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本研究は、NICUから一般病棟へ転棟した児の母親の転棟直後からその後にかけての体験を明らかにし、NICUから一般病棟へ転棟した児の母親に対する支援について検討することを目的とした。医学中央雑誌Web版にて、NICU、母親、小児病棟、産科、転棟をキーワードに検索し、４件を分析対象とした。NICUから一般病棟へ転棟直後の母親の体験は３カテゴリー、６サブカテゴリー、その後の体験は８カテゴリー、18サブカテゴリーで構成された。母親は複雑な心情を抱きながらも児のためにケアや医療的ケアを頑張り、心身共に疲労していた。母親への看護として、転棟直後の不安軽減、母親の状態を見極め力を引き出す丁寧な関り、疲労緩和の必要性が示唆された。

Background Nurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards. Objectives The aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings. Methods A qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed. Findings Three main themes emerged from the data analysis. The first, “reaching a collective understanding of patients' conditions’, identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, “role expectations of each other”, describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, “lacking in shared decision-making”, depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care. Conclusions A less-than-optimal collaborative EN–RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN–RN collaborative practice. Nurse managers and educators are instrumental in fostering EN–RN collaboration and providing ongoing education on nursing teamwork skills and competencies.

Aim To explore the family caregivers' experiences and needs of transitional care during the transfer from an intensive care unit to a general ward in China. Background The transfer of patients from the intensive care unit to the ward is a vulnerable time for patients and caregivers, exposing the risk of readmission and death. However, there are few qualitative studies on the family caregivers' views of transitional care for their loved ones in China. Methods With a qualitative research design, 15 interviews were conducted with 15 family caregivers of hospitalized patients transferred from the neurosurgery ICU to the general ward. Colaizzi's (1978) method of data analysis was performed using the NVivo 11.0 software. Results Based on data analysis, four themes were obtained: perception of transfer decision, the experience of transitional care, the obstacles to maintaining care efficiency, and demand for transitional care. Conclusion In order to enhance the continuity of care and improve patient safety during the transfer from an ICU to a general ward in China, priorities should be given to the implementation of effective strategies and methods, including providing psychological and emotional support, encouraging active participation of caregivers, and various communication and collaboration procedures. Implications for nursing The findings from this study can be used as a guide to better preparation and awareness among healthcare professionals to achieve the much-needed demands of family caregivers, as well as the increased quality of transitional care.

Purpose Emergency endotracheal intubations outside the operating room (OR) are associated with high complications. We compare the outcome of emergency endotracheal intubation in the general ward, the intensive care unit (ICU) and the emergency department (ED). Materials and methods We retrospectively analyzed adult patients requiring emergency endotracheal intubation that called for anesthesiologists at our tertiary care institution from January 1, 2015 to December 31, 2016. We evaluated the outcomes, including aspiration, hemodynamic collapse, pneumothorax, emergency tracheostomy, and survival to hospital discharge in the general ward, ICU, and ED. Results There were 416 non-OR emergency endotracheal intubation calls for the anesthesiologist. Among these areas, the ED had the highest proportion of difficult endotracheal (DET) intubation (n = 144 [80.4%]), followed by the general ward (n = 85 [66.4%]), and then the ICU (n = 65 [59.6%]). The incidence of hemodynamic collapse was higher in the general ward (n = 44 [34.4%]) than the ICU (n = 18 [16.5%]) or the ED (n = 16 [9.0%]). We reported the survival rate of the general ward (55.5%), which was lower than the ICU (63.3%) and the ED (80.4%). Among these locations, the ED had the highest rate of neurologically intact (91%) to hospital discharge, compared to the ICU (56.6%) and the general ward (55%). As for the ED, although there was no difference in survival between non-preventive and preventive intubations, preventive intubations was associated with high neurological intact with hospital discharge. Conclusion Emergency and DET intubation in the general ward and ICU resulted in a higher incidence of hemodynamic collapse and mortality than those performed in the ED. Early calls for the anesthesiologist for DET intubation without medications in the ED resulted in a higher rate of neurologically intact survival to hospital discharge.

