Emergency department crowding increases 10-day mortality for non-critical patients : a retrospective observational study

The current evidence suggests that higher levels of crowding in the Emergency Department (ED) have a negative impact on patient outcomes, including mortality. However, only limited data are available about the association between crowding and mortality, especially for patients discharged from the ED. The primary objective of this study was to establish the association between ED crowding and overall 10-day mortality for non-critical patients. The secondary objective was to perform a subgroup analysis of mortality risk separately for both admitted and discharged patients. An observational single-centre retrospective study was conducted in the Tampere University Hospital ED from January 2018 to February 2020. The ED Occupancy Ratio (EDOR) was used to describe the level of crowding and it was calculated both at patient’s arrival and at the maximum point during the stay in the ED. Age, gender, Emergency Medical Service transport, triage acuity, and shift were considered as confounding factors in the analyses. A total of 103,196 ED visits were included. The overall 10-day mortality rate was 1.0% (n = 1022). After controlling for confounding factors, the highest quartile of crowding was identified as an independent risk factor for 10-day mortality. The results were essentially similar whether using the EDOR at arrival (OR 1.31, 95% CI 1.07–1.61, p = 0.009) or the maximum EDOR (OR 1.27, 95% CI 1.04–1.56, p = 0.020). A more precise, mortality-associated threshold of crowding was identified at EDOR 0.9. The subgroup analysis did not yield any statistically significant findings. The risk for 10-day mortality increased among non-critical ED patients treated during the highest EDOR quartile.Peer reviewe

The outcome of “non-urgent'' patients diverted by triage at an emergency department

No universal definitions have been proposed for non-urgent emergency department (ED) patients. Robust evidence on safety issues and the subsequent utilisation of health care services among diverted patients is insufficient. The aim of this study was to establish the revisit rate within 7 days, as well as the 30-day mortality and outcome of patients diverted by triage. An observational single-centre retrospective study was conducted at the Tampere University Hospital ED for the full calendar year of 2019. The primary outcomes were a revisit within 7 days and 30-day mortality. A total of 92,406 ED visits were registered. Of these patients, 7.8% (7216 visits) were diverted by triage. Among the diverted patients, the hospital revisit rate within 7 days was 10.1%, and a diagnostic or therapeutic intervention was performed on 81.4% of the readmitted patients. The all-cause 30-day mortality, hospitalisation and intensive care unit admission rates of diverted patients were 0.07%, 1.7% and 0.1%, respectively. Diverting non-urgent patients reduces ED visits. The current study showed a revisit rate of 10.1% and a 30-day mortality rate of 0.07% for diverted patients. There were more unanticipated adverse outcomes than reported previously, and the strategy may thus be suitable only for some groups of patients without increasing risks. Therefore, further investigation is needed to determine the factors associated with readmissions and adverse outcomes to enhance the performance of triage in the future.Peer reviewe

Correlation of gene expression and protein production rate - a system wide study

<p>Abstract</p> <p>Background</p> <p>Growth rate is a major determinant of intracellular function. However its effects can only be properly dissected with technically demanding chemostat cultivations in which it can be controlled. Recent work on <it>Saccharomyces cerevisiae </it>chemostat cultivations provided the first analysis on genome wide effects of growth rate. In this work we study the filamentous fungus <it>Trichoderma reesei </it>(<it>Hypocrea jecorina</it>) that is an industrial protein production host known for its exceptional protein secretion capability. Interestingly, it exhibits a low growth rate protein production phenotype.</p> <p>Results</p> <p>We have used transcriptomics and proteomics to study the effect of growth rate and cell density on protein production in chemostat cultivations of <it>T. reesei</it>. Use of chemostat allowed control of growth rate and exact estimation of the extracellular specific protein production rate (SPPR). We find that major biosynthetic activities are all negatively correlated with SPPR. We also find that expression of many genes of secreted proteins and secondary metabolism, as well as various lineage specific, mostly unknown genes are positively correlated with SPPR. Finally, we enumerate possible regulators and regulatory mechanisms, arising from the data, for this response.</p> <p>Conclusions</p> <p>Based on these results it appears that in low growth rate protein production energy is very efficiently used primarly for protein production. Also, we propose that flux through early glycolysis or the TCA cycle is a more fundamental determining factor than growth rate for low growth rate protein production and we propose a novel eukaryotic response to this i.e. the lineage specific response (LSR).</p

