ABSTRACT This paper explores the co-evolution of international business studies and institutions, employing a scientometric approach and bibliometric review on the application of institutional concepts in international business studies, outlining a research agenda. We compiled a database of 3,520 articles and conducted a scientometric analysis to examine the evolution of the term “institutions” in international business in ABS-ranked journals. Our findings show that (1) over the past two decades, there has been a shift in the use of the term institutions from a political and economic connotation to a sociological perspective to explain how firms adopt strategies, make decisions, and address intra-national problems during the internationalization process; (2) traditional approaches were found to be insufficient in explaining context-dependent events that affect international business; and (3) China has emerged as a critical player in international business studies, which has helped to redirect the focus of institutions from political and economic aspects to the sociological context. Finally, we propose an agenda for future research, highlighting potential pitfalls and remedies.

RESUMEN Este artículo tiene como objetivo explorar la coevolución de los estudios de negocios internacionales y las instituciones, empleando un enfoque cienciométrico y una revisión bibliométrica sobre la aplicación de conceptos institucionales en los estudios de negocios internacionales, delineando una agenda de investigación. Recopilamos una base de datos de 3.520 artículos y realizamos un análisis cienciométrico para examinar la evolución del término "instituciones" en las revistas clasificadas en el ranking ABS en relación con los negocios internacionales. Nuestros hallazgos muestran que: (1) en las últimas dos décadas, ha habido un cambio en el uso del término instituciones de una connotación política y económica a una perspectiva sociológica, que busca explicar cómo las empresas adoptan estrategias, toman decisiones y abordan los problemas intranacionales durante el proceso de internacionalización; (2) se encontró que los enfoques tradicionales eran insuficientes para explicar los eventos dependientes del contexto que afectan los negocios internacionales; y (3) China ha emergido como un actor clave en los estudios de negocios internacionales, lo que ha ayudado a redirigir el enfoque de las instituciones desde los aspectos políticos y económicos al contexto sociológico. Finalmente, proponemos una agenda para futuras investigaciones, destacando posibles dificultades y soluciones.

RESUMO Este artigo tem como objetivo explorar a coevolução dos estudos sobre negócios internacionais e instituições, utilizando uma abordagem cientométrica e conduzindo uma revisão bibliométrica da aplicação de conceitos institucionais em estudos de negócios internacionais, de forma a delinear uma agenda de pesquisa. Compilamos um banco de dados de 3.520 artigos e realizamos uma análise cientométrica para examinar a evolução do termo “institutions” (instituições) no contexto dos negócios internacionais em periódicos classificados no ranking ABS. Nossos resultados mostram que: (1) nas últimas duas décadas, houve uma mudança no uso do termo institutions de uma conotação política e econômica para uma perspectiva sociológica, que busca explicar como as empresas adotam estratégias, tomam decisões e abordam problemas intranacionais durante o processo de internacionalização; (2) as abordagens tradicionais foram consideradas insuficientes para explicar eventos dependentes do contexto que afetam os negócios internacionais; e (3) a China emergiu como um ator-chave nos estudos de negócios internacionais, o que ajudou a redirecionar o foco das instituições dos aspectos políticos e econômicos para o contexto sociológico. Por fim, propomos uma agenda de pesquisa para futuros estudos, destacando possíveis armadilhas e soluções.

■ ABSTRACT Cutis laxa is a rare connective tissue disease characterized by dysfunction of elastic fibers. Individuals affected by this disease complain about their aged appearance. Treatments are based on the use of cosmetics or surgical techniques, with plastic surgery being an extremely relevant tool. Blepharoplasty aims to improve the senile appearance and provide rejuvenation in the area around the eyes, making the look appear more rested and alert. This is a retrospective observational study using medical record data. Case Report: A female patient, 17 years old, was referred to the Plastic Surgery Service of the Walter Cantídio University Hospital, Fortaleza-CE, for treatment due to dissatisfaction with her appearance. She underwent upper and lower blepharoplasty associated with canthopexy without canthotomy. In the postoperative period, a satisfactory result was observed for the proposed surgery and adequate correction of existing changes. Conclusion: The importance of facial surgical correction in cases of lax skin is observed, highlighting the relevance of applying appropriate surgical techniques and improving them in this patient profile.

