Heart rate patterns of captive Asian elephant (Elephas maximus) in their natural habitat at Wild Elephant Valley, Xishuangbanna of China.

There are few studies on the changes of heart rate of the Asian elephant (Elephas maximus), one of the largest tropical terrestrial mammals, with its self-factors and external environment. By measuring the heart rate of 35 Asian elephants, ranging in age from 4 months to 52 years, using a non-invasive electrocardiogram sensor in their natural habitat at Wild Elephant Valley, Xishuangbanna of China, we found factors that significantly influenced the HR were season, phase of the day, age, body weight, and the interaction between some of the above factors. We also observed that Asian elephants had lower resting heart rate in the morning of hot season than the cold and mild season, and the differences were significant, but the heart rate increased to similar levels in the afternoon regardless of the season. HR also decreased with age in all seasons and phases of the day. However, there was no significant effect of sex. This study reveals the adaptability of Asian elephant to tropical environment, and provides a basic reference for heart rate of Asian elephant under various natural conditions.

Exploring the nurses' experiences in recognising and managing clinical deterioration in emergency patients: A qualitative study.

BACKGROUND: Emergency Department (ED) patients are particularly at a high risk of deterioration. The frontline nurses are key players in identifying and responding to deterioration events; however, few studies have sought to explore the whole process of recognition and management of clinical deterioration by emergency nurses. OBJECTIVES: The aim of this study was to explore the experiences of emergency nurses and provide a whole picture of how they recognise and manage clinical deterioration. METHODS: A qualitative descriptive study involving 11 senior nurses and seven junior nurses was conducted in the ED of a 3000-bed tertiary general hospital using semistructured interviews. The interviews were transcribed and thematically analysed. FINDINGS: Four salient themes emerged from the data analysis. The first, 'early recognition and response', revealed the importance of vital signs assessment in recognising and responding to clinical deterioration. The second, 'information transfer', depicted the skills and difficulties of transferring information in escalations of care. The third, 'abilities, education, and training', presented the abilities that emergency nurses should have and their perspectives on training. The fourth, 'support culture', described the major role of senior nurses in collaboration with colleagues in the ED. CONCLUSIONS: This study explored the experiences of emergency nurses in recognising and managing clinical deterioration. The findings illuminate the need to support the critical role of emergency nurses, with an emphasis on their abilities and continuous interprofessional collaboration training to improve the recognition and management of clinical deterioration.

The effectiveness of education strategies for nurses to recognise and manage clinical deterioration: A systematic review.

OBJECTIVES: To identify, critically appraise and synthesise evidence on the efficacy of education strategies for nurses to recognise and manage clinical deterioration, as well as provide recommendations for standardised educational programmes. DESIGN: A systematic review of quantitative studies. METHODS: Quantitative studies published in English between 1 January 2010 and 14 February 2022 were chosen from nine databases. Studies were included if they reported education strategies for nurses to recognise and manage clinical deterioration. The quality appraisal was performed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project. The data were extracted and the findings were integrated into a narrative synthesis. RESULTS: Altogether, 37 studies published in 39 eligible papers were included in this review, encompassing 3632 nurses. Most education strategies were determined to be effective, and outcome measures can be divided into three types: nurse outcomes; system outcomes; and patient outcomes. The education strategies could be divided into simulation and non-simulation interventions, and six interventions were in-situ simulations. Retention of knowledge and skills during the follow-up after education was determined in nine studies, with the longest follow-up interval totalling 12 months. CONCLUSIONS: Education strategies can improve nurses' ability and practice to recognise and manage clinical deterioration. Simulation combined with a structured prebrief and debrief design can be viewed as a routine simulation procedure. Regular in-situ education determined long-term efficacy in response to clinical deterioration, and future studies can use an education framework to guide regular education practice and focus more on nurses' practice and patient outcomes.

Using NEWS2 to triage newly admitted patients with COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID-19 usually deteriorate rapidly and need further intensive care. AIM: We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID-19 at risk of serious events. DESIGN: We conducted a retrospective single-centre case-control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. METHODS: The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non-invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. RESULTS: There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut-off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC = 0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC = 0.71). CONCLUSIONS: NEWS2 has an appropriate ability to triage newly admitted patients with COVID-19 into three levels of risk: low risk (NEWS2 = 0-3), medium risk (NEWS2 = 4-6), and high risk (NEWS2 ≥ 7). RELEVANCE TO CLINICAL PRACTICE: Using NEWS2 may help nurses in early identification of at-risk COVID-19 patients and clinical nursing decision-making. Using NEWS2 to triage new patients with COVID-19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety.

