Fluid restriction versus conventional fluid administration in acute lung injury patients (Comparative study between different strategies of fluid administration in acute lung injury patients)

Background Acute lung injury and ARDS are major causes of morbidity and mortality all over the world. Major steps of understanding the pathophysiology, causes, diagnosis and treatment of this syndrome were taken in last twenty year. Diagnosis of this condition remains underestimated by physicians particularly mild form of this syndrome specially in developing world in which presence of investigations and well trained physicians is not adequate. Objective To compare between the outcomes of fluid administration strategies in the form of restricted or conventional fluid administration that affect oxygenation, weaning of mechanical ventilation and free days of icu admission in acute lung injury patients and its severe form ARDS. To detect the optimal strategy of fluid administration which decrease morbidity and mortality. Patients and Methods Type of Study: Prospective study. Study Setting: The study will be conducted in the ICU units at Ain-Shams University Hospitals and Ahmed Maher Teaching Hospital. Study Period: Four months from date of approval of the protocol. 90 adult patients- divided into three groups each group include 30 patients- (fulfilling inclusion criteria) admitted in the ICU units at Ain Shams University Hospitals and Ahmed Maher Teaching Hospital were included. Results Based on more than one point of view; underlying cause of ARDS palys major role in predicting these unpredictable results of this study in haemodynamically unstable patients. There are many factors, rather than hypoxemia, that affect organ outcomes (including respiratory system itself) in haemodynamically unstable patients which may caused by septic shock and other types of shock. Conclusion This small trial evoked new questions more than answering traditional ones about fluid management of acute lung injury and ARDS. Firstly; the accurate method to assess and guide fluid therapy in ARDS should be on top of searching priorities. Although using central venous pressure to guide fluid therapy could theoretically results in outcome improvement, but according to its many limitations and poor relation to volume status, its using in that issue is questionable. Secondly; establishing one fluid management strategy to all patients with ARDS seems to be not accurate. Unpredictable results on outcomes in ARDS patients receiving fluids particularly in those were haemodynamically unstable drive us to seek for new classification of ARDS patients based on underlying cause, haemodynamic stability and other elements that responsible for organ failure rather than volume status. However; this small trial suggests conservative fluid strategy in acute lung injury patients which are haemodynamically stable. And using of both conservative and liberal fluid administration strategies wisely in those patients which are haemodynamically unstable to reach the optimal intravascular volume– pressure with the best risk–benefit ratio.

C-STICH2: emergency cervical cerclage to prevent miscarriage and preterm birth—study protocol for a randomised controlled trial

Background Cervical cerclage is a recognised treatment to prevent late miscarriage and pre-term birth (PTB). Emergency cervical cerclage (ECC) for cervical dilatation with exposed unruptured membranes is less common and the potential benefits of cerclage are less certain. A randomised control trial is needed to accurately assess the effectiveness of ECC in preventing pregnancy loss compared to an expectant approach. Methods C-STICH2 is a multicentre randomised controlled trial in which women presenting with cervical dilatation and unruptured exposed membranes at 16 + 0 to 27 + 6 weeks gestation are randomised to ECC or expectant management. Trial design includes 18 month internal pilot with embedded qualitative process evaluation, minimal data set and a within-trial health economic analysis. Inclusion criteria are ≥16 years, singleton pregnancy, exposed membranes at the external os, gestation 16 + 0–27 + 6 weeks, and informed consent. Exclusion criteria are contraindication to cerclage, cerclage in situ or previous cerclage in this pregnancy. Randomisation occurs via an online service in a 1:1 ratio, using a minimisation algorithm to reduce chance imbalances in key prognostic variables (site, gestation and dilatation). Primary outcome is pregnancy loss; a composite including miscarriage, termination of pregnancy and perinatal mortality defined as stillbirth and neonatal death in the first week of life. Secondary outcomes include all core outcomes for PTB. Two-year development outcomes will be assessed using general health and Parent Report of Children’s Abilities-Revised (PARCA-R) questionnaires. Intended sample size is 260 participants (130 each arm) based on 60% rate of pregnancy loss in the expectant management arm and 40% in the ECC arm, with 90% power and alpha 0.05. Analysis will be by intention-to-treat. Discussion To date there has been one small trial of ECC in 23 participants which included twin and singleton pregnancies. This small trial along with the largest observational study (n = 161) found ECC to prolong pregnancy duration and reduce deliveries before 34 weeks gestation. It is important to generate high quality evidence on the effectiveness of ECC in preventing pregnancy loss, and improve understanding of the prevalence of the condition and frequency of complications associated with ECC. An adequately powered RCT will provide the highest quality evidence regarding optimum care for these women and their babies. Trial registration ISRCTN Registry ISRCTN12981869. Registered on 13th June 2018.

