Effect of Multimodal Integrative Interventions on Pain-Related Outcomes among Critically Ill Patients

Context: Pain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based non-pharmacological approaches for pain treatment in critically ill patients have been found. Aim: To evaluate the effect of multimodal integrative interventions on pain-related outcomes among critically ill patients. Methods: A quasi-experimental design (pre / post-test) was utilized to fulfill the aim of this study. A convenience sample of sixty adult critically ill patients was recruited from the intensive care unit at Benha University Hospital affiliated to Benha University at Qualyubia Governorate, Egypt. Three tools were used to conduct this study as follows: Critically ill patients' assessment record; The Critical-Care Pain Observation Tool (CCPOT); The Groningen Sleep Quality Scale. Results: The results show decreased frequency of pain occurrence in the post intervention periods (75%) immediately post to 50% after 48 hours of intervention compared with pre-intervention (100%). The results show a highly statistically significant differences at p ≤0.001 between pre and post of intervention periods regarding the intensity of the pain mean score among studied patients. It also shows statistically significant differences with p-value ≤0.05 regarding all items of sleep quality immediately after and after 48 hours of intervention compared to pre-intervention, except related to having a deep sleep last night, and feel like a slept poorly last night with a p-value ≥0.05. There was a highly positive statistically significant correlation at p-value ≤ 0.001 between pain intensity and other secondary outcomes, including quality of sleep, blood pressure, heart rate and respiratory rate. Conclusion: Multimodal integrative interventions effectively decrease pain and improve pain-related outcomes among critically ill patients. Appropriate pain assessment must be partnered with an adequate, multimodal, evidence-based management strategy that incorporates both pharmacologic and non-pharmacologic modalities of pain control

Effect of Nursing Protocol Regarding Nasal Skin Breakdown for Preterm Infants Receiving Continuous Positive Airway Pressure

Context: Neonates, particularly those born premature, may require ventilation assistance immediately after birth since their lungs may not be fully developed. The use of nasal continuous positive airway pressure (CPAP) is increasing as a means of respiratory support in many premature infants. So, the presence of nasal skin breakdown may be seen as a complication.Aim: Evaluate the effect of nursing protocol regarding nasal skin breakdown for preterm infants receiving nasal continuous positive airway pressure (CPAP). Methods: A quasi-experimental research design was utilized to conduct the current study. The study was conducted at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit "SNICU" of Benha Specialized Pediatric Hospital at Benha city. A convenient sample of nurses (70) working in NICU and SNICU and a purposive random sample of (77) preterm infants were included from the settings mentioned above. Those premature infants were divided into two groups (study and control) (35) in the control group and (42) in the study group, who were selected according to the power analysis equation based on the total number of preterm infants admitted to the setting mentioned above during 2017. Three tools were used. A structured interviewing questionnaire was designed to assess nurses' sociodemographic characteristics, nurses' knowledge regarding CPAP, care provided to preterm infants undergoing CPAP, and nasal skin breakdown. The second tool was a nursing practice observation checklist to assess nurses' practice regarding nasal CPAP. The third tool was Preterm Medical Assessment Record. It is designed to assess the characteristics of preterm infants and medical data of preterm infants. The last tool was the Neonatal Skin Condition Score (NSCS) scale, designed to assess the neonates' skin condition. Results: Findings of the present study revealed a statistically significant difference (P<0.05) pre and post-nursing protocol implementation regarding CPAP, the role of the nurse caring for preterm infants undergoing nasal CPAP, and nasal skin breakdown. The results also revealed a highly statistically significant difference in nursing practice regarding care for preterm infants undergoing nasal CPAP pre and post-nursing protocol implementation at (p<0.001). Nasal Skin Breakdown in the study group was significantly less than in the control group at a different time of assessment at (p˂0.001). Conclusion: It can be concluded that the research hypothesis is accepted; the nursing protocol implemented for nurses improved their knowledge and practice as well as reduced nasal skin breakdown in the preterm newborns receiving NCPAP. The study recommended applying the nursing protocol for nurses caring for preterm infants to reduce nasal skin breakdown during CPAP ventilation, an effective and safe non-invasive intervention in all NICUs as a standard of care for all preterm infants

Modified flower pollination algorithm for global optimization

In this paper, a modified flower pollination algorithm (MFPA) is proposed to improve the performance of the classical algorithm and to tackle the nonlinear equation systems widely used in engineering and science fields. In addition, the differential evolution (DE) is integrated with MFPA to strengthen its exploration operator in a new variant called HFPA. Those two algorithms were assessed using 23 well-known mathematical unimodal and multimodal test functions and 27 well-known nonlinear equation systems, and the obtained outcomes were extensively compared with those of eight well-known metaheuristic algorithms under various statistical analyses and the convergence curve. The experimental findings show that both MFPA and HFPA are competitive together and, compared to the others, they could be superior and competitive for most test cases

USING MOBILE AUGMENTED REALITY TECHNOLOGIES IN ARCHITECTURAL EDUCATION

Effective applied research is based on close collaboration between research and industry. The teaching and learning methods used for decades in Architectural learning process should be reviewed taking into account habits of learning and the existing challenges provided by contemporary information technologies for a new generation of students. This paper introduces a pilot study based on using Augmented Reality (AR) as a new tool in architectural learning process. AR is an emerging technology which enables participants to interact with digital information embedded within the physical environment. Egyptian educational architectural institutions today are largely unaware of new concepts such as Augmented Reality opportunities for architectural practice, and the prototypes that are being developed by researchers worldwide. The paper goal is to present how it is very helpful to use such new advanced technology in architectural learning process. Testing its possibilities for graphical and spatial capabilities and recognition improvements for the first year architectural students in the Building Construction course, at the Department of Architecture, Menoufia University, Egypt. The case study was applied at the first semester of the academic year of 2015-2016

