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PubMedDate not supplied

Recognition and management of ARI--a KAP study on private medical practitioners.

We interviewed 113 private medical practitioners (PMPs) of all system of medicine in Ambedkar Nagar area of South Delhi to determine as to how they recognise and treat Acute Respiratory tract Infections (ARI) in children, in particular, pneumonia. Allopathic PMPs reported viruses and bacteria as causes of ARI as compared to PMPs of other system of medicine who often reported exposure to cold, change in weather and dietary habits as a cause of ARI. Sixty-eight PMPs out of 113 did not count the respiratory rate (RR) in children with ARI and among those who counted, only 19.5% PMPs could correctly tell the normal RR in children aged less than two months. In children aged 2-12 months, the percentage of PMPs responding correctly was 15.0%. Relatively greater proportion of PMPs (31.8%) could correctly tell the normal respiratory rate in children aged 1-5 years. X-ray to diagnose pneumonia was suggested by 102 (90.3%) PMPs. Majority of PMPs prescribed some form of medication including antibiotics for the treatment of cough and cold. Eighty-seven (77%) PMPs prescribed antibiotics, 53 (46.9%) antihistaminics and 49 (43.4%) prescribed allopathic cough syrups to treat cough and cold. For pneumonia, 108 (96.4%) PMPs prescribed antibiotics and 31 (27.7%) PMPs prescribed steroids among other things.

Adrenal Cortex Hormones↗
PubMed1998

Implementing teleradiology in a private radiology practice: lessons learned.

The private practice of radiology deals with the delivery of high quality, timely service to referring physicians. Technology offers the promise of supporting this objective through faster reading of studies through electronic imaging and the delivery of results in a fast, efficient manner. In order to be successful, the practice must clearly define its objectives, understand its fundamental business processes and select a technology solution that is proven to meet those objectives.

Contract Services↗
PubMed2002

Cross-boundary cooperation in a watershed context: the sentiments of private forest landowners.

Ecosystem management and sustainable forestry on mixed ownership landscapes will require some level of cross-boundary coordination or management. Oregon's experiment with local, voluntary, collaborative forums, called watershed councils, is one mechanism to foster cross-boundary management. Fifty qualitative, in-depth interviews in three study areas were conducted with nonindustrial private forest (NIPF) landowners, watershed council members, and agency employees to learn how and why landowners participate (or not) on watershed councils. Study areas were located in three different areas of the state to reflect different ecological and organizational settings. Our case study identified three themes-stewardship ethic, property rights amid uncertainty, and action orientation-that were most salient among landowners when deciding to participate in their local watershed council. Other factors related to competing opportunities were also identified. Our results relate to the social psychological antecedents to cooperation of perceived consensus, group identity, and legitimacy of authority as well as to applied situations where cross-boundary coordination and management are goals.

Conservation of Natural Resources↗
PubMed2007

Treatment with antidepressant medications in private health plans.

This study analyzed 2002 MarketScan data from a convenience sample of enrollees with private health insurance from the largest U.S. firms to examine utilization, expenditures, and factors associated with antidepressant prescriptions. Of enrollees, 11% received at least one antidepressant prescription during the year with average expenditures per enrollee of $51.55. Antidepressant prescriptions were more frequently used than any form of other mental health care and for 42% of users was not associated with any clearly identified mental health or "off-label" indication. In logistical regression analyses, health plan type, prescription days supply, gender, region, age, employment status, and subscriber status were associated with unexplained antidepressant prescription use.

Adolescent↗
PubMed1978

The importance of cauterization to maintain a healthy cervix. Long-term study from a private gynecologic practice.

A total of 13,897 patients from a private gynecologic practice were retrospectively analyzed with special regard to the benefits obtained from hot linear cautery. This has been performed as an office procedure since 1937, providing unique long-term follow-up. The exposed cervical transitional zone and mild, atypical, or dysplastic cervical cytology were so treated in 6,364 patients. A significantly higher percentage of carcinoma in situ and invasive disease was found in the noncauterized cervices. With the trend of cervical intraepithelial neoplasia (CIN) toward development at an earlier age in today's population, the importance of office cauterization in preventing cervical cancer becomes apparent.

Adolescent↗
PubMed1987

Gestational diabetes screening in a private, midwestern American population.

This prospective investigation was undertaken to compare the value of routine versus selective diabetes screening in a group of predominantly middle-class, healthy, Caucasian pregnant women. Two thousand consecutively chosen persons were divided into two groups: those to undergo routine screening between 24 and 28 weeks' gestation and those to be tested selectively in the presence of standard risk factors. The two groups of patients were otherwise similar. The method of screening involved a 50 gm oral glucose challenge, followed by a 3-hour glucose test if necessary. The incidence of gestational onset diabetes in the selectively screened group (19/453, 4.2%) was twice that in the routinely screened group (21/1000, 2.1%). Evidence of glucose intolerance without a risk factor was found in only one case (1/1000, 0.1%) in the routinely screened group. This assessment of our clinical practice has allowed us to safely eliminate the need for diabetes screening in more than half of our private patients, which will reduce office time, patient inconvenience, and expense.

Female↗
PubMed1993

Experience with external cephalic version and selective vaginal breech delivery in private practice.

OBJECTIVE: The purpose of this study was to decrease the rate of cesarean delivery for breech presentation through use of a protocol that calls for external cephalic version and selected vaginal delivery of the infant in breech position. STUDY DESIGN: I offered external cephalic version to patients whose fetuses were in the breech position beyond 36 weeks' gestation and who were not in active labor. Patients in active labor were included in the review if they agreed to a trial of labor. RESULTS: Sixty-five deliveries were included in this review. The success rate of the version procedure was 53%. Among patients in whom version was successful 28% required cesarean delivery. Of those remaining breech fetuses believed to be candidates for vaginal delivery, 80% were successfully delivered vaginally. The overall vaginal delivery rate was 31 of 65 deliveries, or 48%. CONCLUSION: Protocols that call for external cephalic version with vaginal delivery of selected fetuses in breech presentation that either do not respond to or are not candidates for version can be used in the private practice setting. Such protocols should result in a decreased number of cesarean sections.

Breech Presentation↗
PubMed1986

Evaluation of a new triphasic oral contraceptive in private practice.

We evaluated the clinical and metabolic effects of a new triphasic regimen developed in the continuing attempt to reduce the dose of estrogen and progestogen in oral contraceptives. A combination of ethinyl estradiol (EE) and levonorgestrel (LNg) was used (six tablets with 30 micrograms EE + 50 micrograms LNg, five tablets with 40 micrograms EE + 75 micrograms LNg, and 10 tablets with 30 micrograms EE + 125 micrograms LNg), also known as Triphasil (Wyeth). In a private practice, 409 subjects participated in 7,286 treatment cycles. Three pregnancies occurred, all due to subject failure. Menstrual regulation was excellent and the incidence of side effects extremely low. Withdrawals from the study for possibly drug-related medical reasons totaled 9.0% through 56 cycles of treatment. Metabolic changes also were evaluated in 14 of these women over a 6-month period. The only statistically significant increase in carbohydrate values occurred at 6 months. The mean glucose level at 30 minutes of the oral glucose tolerance test was above the baseline mean value, but serum insulin levels showed no statistically significant deviation. Lipid values presented are total lipids, total cholesterol, triglycerides, alpha-, beta-, and pre-beta-lipoproteins, and high density and low density lipoprotein cholesterol. There was no statistically significant difference between the mean values at baseline and those during treatment for any lipid variable. These results indicate that this triphasic oral contraceptive has a high degree of efficacy, a low incidence of side effects, excellent cycle control, and high subject compliance, and would seem to indicate a minimal influence on the metabolism of lipids and carbohydrates in the small number of subjects studied.

Blood Glucose↗
PubMed1990

Private prosthodontic practice: a status report.

This article reports the data of a national poll of private prosthodontic practitioners. It reports incomes, overhead expenses, staff size, and character of prosthodontic practices. The study also develops a profile for a median prosthodontic practice and practitioner.

Adult↗
PubMed1987

Use and quality of bitewing films in private dental offices.

Patient records (387) were obtained from twenty-five dentists in private practice in Rochester, New York. The number and types of radiographs taken at each recall examination in the most recent 10-year period were recorded. Bitewing radiographs were taken at 50.5% of the recalls with size 2 film used most frequently (83.7%). The average recall interval was 8.4 months overall and 18.0 months for bitewing recalls. Of all proximal surfaces available on the bitewing films, 68.2% were judged adequately separated for diagnostic purposes. For individual surfaces, the highest percentages were recorded for the mesial surface of the maxillary second premolar (89.9%) in the permanent dentition and for the distal surface of the mandibular second molar (83.7%) in the deciduous dentition. Taking four bitewing films instead of two improved the percentage of adequately separated proximal surfaces at a given recall by 2% to 25%. The percentage of unreadable proximal surfaces caused by overlapping or distortion on the bitewing radiographs, when excluding the canines, ranged from 6.3% to 39.5% in the permanent dentition and from 12.5% to 24.9% in the deciduous dentition.

Private Practice↗
PubMed1981

Private practice experience with radical surgical treatment of cancer of prostate.

This private practice series of 255 men with adenocarcinoma of the prostate was evaluated with regard to the efficacy of radical prostatectomy in controlling disease. Sixty-seven men underwent radical surgery: 77 per cent are surviving longer than ten years post-operatively with several of these individuals now in their fifteenth year, 9 per cent died of their disease, and 10 per cent are totally incontinent. The survival in this series are compared with those of other series and the differences discussed.

Adenocarcinoma↗
PubMed1984

Nutrition counseling in private practice: attitudes and activities of family physicians.

