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PubMed2002

Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain.

OBJECTIVE: The purpose of this study was to examine body mass index and pregnancy weight gain as risk factors for primary cesarean delivery in nulliparous women in a middle-class private practice. STUDY DESIGN: Primiparous women who delivered in a private practice setting between February 1993 and July 13, 2001, were included. CIs along with Z statistics for paired count data were used to assess the statistical significance and relative importance of the relationships of body mass index and maternal weight gain to cesarean delivery. The effect of body mass index was examined as related to known confounders such as gestational age, birth weight, maternal age, and maternal height. RESULTS: The overall cesarean delivery rate for primiparous women was 21.76%. Risk of cesarean delivery increased consistently and significantly (P <.0001) with increasing body mass index. This effect was primarily mediated through an increase in cesarean delivery carried out for cephalopelvic disproportion/failure to progress. In our practice, the primiparous woman whose body mass index is >30 kg/m(2) is six times more likely to have a cesarean delivery for the diagnosis of cephalopelvic disproportion/failure to progress than the primiparous woman whose body mass index is <20 kg/m(2). This differential in cesarean delivery rate persisted when controlled for birth weight and gestational age and continues to persist when maternal age and height are also controlled. Excessive pregnancy weight gain exerted a statistically significant effect on cesarean delivery rate. This increase was primarily related to cephalopelvic disproportion/failure to progress among the nonobese women. CONCLUSION: Maternal body mass index is related strongly to the ability of primiparous women to be delivered vaginally without great difficulty. In fact, lean patients are excellent labor performers, particularly in contrast with obese patients. The relationship of increased body mass index to increased cesarean delivery is due to an increased rate of cephalopelvic disproportion/failure to progress. Excessive pregnancy weight gain is associated with a doubling of cephalopelvic disproportion/failure to progress rate in nonobese patients.

Adult↗
PubMed1991

Nurse-physician collaborative practice: the clinical nurse specialist in a radiation oncology private practice.

The role of the clinical nurse specialist (CNS) has been established and described in some detail. The majority of these specialists practice in academic centers or large hospitals, often in concert with a group of their peers and with strong administrative support for the advanced practice role. Changes in the healthcare system, particularly the recent trend toward the establishment of freestanding cancer centers, have opened new practice opportunities for advanced nursing practitioners. This article describes the transition of a radiation oncology CNS from a university hospital to a collaborative practice in a private radiation oncology setting. The CNS describes important steps in this process, including negotiation of role functions and benefits, maintenance of professional commitments, and collaborative practice issues. Comments from the radiation oncologist, along with speculation on the future of the practice, also are included.

Communication↗
PubMed1977

Setting up in private practice. A guide for the newly appointed consultant.

If you are considering going into private practice under the present contract weigh up the cost, seek advice as to prospective earnings, join a partnership if you can, buy sound sensible equipment (second-hand if possible), insure for super-annuation and sickness benefits right away--it is both cheaper and safer. Agree a sensible NHS programme from the start using the advice of the BMA and the Association of Anaesthetists, and, when you are an established practitioner and a young colleague joins you, try to give him a helping hand and sound advice. The sine qua non of survival is co-operation.

Anesthesiology↗
PubMed2004

A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implants. