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At least 1,351 records · Page 75Linked to original sources
PubMed2004

Comprehensive care for women veterans: indicators of dual use of VA and non-VA providers.

OBJECTIVE: To compare women who use Department of Veterans Affairs (VA) health care providers only with women who use VA and non-VA providers (dual users). METHODS: An anonymous survey was mailed to women veterans randomly sampled from 10 VA medical centers in 3 states. We measured reports of dual use of VA and non-VA providers according to the VA provider's gender, provision of routine gynecological care by VA provider, use of VA women's clinic, and overall satisfaction with VA care. Multiple logistic regression analyses were performed with adjustment for patient demographics, health status, VA service connection status, and clustering by site to determine what factors influenced dual use of providers. RESULTS: In the fully adjusted logistic regression model, provision of routine gynecological care by VA providers (odds ratios [OR] 0.37; 95% confidence intervals [CI] 0.22, 0.60) and use of VA women's clinics (OR 0.56; CI 0.35, 0.90) were strongly associated with a lower likelihood of dual use. Dissatisfaction with care (OR 1.88; CI 1.04,3.41) and higher income (OR 1.89; CI 1.32, 2.71) were also associated with an increased likelihood of dual use. Having a female VA provider was not associated with dual use. CONCLUSIONS: Women veterans' use of VA and non-VA providers is influenced by the scope of clinical services and dissatisfaction with those services. VA clinics should either promote routine gynecological care within primary care clinic settings or pair traditional primary care with VA women's clinics to enhance coordination and comprehensiveness and, thus, reduce fragmentation of care for veteran women.

Adult↗
PubMed2004

Use of drainability and filterability simulations for evaluation of oxidative treatment and polymer conditioning of sludge.

In the traditional view of sludge structure, a two-phase system is visualized. The solid phase is often illustrated as consisting of uniform, spherical, negatively charged particles. This simplistic picture limits the understanding of both conditioning and dewatering. Specifically, it limits us to only two strategies for destabiiization: charge neutralization (using cationic coagulant species with either uniform or patch effects), and bridging (using polymeric flocculants). In fact, the situation is more complex in many respects. In this paper, we compared chemical conditioning of anaerobically digested biosolids using (1) conventional polymeric flocculation, and (2) treatment by chemical oxidants. Since these strategies may alter dewatering behavior by very different mechanisms, we report comparisons using a lab-scale simulator of belt press dewatering, including separate steps for the drainage and filtration processes. This allows greater insight into the effects of these conditioning methods and how they might be properly employed.

Delaware↗
PubMed2004

Physical characteristics of a waste activated sludge: conditioning responses and correlations with a synthetic surrogate.

The efficient and economic management of waste activated sludge (WAS) requires a proper understanding of the sludge's material properties. Though there has been much study of WAS, an adequate linkage between its physical and chemical properties has been elusive. In particular, the conditioning and dewatering of WAS are expensive operations, and the addition of polymer to WAS leads to even more complex material behavior that is difficult to optimize. This paper reports on an extensive characterization of WAS, both with and without polymer conditioning. We combined the classical "jar test" approach with less conventional rheometric and electrokinetic measurements. In addition to the use of sampled WAS, a synthetic surrogate sludge was formulated, attempting to duplicate properties of WAS and allow more extensive characterization of a reproducible surrogate to WAS. Results with both the synthetic surrogate and WAS indicated that the traditional, electrokinetic, and rheological properties were related. However, the dose optima by rheometry were somewhat higher in both cases.

Delaware↗
PubMed2001

Percent free PSA as an additional measure in a prostate cancer screen.

OBJECTIVE: To assess the ability of the ratio of free prostate specific antigen to total prostate specific antigen (% fPSA) to aid in selection of subjects who would require follow-up studies. DESIGN: Retrospective, nonrandomized analysis measuring total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) in serum from men enrolled in a community-based prostate cancer screening offered by the Cancer Outreach Program (COP), Christiana Care Health Systems (CCHS), Wilmington, DE. PARTICIPANTS Informed consent was obtained from 172 of the 231 eligible participants. Complete laboratory and follow-up data, excluding ethnic origin, was gathered from 157 participants; therefore, theoretical participation was 75% (172/231) while realized participation rate was 68% (157/231). Criteria for inclusion in this study included ambulatory men of age 40 and older with serum total PSA (tPSA) level >1.9 ng/mL and/or an enlarged or abnormal prostate by digital rectal examination (DRE). Subjects with a history of prostate cancer or prostatitis were excluded. MAIN OUTCOME MEASURES: Laboratory tests to determine tPSA and fPSA were performed on serum samples obtained from consenting participants. Percent fPSA was calculated. Results of clinical findings with respect to each participant's DRE were recorded as normal, suggestive of a benign condition, such as benign prostate hyperplasia, or suspicious for prostate cancer. When available, transurethral ultrasound (TRUS) results and biopsy results were also noted. Each participant's results were evaluated and given one of the following diagnoses: Normal prostate (N), Benign Prostate Hyperplasia (BPH), or Prostate Cancer (PCa). RESULTS: Prevalence of cancer 3/157 = 0.0191; of BPH = 0.688; of N = 0.293. Median values for tPSA for each of these groups were as follows: N, 2.9 ng/mL; BPH, 3.0 ng/mL; and PCa, 6.3 ng/mL; (p = 0.079). Median values for fPSA were as follows: N, 0.6 ng/ mL; BPH, 0.5 ng/mL; PCa, 0.5 ng/mL; (p = 0.51). Median values for % fPSA were as follows: N, 19%; BPH, 17%; and PCa, 9%; (p = 0.01). Medians were found to differ for % fPSA measurements, but not for tPSA or fPSA values. DRE screening results of 110 subjects were reported as not normal indicating either an enlarged (n = 97) or abnormal prostate gland (n = 13). Nine subjects had normal DRE results with serum tPSA level above 4.0 ng/mL. Using the combination of DRE and tPSA > 4.0 ng/mL as criteria for the recommendation of follow-up studies, 119 of the participants would have been advised to seek additional testing. CONCLUSION: Using these two routine criteria, 119 (119/157; 76%) subjects would be candidates for follow-up procedures, such as transurethral ultrasound (TRUS) and/or sextant prostate biopsy. By adding % fPSA results of < 10% fPSA to tPSA results > 4.0 mg/mL as criteria for follow-up studies, specificity can be improved threefold with sensitivity unchanged. If an abnormal DRE suggestive of malignancy was included as part of the criteria, sensitivity of the diagnostic scheme would reach 100%. Using the triple diagnostic parameters of tPSA > 4.0 ng/mL, the ratio of free prostate specific antigen to total prostate specific antigen <10%, and an abnormal prostate DRE, 16 participants would be recommended for follow-up studies (16/157; 10%). This would eliminate 103 subjects from unnecessary and expensive testing.

Adult↗
PubMed2005

Most ED patients feel safe, but many fear errors.

Involving your patients in the care process can help ease their fears and promote safety. --In a culture of safety, ED managers must be accountable for keeping patients well informed. --Easing patient safety concerns can contribute to higher levels of satisfaction and more return visits. --Even worries about potential errors can affect the likelihood a patient will recommend your facility.

Delaware↗
PubMed2005

Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm.

BACKGROUND: When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure. OBJECTIVE: To compare automatic noninvasive measurements of blood pressure in the upper arm and forearm. METHODS: A descriptive, correlational comparison study was conducted in the emergency department of a 1071-bed teaching hospital. Subjects were 204 English-speaking patients 6 to 91 years old in medically stable condition who had entered the department on foot or by wheelchair and who had no exclusions to using their left upper extremity. A Welch Allyn Vital Signs 420 series monitor was used to measure blood pressure in the left upper arm and forearm with the subject seated and the upper arm or forearm at heart level. RESULTS: Pearson r correlation coefficients between measurements in the upper arm and forearm were 0.88 for systolic blood pressure and 0.76 for diastolic blood pressure (P < .001 for both). Mean systolic pressures, but not mean diastolic pressures, in the upper arm and forearm differed significantly (t = 2.07, P = .04). A Bland-Altman analysis indicated that the distances between the mean values and the limits of agreement for the 2 sites ranged from 15 mm Hg (mean arterial pressure) to 18.4 mm Hg (systolic pressure). CONCLUSIONS: Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.

Adolescent↗