C-STICH2: Emergency Cervical Cerclage To Prevent Miscarriage And Preterm Birth: Study Protocol For A Randomised Controlled Trial

Background: Cervical cerclage is a recognised treatment to prevent late miscarriage and pre-term birth (PTB). Emergency cervical cerclage (ECC) for cervical dilatation with exposed unruptured membranes is less common and the potential benefits of cerclage are less certain. A randomised control trial is needed to accurately assess the effectiveness of ECC in preventing pregnancy loss compared to an expectant approach.Methods: C-STICH2 is a multicentre randomised controlled trial in which women presenting with cervical dilatation and unruptured exposed membranes at 16+0 to 27+6 weeks gestation are randomised to ECC or expectant management. Trial design includes: 18 month internal pilot with embedded qualitative process evaluation; minimal data set; and a within-trial health economic analysis. Inclusion criteria are: ≥16 years, singleton pregnancy, exposed membranes at the external os, gestation 16+0-27+6 weeks, informed consent. Exclusion criteria are: contraindication to cerclage, cerclage in situ or previous cerclage in this pregnancy.Randomisation occurs via an online service in a 1:1 ratio, using a minimisation algorithm to reduce chance imbalances in key prognostic variables (site, gestation and dilatation). Primary outcome is pregnancy loss; a composite including miscarriage, termination of pregnancy and perinatal mortality defined as stillbirth and neonatal death in the first week of life. Secondary outcomes include all core outcomes for PTB. Two year development outcomes will be assessed using general health and Parent Report of Children's Abilities-Revised (PARCA-R) questionnaires. Intended sample size is 260 participants (130 each arm) based on 60% rate of pregnancy loss in the expectant management arm and 40% in the ECC arm, with 90% power and alpha 0.05. Analysis will be by intention-to-treat.Discussion: To date there has been one small trial of ECC in 23 participants which included twin and singleton pregnancies. This small trial along with the largest observational study (n=161) found ECC to prolong pregnancy duration and reduce deliveries before 34 weeks gestation. It is important to generate high quality evidence on the effectiveness of ECC in preventing pregnancy loss, and improve understanding of the prevalence of the condition and frequency of complications associated with ECC. An adequately powered RCT will provide the highest quality evidence regarding optimum care for these women and their babies. Trial registration: ISRCTN12981869 Registered on 13th June 2018

Development of Assistive Media for Passing Volleyball for FIK UNIMED Students

The main objective of this research is developing a medium for assisting passing over as a volleyball learning media. This research was conducted at FIK State University of Medan in 2021. Research at FIK UNIMED Medan will be carried out from February 9 to March 4, 2021. The type of research used is research and development, a small trial sample of 6 students and a large trial of 10 students as well as media, sports and language experts. In small group trialsvalidated by 3 experts, where the percentage of validity reaches 82% - 94.11% with valid criteria can be used. In large group trials the percentage of validity reaches 90% - 98.88%with valid criteria can be used.The small group trial sample of 6 PKO FIK UNIMED students reached 80% with valid criteria, and the large group trial sample of 10 PKO FIK UNIMED students reached 88% with valid criteria. From the test of the effectiveness and efficiency of the passing over aids with learning media experts, it reached 98.18% with valid criteria for use and sports experts reached 96.36% with valid criteria for use. On the basis of the data obtained, the development of the passing-over aids media product is deemed feasible to be developed as one of the learning media aids in volleyball game material.

Hydrocarbon and Petroleum with SETS Approach Module to Train Students’ Critical Thinking Skills

The aim of this study was to develop a module with the Science, Environment, Technology and Society (SETS) approach to train critical thinking skills on hydrocarbons and petroleum using the Research and Development (R and D) method. This development modul was validated by 3 experts, while the limited trial was only limited to a small trial with 3 respondents from class XII students of SMAN 10 Surabaya to obtain practical and effective data of modules that developed on a small scale. This experiment obtained expert validation results 87% with the “very valid” category, module practicality 94% with the “very practical” category and module effectiveness of 0.8 with the “high” category. The effectiveness of the module is obtained from the pretest and posttest that 3 students have increased their critical thinking skills after the module is given. Based on this study, it can be concluded that the module with the SETS approach in the material of hydrocarbons and petroleum can train students’ critical thinking skills and it is feasible to be tested on larger respondents.

The development of a Futsal speed training model

The objective of this research was to produce a speed training model for use with Indonesian futsal players. A research and development model was employed using seven steps adapted from Sugiyono (2005). These steps included an evaluation undertaken by three experts, a small trial conducted with ten Indonesian futsal athletes and, following an initial product revision, a large trial conducted with twenty Indonesian futsal athletes before confirmation of the final product. Assessment sheets and questionnaires were administered as part of the process, and results of the evaluation reported in descriptive and percentage forms. A test speed run of fifty yards using a pretest posttest design was used to further assess product effectiveness with the large trial group. The results provided additional support for the effectiveness of the seven-item futsal speed training model for use with Indonesian futsal athletes.