Inconsistency and Ambiguity Within the International Classification of Disease 10 Procedure Coding System for Hip Fractures.

BACKGROUND: The International Statistical Classification of Diseases (ICD), 10th Revision Procedure Coding System (PCS) was created to increase the granularity of procedural coding. These codes are entered by hospital coders from information derived from the medical record. Concern exists that this increase in complexity could lead to inaccurate data. METHODS: Medical records and ICD-10-PCS codes were reviewed for operatively treated geriatric hip fractures from January 2016 through February 2019 at a tertiary referral medical center. Definitions for each of the 7-unit figures from the 2022 American Medical Association's ICD-10-PCS official codebook were compared to the medical, operative, and implant records. RESULTS: There were 56% (135 of 241) of PCS codes that had ambiguous, partially incorrect, or frankly incorrect figures within the code. One or more inaccurate figures were noted in 72% (72 of 100) of fractures treated with arthroplasty compared to 44.7% (63 of 141) treated with fixation (P < .01). There was at least 1 frankly incorrect figure contained in 9.5% (23 of 241) of codes. Approach was coded ambiguously for 24.8% (29 of 117) of pertrochanteric fractures. Device/implant codes were partially incorrect in 34.9% (84 of 241) of all hip fracture PCS codes. Hemi and total hip arthroplasties were partially incorrect in 78.4% (58 of 74) and 30.8% (8/26) of device/implant codes, respectively. Significantly more femoral neck (69.4%, 86 of 124) than pertrochanteric fractures (41.9%, 49 of 117) had 1 or more incorrect or partially correct figures (P < .01). CONCLUSION: Despite the increased granularity of ICD-10-PCS codes, the application of this system is inconsistent and often incorrect when applied to hip fracture treatments. The definitions in the PCS system are difficult to be utilized by coders and do not reflect the operation performed.

Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial.

BACKGROUND AND METHODS: With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single-blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US-guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. RESULTS: In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. CONCLUSIONS: It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

Country-based report: the safety of omalizumab treatment in pregnant patients with asthma

Background/aim: We aimed to report outcomes of pregnant patients with asthma under omalizumab treatment and their infants in our country. Materials and methods: Patients with asthma who received omalizumab for at least 6 months and at least one dose during their pregnancy were retrospectively evaluated using a questionnaire regarding their disease and therapy and the health of their infants. Results: Twenty pregnant patients and their 23 infant's data were analyzed. The mean delivery age was 31.8 ± 7.4 years. They received omalizumab for 28.9 ± 21.8 months. Eight (36.4%) patients showed exacerbation of the disease during pregnancy. Forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) scores at the starting time of omalizumab administration, first month of the pregnancy, and after delivery were 71 ± 18%, 83.4 ± 10.5%, and 80.5 ± 13% (FEV1), and 11.9 ± 4.9, 20.2 ± 2.6, and 20.4 ± 2.2 (ACT), respectively. One patient gave birth to twin infants, two patients to two infants each in different years, and 17 to one infant each. Three (13%) infants had low birth weight and five (21.7%) were born prematurely. No congenital anomalies were detected. Seven (30.4%) infants presented atopic diseases during their life. Conclusion: Omalizumab treatment during pregnancy seems to be safe for both patients and their infants.

Effect of habitual cigarette smoking on the index of cardiac electrophysiological balance in apparently healthy individuals.

BACKGROUND AND AIM: Chronic cigarette smoking has been suggested to portend risk for cardiac arrhythmia generation. Index of cardiac electrophysiological balance (iCEB) is a relatively new ECG parameter indicating balance between ventricular depolarization and repolarization, thereby providing more insight concerning ventricular arrhythmogenesis (VA) than other classical ECG parameters such as QT and corrected QT (QTc) intervals. The present study aimed to assess the status of iCEB in healthy habitual smokers. METHODS: This retrospective study included a total of 80 apparently healthy subjects (45% female, mean age 39.4 ±â€¯8.1 years) with smoking habit and 82 healthy non-smoking subjects (40% female, mean age 37.0 ±â€¯8.6 years) were included between January-September 2019. Demographic, clinical and ECG characteristics were obtained from medical records. iCEB and corrected iCEB values were calculated by dividing respective QT and QTc intervals by QRS duration. RESULTS: Mean PR, QRS and QT intervals were similar between the groups, whereas mean heart rate and QTc interval were greater in the smoker group compared with the non-smokers [(82.0 ±â€¯8.9 bpm vs 77.8 ±â€¯12.4 bpm, respectively, p = 0.016) and (427.05 ±â€¯22.6 msec vs 399.9 ±â€¯12.8 msec, respectively, p < 0.001)]. Subject with smoking habit had greater iCEBc than the controls (5.10 ±â€¯0.49 vs 4.68 ±â€¯0.39, respectively, p < 0.001). However, there was no significant difference in regard of iCEB between the groups (4.37 ±â€¯0.46 vs 4.32 ±â€¯0.42, respectively, p = 0.456). CONCLUSION: iCEBc increases significantly in healthy smokers compared with non-smokers. This may suggest an increased predisposition to Torsades de Pointes-mediated VA in healthy smokers, or in chronic smokers with inherent QT-prolonging genetic variations or those on QT-prolonging drug therapy.

Neurofibromatosis type 1 and pneumoconiosis: A case report on a coincidence.

Neurofibromatosis (NF) is a neurocutaneous syndrome characterized by the development of central or peripheral nervous system tumors. The most common form, known as NF1 or Von Recklinghausen's disease, presents with distinct clinical features, including cutaneous and ocular manifestations, along with various other organ and systemic symptoms. While the lung findings associated with neurofibromatosis lack specificity, they can include parenchymal cysts and bullae formation, primarily in the upper-apical regions. Additionally, progressive fibrotic changes, such as ground-glass areas, consolidations, and paving stone patterns, may manifest in the basal parts of the lungs. In this case report, a case of NF1 diagnosed in adulthood and accompanying pneumoconiosis was discussed as a coincidence.

Endobronchial Tuberculosis in an HIV-positive Case.

INTRODUCTION: Tuberculosis is an opportunist infection that is fatal and most frequently seen in HIV-positive patients due to immunosuppression. Endobronchial lesions can portray symptoms in different ways. Endobronchial Tuberculosis is one of these lesions. CASE REPORT: An HIV-positive, untreated 26-year-old patient with fever, cough, and dyspnea consulted our clinic. In the chest X-ray taken, effusion on the right side and non-homogeneous density increase in the middle and upper lobes, bilaterally more prominent on the right side, were observed. Therefore, the patient underwent bronchoscopy because the CT (computerized tomography) showed mediastinal lymphadenopathy (LAP) and an endobronchial lesion in the left main bronchus. During bronchoscopy, a vegetative endobronchial lesion that causes obstruction in the left main bronchus was monitored. With the help of Pathology and PCR results, endobronchial tuberculosis was diagnosed. CONCLUSION: Even if Acid-alcohol-resistant Bacillus (ARB) is detected negative in patients who stop responding to antimicrobial treatment and are being monitored under radiological scanning, a distinctive diagnosis of endobronchial tuberculosis should be kept in mind while performing bronchoscopy.

The Effect of Hounsfield Unit Value on the Differentiation of Malignant/Benign Mediastinal Lymphadenopathy and Masses Diagnosed by Endobronchial Ultrasonography.

Aim: In cases where standardized maximum uptake (SUVmax) values in positron emission tomography (PET-CT) were not sufficient to differentiate mediastinal lymphadenopathy and masses from malignant or benign, the contribution of Hounsfield unit (HU) values in thorax computed tomography to the diagnosis was evaluated. Material Method: The study was conducted by evaluating the data of 182 patients between 2019 and 2023. HU values on non-contrast thorax computed tomography and PET-CT SUVmax values of biopsied masses and lymph nodes were compared with histopathological diagnoses. Results: Patients, 58 females (31.9%) and 124 males (68.1%), who underwent EBUS were included in the study. Biopsies were taken from 233 stations (199 lymph nodes, 34 masses) from 182 patients. A total of 135 of the biopsies taken from 233 stations were histopathologically malignant and 98 were benign. While PET-CT SUVmax values of cases with benign histopathology were 4.5 ± 3.5, it was 7.6 ± 4.2 in patients with malignant pathology (p<0.05). The HU value on non-contrast thorax tomography in patients with benign histopathology was 43.1 ± 15.7, and in patients with malignant histopathology it was 40.5 ± 13.7 (p>0.05). When HU was compared according to lung cancer type, it was found to be significantly higher in non-small cell lung cancer (p=0.035). A weak (r=0.182) positive and significant relationship (p<0.01) was found between PET-CT values and HU values in thorax computed tomography. Conclusion: While positron emission tomography maintains its importance in the differentiation of mediastinal lymphadenopathy and masses from malignant to non-malignant, it was concluded that HU values in computed tomography are not sufficient to distinguish malignant/non-malignant.

