Accidental critical care device removals in intensive care units (ICUs) are serious preventable incidents that have major implications. The study aimed to understand possible causes of such events and identify interventions that reduced their occurrence. The researchers conducted a single-center audit by collecting patient data and bundle forms for accidental device removal across two consecutive periods; they retrospectively reviewed the data from the first period (August 1, 2019 to January 31, 2020) and prospectively analyzed the data from the bundle forms obtained in the second (February 1, 2020 to July 31, 2020). From the findings of the first period, the researchers designed an intervention comprising nurses’ adherence to a care bundle checklist and an educational campaign for the care-taking team and applied it in the second period. Patients either accidentally removed the central venous lines secondary to agitation (47%), or it happened by loss of catheter securement (21%), or during daily care (17%) or patient transfer (13%). Such inadvertent incidents resulted in reinsertion with another central venous line (69%), agitation due to sedation interruption (47%), development of hemodynamic instability because of interruption of inotrope administration (30%), significant bleeding that required intervention (21%), and no complications (39%). The overall nurses’ compliance to the care bundle checklist improved from 87% to 97% after introduction of the intervention and the number of devices found in place increased. Therefore, the designed care bundle checklist and educational program successfully decreased the accidental removal of critical care devices.

Context: A cluster and increase in pneumonia cases with unknown cause were detected in Wuhan, Hubei province, China, in December 2019. These cases were reported to be associated with a new coronavirus type by the Chinese health authorities on January 7, 2020. The first case in Turkey was diagnosed on March 11, 2020. COVID-19 (SARS-CoV-2 infection) guide was prepared for the pandemic by the Ministry of Health scientific committee. However, despite strong clinical, laboratory and radiological suspicions, there are also patients who do not meet the exact case definition. Case report: In this case report, we aimed to discuss two cases that did not meet the definitive case definition and followed up in our clinic. Conclusions: Although gold standard method for the definitive diagnosis of SARS-CoV-2 infection is PCR, rapid antibody tests and CT findings are used in combination with PCR for a more effective struggle in the pandemic process would enhance rapid diagnosis of cases, necessary treatment and isolation measures to prevent transmission. It is thought that it would be useful to make case definitions.

Mucoceles of the paranasal sinuses are benign expansive cystic lesions, originated from the obstruction of the nasal drainage, have mucous or mucopurulent secretions and are covered by respiratory epithelium. Its development is insidious, generally unilateral and has a higher incidence between the third and fourth decades of life, with no gender predilection. Objective: To present a rare case of mucocele in the maxillary sinus, addressing the methods used in diagnosis and treatment. Final comments: The clinical evaluation associated with imaging tests suggest the diagnosis of mucoceles and the definitive treatment must be surgical.

Primary health care (PHC) was conceptualized to play a ‘central hub’ role in health systems. Diabetes care services are presently unavailable in PHC facilities, except the screening programs that are carried out by non-governmental organizations. This implies there is issue of behavioural change wheel (BCW) of the stakeholders including the quartet of ministry of health, hospital management board, healthcare professionals (HCP) and diabetes patients. This narrative review investigates perception of stakeholders towards scaling-up of a diabetes context of PHC agenda in Delta State Nigeria. The study utilized data from ongoing studies including opportunistic and purposive sampling designs. Data from published literatures on Nigeria were also reviewed. The various stakeholders’ perceptions is that motivation is poor across board. The ministry of health as well as the hospitals management board, but not patients, have the capacity. Suggested ways of improving BCW in the state include increased allocation for the ministry of health, and retraining healthcare professionals. Others improvement measures including tackling socio-cultural beliefs, and taboos are suggested. Scaling-up and sustaining diabetes care program at the PHC level in Delta State is agreed to be the responsibility of all stakeholders. There is need to enhance capacity/knowledge among community members living with diabetes, and opportunity/practice among the HCPs, but most importantly attitude/motivation of all stakeholders.

In this piece of the series on primary health care (PHC) as a ‘central hub’ role in health systems of Delta State Nigeria, focus is on gestational diabetes screening and postpartum follow up. Antenatal services offered by the governmental health system are rarely available in PHC facilities. Based on preliminary reports from ongoing studies, this narrative review articulates the potential of PHC to offer antenatal services including gestational diabetes screening and postpartum follow up. The basic evidence and need to enhance behavioural change wheel among all stakeholders, including but not limited to both the healthcare providers and community members, are presented.