A community approach to cardiovascular disease control is advocated for the United States because of the high disease incidence and prevalence relative to other countries. The goal of this approach is to change nutrition behavior of all members of the community. As part of a program to identify barriers to physician participation, a survey of a random sample of family practice clinical faculty in a midwestern state was made to determine (a) if physicians agree that it is appropriate to give nutritional advice to a patient who came to the clinic for another reason, (b) the proportion of patients given nutritional advice, and (c) the barriers to giving nutritional advice. Most physicians report that giving nutritional advice to patients visiting them for other reasons is considered appropriate, but almost half the physicians give advice about dietary fat, dietary sodium, or dietary fiber to fewer than 20% of their patients. Only about 10% of physicians give advice to more than 80% of their patients. Absence of elevated risk factor levels or nutritional disease is the most common reason for not giving advice. Perceived lack of patient interest and expectation of patient nonadherence are also barriers. Unpalatability of the diet is occasionally a barrier. Cost of the diet is not a consideration. From these data it is concluded that family physicians consider it appropriate to give nutritional advice to patients who are not necessarily seeking it, but the perception that patients do not need or want, and would not follow, the advice inhibits physicians from delivering nutrition messages in private practice.

Adult↗
PubMed1983

The use of private health care providers in rural Bangladesh: a response to Claquin.

This study examines the distribution and differential use of private health care practitioners in one area of Bangladesh. It highlights the importance of gender, age and class factors as these impinge upon the utilization of different health care providers. Based on the complexity of these factors in influencing the utilization of health services, the feasibility of Claquin's recommendation to employ a palli chikitshok cadre of fee-for-service doctors in rural Bangladesh is reassessed. It is concluded that, as presently envisaged, the employment of these health providers would serve to solidify the rural elite structure and further remove quality health care from poor rural villagers.

Adult↗
PubMed1988

Swedish physicians' perspectives on work and the medical care system--III: Private practitioners on the public system.

This paper reports the results of focused interviews in 1978-1979 with Swedish physicians in private practice about the public system of medical care in Sweden. They were asked about the system as a work environment for physicians and as a system of care for patients. Respondents, who were outside the public system (although financed mainly by public mechanisms) said the public system as a place to work had advantages in its high technical quality, facilities for research and training, and the capacity to treat complicated disease; its disadvantages were said to be inefficiency, lack of communication, poor patient care, and blocked mobility for physicians without doctorates. As a system of care, its one advantage was said to be that it provided care at less out-of-pocket cost to patients; its reported disadvantages were poor quality care and a tendency to be overly comprehensive. These perspectives are discussed with respect to their structural and historical contexts.

Ambulatory Care↗
PubMed1994

Private insurance coverage for the treatment of mental illness versus general medical care: a policy of inequity.

Private insurance coverage has historically been and continues to be discriminatory toward patients requiring treatment for mental illness and substance abuse disorders in comparison with those in need of general medical care. Factors contributing to this disparity include stigma, relatively low overt consumer demand for psychiatric care, lack of knowledge about psychiatric illness and treatment on the part of insurers, a historical reliance on public sector psychiatry, and the assumption that more liberal psychiatric benefits result in unnecessary and excessive use. Strategies aimed at eliminating discriminatory insurance practices against those in need of mental health care must be implemented. Recommended approaches include further research on the cost effectiveness of mental health care, public education regarding the nature of mental illness and its treatment, patient/family advocacy, and the marketing of services by mental health professionals.

Cost-Benefit Analysis↗
PubMed2004

Private sector hospital response to the 2003 dengue outbreak in the Indian capital metropolis of Delhi.

During 2003, the Indian capital metropolis of Delhi was afflicted with an outbreak of dengue. A private-sector tertiary care hospital responded instantly to the sudden influx of 162 patients during an 8-week interval. That was an unusual challenge because, until 1997, the hospital had exclusively managed patients with ophthalmic disorders. Dengue patients received fiscal concessions and several free services. A multidisciplinary cell was commissioned for case management. Apart from a diagnosis of patients with dengue and their clinical management, suspected or confirmed dengue episodes were instantly reported to health authorities. Anti-mosquito measures in the hospital premises including residential areas for the nursing personnel prevented any local virus transmission. The integrated therapeutic and public health response was associated with a 1.23% case fatality rate. The protocol developed during the dengue outbreak would address every locally reportable disease in the future.

Adolescent↗
PubMed2006

[Early discharge from the maternity ward: telephone survey about the availability of private-practice and public health pediatricians in Ile-de-France].

OBJECTIVES: To assess the possibility and time period within which a mother and her newborn can consult a pediatrician after their early discharge from the maternity ward. METHODS: In May 2004, 2 investigators presenting themselves as mothers just discharged from the maternity ward, called pediatricians' offices and public infant cliniques (PMI centers) in the Paris metropolitan region, to request appointments. RESULTS: Of 99 pediatricians' offices contacted, 89 (89%) offered appointments, for an average of 4.4 days later. Of the 93 PMI centers contacted, 55 (59%) offered appointments by telephone, with a mean waiting time of 18 days. CONCLUSION: This study, conducted in the spring of 2004 in the Paris metropolitan region, showed that private-practice pediatricians are capable of taking over management of newborns rapidly after early discharge from the maternity ward. It is more difficult to make appointments by telephone with PMI centers, which operate differently, and the delay is substantially longer. We underline that these results observed in a region with a high density of pediatricians and during a favourable period for managing appointments. Further studies are needed in other regions and at different periods. The management of newborns after early discharge from the maternity ward should be actually throught the arising development of health networks.

Appointments and Schedules↗

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