The Effect of Mask Use on Seasonal Virus Diversity in SARS CoV-2 Negative Patients Treated as Inpatients During the 2021-2022 and 2022-2023 Seasonal Flu Period.

The study aimed to explore the protective effect of mask use against respiratory tract viral agents during the pandemic. The study included patients with a COVID-19 negative test who were hospitalized in the pulmonary disease clinic with the diagnoses of asthma attack, chronic obstructive pulmonary disease (COPD) exacerbation, and pneumonia in two periods: during mandatory mask use (October 2021 - May 2022) and after the mask mandate was lifted (October 2022 - May 2023). Combined nose and throat swab samples taken from the patients were evaluated for viral agents by using the PCR test method. Viral agents isolated from the patients in the two periods were compared based on hospitalization diagnoses and periods. The study enrolled 1,335 patients, 483 female and 852 male. It was found that viral agents significantly increased during the period without a mask mandate compared to the period when the mask mandate was in effect (41.6% vs. 23.4%) (p < 0.001). During the period without mask mandate, influenza A, H1N1, and RSV/AB viruses significantly increased (p = 0.019, p = 0.003, p < 0.001, respectively). Our results indicated that mask use during the pandemic is protective against the transmission of respiratory tract viruses. Thus, it can be concluded that mask use is important not only in the coronavirus pandemic but also especially in influenza and RSV epidemics.

Functional Articulating Antibiotic Spacers for Chronic Native Septic Knee Arthritis.

Background: Semipermanent functional spacers are now utilized for prosthetic joint infection in an attempt to avoid another surgery with 2-stage treatment. This study evaluates the results of metal-on-polyethylene articulating spacers for the treatment of chronic native septic knee arthritis. Methods: This is a retrospective review of 18 patients treated with metal-on-polyethylene articulating antibiotic spacers constructed with all-polyethylene tibial components or with polyethylene inserts (PIs) with Steinmann pins or screws for chronic native knee infection. Demographic information, spacer construct type, prior knee surgery, complications, infecting organisms, infection eradication, and functional results were analyzed. Results: Of 18, 8 (44%) spacers were all-polyethylene tibial components and 10 (56%) were PI. Of 18 patients, 5 (28%) experienced spacer complications. Of 18 patients, 12 (67%) underwent a second reimplantation surgery (mean 106 days), while 6 (33%) retained their spacer (average duration 425 days). The PI group performed better in Knee Injury and Osteoarthritis Outcome score for Joint Replacement according to minimum clinically important difference and patient acceptable symptom state (PASS) criteria. The overall reimplantation group achieved Knee Injury and Osteoarthritis Outcome score for Joint Replacement PASS criteria and minimum clinically important difference criteria, while the maintained articulating spacer group did not achieve PASS criteria; however, they did reach minimum clinically important difference. Conclusions: Functional articulating spacers are a viable treatment for chronic, native knee septic arthritis. The PI patient group had a greater improvement in Knee Injury and Osteoarthritis Outcome score for Joint Replacement scores and had no significant difference in reimplantation rate as the all-polyethylene tibial components patient group. Both planned 2-stage reimplantation and longer-term spacer retention show promising results for this difficult clinical problem.

Leveraging machine learning to enhance postoperative risk assessment in coronary artery bypass grafting patients with unprotected left main disease - A retrospective cohort study.

BACKGROUND: Risk stratification for patients undergoing coronary artery bypass surgery (CABG) for left main coronary artery (LMCA) disease is essential for informed decision-making. This study explored the potential of machine learning (ML) methods to identify key risk factors associated with mortality in this patient group. METHODS: This retrospective cohort study was conducted on 866 patients from the Gulf Left Main Registry who presented between 2015 and 2019. The study outcome was hospital all-cause mortality. Various machine learning models [logistic regression, random forest (RF), k-nearest neighbor, support vector machine, naïve Bayes, multilayer perception, boosting] were used to predict mortality, and their performance was measured using accuracy, precision, recall, F1 score, and area under the receiver operator characteristic curve (AUC). RESULTS: Nonsurvivors had significantly greater EuroSCORE II values (1.84 (10.08-3.67) vs. 4.75 (2.54-9.53) %, P<0.001 for survivors and nonsurvivors, respectively). The EuroSCORE II score significantly predicted hospital mortality (OR: 1.13 (95% confidence interval: 1.09-1.18), P<0.001), with an AUC of 0.736. RF achieved the best ML performance (accuracy=98, precision=100, recall=97 and F1 score=98). Explainable artificial intelligence using SHAP demonstrated the most important features as follows: preoperative lactate level, emergency surgery, chronic kidney disease (CKD), NSTEMI, nonsmoking status, and sex. QLattice identified lactate and CKD as the most important factors for predicting hospital mortality this patient group. CONCLUSION: This study demonstrates the potential of ML, particularly the Random Forest, to accurately predict hospital mortality in patients undergoing CABG for LMCA disease and its superiority over traditional methods. The key risk factors identified, including preoperative lactate levels, emergency surgery, chronic kidney disease, NSTEMI, nonsmoking status, and sex, provide valuable insights for risk stratification and informed decision-making in this high-risk patient population. Additionally, incorporating newly identified risk factors into future risk scoring systems can further improve mortality prediction accuracy.

[Spontaneous tension haemopneumothorax]. / Spontan tansiyon hemopnömotoraks.

Spontaneous tension haemopneumothorax is a very rare condition. Forty two-year- old male patient who applied with sudden onset of dyspnea, chest pain was tachypneic, tachycardic, cyanotic and hypotensive. This is the second case of spontaneous tension haemopneumothorax in English literature, according to our knowledge. We present this case because of being a rare condition.

Evaluation of Anxiety, Depression, and Work-Related Strain Inventory of Code Blue Teams in Turkey During the COVID-19 Pandemic: A Cross-Sectional Survey Study.

OBJECTIVE: This study aimed to evaluate the anxiety, depression, and work-related strain inventory with a cross-sectional electronic questionnaire in code blue teams during the coronavirus disease-2019 pandemic in Turkey. METHODS: A web-based electronic questionnaire was sent to healthcare workers registered in the database of the Turkish Society of Anaesthesiology and Reanimation and the Turkish Resuscitation Council who are in the code blue teams of the hospital where they work. An electronic questionnaire including the hospital anxiety-depression scale and the work-related strain inventory was sent to healthcare professionals. A total of 259 participants who answered the questionnaire were included in the study. RESULTS: It was determined that 41.3% (n=107) of all participants were at risk in terms of anxiety and 64.1% (n=166) were at risk in terms of depression by taking above the threshold value. The mean work-related strain inventory score of the participants was found to be 41.19 ± 6.31. The mean work-related strain inventory values of the participants who received above-threshold values from both the anxiety and depression subscales were also found to be statistically significantly higher than the participants who received below-threshold values (P <.001). CONCLUSION: It was determined that approximately half of the code blue teams were at risk for anxiety and two-thirds of them for depression.

The assessment of risk factors associated with difficult intubation as endocrine, musculoskeletal diseases and intraoral cavity mass: A nested case control study.

BACKGROUND: The predictive factors of difficult airway have been studied to reduce especially the incidence of unanticipating difficult intubation, provide patient safety, and avoid wasting resources. In this study, it was aimed to investigate whether endocrine, musculoskeletal diseases, presence of intraoral mass, and demographic factors have predictive values in the evaluation of difficult air-way as well as frequently used airway assessment tests. METHODS: This study was designed a nested-case control study. After eligibility criterions, totally 1012 patient data were collected, 92 of them were difficult intubation, 920 of them were non-difficult intubation patients (1: 10 ratio). Demographic characteristics of the patients (age, gender), body mass index (BMI), Mallampati, Cormack-Lehane Score (CLS), sternomental distance (SMD), inter incisor gap (IIG), type of surgery, endocrine, musculoskeletal and cardio-pulmonary diseases, and the presence of intraoral mass were compared between groups. RESULTS: Age >52 years, male gender, ASA 3-4, higher BMI, CLS 3-4, Mallampati 3-4, IIG <4 cm, and SMD <10 cm were found statistically significant in terms of difficult intubation. Besides, a statistically significant relationship was found when the groups were compared in the presence of intraoral mass (17.57 times higher, p<0.05), endocrine diseases (3.51 times more common, p<0.05) and musculoskeletal system diseases (4.5 times higher, p<0.05). CONCLUSION: In this study, it was demonstrated that endocrine disorders such as diabetes mellitus and thyroid disorders, musculoskeletal system diseases, and the presence of intraoral cavity mass should be used as predictors for difficult intubation with commonly used airway assessment tests.

Heart type fatty acid binding protein is more sensitive than troponin I and creatine kinase myocardial band at early stage in determining myocardial injury caused by percutaneous coronary intervention.

Measurement of circulating cardiac biomarkers has enabled early diagnosis and risk assessment of acute coronary syndrome. Heart type fatty acid binding protein (H-FABP) is a relatively novel marker for the diagnosis of myocardial injury. The purpose of the present study was to compare H-FABP with Troponin I (cTnI) and creatine kinase myocardial band (CK-MB) in determining myocardial injury in patients with early stage of percutaneous coronary intervention (PCI). Blood was withdrawn one hour before and 3 hours after PCI from 40 patients to measure H-FABP, cTnI and CKMB. H-FABP was measured qualitatively. CK-MB and cTnI were measured by a sandwich enzyme-linked immunosorbent assay. Before PCI, H-FABP was found to be negative, while cTnI and CK-MB were found to be in normal ranges. Statistical analysis of measurements 3 hours after PCI revealed that H-FABP was significantly positive in 15 (37%) patients, while cTnI was elevated in 11 (27%) patients and CKMB was elevated in 8 (20%) patients. H-FABP is statistically more sensitive than cTnI and CK-MB at detecting myocardial injury after PCI.H-FABP can be used in early stages to detect myocardial injury caused by PCI. H-FABP is more sensitive than cTnI and CK-MB in determining myocardial injury due to PCI within 3 hours. H-FABP may help us stratify a patient's risk in early stages after PCI.

Did unprogrammed tobacco control efforts over seven years decrease smoking prevalence in the medical school?

Medical students will have significant roles in combating against death tool of tobacco. The aim of this study is to evaluate whether any decrease in the smoking prevalence of the medical students over seven years of many tobacco control efforts. A self-administered questionnaire was carried out among 764 of 854 (89.4%) medical students in order to determine the knowledge, attitudes and behaviors towards tobacco use. Chi-square tests, Student's t-test and multiple logistic regression methods were used. Results were compared with the historical control study that was done seven years ago with same methods. 25.9% of the students were smoker (36.6% of males, 16.3% of females), 4.9% was exsmoker and 69.2% was non-smoker. Quit rate was high among males than females (6.8% versus 3.3%, p< 0.05). When compared with historical cohort in 1999, smoking rate decreased only 3.8% for males and 5.5% for females, and quit rates were not higher. Lower curriculum year, and lower knowledge level about the harms of smoking and environmental tobacco smoke in lower grades, living in bachelor homes, easy access to smuggled cigarettes, using non-cigarette tobacco products were main factors for smoking. There was little decline in smoking rates of medical students despite of many local and national tobacco control efforts over seven years. Special attention and organized, programmed efforts are needed in medical schools in Turkey.

Quantitative Neuromuscular Monitoring With Train-of-Four Ratio During Elective Surgery: A Prospective, Observational Study.

