Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear.This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma.Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit.In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.iii

Objective: The aim of this research was to evaluate the effect of teaching patients stretching neck exercises on pain and disability of the neck following thyroidectomy. Methods: Research design: a randomized controlled trial was utilized. Setting: the study was conducted at the general surgery ward and outpatient surgery clinic-Assiut university hospital. Sample: 60 adult male and female patients scheduled to undergo thyroidectomy and are willing to take part in this study. Tools of data collection: Tool (I): Patient assessment sheet, Tool II: Neck pain and disability index questionnaire. Results: There was no statistically significant difference between both groups regarding their socio-demographic variables and medical data while there was a highly statistical significant difference between both groups regarding pain in the neck and disability 7 days post thyroidectomy. Conclusions: Teaching and applying neck stretching exercises significantly improved the neck condition of patients in the study group regarding pain and disability of the neck. Nurses working in the general surgery department must include the stretching neck exercises in care and follow-up protocols of patients undergoing total thyroidectomy and to use the validated neck pain and disability questionnaire in monitoring patient's condition.

Background: Diabetes is a serious chronic disease. Uncontrolled diabetes and poor diabetic patients' knowledge can lead to a high morbidity and mortality. The aim of this study was to assess the effectiveness of structured teaching program on improvement of diabetic patient's health information, treatment adherence and glycemic control. Method: A quasi-experimental research design (pre posttest) was utilized on 72 diabetic patients at Minia University and general hospitals. A Structured Interview questionnaire about diabetic knowledge and treatment adherence. Glucose monitoring parameter (Glycated Hemoglobin & Random Blood Sugar),was monitored. Results: There was a highly a significant improvement in diabetic patients knowledge, treatment adherence and glycemic control post 1 st and 2 nd follow than pre application of teaching program. Conclusion: The diabetic teaching program would improve patient's knowledge about disease, treatment adherence and glycemic control. Recommendations: Nurses should emphasis to provide an teaching program tailored to each diabetic patient and increase their awareness about the importance of diabetic education to improve glycemic control.

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