Is a single dose of commonly used antibiotics effective in preventing maternal infection after cesarean section? A network meta-analysis.

OBJECTIVE: This study aimed to compare the efficacy of different antibiotic classes and dosages in preventing maternal infection after cesarean delivery. METHODS: Databases were searched for randomized controlled trials (RCTs) published between January 1980 and January 2021 on antibiotic use for the prevention of maternal infection after cesarean delivery. The outcomes were endometritis, febrile morbidity, and wound infection, reported as odds ratios (OR) and surface under the cumulative ranking curve analysis scores. RESULTS: A total of 31 RCTs met the inclusion criteria. In the network meta-analysis (NMA) for endometritis, pooled network OR values indicated that the following interventions were superior to placebo: cephalosporins (OR: 0.18, 95% credibility interval [CrI]: 0.07-0.45), penicillins (OR: 0.19, 95% CrI: 0.07-0.50), penicillins (multiple doses) (OR: 0.20, 95% CrI: 0.05-0.65), combination therapies (OR: 0.22, 95% CrI: 0.09-0.54), and cephalosporins (multiple doses) (OR: 0.25, 95% CrI: 0.08-0.74). In the NMA for febrile morbidity, placebo was more effective than the other interventions. In the NMA for wound infection, pooled network OR values indicated that the following interventions were superior to placebo: penicillin (OR: 0.14, 95% CrI: 0.05-0.37), cephalosporins (OR: 0.19, 95% CrI: 0.08-0.41), cephalosporins (multiple doses) (OR: 0.20, 95% CrI: 0.06-0.58), combination therapies (OR: 0.29, 95% CrI: 0.13-0.57), macrolides (OR: 0.33, 95% CrI: 0.15-0.74), and penicillins (multiple doses) (OR: 0.40, 95% CrI: 0.17-0.91). CONCLUSIONS: Compared with placebo, a single dose of commonly used antibiotics may prevent maternal infection after cesarean delivery. However, the incidence of febrile morbidity was not reduced.

Demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 in large general hospital. / 大型综合性医院2019å† çŠ¶ç— æ¯’ç— ç–«æƒ æœŸé—´é—¨æ€¥è¯Šæ‚£è€ å°±è¯Šéœ€æ±‚åŠåº”å¯¹.

OBJECTIVES: To discuss the demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 (COVID-19) in large general hospital. METHODS: By analyzing patients' demands, outpatient service system and emergency system complemented each other with the help of "internet medical" to provide online medical treatment, self-diagnosed pneumonia program, online pharmacies, outpatient appointment and online pre-examination services, open green channels for special patients, and to provide referral services for critical patients. The COVID-19 suspected patients and other common fever patients were separated from other patients. RESULTS: From January 28 to March 1, we have received 26 000 patients online, 1 856 special patients, 2 929 suspected patients and common fever patients including 31 confirmed patients, 0 case of misdiagnosis and cross-infection. CONCLUSIONS: Targeting patient's demands and taking appropriate measures are effective on meeting the needs of outpatients' and emergency patients' medical services.

Assessment of effective conservation of the Sichuan takin by giant panda reserves through functional zoning.

The flagship species conservation strategy is widely practiced in nature reserves. However, few studies have quantitatively explored whether the current functional zoning adequately conserves the habitats of other species. To examine this problem, we selected the Tangjiahe, Xuebaoding, and Wanglang national nature reserves in southwest China and tested the protective efficiency of the giant panda (Ailuropoda melanoleuca) reserves on a local herbivore-Sichuan takin (Budorcas taxicolor tibetana) in functional zoning. We predicted that the habitat distribution of the Sichuan takin with Maxent and habitat suitability would be classified as very low, low, moderately, or highly suitable. We calculated the percentage of each type of habitat class across the core, buffer, and experimental zones in these reserves and introduced an economic index present value index to further assess the efficacy of the functional zoning in conserving the habitat of Sichuan takin. Our findings indicate that suitable habitat distributions of Sichuan takin are multicore and influenced by diverse variables in different nature reserves. The percentage of moderately suitable and highly suitable habitat in the core zone is 69% and 54% in Tangjiahe, 76% and 75% in Wanglang, and 47% and 28% in Xuebaoding, respectively. The present value index of moderately and highly suitable habitat is 1.01 and 0.79 (Tangjiahe), 0.87 and 0.86 (Wanglang), 0.76 and 0.44 (Xuebaoding), respectively. The efficiency of functional zoning on Sichuan takin seems lower than imagined in giant panda reserves, and species that have important impacts on local ecosystem need further estimation and greater focus.