OBJECTIVES: Postoperative residual neuromuscular block (PRNB) is a serious problem that can cause death after surgery. It was aimed to evaluate the adequacy of neuromuscular block (NMB) during endotracheal intubation and the adequacy of neuromuscular recovery during clinically extubation decision and follow-up with the train-of-four ratio (TOFR) using quantitative monitoring. METHODS: This study has a prospective-observational single-blind study design. A total of 205 adult patients who underwent elective surgery, who had American Society of Anesthesiologists physical statuses I to III, and who were intubated with neuromuscular blocking agent under general anesthesia were included in the study. Train-of-four ratio measurements were provided single-blindly by another anesthesiologist outside the team. The TOFRs were measured at the time of intubation (TOFRind), before reversal agent administration (TOFRpre-rev) and after (TOFRpost-rev), at the time of extubation (TOFRext), and on admission to the postoperative care unit (TOFRPACU). If clinical signs of PRNB appeared, the recovery protocol was applied and then TOFRrec was measured. Postoperative respiratory complications were also evaluated for the first 24 hours after surgery. RESULTS: Endotracheal intubation was performed in 41.5% of the patients (n = 85) without adequate NMB. In 48.8% (n = 100) of the patients, adequate recovery (TOFRext ˂0.9) was not available at the time of extubation. Adequate TOFRPACU rate was found to be significantly higher in those who did not receive additional neuromuscular blocking agent doses (P < 0.001). In the recovery protocol, low-dose sugammadex administered to patients with clinical signs of PRNB significantly increased the TOFRrec rate compared with neostigmine (P ˂ 0.001). The first 24 hours, postoperative respiratory complication rate was 5.4% (n = 11), and the most common hypoxemia was observed. CONCLUSIONS: Approximately half of the patients are intubated without sufficient NMB and extubated without sufficient neuromuscular recovery. This suggests that routine use of quantitative neuromuscular monitoring is necessary for patient safety.

Long-term follow-up results of unfractionated heparin infusion treatment for submassive pulmonary thromboembolism.

OBJECTIVE: Treatment options for submassive pulmonary thromboembolism cases vary depending on the patient's hemodynamic stability, comorbidities, and bleeding risk. The long-term effect of unfractionated heparin treatment on pulmonary hypertension and mortality is unclear. The aim of this study was to investigate the long-term effect of unfractionated heparin treatment on pulmonary thromboembolism. METHODS: This is a cross-sectional study with 22 patients who were diagnosed with submassive pulmonary thromboembolism and followed up at the outpatient clinic between 2016 and 2020 and received unfractionated heparin treatment. RESULTS: Mean pulmonary artery pressure was 53±13.6 mmHg during hospital admission and 42.7±13.4 mmHg at hospital discharge. There was a statistically significant decrease in d-dimer and pulmonary artery pressure levels before and after treatment (p=0.001). At the end of one year, pulmonary artery pressure was considered high in three patients of this study. CONCLUSION: Our study suggests that unfractionated heparin is safe in the treatment of submassive pulmonary thromboembolism in terms of bleeding risk and reduces pulmonary artery pressure.

Evaluation of Nurses' Approaches to Deteriorating Patients: Survey Study.

OBJECTIVE: Prevention of cardiopulmonary arrest in hospitalised patients is the first and most important step in the life-saving chain. When the condition of the inpatients is worsened, nurses are usually the first to see and evaluate the patient. The aim of this study was to evaluate the attitudes of the nurses working at the Mersin University Hospital, during their routine follow-up to the deteriorating patients and the early warning scoring (EWS) awareness. METHODS: A web-based questionnaire was sent to all nurses working in inpatient services and intensive care units (ICUs) and registered to the hospital database at Mersin University Hospital via e-mail. In the questionnaire, a total of 10 multiple-choice questions were asked to the nurses questioning the unit they worked for, the EWS they used, the complaints they frequently complain about and the applications for the call for help. A total of 146 nurses were included in the study. RESULTS: 43.8% (n » 64) of the participants were in ICU, and 56.1% (n » 82) were in service units. Participants were asked whether they used a special scoring system to recognise the deteriorating patient; 45.2% (n » 66) used the scoring system; and 54.8% (n » 80) reported that they did not use it. Participants working in ICU were more likely to use EWS system. Participants answered the most commonly used scoring system as the Glasgow Coma Scale (n » 40). The participants reported that the most common respiratory distress (n » 135), changes in consciousness (n » 109), palpitations (n » 98) and chest pain (n » 92) occurred in the deteriorating patients. Participants reported that they frequently asked for help from a doctor (80.1%), other nurses (7.5%) and a blue code team (7.5%). CONCLUSION: According to the findings, it is necessary to determine the habits of calling for help and raising awareness for a functional EWS.