Objective: To analyze the application of the Mini-Mental State Examination (MMSE) scale in cognitive assessment of elderly patients in a general ward. Methods: Elderly patients who underwent nephrosurgery and thoracic surgery between July 2015 to June 2019 were eligible for the study. A total of 713 patients enrolled and data were collected for the assessment of cognitive status. We analyzed the relationship between cognitive impairment, degree of cognitive impairment, age, and gender. Result: In the 713 cases of cognitive ability assessment by the MMSE, there was cognitive impairment in 21 (4.04%) male patients, and 10 (5.18%) female patients. In addition, the analysis of the correlation between cognitive impairment and gender showed a P value of 0.51, which was not statistically significant. In the participants age research, the average age of the patients in the cognitive normal group was 72.30±6.50 years old, and the average age of the patients in the cognitive impairment group was 78.61±6.90 years old. Their p value was

Introduction: Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. We aimed to evaluate associations between the initial EWS and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS). Methods: We performed a retrospective cohort study of adult patients admitted to a general hospital ward between July 1, 2014–December 31, 2017. Data were obtained from electronic health records (EHR). The primary outcome was in-hospital mortality. Secondary outcomes were ICU admission and hospital LOS. We categorized patients into three risk groups (low, medium or high risk of clinical deterioration) based on EWS. Descriptive analyses were used. Results: After applying inclusion and exclusion criteria, we included 53,180 patients for analysis. We found that the initial (low- vs high-risk) EWS was associated with an increased in-hospital mortality (1.5% vs 25.3%, P

BackgroundWe aimed to determine the incidence, nature of and predisposing factors for risk events (REs) that occur during the intrahospital transport of patients from the ED.MethodsWe undertook a prospective, observational study of intrahospital patient transports from a single ED between 30 January and 20 March 2020. An investigator attended each transport and recorded any RE on a specifically designed data collection document. An RE was any mishap, even if not foreseen, that had the potential to cause the patient harm. A patient equipment number was assigned based on the number of pieces of equipment required during the transport. Poisson regression generated incidence rate ratios (IRRs) and determined risk factors for REs.ResultsOf 738 transports, 289 (39.1%, 95% CI 35.6% to 42.8%) had at least one RE. The total of 521 REs comprised 125 patient-related, 279 device-related and 117 line/catheter-related REs. The most common included trolley collisions (n=142), intravenous fluid line catching/tangling (n=93), agitation/aggression events (n=31) and cardiac monitoring issues (n=31). Thirty-four (6.5%) REs resulted in an undesirable patient outcome, most commonly distress and pain. Predisposing factors for REs included an equipment number ≥3 (IRR 5.68, 95% CI 3.95 to 8.17), transport to a general ward (IRR 2.68, 95% CI 2.12 to 3.39), hypertension (IRR 1.93, 95% CI 1.07 to 3.50), an abnormal temperature and a GCSConclusionsREs are common in transport of patients from the ED and can result in undesirable patient outcomes. Adequate pre-transfer preparation, especially securing equipment and lines, would result in a reduced risk.

The influence of peripheral muscle strength on prognosis after extubation and subsequent functional outcomes is not evident. The objectives of this study were to determine (1) whether peripheral muscle strength can be used as a predictor for patients’ prognoses after extubation, and (2) whether the peripheral muscle strength before extubation is correlated with patients’ subsequent ambulation ability and in-hospital mortality. This study was a prospective observational cohort study. A hand-held dynamometer was used for evaluated the muscle strength of the biceps and quadriceps right before extubation. Besides, after the patients had been transferred from the ICU to the general ward, a 2-minute walk test was performed. A total of 52 patients were enrolled in this study, and the rate of extubation failure was 15%. The muscle strength of the quadriceps was significantly correlated with the prognosis after extubation, 48% of the patients were able to ambulate after being transferred to the general ward. The overall mortality rate was 11%, and there was a significant correlation between the biceps muscle strength and in-hospital mortality. Peripheral muscle strength may serve as an important predictor of a patients’ prognoses after extubation. Poor peripheral muscle strength is indicative of not only a higher risk of re-intubation but also higher in-hospital mortality and poorer functional outcomes.Trial registration: ISRCTN16370134. Registered 30 May 2019, prospectively registered. https://www.isrctn.com/ISRCTN16370134.

