الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
The term ”urolithiasis” describes stone or calculus that occurs in the urinary tract system. It is characterized by the development of deposites in the urinary system, although it most frequently occurs in the ureters or kidneys, it can also affect the bladder or urethra.The third most frequent condition affecting the urinary tract, nephrolithiasis or urolithiasis, has become more prevalent in current years. High risk of end-stage renal failure, heart disease, hypertension, and diabetes has all been linked to urinary tract stones. If nephrocalcinosis is present, urinary system stones can cause up to 3% of incidents of end-stage renal disease. Genetics, age, gender, (BMI), weight, fluid intake, medical conditions, occupation, hot climate, and dietary habits are some of the risk factors for renal stone.Higher consumption of oxalate, sodium chloride salt, a diet heavy in protein (animal protein), and poor fluid intake are dietary risk factors. Low fluid intake produces urine that is highly saturated and low in volume, which is an important for the development of a variety of an important approach for preventing kidney stone recurrences is dietary and lifestyle changes. The goal of dietary intervention is to treat urine problems that are known to trigger lithogenesis. Patient education improves comprehension and compliance with medical advice, which has a significant impact on long-term results and enhances their quality of life. New and flexible educational techniques are required in order to appropriately meet the educational needs of patients. The multimedia approach to education is one of the newer methods. The use of multimedia improves educational clarity, makes the subject matter more comprehensible and engaging, broadens patients’ comprehension, strengthens the lasting effects of learning, improves patients’ involvement in learning, and offers appropriate feedback. This study aims to: Evaluate the effect of multimedia on dietary regimen for patients with urinary system stones. Research Hypothesis 1-Among patients with urinary system stones, the knowledge scores regarding dietary regimen is expected to be improved after multimedia has been provided when compared with base line (pretest) knowledge scores. 2- Among patients with urinary system stones, the level of perception regarding multimedia is expected to be increased. Setting and sample: The study was conducted at two clinical places; the first one was the Student Educational Hospital which has been affiliated to Tanta University hospital. The second setting is Urology Department at Tanta Universal Teaching Hospital. A quasi experimental research design was used to fulfill the study’s purpose. A convenience sampling of 60 adult conscious patients diagnosed with urolithiasis who met the requirements for inclusion and exclusion at the previously mentioned setting was selected. Three tools were utilized for collection of data. Tool (I): Socio-demographic and clinical data: It was established by the researcher after reviewing the recent literatures and it consisted of three parts: Part (1): Patients` Socio-Demographic such as age, sex, occupation, education level, income, marital status, and residence data. Part (2): Patients` Medical History which included: stone history as (onset of present urinary stone attack, types of present therapy, and family history of urinary stone).Medical problems (gout-hyperparathyroidism-urinary tract infection- Cohn’s disease).Use of stone provoking drugs such as (diuretics, vitamins as C or D, antihypertensive drugs and others). Part (3): Patient’s laboratory tests which included: lab investigations such as urinalysis as (urine specific gravity, urine pH) and urine culture. Blood analysis which included (serum creatinine, urea) according patient hospital records. Tool (II): Patient’s knowledge assessment questionnaire This tool developed by the researcher after reviewing the related literatures, it consisted of 3parts Part (1): Assessment of patient s` knowledge regarding urinary system stone disease (definition, types of kidney stone, symptoms, risk factors) Part (2): Assessment of patients` knowledge regarding food items for prevention of complications of urinary system stone formation: such as eating more or less of foods such as fruits, vegetables, sugary food, red meat, dark chocolates. Part (3): Assessment of Patient’s knowledge related to fluids and beverages intake. Such as drink a lot of fluid during hot weather situation, drink one or two cups of water before sleep or when at morning a after waking up, drinking enough amount of fluid in case of fever and severe diarrhea. Tool (III): patient’s perception assessment regarding using multimedia questionnaire. This part was adapted from Krauss and Alleys (2007)(25)modified Learning Object Review Instrument (LORI)This part consisted of 9 items to assess patient awareness regarding using multimedia such as (using multimedia was attractive, using graphics and animated movie was effective over any traditional approach, multimedia provide helpful on-line information when required, multimedia retained attention. Tools (I) was used by the researcher before beginning of intervention and tool II was used three times before, immediately and after 1month of intervention and tool (III) was used after 1month. The tools were presented to a jury of seven medical-surgical nursing professionals to assess validity and applicability of each tool. Necessary modifications were done .pilot study was conducted on10% of the sample to test clarity and applicability of the tool. The main findings of the study: - It was found that (21%)of the studied patients their age ranged between(50- 60)years and the Mean± SD for age of studied group was (45.583 ± 10.165). - The study show that (76.7%) of patients were males and (7%) were married. - The study revealed that (68.3%) resided in rural communities. - It was observed that (40%) were Illiterate and (51.6) had Manual work. - It was found that (56.7%) did not have enough income. - Regarding medical history; it was found that (70%) have kidney stone, (46.7) had onset of prior urinary stone (more than or equal 9 months), (73 .3%) used Instrumental therapy. (54%) of them used PCNL. - Regarding family history, (70%) of patients have family history of stone. - Regarding medical problems, more than one third of the studied samples (38.3%) have UTI. - Concerning the laboratory tests, (41.7%) of patients has calcium oxalate stone and (33.3%) has uric acid stone - Regarding receiving information about urinary stone diet, (71.7%) didn’t receive information about urinary stone diet. - Our study illustrated that only (6.6%) of studied group has high knowledge regarding urinary stone pretest, which developed to (78.3%) posttest then become (80%) in follow up. - In relation to level of knowledge concerning overview of urinary tract stones among the studied groups. It illustrates highly statistical significant differences for the studied group prior to, immediately and one month after of apply of multimedia, p=0.000**. - Concerning knowledge of food that prevents complications of urinary stones among the studied groups prior to, immediately and one month after of implementing of multimedia. It illustrates highly statistical significant differences for the studied group prio to, immediately and one month after of implementation of multimedia. (p value 0.000). - In relation to knowledge of fluids & beverages that prevent complications of urinary stones. There was a highly statistical significant difference for the studied group before, immediately and after one month of application of multimedia. (p value 0.000). - Concerning perception regarding using multimedia to prevent complications of urinary stones, (81.7%) have satisfaction regarding using multimedia and only (18.3%) don’t have satisfaction. - Additionally, it was found that there was a statistically significant effect of socio-demographic characteristics on total knowledge level for the studied patients after health education and follow-up. - Finally, a positive significance correlation was revealed between patient knowledge (pretest) and patient knowledge (posttest) where r (0.283) and p (0.028*). Conclusion: Among patients with urinary system stone, multimedia based educational program was effective in increasing the knowledge scores regarding dietary regimen as well as level of perception. According to the results of this study, it was recommended that using multimedia and audio-visual materials in continuous health education program regarding urinary tract stone. Additionally, it is recommended to conduct research on greater probability samples to generalize the results.