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The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience.OBJECTIVESThe COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience.Prospective cohort study.STUDY DESIGNProspective cohort study.We implemented (1) pushing most extended wait times to the end of the workflow by rooming the patient directly and (2) using distractions during the waiting process by using educational videos and a timer for physician arrival in the patient exam room. We compared the patient wait times and subcomponents of Press Ganey scores as a surrogate for changes in patient experience and satisfaction from the preimplementation period (n = 277) to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218).METHODSWe implemented (1) pushing most extended wait times to the end of the workflow by rooming the patient directly and (2) using distractions during the waiting process by using educational videos and a timer for physician arrival in the patient exam room. We compared the patient wait times and subcomponents of Press Ganey scores as a surrogate for changes in patient experience and satisfaction from the preimplementation period (n = 277) to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218).There was a significant reduction in overall throughput time (38 vs 35 minutes) and wait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17 minutes) (P < .0001 for all). These results corresponded with a significant improvement in Press Ganey subcomponents of (1) waiting time in the exam room before being seen by the care provider, (2) degree to which you were informed about any delays, (3) wait time at clinic (from arriving to leaving), and (4) length of wait before going to an exam room (P < .001 for all).RESULTSThere was a significant reduction in overall throughput time (38 vs 35 minutes) and wait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17 minutes) (P < .0001 for all). These results corresponded with a significant improvement in Press Ganey subcomponents of (1) waiting time in the exam room before being seen by the care provider, (2) degree to which you were informed about any delays, (3) wait time at clinic (from arriving to leaving), and (4) length of wait before going to an exam room (P < .001 for all).Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.CONCLUSIONSSimple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.

Background. Human papillomaviruses (HPVs) primarily sort into 3 genera: Alphapapillomavirus (α-HPV), predominantly isolated from mucosa, and Betapapillomavirus (β-HPV) and Gammapapillomavirus (γ-HPV), predominantly isolated from skin. HPV types might infect body sites that are different from those from which they were originally isolated. Methods. We investigated the spectrum of HPV type distribution in oral rinse samples from 2 populations: 52 human immunodeficiency virus (HIV)-positive men and women and 317 men who provided a sample for genomic DNA for a prostate cancer study. HPV types were detected with the MY09/MY11 and FAP59/64 primer systems and identified by dot blot hybridization and/or direct sequencing. Results. Oral rinse specimens from 35 (67%) of 52 HIV-positive individuals and 117 (37%) of 317 older male participants tested positive for HPV DNA. We found 117 type-specific HPV infections from the HIV-positive individuals, including 73 α-HPV, 33 β-HPV, and 11 γ-HPV infections; whereas, the distribution was 46 α-HPV, 108 β-HPV, and 14 γ-HPV infections from 168 type-specific infections from the 317 male participants. Conclusions. The oral cavity contains a wide spectrum of HPV types predominantly from the β-HPV and γ-HPV genera, which were previously considered to be cutaneous types. These results could have significant implications for understanding the biology of HPV and the epidemiological associations of HPV with oral and skin neoplasia.

Detection of human papillomavirus (HPV) in head and neck cancer has therapeutic implications. In situ hybridization and immunohistochemistry for p16 are used by surgical pathologists. We compared the sensitivity and specificity of three popular commercial tests for HPV detection in head and neck squamous cell carcinomas with a ‘gold standard’ HPV PCR assay. A total of 110 prospectively collected, formalin-fixed tumor specimens were compiled onto tissue microarrays and tested for HPV DNA by in situ hybridization with two probe sets, a biotinylated probe for high-risk (HR) HPV types 16/18 (Dako, CA, USA) and a probe cocktail for 16/18, plus 10 additional HR types (Ventana, AZ, USA). The p16 INK4 expression was also assessed using a Pharmingen immunohistochemistry antibody (BD Biosciences, CA, USA). Tissue microarrays were stained and scored at expert laboratories. HPV DNA was detected by MY09/11-PCR, using Gold AmpliTaq and dot-blot hybridization on matched-fresh frozen specimens in a research laboratory. HPV 16 E6 and E7 -RNA expression was also measured using RT-PCR. Test performance was assessed by a receiver operating characteristic analysis. HR-HPV DNA types 16, 18 and 35 were detected by MY-PCR in 28% of tumors, with the majority (97%) testing positive for type 16. Compared with MY-PCR, the sensitivity and specificity for HR-HPV DNA detection with Dako in situ hybridization was 21% (95% confidence interval (CI): 7–42) and 100% (95% CI: 93–100), respectively. Corresponding test results by Ventana in situ hybridization were 59% (95% CI: 39–78) and 58% (95% CI: 45–71), respectively. The p16 immunohistochemistry performed better overall than Dako ( P =0.042) and Ventana ( P =0.055), with a sensitivity of 52% (95% CI: 32–71) and specificity of 93% (95% CI: 84–98). Compared with a gold standard HPV-PCR assay, HPV detection by in situ hybridization was less accurate for head and neck squamous cell carcinoma on tissue microarrays than p16 immunohistochemistry. Further testing is warranted before these assays should be recommended for clinical HPV detection.