Proteomics – Challenges and possibilities in Finland

The discipline of proteomics, i.e. simultaneous analysis of all the proteins in a cell at a given point in time, is undergoing strong development and growth. The market is estimated to be worth USD 2.9 billion in 2005. A recent report by the Cambridge Healthtech Institute estimated the expenditure on proteomics to increase by 15% to 50% in 2003, compared with 2002. Major areas of increase were sample preparation (increase in two- and multi-dimensional liquid chromatography systems) and mass spectrometric analysis. Of the estimated USD 2.9 billion proteomics market in 2005, two-dimensional sample separation is expected to account for approximately 30%. Regarding protein analysis, 300% more mass spectra were expected to be generated in 2003, compared with 2002. Interestingly, the biggest increase in market value was envisaged for protein chips. In proteomics, Finland is lagging behind countries such as Sweden, Denmark and Netherlands. There has been no focused investment to form bigger core facilities, as done in other countries. In Finland, proteome analysis is mainly performed in university laboratories whose remit is to serve the needs of academic research. The Finnish biotechnology industry has not used the capabilities of proteomics technology to full potential. This appears to be partly due to poor awareness of the services available. To achieve high throughput, proteomic methods need to be further automated and standardised. New technology is needed to accomplish this. Microarrays (e.g. protein or antibody arrays) present an interesting technology platform for future exploitation. The first protein chip products are already on the market, and the field is expected to continue to develop rapidly. So far, there is not sufficient content (i.e. characterised proteins, antibodies, etc.) to be spotted onto the chips. Protein arrays evidently possess high potential to resolve many of today’s unresolved bottlenecks in proteome analysis. Array technology may open new avenues for functional proteomics and, later on, for clinical proteomics. The development of clinically relevant content for next-generation proteomics and the application of new technologies such as microfluidistics present additional future business opportunities in Finland. During the past few years. proteomics has evolved as intellectual property-intensive activity. The number of proteomics-related patent applications has doubled every year since the early days of proteomics. The great majority of the applications (60%) have been filed in the USA, followed by Japan and Germany. Interestingly, China is among the top four countries, in front of the United Kingdom and France. Finland lags behind in proteome patent applications, too. As the field is young and developing rapidly, the rate of seeking intellectual property rights protection will probably be maintained at least at the current level for some time. In Finland, like elsewhere in the world, proteomics offers a new means to improve the competitiveness of the bioindustry. Proteomics can help to enhance the efficiency and control of the processes used in the biotechnology industry to produce bioactive compounds. New targets for drug development can be identified and validated, diagnostics can be improved by proteomic profiling, and novel biomarkers can be found. Applicable to the theranostics and personalised medicine of the future, the more precise biomarkers will bring diagnostic and clinical research capabilities to new levels. In Finland, these potentials in combination existing sample collections, capabilities to perform clinical studies and clinical expertise offer additional competitive edge. Many Finnish companies would already benefit from the new data obtainable by proteomics methods. The existence and range of the current services would need to be better communicated to Finnish companies. It is therefore proposed that an open planning meeting be arranged to touch off the communication between service providers and users. Furthermore, the services in Finland would need to be developed further in terms of quality, robustness, throughput and pricing. For the future, a new technology development programme should be drawn up to take advantage of the current business window in proteomics. With its clinical expertise, potential for technology development. re-agent manufacturing skills and software development capabilities, Finland is well geared to deal with this challenge