Effect of Educational Empowerment on Student Nurses’ Knowledge, Practice, and Attitude toward Genomic Counselling

Context: All over the world, the increased awareness of the importance of early diagnosis of genetic diseases has given them priority in primary health care. However, more recent surveys indicate that genetics content is still lacking in nursing curricula.Aim: Evaluate the effect of educational empowerment on student nurses' knowledge, practice, and attitude toward genomic counseling. Methods: Quasi-experimental (pre/post-test) design was utilized to collect the data for this study. The study was conducted at the Faculty of Nursing affiliated to Ain Shams University. The subjects were all available adolescent nursing students who enrolled in the pediatric and obstetric course in the third year. The study sample was composed of 340 nursing students. Researchers used a self-administered questionnaire that includes characteristics of subjects and the assessment of knowledge, attitude, and practice of students. Results: 47.65% of the studied students had poor knowledge at the pre-educational program phase, while 55.88% had good knowledge at the post educational program, with a highly significant difference at p-value <0.01. There was a highly significant difference between studied students' attitudes toward genetic disease, health history benefits, genetic examination benefits, genomic counseling, follow-up, and decision-making process domains in pre and post-educational program at p-value <0.001. Also, the results reveal that 79.41% of studied students had unsatisfactory practice in the pre-educational program, while 70.59% of them had satisfactory practice in post educational program. There was a highly positive correlation between knowledge, practice, and attitude of studied students about genomic counseling at the pre-educational program. Conclusion: Educational empowerment positively affected the knowledge, attitude, and practice of adolescent nursing students regarding genomic counseling. The study recommended continuous training for adolescent nursing students about genetic counseling to prepare them for their future roles. Future studies are needed to examine the relationship between knowledge, attitude, and practice of adolescent nursing students regarding genomic counseling

The Antibiotic Resistance and Multidrug Resistance Pattern of Uropathogenic Escherichia coli at Soba University Hospital: A Descriptive Retrospective Survey

Background: The irrational use of antibiotics for the treatment of urinary tract infections (UTIs) may lead to increased antimicrobial resistance among uropathogenic Escherichia coli (E. coli), as well as multidrug resistance worldwide, which will limit available treatment options for UTIs caused by these organisms. This study aimed to determine the resistance pattern of E. coli causing UTIs in out-patients and in-patients of Soba University Hospital. Methods: Data were collected from the laboratory records in the Department of Microbiology in Soba Teaching Hospital by using a predesigned checklist and then analyzed using the statistical package for social sciences. Bivariate analysis (Chi-square test) was used to compare between variables. Results: Out of the 231 E. coli urine cultures, 160 (69.3%) were collected from females. The results showed high resistance to ampicillin (92.4%), amoxicillin-clavulanic acid (83.3%), cephalexin (90.6%), cefuroxime (72%), ceftazidime (71%), ceftriaxone (72%), ciprofloxacin (68%), and co-trimoxazole (75.3%). Collectively, around 188 (81.4%) were multidrug-resistant. On the other hand, the sensitivities of E. coli isolates were 68.8%, 93.1%, 89.4%, and 100% to gentamicin, amikacin, and carbapenems, respectively.  Conclusion: The rate of E. coli resistance was observed to be high to the commonly prescribed drugs for UTIs, including ampicillin, amoxicillin/clavulanic acid, different cephalosporins, fluoroquinolones, and co-trimoxazole. However, E. coli showed lower resistance rates to nitrofurantoin, amikacin, and carbapenems. Thus, these drugs can be reserved for the empirical treatment of UTIs caused by E. coli

Use of combined CZM and XFEM techniques for the patch shape performance analysis on the behavior of a 2024-T3 aluminum structure reinforced with a composite patch

The presence of a geometric discontinuity such as a crack or a notch can cause the failure of a structure during its use. Under various mechanical or thermal stresses, a high concentration of stresses can take place at the level of these discontinuities, which in most cases will lead to the total failure of the structure. The service life of these structures can be improved with the use of the repair technique by bonding a composite patch. This technique is of significant interest in several fields, especially with the use of composite materials. This technique is widely used in aeronautics and ensures a long life of damaged structures. Current research aims to optimize the shape size and fiber's nature of this composite patch in order to ensure good load transfer by reducing the stresses in the damaged area. In this work, a finite element method is used to analysis the effect of the shape of the patch on the global response of a 2024-T3 aluminum structure in the presence of a central circular notch. The composite patch is of the carbon/epoxy type bonded through an A-140 Adekit type adhesive on the damaged part of the plate. The analysis consists in determining the force-displacement curves of the repaired structure by using the combination of the two techniques, XFEM for the damage of the aluminum plate 2024-T3 by the automatic creation of the crack and CZM for the analysis of the adhesive debonding. The analysis takes into account the damage in the plate and in the adhesive. However, for the composite patch, and since there will be no damage, we have just analyzed the effect of its shape and essentially the shape of its edges on the load transfer and consequently on the resistance of the structure under loading in tension. Two main patch shapes have been highlighted, namely the square and circular shape. The results show clearly that the shape of the patch’s edges has an impact on the stresses reduction in the plate and subsequently ensures good resistance in terms of force-displacement curve and consequently delays the peeling of the adhesive