACTIONS UNDER LONG TERM CONTAMINATED SOILS

The relationships between heavy metals in soils and crop tissues are critical in understanding the potential risk to crop yields from Zn, Cu and Ni (the principal phytotoxic elements of concern in sludge), and the possible effects on dietary Cd (the critical zootoxic element that is labile in sludge-treated soil and readily absorbed by plants. These relationships cannot be derived from the agronomic trials because the quantities of heavy metals applied to the soil in sludge are small. These are field sites have been treated with sludge for many years in operational practice and where the oncentrations of heavy metals have been significantly raised above background values, representing potentially a worse-case of soil contamination. The purpose of the study was to provide a surrogate for long-term sludge-treated agricultural soil by examining the effects on crops of heavy metals in soil irrigated with raw sewage effluent for periods of more than 80 years and containing significantly elevated concentrations of heavy metals. Methodology: Two surveys of the Gabal El Asfar Old Farm were undertaken to assess the long-term effects of heavy metals in sludge-treated soil on crop quality. In the first survey, the relationships between total and DTPA extractable heavy metals in soil and concentrations in citrus fruit were examined. Concentrations of heavy metals in leaves of citrus were measured in the second survey and related to total and DTPA extractable metals in soil. The heavy metal contents of citrus leaves and fruit (orange - eleven sampling sites; mandarin - four sampling sites), and total and DTPA extractable concentrations in soils were measured in samples collected from different areas of the Farm during two site surveys. Total and DTPA concentrations of heavy metals in the surveyed soils showed significant enrichment by long-term irrigation with sewage effluent. For example, the maximum total concentrations of Zn and Cu were 530 and 366 mg kg-1, respectively, representing a potential risk to crop yields The maximum Cd concentration detected was 9 mg kg-1 and may be a potential risk to the human food chain from uptake into staple crops grown at the farm. DTPA extractable metals were significantly (P<0.001) correlated with the total contents of Zn (r=0.91***), Cu (r=0.83***), Ni (r=0.63***) and Pb (r=0.85***) in soil when data from both surveys were pooled for statistical evaluation. There was also evidence of a weak relationship between DTPA extractable Cd and the total soil Cadmium is the only element of concern in terms of the risk to human health from uptake into food crops grown on sludge-treated soil. The total Cd concentration in soil was raised to a value 3 times the maximum EU limit for this element in sludge-treated agricultural soil. Despite the marked increase in soil Cd content, there was no detectable transfer into citrus leaves or fruit (Figure 1). The absence of Cd uptake into citrus fruit is to be expected because fruits are amongst the least sensitive plant parts to Cd accumulation. These data emphasise the minimal risk to the human diet from Cd in fruit crops grown on sludge-treated soil. . In all cases, leaf tissue concentrations were low and in some cases Cu status was below the deficiency threshold. The Cd content in leaves was small and generally <0.02 mg kg-1 DM.

Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

Back ground: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of stroke rehabilitation and examine the effect of stroke rehabilitation on stroke patients' knowledge and practices in relation to disease and activities of daily living strategies. To fulfill the aim of these study three research hypotheses were formulated; Quasi-experimental research design was utilized to fulfill the aim of this study. The study sample included 60 male and female adult patients with stroke they were allocated randomly into two groups, study and control (30 patients each) the sitting Rheumatology and Rehabilitation Department at Minia University Hospital. Four tools were utilized for data collection; socio-demographic and medical data sheet, pre/post knowledge questionnaire interview schedule, Barthel index scale, Ashworth scale and Construction patient teaching booklet about stroke and activities of daily living performance. Before, immediate post test, after two month. Results of the study documented a significant improvement in knowledge and practices post strategies in study group in addition to reaching of an optimum level of independence for daily activities living and improvement degree of spasticity in study group more than control group, . In conclusion, education of stroke patient is necessary to achieve an optimum level of functioning. Replication of this study on larger probability sample is highly recommended. Key words: Activities of Daily Living Strategies - Stroke- Patient's out come

Preparation, Surface active properties, and Anticorrosion Application of some novel surfactants based on cottonseed oil and diethanolamine on carbon steel in CO2 environments

Novel surfactants were synthesized based on cottonseed oil and diethanolamine and the structures of these compounds were confirmed by FTIR spectroscopy. The surface and thermodynamic properties of these compounds have been investigated. The corrosion behavior of the synthesized surfactant corrosion inhibitors was evaluated by using potentiodynamic (Tafel) polarization curves, linear polarization resistance corrosion rate techniques. The experimental results showed that these inhibitors revealed a very good corrosion inhibition even at low concentrations. The protection efficiency increased with increasing inhibitor concentration, getting maximum values ranged between 87.37 and 97.91 % at 100 ppm after 20 hour of exposure. The adsorption process was found to obey the Langmuir adsorption isotherm

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries