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The purpose of this research is to ascertain whether there has been a change in the outcome of critically ill pregnant women from the indigent South African population from a clearly defined region in Pretoria, after the introduction of new management protocols supported by regular audit and feedback.

A comparison of outcome of all women with severe acute maternal morbidity or maternal deaths was made between 1997/1998 (original protocol) and 2002/2004 (new protocol) was performed.

It was found that there was a significant increase in the prevalence of critically ill pregnant women between 1997/1998 (8.40/1,000 births) and 2002/2004 (10.22/1,000 births; p<0.014), but a reduction in the MMR 133.2/100,000 births to 104.9/100,000 births (Odds Ratio 0.79, 95 Confidence Intervals 0.51 and 1.2) and in the mortality index from 15.9 per cent to 10.3 per cent (Odds Ratio 0.61, 95 per cent Confidence intervals 0.39 and 0.96). The pattern of primary obstetric causes of critically ill pregnant women has remained unchanged during the study period, but the prevalence of each disease category increased. The average number of dysfunctional organ systems per patient declined from 1.41 in 1997/1998 to 1.19 in 2002/2004. There were significant reductions in the number of critically ill pregnant women with renal dysfunction, metabolic dysfunction and cerebral dysfunction. The number of patient related, administrative related and medical personnel avoidable factors all decreased.

The new protocols, audit and feedback have been associated with a reduction in the number of preventable and manageable complications experienced by critically ill pregnant women over the past five years.

Multiple pathologies and age-related physiological changes lead to acute respiratory failure. This necessitates mechanical ventilation among elderly patients. Mechanically ventilated critically ill elderly patients may confront various problems, including physical and psychological issues. Therefore, the purpose of this paper is to present the frequent problems encountered by critically ill elderly patients and management of such problems.

This paper reviews relevant literatures.

Physical problems include pain and respiratory infections. Additionally, psychological problems include anxiety and stress. Such problems should be managed by physicians, nurses and family members. Pharmacological and non-pharmacological approaches can be used to manage these problems. Pharmacological management involves use of medications, while non-pharmacological interventions include use of music therapy, acupuncture and sensory stimulation.

The paper indicates physical and psychological problems of mechanically ventilated critically ill elderly patients. To ensure effective management of complications encountered by mechanically ventilated elderly patients, health-care professionals ought to be aware of physical and psychological age-related changes.

Bioelectrical impedance vector analysis (BIVA) and phase angle (PA) have importance in assessing nutritional and prognosis, and this study hypothesized that these measurements can have a relationship with nutritional risk and outcomes. This study aims to analyze the association between Nutrition Risk in the Critically ill (NUTRIC) score and bioelectrical impedance measures with hospital mortality in critically ill patients.

A prospective, cohort study was performed with a consecutive sample of patients admitted to an intensive care unit (ICU), between January and June 2017 at a hospital university in Northwest Brazil. The NUTRIC score and the bioelectric measures, such as resistance (R), reactance (Xc), PA and BIVA, were completed within the first 24 h of admission. The Student’s t or Mann–Whitney, Pearson’s or Spearman’s coefficient and Fisher’s exact tests and BIVA were used for statistical analyses.

The sample consisted of 81, with a mean age of 57 (16.7) years, with 60.5% women. It was detected that PA and Xc were lower (p < 0.001), and age was higher (p < 0.001) in a high nutritional-risk group. It was found an association between low nutritional risk and hospital discharge (p < 0.001), and that individuals who died spent more days in the ICU (p = 0.0375), had significantly lower PA and Xc values (p = 0.043 and p = 0.0172, respectively) and higher NUTRIC scores (<0.0001). There was a displacement of the mean impedance vector in men and women with high nutritional risk (p = 0.0037 and p = 0.004, respectively).

The height measurement was estimated using predictive formulas, which may affect the accuracy of the values; BIA was performed only upon admission of the patient to the ICU and the study population was heterogeneous, as it is a general ICU.

This paper shows that, in critically ill patients, nutritional screening and the assessment of bioelectrical measures help in clinical-nutritional decisions, and were able to predict outcomes.

This qualitative phenomenological study examined the experiences of patients, their family members, and the nurses in the intensive care unit during critical illness. Five participants from each category participated in two interviews over a period of five months. Content analysis of the interview transcripts revealed five integrating common themes, each reflecting concepts from the Roy Adaptation Model (RAM). The ICU experience among all participants is interdependence. Adaptation in the ICU integrated family as a unit, physical care/comfort, physiological care and psychosocial support, resulting in transformation.

The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations.

A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines.

A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate >5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission.

To the authors' knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.

This study presented the experience of improving the nucleic acid sample collection and transportation service in response to the epidemic. The main purpose is that through intelligent path planning, combined with the time scheduling of sample points, the process of obtaining results to determine the state of COVID-19 patients could be speeding up.

The research optimized the process, including finding an optimal path to traverse all sample points in the hospital area via intelligent path planning method and standardizing the operation through the time sequence scheduling of each round of support staff to collect and send samples in the hospital area, so as to ensure the shortest time in each round. And the study examines these real-time experiments through retrospective examination.

