Impact of Spatial Separation for Respiratory Patients on Emergency Department Flow Process Intervals and Length of Stay.

BACKGROUND: Spatial separation in emergency departments (ED) is empirically practised as part of transmission-based precaution. Despite its potential benefits in segregating potentially infectious patients, the effects of spatial separation on patient flow remains uncertain. AIM: To explore the impact of spatial separation on ED patient flow and identify specific clinical factors and flow process intervals (FPI) influencing ED length-of-stay (EDLOS). METHODS: This was a retrospective study of data extracted from patients' electronic medical records from January 1 to March 31, 2022 conducted at the ED of a tertiary hospital in Kuala Lumpur, Malaysia. During this period, patients were separated into respiratory areas (RA) and non-respiratory areas (NRA) based on Centers for Disease Control and Prevention recommendations. The study obtained ethics approval from the institution's ethics board. FINDINGS: A total of 1,054 patients were included in the study, 275 allocated to RA and 779 to NRA. Patients in RA had a significantly longer median EDLOS compared to in NRA (9 hours 29 minutes versus 7 hours 6 minutes, p<0.001, d=0.41). A lower proportion of patients in RA achieved an EDLOS ≤8 hours compared to NRA (41.8% versus 58.3%, p<0.001). Independent factors affecting EDLOS were triage category, re-triaging, hypertension, performing biomedical imaging, medical, surgical, and critical care consultations, and disposition plan. Bottlenecks significantly prolonging EDLOS were decision-to-departure, ultrasound interval and referral-to-consultation. CONCLUSION: Spatial separation prolongs FPI and EDLOS. Addressing inpatient access block and streamlining specialty review and biomedical imaging processes may reduce RA EDLOS.

Loss of caveolin-1 alters extracellular matrix protein expression and ductal architecture in murine mammary glands.

The extracellular matrix (ECM) is abnormal in breast tumors and has been reported to contribute to breast tumor progression. One factor, which may drive ongoing matrix synthesis in breast tumors, is the loss of stromal caveolin-1 (cav-1), a scaffolding protein of caveolae, which has been linked to breast tumor aggressiveness. To determine whether loss of cav-1 results in the abnormal expression of matrix proteins, mammary glands from cav- 1-/- and cav- 1 +/+ mice were investigated for differences in expression of several ECM proteins. In addition, the presence of myofibroblasts, changes in the vessel density, and differences in duct number and size were assessed in the mammary glands of both animal models. Using immunohistochemistry, expression of fibronectin, tenascin-C, collagens and αSMA were significantly increased in the mammary glands of cav-1-/- mice. Second harmonic generation revealed more organized collagen fibers in cav-1 -/- glands and supported immunohistochemical analyses of increased collagen abundance in the glands of cav-1 -/- mice. Analysis of the ductal structure demonstrated a significant increase in the number of proliferating ducts in addition to significant increases in the duct circumference and area in cav-1 -/- glands compared to cav- 1 +/+ glands. Differences in microvessel density weren't apparent between the animal models. In summary, we found that the loss of cav-1 resulted in increased ECM and α-SMA protein expression in murine mammary glands. Furthermore, we found that an abnormal ductal architecture accompanied the loss of cav-1. These data support a role for cav-1 in maintaining mammary gland structure.

Elderly suicide: an analysis of coroner's inquests into two hundred cases in Cheshire 1989 - 2001.

Elderly suicide is an index of more widespread disorder and discontent among the elderly, and furthermore is a potentially preventable cause of death. This study used coroner's inquest records of 200 elderly in Cheshire who killed themselves, and in which their unexpected deaths attracted a verdict of suicide. Sociodemographic characteristics, clinical aspects of the suicidal process and health care contact before death are reviewed. Unlike most available studies, cases of unexpected death in which an open verdict was given were not included in this study, which covered a 13 year period. The findings are interpreted and compared to the currently available literature on suicide in the elderly. Late life suicide is characterised by less warning, higher lethality and greater prevalence of depression and physical illness. However, suicide risk often remains undetected. All suicidal behaviour in the elderly should be taken seriously by psychiatric and primary care services, in order to reduce suicide rates in the elderly.