AIM: To explore the impact of spatial separation on ED patient flow and to identify specific clinical factors and flow process intervals (FPIs) influencing ED length of stay (EDLOS).
METHODS: This was a retrospective study of data extracted from patients' electronic medical records from January 1st to March 31st, 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 1054 patients were included in the study, 275 allocated to RA and 779 to NRA. Patients in RA had a significantly longer median EDLOS compared with NRA (9 h 29 min vs 7 h 6 min, P < 0.001, d = 0.41). A lower proportion of patients in RA achieved an EDLOS ≤8 h compared to NRA (41.8% vs 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 FPIs and EDLOS. Addressing inpatient access block and streamlining specialty review and biomedical imaging processes may reduce RA EDLOS.
PATIENTS AND METHODS: This analysis included patients with treatment-naive, EGFR-mutant advanced NSCLC randomized to amivantamab-lazertinib (n = 429) or osimertinib (n = 429) in MARIPOSA. Pathogenic alterations were identified by next-generation sequencing (NGS) of baseline blood ctDNA with Guardant360 CDx. Ex19del and L858R ctDNA in blood was analyzed at baseline and cycle 3 day 1 (C3D1) with Biodesix droplet digital polymerase chain reaction (ddPCR).
RESULTS: Baseline ctDNA for NGS of pathogenic alterations was available for 636 patients (amivantamab-lazertinib, n = 320; osimertinib, n = 316). Amivantamab-lazertinib improved median PFS (mPFS) versus osimertinib for patients with TP53 co-mutations {18.2 versus 12.9 months; HR 0.65 [95% confidence interval (CI) 0.48-0.87]; P = 0.003} and for patients with wild-type TP53 [22.1 versus 19.9 months; HR 0.75 (95% CI 0.52-1.07)]. In patients with EGFR-mutant, ddPCR-detectable baseline ctDNA, amivantamab-lazertinib significantly prolonged mPFS versus osimertinib [20.3 versus 14.8 months; HR 0.68 (95% CI 0.53-0.86); P = 0.002]. Amivantamab-lazertinib significantly improved mPFS versus osimertinib in patients without ctDNA clearance at C3D1 [16.5 versus 9.1 months; HR 0.49 (95% CI 0.27-0.87); P = 0.015] and with clearance [24.0 versus 16.5 months; HR 0.64 (95% CI 0.48-0.87); P = 0.004]. Amivantamab-lazertinib significantly prolonged mPFS versus osimertinib among randomized patients with [18.2 versus 11.0 months; HR 0.58 (95% CI 0.37-0.91); P = 0.017] and without baseline liver metastases [24.0 versus 18.3 months; HR 0.74 (95% CI 0.60-0.91); P = 0.004].
CONCLUSIONS: Amivantamab-lazertinib effectively overcomes the effect of high-risk features and represents a promising new standard of care for patients with EGFR-mutant advanced NSCLC.
OBJECTIVE: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women's uptake of HIV pre-exposure prophylaxis (PrEP).
METHODS: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app's features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes.
RESULTS: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features.
CONCLUSIONS: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services.
OBJECTIVE: Thus, this study aimed to evaluate their perception of face mask wearing during COVID-19 and its contributing factors.
METHODOLOGY: A total of 1024 respondents, aged ≥ 18 years, participated in this online cross-sectional survey from October 2021 to December 2021. The Face Mask Perception Scale (FMPS) was used to measure their perceptions.
RESULTS: Most of the respondents perceived wearing a face mask as uncomfortable. Our findings also revealed statistically significant differences and a small effect (f2 = 0.04) in which respondents who were concerned about being infected by the virus perceived face mask wearing appearance positively (B = - 0.09 units of log-transformed, 95% CI = - 0.15, - 0.04), whereas married respondents perceived it negatively (B = 0.07 units of log-transformed, 95% CI = 0.03, 0.09). There were no statistically significant differences in other domains of FMPS.
CONCLUSION: In conclusion, discomfort was a major complaint. Marital status and fear of COVID-19 infection affected their perceptions. The public health implications of these findings highlight the importance of addressing discomfort and societal perceptions, particularly those influenced by factors such as marital status and COVID-19 experience, to promote widespread acceptance and consistent usage of face masks, which is crucial in mitigating the spread of COVID-19.
METHODS: Various techniques including qRT-PCR, western blotting, and immunohistochemistry assays were utilized to examine gene expression patterns. Functional assays such as wound-healing assay, transwell invasion assay, 5-Ethynyl-2'-deoxyuridine assay, and metabolic assays were conducted to assess the impact of CEP55 on the behaviors of TNBC cells. CD163-positive macrophages were quantified by flow cytometry. The chromatin immunoprecipitation assay and dual-luciferase reporter assay were performed to assess the association of SPI1 with CEP55. A xenograft mouse model experiment was used to analyze the impact of SPI1 on tumor development in vivo.
RESULTS: CEP55 and SPI1 expression levels were significantly upregulated in TNBC tissues and cells. The depletion of CEP55 led to decreased TNBC cell migration, invasion, proliferation, glucose metabolism, and M2 macrophage polarization, indicating its crucial role in promoting TNBC progression. Moreover, SPI1 transcriptionally activated CEP55 in TNBC cells, and its overexpression was associated with accelerated tumor growth in vivo. Further, CEP55 overexpression relieved SPI1 silencing-induced inhibitory effects on TNBC cell migration, invasion, proliferation, glucose metabolism, and M2 macrophage polarization.
CONCLUSION: SPI1-mediated transcriptional activation of CEP55 plays a key role in enhancing TNBC cell migration, invasion, proliferation, glucose metabolism, and M2 macrophage polarization. These insights provide valuable information for potential targeted therapies to combat TNBC progression by modulating the SPI1-CEP55 axis.
METHODS: We searched eight databases to identify relevant articles from their inception to April 2024. Experimental studies that evaluate the effects of mind-body movement therapy on sleep disturbance and depression in older adults were included. The Cochrane Risk of Bias tool version 2.0 was used to appraise included studies. The pairwise meta-analysis was performed through the software Comprehensive Meta-Analysis Version 3.0. Moreover, subgroup analysis was utilized to understand the effect size on each form of mind-body exercise and to determine the source of heterogeneity.
RESULTS: A total of 27 studies were eligible and synthesized. The mind-body exercise appears statistically significant in reducing sleep disturbance (SMD = -0.60, 95% CI: 0.76 ∼ 0.44) and depression (SMD = -0.56, 95% CI: 0.75 ∼ 0.36) among older adults. Each form of mind-body exercise, including pilates, yoga, qigong, and tai-chi, effectively decreases sleep disturbance and depression, but there were no significant differences in the effects between these practices.
CONCLUSION: The cumulative evidence concludes that older adults who participated in mind-body exercise programs showed potential improvements in sleep disturbance and depression. This finding may serve as evidence for professionals to use this approach as a non-pharmacological approach to help older adults in the community and long-term care facilities who are having sleep disturbance and depression. More clinical trials are needed for an in-depth meta-analysis that can rank and compare the efficacy of each mind-body exercise practice.