■ RESUMO Cútis laxa é uma rara doença do tecido conectivo caracterizada pela disfunção das fibras elásticas. Indivíduos acometidos por essa enfermidade queixam-se de sua aparência envelhecida. Os tratamentos se baseiam no uso de cosméticos ou em técnicas cirúrgicas, sendo a cirurgia plástica uma ferramenta de extrema relevância. A blefaroplastia tem o objetivo de melhorar a aparência senil e proporcionar rejuvenescimento na área ao redor dos olhos, fazendo com que o olhar pareça mais descansado e alerta. Trata-se de um estudo observacional retrospectivo utilizando os dados do prontuário. Relato do Caso: Paciente do sexo feminino, 17 anos, encaminhada ao serviço de Cirurgia Plástica do Hospital Universitário Walter Cantídio, Fortaleza-CE, para tratamento devido à insatisfação com a sua aparência. Submetida a uma blefaroplastia superior e inferior associada a cantopexia sem cantotomia. No período pós-operatório, foi observado resultado satisfatório para a cirurgia proposta e adequada correção das alterações existentes. Conclusão: Observa-se a importância da correção cirúrgica facial nos casos de cútis laxa, ressaltando a relevância da aplicação de técnicas cirúrgicas adequadas e o aprimoramento das mesmas nesse perfil de paciente.

Abstract Roadkill is one of the most direct impacts on fauna, leading to numerous direct and indirect impacts. Road-killed animals could serve as a resource for research and teaching purposes, but first, they need to have their tissues preserved by some technique. Plastination is one of the most modern techniques for the conservation of biological tissues, its principle is the replacement of body fluids by a curable polymer, resulting in a non-toxic, odorless, and manipulable material. So the main aim of this work was to compose a collection of plastinated roadkill victims from the Biological Reserve Sooretama region, adapting the standard protocol to the different taxa worked here (Avialae, Reptilia, Amphibia, and Mammalia). For this, 42 animals were used, previously frozen and stored in the Sooretama Biological Reserve and Vale Natural Reserve until they were sent for processing. Upon arriving at the Plastination laboratory at the Federal University of Espírito Santo, the animals underwent the 4 stages of plastination: fixation, dehydration, forced impregnation, and chemical cure; some adaptations were made to improve the final specimens. The results proved that the plastination of these animals is extremely viable in generating satisfactory results. Given the results obtained, it becomes clear how plastination can become an alternative to implement in the composition of biological collections using roadkill animals. The animals prepared in this work comprise an unprecedented collection available for different applications, such as exhibitions, practical classes, and research.

Abstract This work assesses the flexural reliability of compact sections and full-interaction steel-concrete composite beams designed according to NBR 8800:2008. Reliability indexes are obtained for different grades of concrete, slab heights, and load combination. The results show a lower level of safety in situations where live loads are predominant in the load combination. A partial safety factors calibration procedure is also proposed based on a target reliability index βT = 3.5. It is shown that the calibrated partial safety factors reduce the variability of reliability indexes in the proposed design situations.

Resumo Este trabalho avalia a confiabilidade à flexão de vigas mistas aço-concreto com seção compacta e interação completa dimensionadas conforme prescrições da NBR 8800:2008. Os índices de confiabilidade são obtidos para diferentes classes de concreto, alturas de mesa comprimida e combinações de ações. Os resultados obtidos indicam um nível de segurança inferior nas situações em que as ações acidentais predominam na combinação de ações. Propõe-se também a calibração dos coeficientes parciais de ponderação com base em um índice de confiabilidade alvo βT = 3.5. É evidenciado que os coeficientes parciais de ponderação calibrados reduzem a variabilidade dos índices de confiabilidade nas situações de projeto analisadas.

Abstract This paper presents a reliability analysis of the punching shear of flat slabs without shear reinforcement. The evaluation is performed for the codes ACI 318, Eurocode 2, Model Code 2010, and ABNT NBR 6118:2014. Six models were used for predicting the punching strength, the design models, the Critical Shear Crack Theory (CSCT), and a Nonlinear Finite Element Analysis (NLFEA) model. Reliability analysis was performed to evaluate the safety level of code provisions. Design code provisions were evaluated in terms of sufficient reliability criteria based on target reliability β=3.8. This target reliability was based in the Model Code 2010 criteria. This criterion represents an acceptable value level of safety in design of structures. The results showed that the reliability indexes β presented satisfactory for all slabs designed by the Model Code 2010. However, this paper also shows some of the tested slabs presented reliability index below 3.0, being the ACI 318 the code with the lowest reliability index.

Resumo Este artigo apresenta a análise de confiabilidade do dimensionamento à punção de lajes lisas sem armadura de cisalhamento. A pesquisa avaliou a confiabilidade obtida pela norma ACI 318, Eurocode 2, Código Modelo 2010 e pela norma brasileira ABNT NBR 6118:2014. Para a estimativa da resistência à punção seis modelos foram estudados, os modelos das normas, a Teoria da Fissura Crítica de Cisalhamento (TFCC) e um modelo não-linear em elementos finitos. A avaliação da confiabilidade foi realizada para avaliar o nível de segurança das prescrições normativas. Para isso, o critério utilizado é baseado na comparação dos índices de confiabilidade β com o índice de confiabilidade alvo, estipulado em 3,8, conforme critério do Código Modelo 2010. Esse critério representa um valor aceitável no nível de segurança do dimensionamento da estrutura. Os resultados obtidos a partir dessa metodologia mostrou que o Código Modelo 2010 é a norma que apresenta os índices mais elevados de confiabilidade. Por outro lado, a norma ACI 318 apresentou os menores índices de confiabilidade, alcançando índices de confiabilidade menores que 3,0.

RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências. médicas oftalmologia assim isso literatura MEDLINEPUBMED MEDLINE PUBMED MEDLINE/PUBMED EMBASE LILACS SCOPUS SCIELO final original editorial correspondência eficaz tema entanto terapêutica Portanto residências

ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians’ confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies. conversations Thus MEDLINEPUBMED MEDLINE PUBMED MEDLINE/PUBMED EMBASE LILACS SCOPUS COCHRANE SCIELO publications shortlisted short listed ones article editorial communication correspondence reviewed Nevertheless physicians thus family Therefore residencies

ABSTRACT Objective: To evaluate smartphone addiction and postural alterations in the cervical region in adolescents. Methods: A cross-sectional study with 281 adolescents (15 to 19 years old), attending the 1st to the 3rd grades of High School, carried out between September and October 2019 in the city of Fortaleza, Ceará, Brazil. Data collection took place in two stages. In the first, they answered four self-administered questionnaires: sociodemographic questionnaire, health conditions and smartphone use, Nordic Musculoskeletal Symptom Questionnaire (NMQ), Self-Report Questionnaire (SRQ-20) and the Smartphone Addiction Inventory (SPAI-BR). In the second stage, they were submitted to photogrammetry using the Postural Assessment Software (SAPO) and anthropometric assessment (weight and height). The software SPSS Statistics version 23.0 was used for data analysis. Results: Of the total number of adolescents, 63.3% (n=178) showed smartphone addiction, using it for 5.8 hours (±3.5) during the week and 8.7 (±4.0) hours on the weekend. When analyzing postural alignment in the anterior view, a significant reduction in the lateral head tilt was observed when typing on the smartphone (p=0.002) compared to the anatomical position (baseline). In the lateral view, an increase in head anteriorization was observed during smartphone use (p<0.05). There was an association between smartphone addiction and head anteriorization (p<0.05). Conclusions: The use of the smartphone in the typing position causes postural alterations in the cervical region, especially in adolescents with smartphone addiction. Therefore, health promotion measures that alert adolescents to the adverse effects caused by prolonged smartphone use are necessary.

RESUMO Objetivo: Avaliar a dependência do smartphone e a alteração postural da região cervical em adolescentes. Métodos: Estudo transversal, com 281 adolescentes (15 a 19 anos), que frequentavam da 1ᵃ à 3ᵃ série do ensino médio, realizado entre setembro e outubro de 2019 na cidade de Fortaleza, Ceará, Brasil. A coleta dos dados ocorreu em duas etapas. Na primeira, eles responderam a quatro questionários autoaplicáveis: questionário sociodemográfico, condições de saúde e uso do smartphon e, Questionário Nórdico de Sintomas Musculoesqueléticos (NMQ), Self-Report Questi onnaire (SRQ-20) e o Smartphone A ddiction Inventory (SPAI-BR). Na segunda etapa, foram submetidos a fotogrametria pelo Software de Avaliação Postural (SAPO) e avaliação antropométrica (peso e altura). Para a análise dos dados, foi utilizado o SPSS Statistics versão 23.0. Resultados: Do total, 63,3% (n=178) dos adolescentes apresentaram dependência do smartphone, com o uso de 5,8 horas (±3,5) durante a semana e 8,7 (±4,0) no fim de semana. Ao analisar o alinhamento postural na visão anterior, observou-se redução significativa da inclinação lateral de cabeça ao digitar no smartphon e (p=0,002) comparado à posição anatômica (baseline). Na visão lateral foi constatado aumento da anteriorização de cabeça durante o uso do smartphon e (p<0,05). Houve associação da dependência do smartphone com a anteriorização de cabeça (p<0,05). Conclusões: O uso do smartphone na posição de digitação causa alteração postural na região cervical, destacadamente naqueles que apresentam dependência do dispositivo. Dessa forma, são necessárias medidas de promoção de saúde que alertem os adolescentes sobre os efeitos adversos causados pelo uso prolongado do smartphone.

Resumo A viuvez é o “estado de uma pessoa depois da morte de seu cônjuge”. É considerada como um dos eventos de vida não normativos, de mais difícil manejo, particularmente em pessoas idosas, dado o conjunto de demandas emocionais, sociais e comportamentais que acarreta. Este estudo teve o objetivo de identificar as variáveis de saúde e/ou psicossociais relacionadas a viuvez em idosos. Foi realizada uma revisão integrativa da literatura por meio de busca nas bases de dados AgeLine, BVS, PsycoInfo, Pubmed e Scielo. Foram selecionados estudos publicados no idioma inglês, espanhol e português, com idosos de 60 anos ou mais, transversais ou longitudinais que incluíram descrições e detalhamentos sobre o processo de viuvez, como resultado primário e/ou secundário. Sintomas depressivos, suporte social, impacto das experiências prévias da relação marital no estado de viuvez, estado e/ou condição nutricional enquanto auto percepção de saúde, bem-estar psicológico, satisfação com a vida, religiosidade e espiritualidade podem atuar como fatores agravantes ou de proteção na viuvez.

Abstract Widowhood is “the state of a person after the death of his or her spouse”. It is considered one of the most difficult non-normative life events to manage, particularly in the elderly, given the set of emotional, social and behavioral demands that it entails. This study aimed to identify health and/or psychosocial variables related to widowhood in the elderly. An integrative literature review was carried out by searching the AgeLine, BVS, PsycoInfo, Pubmed and Scielo databases. Cross-sectional or longitudinal studies published in English, Spanish and Portuguese, with elderly aged 60 years and over, including descriptions and details about the widowhood process, as a primary and/or secondary result, were selected. Depressive symptoms, social support, impact of previous experiences of the marital relationship on the state of widowhood, nutritional state and/or condition as self-perception of health, psychological well-being, satisfaction with life, religiosity and spirituality can act as aggravating or debilitating factors. widowhood protection.