Rhodri Saunders, Amanda Hansson Hedblom Coreva Scientific GmbH & Co. KG, Königswinter, GermanyCorrespondence: Rhodri SaundersCoreva Scientific GmbH & Co. KG, Im Mühlenbruch 1, Königswinter, 53639, GermanyTel +49 2223 781 8010Fax +49 761 76999421Email rhodri@coreva-scientific.comIntroduction: Sternal wound infections (SWIs) are severe adverse events of cardiac surgery. This study aimed to estimate the economic burden of SWIs following coronary artery bypass grafts (CABG) in Australia. It also aimed to estimate the national and hospital cost-benefit of adopting single-patient electrocardiograph (spECG) systems for CABG monitoring, a measure that reduces the rate of surgical site infections (SSIs).Material and Methods: A literature review, which focused on CABG-related SSIs, was conducted to identify data which were then used to adapt a published Markov cost-effectiveness model. The model adopted an Australian hospital perspective.Results: The average SWI-related cost of care increase per patient was estimated at 1022 Australian dollars (AUD), and the annual burden to the Australian health care system at AUD 9.2 million. SWI burden comprised 360 additional intensive care unit (ICU) days; 1979 additional general ward (GW) days; and 186 readmissions. Implementing spECG resulted in 103 fewer ICU days, 565 fewer GW days, 48 avoided readmissions, and a total national cost saving of AUD 2.5 million, annually. A hospital performing 200 yearly CABGs was estimated to save AUD 54,830.Conclusion: SWIs cause substantial costs to the Australian health care system. Implementing new technologies shown to reduce the SWI rate is likely to benefit patients and reduce costs.Keywords: sternal wound infection, surgical site infection, electrocardiography, patient readmission, patient safety, medical economics

Xiudi Han,1 Liang Chen,2 Yimin Wang,3 Hui Li,3 Hong Wang,4 Xiqian Xing,5 Chunxiao Zhang,6 Lijun Suo,7 Jinxiang Wang,8 Guohua Yu,9 Guangqiang Wang,10 Xuexin Yao,11 Hongxia Yu,12 Lei Wang,13 Xuedong Liu,1 Bin Cao3 On behalf of the CAP-China Network1Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People’s Republic of China; 2Department of Infectious Disease, Beijing Jishuitan Hospital, Beijing, People’s Republic of China; 3National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 4Department of Nosocomial Infection, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, Yan’an Hospital Affiliated to Kunming Medical University, Kunming City, Yunnan Province, People’s Republic of China; 6Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, People’s Republic of China; 7Department of Pulmonary and Critical Care Medicine, Zibo Municipal Hospital, Zibo City, Shandong Province, People’s Republic of China; 8Department of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 9Department of Pulmonary and Critical Care Medicine, Weifang No. 2 People’s Hospital, Weifang City, Shandong Province, People’s Republic of China; 10Department of Respiratory Medicine, Shandong University Affiliated Qilu Hospital (Qingdao), Qingdao City, Shandong Province, People’s Republic of China; 11Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police Forces, Beijing, People’s Republic of China; 12Department of Infectious Disease, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai City, Shandong Province, People’s Republic of China; 13Department of Pulmonary and Critical Care Medicine, Rizhao Chinese Medical Hospital Affiliated to Shandong Chinese Medical University, Rizhao City, Shandong Province, People’s Republic of ChinaCorrespondence: Xuedong LiuDepartment of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Jiaozhou Road, Qingdao City, 266011, Shandong Province, People’s Republic of ChinaTel +86-18661678256Fax +86-532-82789055Email xuedongliu@263.netBin CaoNational Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, People’s Republic of ChinaTel +86-13911318339Fax +86-10-84206264Email caobin_ben@163.comPurpose: The cost-effectiveness of different guideline-concordant antimicrobial regimens for elderly patients with community-acquired pneumonia (CAP) was rarely discussed. This study attempts to explore the most appropriate cost-effectiveness of guideline-concordant antimicrobial regimen for elderly patients with CAP in general wards.Patients and Methods: This was a multicenter, retrospective, 4:2:1 matched study enrolling 511 elderly patients with CAP hospitalized in general wards. Two hundred ninety-two patients prescribed with β-lactam monotherapy (group A), 146 patients prescribed with fluoroquinolone monotherapy (group B) and 73 patients prescribed with β-lactam/macrolide combination therapy (group C). Clinical outcomes and medical costs were analyzed by χ2 test for categorical variables or Kruskal–Wallis H-test for continuous variables.Results: There were no statistical differences in imaging features, etiology and complications during hospitalization among these three groups. The rates of clinical failure occurrence, in-hospital mortality, 30-day mortality and 60-day mortality also had no significant differences among group A, B and C patients; however, the median length of stay (LOS) in group A patients was 12.0 days, which was significantly higher than that in group B and C patients (both 10.0 days, p< 0.02). The median total, drug, and antibiotic costs for one elderly CAP episode in group B patients were RMB 10368.4, RMB 3874.8, and RMB 1796.3, respectively, which were significantly lower than those in group A and C patients (p< 0.01).Conclusion: Non-inferiority of clinical failure occurrence and short-term mortality was observed in different guideline-concordant antimicrobial regimens for elderly patients with CAP in general wards; however, the median LOS and hospitalization-associated costs for one elderly CAP episode with fluoroquinolone monotherapy were significantly lowest, and this strategy was considered to be the most cost-effective strategy in general wards.Keywords: community-acquired pneumonia, cost-effectiveness, antimicrobial regimen, elderly, general ward