The real-time experiments' data showed that the proposed path planning and scheduling model could provide a reliable reference for improving the efficiency of hospital logistics. Testing is a very important part of diagnosis and prompt results are essential. It shows the possibility of applying the shortest-path algorithms to optimize sample collection processes in the hospital and presents the case study that gives the expected outcomes of such a process.

The value of the study lies in the abstraction of a very practical and urgent problem into a TSP. Combining the ant colony algorithm with the genetic algorithm (ACAGA), the performance of path planning is improved. Under the intervention and guidance, the efficiency of hospital regional logistics planning was greatly improved, which may be of greater benefit to critical patients who must go through fever clinic during the epidemic. By detailing how to more rapidly obtain results through engineering method, the paper contributes ideas and plans for practitioners to use. The experience and lessons learned from Tongji Hospital are expected to provide guidance for supporting service measures in national public health infrastructure management and valuable reference for the development of hospitals in other countries or regions.

The purpose of this paper is to analyze the influencing factors of patients’ financial burden through a case study of hospital on public‒private partnerships (PPP) model (Chaonan Minsheng Hospital of Guangdong Province) and provide some useful information to policymakers for better development of hospitals on PPP model.

There are total six indicators that are defined as patients’ financial burden, basing on the policy of “indicators of medical quality management and control on the third level large general hospital (2011 edition),” issued by Chinese Government. In total, 23 potentially influencing factors of patients’ financial burden for hospital on PPP model were chosen from the above policy. The five-year (2007‒2011) data for the above 29 indicators come from statistic department of hospital on PPP model. Grey relational analysis (GRA) was applied to analyze the influencing factors of patients’ financial burden for hospital on PPP model.

A clear rank of influencing factors of patients’ financial burden is obtained and suggestions are provided from results of GRA, which provide reference for policymakers of hospital on PPP model. The five main influencing factors of patients’ financial burden for hospital on PPP model, in sequence, are rescuing critical ill patients on emergency, rescuing critical ill inpatients, inpatient bed occupancy rate, working days per bed and medical building area.

The study on the influencing factors of patients’ financial burden for hospital on PPP model not only provides decision-making for policymaker of hospital and controlling of medical expenditure but also contributes to release patients’ financial burden for hospitals on PPP model.

This study aims to examine the relationship between neutrophil to lymphocyte ratio (NLR), handgrip strength (HGS) and nutritional status in non-critically ill patients and outpatients.

A cross-sectional study was conducted on 80 geriatric patients. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form, Geriatric Nutritional Risk Index, some anthropometric and biochemical parameters. NLR was calculated from the complete blood count results. Data were analyzed using SPSS 24.0.

While 38.3% of patients were malnourished or at risk of malnutrition, 61.7% had normal nutritional status. Mini Nutritional Assessment Short Form was not correlated with NLR, whereas it showed a weak positive correlation with HGS. According to the logistic regression analysis, age, HGS, hemoglobin and platelet to lymphocyte ratio were significant independent factors for predicting malnutrition or risk of malnutrition. The receiver operator characteristic curve analysis showed that the optimum HGS cut-off point for patients with malnourished or at risk of malnutrition was 13.2. In conclusion, HGS was associated with the nutritional status. NLR was not associated with nutritional status but associated with nutritional risk.

It is well known that malnutrition is a serious health problem among older adults, and it is important to assess the nutritional status of older adults because of the adverse health effects. In addition, to the best of the authors’ knowledge, this is the first study to determine the relationship between NLR, HGS and nutritional status in non-critically ill patients and outpatients.

This study aims to assess the quality of life (QOL) and the related factors in patients post-stroke in Jordan.

Prospective, the cross-sectional study recruited 100 participants with stroke from three public hospitals from December 1, 2021 to February 1, 2022. Patients with stroke were interviewed to fill the stroke-specific quality of life questionnaire.

Forty-five per cent of the participants were male. More than half of the participants (53%) were married, and the average age of the participants was 63.6 (SD =3.8). Most of the participants had an ischemic stroke (86%) with an affected left side (65%). The overall QOL of the participants was leveling at (M = 123.5, SD = 45.2), which is a moderate level. It was found statistical significance differences among participants according to gender, type of stroke, affected side and presence of comorbidities (Table 1).

There were some limitations in this study. First, this study was based on mild to moderate Jordanian stroke survivors and did not include critically ill stroke survivors; the QOL critically ill stroke survivors may differ, which could affect the generalizability of data among all stroke survivors. Second, this study is prospective, and this type of study is prone to bias that could influence the reliability of the results. It is recommended to conduct a mixed-method study to reveal an in-depth understanding of the associated factors with QOL, to ensure reliability and to reflect a better view of the Jordanian population.

To sum up, there is a reduction in the level of QOL among stroke survivors; hence, it is crucial to focus on detecting factors contributing to reducing the QOL and taking individual differences between sexes, type and location of the stroke, and comorbidities into consideration to develop a treatment plan that enhances the QOL and well-being for survivors of stroke.

Taking individual differences between sexes, type and location of the stroke and comorbidities into consideration to develop a treatment plan that enhances the QOL and well-being of survivors of stroke.

The findings of this study bring a strong insight toward assessing the main factors indicating a decrease QOL among stroke survivors.