BACKGROUND. Brain natriuretic peptide (BNP) is an established biomarker of morbidity and mortality in cardiac failure. Data also suggest potential prognostic utility in non-heart failure cohorts. The utility of BNP in predicting intensive care unit (ICU) outcomes has not been well evaluated in a mixed critical care population in the South African (SA) context. OBJECTIVE. To evaluate the ability of BNP to predict ICU mortality in a heterogeneous critical care population in SA. METHODS. This was a retrospective observational study of 100 patients admitted to a multidisciplinary, closed, intensivist-run ICU in a tertiary academic hospital serving KwaZulu-Natal Province (1 January 2020 - 31 July 2022). Initial BNP was evaluated as a predictor of ICU mortality using univariate and multivariable analyses. RESULTS. There was a statistically significant difference in BNP between survivors and non-survivors in the cohort of patients without heart failure. The median initial BNP in the non-heart failure cohort was 411 (interquartile range (IQR) 116 - 848) ng/L in non-survivors, and 150 (44 - 356) ng/L in survivors (p=0.028). The optimal cut-off for BNP was determined as 366 ng/L. A BNP >366 ng/L was an independent predictor of ICU outcome. CONCLUSION. This study highlights the potential utility of BNP as a predictor of ICU mortality in a heterogeneous ICU population, with the greatest utility in patients without heart failure. Further studies are required to confirm this finding.

BACKGROUND. Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. OBJECTIVES. To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. METHODS. A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. RESULTS. A final list of 153 core competencies in critical care was identified. CONCLUSION. The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA.

RESUMO A percepção do tempo é um elemento idiossincrático do processo de internacionalização de empresas de base tecnológica (EBTs)? Essa pergunta serve como ponto de partida para explorar quais fatores influenciam a velocidade de internacionalização e a longevidade das operações internacionais das EBTs. Agrupamos esses fatores em dois grupos com base nos tipos de serviços fornecidos e nas características de seus clientes. Analisamos os processos de internacionalização dessas EBTs e o tempo que elas continuaram operando no exterior, considerando a sobrevivência ao longo do tempo. Usando uma abordagem qualitativa, realizamos um estudo de caso múltiplo de quatro EBTs internacionalizadas do Brasil. Nossas descobertas sugerem que o nível de criatividade exigido pelos clientes impacta tanto a velocidade da internacionalização quanto a longevidade das operações internacionais. Em relação à longevidade e sobrevivência, enquanto as EBTs que atendem a setores criativos tendem a se adaptar mais facilmente a mercados culturalmente similares e desenvolver produtos mais rapidamente, as EBTs que trabalham em setores tradicionais tendem a explorar redes locais, revelando nuances interessantes sobre a percepção do tempo entre as EBTs. (EBTs) exterior qualitativa Brasil rapidamente locais (EBTs

ABSTRACT Is time perception an idiosyncratic element in the internationalization process of technology-based firms (TBFs)? This question serves as the starting point to explore which factors influence international operations’ internationalization speed and longevity in TBFs. We gathered them into two groups based on the types of service provided and the characteristics of their clients. We analyzed these TBFs´ internationalization processes and the length of time they continued operating abroad, considering survival over time. Using a qualitative approach, we conducted a multiple case study of four internationalized TBFs from Brazil. Our findings suggest that the level of creativity required by clients impacts both the speed of internationalization and the longevity of international operations. Regarding longevity and survival, while TBFs serving creative sectors tend to adapt more easily to culturally similar markets and develop products more quickly, TBFs working traditional sectors tend to exploit local networks revealing exciting nuances about the time perception among TBFs. technologybased technology (TBFs) operations abroad approach Brazil quickly (TBFs

ABSTRACT This text deals with an analysis of the book Babel, by Antonia Torreão Herrera (2020), and the film Synonyms, by Nadav Lapid (2019), to rethink language and globalization from the myth of Babel. In this sense, based on Jacques Derrida’s thinking about language and translation, Water Mignolo’s concept of language and Michel Foucault’s discussion of Don Quixote (2012) in dialogue with the film, we seek to outline the problem of the concept of globalization in a decolonial perspective that criticizes the capital-colonial binary logic. Thus, the objective is to think about how Antonia Torreão Herrera’s poetry and Nadav Lapid’s cinematographic narrative intend the tyranny of language and the production of marginalizations in a global context. For this, we discuss the concept of debabelizing, present in the mythical-philosophical-poetic text of Antonia Torreão Herrera, related to the idea of deglobalization, based on the thought of Pablo Solón, in order to rethink the binomials, globalize-babelize, and deglobalize-debabelize. In this way, from the interpretation of the poem and the film, it was possible to delineate the plastic and ambivalent potential of language and artistic language that breaks with the tyrannical binarism of globalization.

RESUMO O presente texto versa sobre uma análise do livro Babel, de Antonia Torreão Herrera (2020), e do filme Sinônimos, de Nadav Lapid (2019), no intuito de repensar a língua e a globalização a partir do mito de Babel. Nesse sentido, baseado no pensamento sobre língua e tradução de Jacques Derrida, no conceito de linguajamento de Water Mignolo e na discussão de Michel Foucault sobre Dom Quixote (2012) em diálogo com o filme, busca-se esboçar a problemática da concepção de globalização em uma perspectiva decolonial que critica a lógica binária capital-colonial. Assim, o objetivo é pensar como a poesia de Antonia Torreão Herrera e a narrativa cinematográfica de Nadav Lapid tencionam a tirania da língua e a produção de marginalizações em um contexto global. Para isso, discute-se o conceito de desbabelizar, presente no texto mítico-filosófico-poético de Antonia Torreão Herrera, relacionado à ideia de desglobalização, baseado no pensamento de Pablo Solón, no intuito de repensar os binômios globalizar-babelizar e desglobalizar-desbabelizar. Dessa forma, a partir da interpretação do poema e do filme, foi possível delinear o potencial plástico e ambivalente da língua e da linguagem artística, que rompe com o binarismo tirânico da globalização.

BACKGROUND: With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation OBJECTIVE: To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU METHODS: A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed. The study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE291/17). Data pertaining to patients' demographics, referring doctor, diagnosis, comorbidities as well as biochemical and haemodynamic parameters were extracted. This information was then cross-referenced to the outcome of the ICU consultation. Data were descriptively analysed RESULTS: Five hundred consultations were reviewed over a 6-month period; 52.2% of patients were male and the mean age was 44 years. Junior medical officers referred 164 (32.8%) of the consultations. Although specialist supervision was available in 459 cases, it was only utilised in 339 (73.9%) of these cases. Most referrals were from tertiary (46.8%) or regional (30.4%) hospitals; however, direct referrals from district hospitals and clinics accounted for 20.4% and 1.4% of consultations, respectively. The appropriate referral pathway was not followed in 81 (16.2%) consultations. Forty-five percent of consults were accepted; however, 9.3% of these patients died before arrival in ICU. A total of 151 (30.2%) patients were refused ICU admission, with the majority (57%) of these owing to futility. Patients were unstable at the time of consult in 53.2% of referrals and 34.4% of consults had missing data CONCLUSION: Critically ill patients are often referred by junior doctors without senior consultation, and directly from low-level healthcare facilities. A large proportion of ICU referrals are deemed futile and, of the patients accepted for admission, almost 1 in 10 dies prior to ICU admission. More emphasis needs to be placed on the training of doctors to appropriately triage and manage critically ill patients and ensure appropriate ICU referral and optimising of patient outcomes