Aim To develop a new general wards patient classification tool based on the nursing intensity level that reflects patients’ clinical characteristics and indirect nursing activities. Design A cross‐sectional design was adopted. This methodological study developed a patient classification system to sort general ward patients based on the intensity of their nursing needs and verified the validity and reliability of this classification system. Methods Thirteen experts verified the tools’ content validity. Data collectors and head nurses classified 150 patients from two hospitals with four general wards and various nurse staffing levels. Inter‐rater reliability was analysed. Staff nurses classified 846 patients following the Korean patient classification system on nursing intensity scores that reflected patients’ clinical status. Content validity was verified based on the classification results. Using K‐group cluster analysis, score ranges for four groups were identified. Results The developed tool includes 8 domains, (symptom management, infection control, nutrition and medication, personal hygiene and secretion, activity, sleep and rest, guidance in nursing/emotional support, nursing activity planning and coordination, indirect activity), 24 subdomains, 66 nursing activities and 124 criteria. Inter‐rater reliability showed high agreement.

Objective: This study was conducted to evaluate the potential drug-drug interactions (pDDIs) among patients admitted in a tertiary care hospital in India. Methods: This was anobservational and cross sectional study for 3 months. All the patients admitted in the general ward under Department of Medicine. Pre-structured proforma and patient’s charts were be used for data collection on the 2nd day of admission. For drug interactions, online ‘Medscape Drug Interaction Checker’ was used. Results: A total of 61 charts were screened. A total of 304 drugs with 57 different types were admitted to these patients (including all dosage forms and routes). The total number of pDDIs were 217, of them 69 were minor, 130 were significant and 18 were serious (including repetitions in different patients). There were 13 unique serious pDDIs. Conclusion: The incidence of pDDIs in our study was high. Controlled study to evaluate whether good clinical management of DDIs can reduce drug-related morbidity or mortality is needed. Keywords:Potential drug-drug interactions (pDDIs), adverse drug reactions (ADRs), poly-medication, hospitalization, pharmacokinetic and pharmacodynamics interactions.

Background Rapid response system (RRS) is being increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes. Methods Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS Results Among 11,612 patients, 5779 and 5883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44–1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45–1.91). Conclusions Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

OBJECTIVES We sought to assess the safety of a restrictive permanent pacemaker implantation (PPI) strategy after transcatheter aortic valve implantation (TAVI) as compared to a liberal strategy. BACKGROUND Conduction disturbances resulting in PPI are common after TAVI. However, conduction disturbances may be transient and PPI may be superfluous in some patients. METHODS Until August 2015, we performed PPI in all patients with new complete left bundle branch block (LBBB, QRS > 120 milliseconds) or higher degree atrioventricular (AV) blocks (liberal strategy). From September 2015 onwards, LBBB established an indication for PPI only in the presence of new-onset AV block (PQ > 200 milliseconds) (restrictive strategy). We analyzed the impact of the restrictive strategy on pacemaker implantation rate, duration of hospital stay, and 1-year mortality. RESULTS Between January 2014 and December 2016, 383 consecutive, pacemaker-naive patients underwent TAVI with the liberal PPI strategy and subsequently 384 with the restrictive strategy. The restrictive strategy significantly reduced the percentage of patients undergoing PPI before discharge (17.2% vs. 38.1%, p

Hanging is one of the common forms of violent mechanical asphyxial death. When compared to other forms of unnatural death all over the world this method stands on top as death is instantaneous.Hanging is always suicidal unless otherwise proved. The aim of this study is to gain new knowledge that would enable the design of effective of measures that would help to prevent suicide by hanging. In this case report, we will discuss the unusual presentation of a young lady who attempts suicide frequently did not result in death. We present data indicating that victims can be resuscitated even after prolonged period of suspension & unconsciousness & some of the reasons why asphyxiation by hanging may be delayed when there is no damage to the spinal cord. The logical, thoughtful management options that we chose at various stages of her disease in general ward with the use of colistin which eventually led to her cure are also discussed here. Emphasis is given on how these tricky cases can be deal with prognostically good results could be achieved, if such victims are vigorously & promptly resuscitated, irrespective of her initial presentation. Bangladesh J Medicine January 2021; 32(1) : 53-57

The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.

This study aims to identify the effect of sexual harassment experiences of nursing students in clinical practice on their self-esteem and clinical competence. The survey data were collected from 319 nursing students in grade 3 and 4 enrolled in three universities located in G province of South Korea, and analyzed by descriptive statistical analysis, t-test and correlation analysis. The results show that 72.7% of nursing students experienced sexual harassment mostly from patients (74.9%) at general ward (64.9%). It is also found that, when experiencing harassment, they sought help from a nurse or head nurse and wanted the hospital to get involved to resolve the issue. A positive correlation was found between their experience with sexual harassment and their self-esteem and clinical competence. This study has contribution on providing basic information that can be used to create a safe nursing practice environment through prevention and protection measures against sexual harassment during clinical practice.

This study aimed to validate the effectiveness of an emergency short-stay ward (ESSW) and its impact on clinical outcomes.This retrospective observational study was performed at an urban tertiary hospital. An ESSW has been operating in this hospital since September 2017 to reduce emergency department (ED) boarding time and only targets patients indicated for admission to the general ward from the ED. Propensity-score matching was performed for comparison with the control group. The primary outcome was ED boarding time, and the secondary outcomes were subsequent intensive care unit (ICU) admission and 30-day in-hospital mortality.A total of 7461 patients were enrolled in the study; of them, 1523 patients (20.4%) were admitted to the ESSW. After propensity-score matching, there was no significant difference in the ED boarding time between the ESSW group and the control group (P = 0.237). Subsequent ICU admission was significantly less common in the ESSW group than in the control group (P 0.001). However, the 30-day in-hospital mortality rate did not differ significantly between the two groups (P = 0.292). When the overall hospital bed occupancy ranged from 90% to 95%, the proportion of hospitalization was the highest in the ESSW group (29%). An interaction effect test using a general linear model confirmed that the ESSW served as an effect modifier with respect to bed occupancy and boarding time (P 0.001).An ESSW can alleviate prolonged boarding time observed with hospital bed saturation. Moreover, the ESSW is associated with a low rate of subsequent ICU admission.

Background Relatives of intensive care unit (ICU) patients play an important role as caregivers and can experience emotional distress, also referred to as post-intensive care syndrome-family. A deeper understanding of what relatives go through and what they need may provide input on how to strengthen family-centred care and, in the end, contribute to the reduction of symptoms of post-intensive care syndrome-family. Method This is a qualitative descriptive study with semistructured face-to-face interviews after ICU transfers. Findings A total of 13 relatives of ICU patients participated. Relatives of ICU patients expressed five types of experiences after transfer from the ICU to the general ward: (1) relief, (2) uncertainty, (3) need to be acknowledged in becoming a caregiver, (4) sharing expectations, and (5) need for continuity in care. Relatives experience major uncertainties and prefer to be more actively involved in care and care decisions. Conclusion Relatives of ICU patients experience gaps in care during the transition from the ICU to a general ward. Nurses can play a crucial role in the need for continuity of care by proactively involving relatives during the care pathway of ICU patients.

Background/aims Scoring systems play an important role in predicting intensive care unit (ICU) admission or estimating the risk of death in critically ill patients with hematological malignancies. We evaluated the modified early warning score (MEWS) for predicting ICU admissions and in-hospital mortality among at-risk patients with hematological malignancies and developed an optimized MEWS. Methods We retrospectively analyzed derivation cohort patients with hematological malignancies who were managed by a medical emergency team (MET) in the general ward and prospectively validated the data. We compared the traditional MEWS with the MEWS plus SpO2/FiO2 (MEWS_SF) score, which were calculated at the time of MET contact. Results In the derivation cohort, the areas under the receiver-operating characteristic (AUROC) curves were 0.81 for the MEWS (95% confidence interval [CI], 0.76 to 0.87) and 0.87 for the MEWS_SF score (95% CI, 0.87 to 0.92) for predicting ICU admission. The AUROC curves were 0.70 for the MEWS (95% CI, 0.63 to 0.77) and 0.76 for the MEWS_SF score (95% CI, 0.70 to 0.83) for predicting in-hospital mortality. In the validation cohort, the AUROC curves were 0.71 for the MEWS (95% CI, 0.66 to 0.77) and 0.83 for the MEWS_SF score (95% CI, 0.78 to 0.87) for predicting ICU admission. The AUROC curves were 0.64 for the MEWS (95% CI, 0.57 to 0.70) and 0.74 for the MEWS_SF score (95% CI, 0.69 to 0.80) for predicting in-hospital mortality. Conclusion Compared to the traditional MEWS, the MEWS_SF score may be a useful tool that can be used in the general ward to identify deteriorating patients with hematological malignancies.

