Privatization of STD services in Tacoma, Washington: a quality review.

BACKGROUND AND OBJECTIVES: This study describes key features of the privatized model of sexually transmitted disease (STD) service provision in Tacoma, Washington. GOALS: To assess the operational characteristics and the quality of care provided in the privatized STD clinics. STUDY DESIGN: Key informant interviews and surveys were conducted. Medical records were reviewed and compared to a standardized STD clinic medical record. Client treatment was compared to the Centers for Disease Control and Prevention (CDC) 1993 STD Treatment Guidelines. RESULTS: In 1997, the contract clinics provided 3,275 publicly sponsored STD visits. The goals of multiple access sites, STD screening, appropriate therapy for laboratory-diagnosed, bacterial STD were achieved. However, medical records were frequently incomplete and Gram stains were not done. Significant deviations from CDC STD Treatment Guidelines were documented in the medical management of pelvic inflammatory disease (PID). CONCLUSIONS: Privatized STD services would be improved by use of a standardized medical record. Availability of a Gram stain and management of PID as recommended by the CDC would augment quality of care.

Surface electrodes in perineal electromyography.

In 40 elderly male patients undergoing multiple urodynamic evaluations, surface electrodes were used for recording electromyographic (EMG) activity of pelvic sphincter muscles; placement site was the external anal sphincter. The measured wave form was displayed as an analog plot. Different types of surface electrodes were evaluated in selected patients. The EMG wave form measurements varied with the type of surface electrode used and placement of the electrode. Surface electrodes for external anal sphincter EMG resulting in optimum signal response require a small metallic recording surface with an adhesive that will secure the electrode to the skin, proper anatomic placement of the electrode, appropriate preparation of the skin surface at the site of application of the electrode, and capabilities for oscilloscope monitoring of the sphincter EMG signal wave form. If properly used, surface electrodes result in a signal amplitude and frequency that approach the quality of concentric needle electrodes.