In the United States, sexually transmitted infections are a significant health challenge, especially in adolescents, with half of the approximately 19 million cases each year occurring in youths 15-24 years old. The purpose of the literature review was to explore social media options for their viability as tools to use for educating adolescents to make more informed sexual decisions and, therefore, reduce the risk of sexually transmitted infections. The implementation of interventions through social media could be the next breakthrough in health care to reduce the financial burden through providing cost-effective disease prevention and management support.

Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47% metropolitan, 8/15, 53% regional) in Australia. Data will be collected at 3 time points: before implementation (T ), immediately after the 6-month implementation period (T ), and again after a 6-month maintenance period (T ). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T ) was completed in March 2020. As of November 2020, 87% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T ). Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. DERR1-10.2196/22902.

The aim of the study undertaken for this Masters of Science thesis was to investigate the fragmentation processes induced by low-energy electron impact with anthracene. This research is relevant in the study of low-energy electron interactions with molecules in gaseous environments, including potentially in the interstellar medium where secondary electrons may be produced by UV-irradiation of interstellar dust grains. An effusive, molecular beam of anthracene, generated in a resistively heated oven, is crossed with a beam of low-energy electrons to form positively charged fragments. A reflectron time-of-flight mass spectrometer with a microchannel plate detector is used to mass-resolve and detect the fragment ions. A multichannel scaler card is used for acquiring single mass spectra. Data acquisition is controlled by LabVIEW code, which ramps the electron impact energy from 0 to 100 eV in 0.5 eV steps, acquires mass spectra as a function of electron impact energy, and adds each mass spectrum to the data that has already been accumulated. The full data set consists of a two-dimensional array of ion yield as a function of time-of-flight and of electron impact energy. Ion yield curves of most of the fragment ions have been determined by fitting groups of adjacent peaks in the mass spectra with sequences of normalized Gaussians. This is done using in-house LabVIEW software. The appearance energies for these fragments have been determined. The groups of fragments containing 8 to 13 carbon atoms provide evidence for hydrogen rearrangements during fragmentation, involving the retention or loss of one or two additional hydrogen atoms. Groups of fragments with 6 and 7 carbon atoms clearly show the presence of doubly-charged fragments. We see broadened peaks in the lower-mass groups with 1 to 4 carbon atoms, which may be due to energetic charge-separation fragmentations of doubly-charged anthracene.

The primary objectives of this study were to evaluate the effect of varying heparin concentrations on International Normalized Ratio values and to assess the accuracy of these values deter mined through the arterial line of the dialysis circuit Twenty-two patients on hemodialysis with central venous catheters were studied After a peripheral venipuncture, timed samples from the arterial line of the hemodialysis circuit were obtained after dialysis was initiated and prior to initiating heparin. Assays for coagulation parameters were performed. There was no signifcant difference in any coagulation parameter measured from the arterial line samples compared to the venipuncture samples. Serial heparin dilutions in vitro demonstrated that residual amounts of heparin in the central venous catheter may falsely elevate International Normalized Ratio values. This study demonstrates that accurate International Normalized Ratio values in patients on hemodialysis with heparinized central venous catheters can be obtained ericiently and cost-effectively from the arterial line within 1 minute of dialysis initiation.