Purpose To predict the risk of developing severe pneumonia among mild novel coronavirus pneumonia (mNCP) patients on admission. Methods A retrospective cohort study was conducted at three hospitals in Shanghai and Wuhan from January 2020 to February 2020. Real-time polymerasechain-reaction assays were used to detect COVID-19. A total of 529 patients diagnosed with NCP were recruited from three hospitals and classified by four severity types during hospitalization following the standards of the Chinese Diagnosis and Treatment of Pneumonia Caused by New Coronavirus Infection (eighth version). Patients were excluded if admitted by ICU on admission (n=92, on a general ward while meeting the condition of severe or critical type on admission (n=25), or there was insufficient clinical information (n=64). In sum, 348 patients with mNCP were finally included, and 68 developed severe pneumonia. Results mNCP severity prognostic index values were calculated based on multivariate logistic regression: history of diabetes (OR 2.064, 95% CI 1.010-4.683; p=0.043), time from symptom onset to admission ≥7 days (OR 1.945, 95% CI 1.054-3.587; p=0.033), lymphocyte count ≤0.8 (OR 1.816, 95% CI 1.008-3.274; p=0.047), myoglobin ≥90 mg/L (OR 2.496, 95% CI 1.235-5.047; p=0.011), and D-dimer ≥0.5 mg/L (OR 2.740, 95% CI 1.395-5.380; p=0.003). This model showed a c-statistics of 0.747, with sensitivity and specificity 0.764 and 0.644, respectively, under cutoff of 165. Conclusion We designed a clinical predictive tool for risk of severe pneumonia among mNCP patients to provided guidance for medicines. Further studies are required for external validation.

Objective To review emergency trolley utilization in the general ward. Method We evaluate the utilization (reason and drug users) in eight emergency trolleys in a private hospital. Based on daily emergency trolley records, we manually search the related patient medical records to identify the reason for using emergency trolleys. Results There were 361 identified reasons for the use of trolleys in the inpatient unit, and not all were for emergency conditions (70.64%), and 9.97% could not be explained. The most common emergency condition was cardiac arrest, while non-emergency reason was shock maintenance treatment. There were situations that the trolley was opening without the use of the drug or not recorded. The drug most often used for emergency conditions was epinephrine, while for non-emergency conditions was norepinephrine. Conclusion The use of emergency trolleys in the inpatient unit was not always for emergency purposes that need more explicit regulation.

Non-invasive ventilation (NIV) is considered a fundamental method in treating patients with various disorders, requiring respiratory support. Often the lack of beds in the intensive care unit (ICU) and the concomitant medical conditions, which refer patients as unsuitable for aggressive treatment in the ICU, highlight the need of NIV application in general non-monitored wards and unusual settings – most commonly emergency departments, high-dependency units, pulmonary wards, and even ambulances. Recent studies suggest faster improvement of all physiological variables, reduced intubation rates, postoperative pulmonary complications and hospital mortality with better outcome and quality of life by early well-monitored ward-based NIV compared to standard medical therapy in patients with exacerbation of a chronic obstructive pulmonary disease, after a surgical procedure or acute hypoxemic respiratory failure in hematologic malignancies. NIV is a ceiling of treatment and a comfort measure in many patients with do-not-intubate orders due to terminal illnesses. NIV is beneficial only by proper administration with appropriate monitoring and screening for early NIV failure. Successful NIV application in a ward requires a well-equipped area and adequately trained multidisciplinary team. It could be initiated not only by attending physicians, respiratory technicians, and nurses but also by medical emergency teams. Ward-based NIV is supposed to be more cost-effective than NIV in the ICU, but further investigation is required to establish the safety and efficacy in hospital wards with a low nurse to patient ratio.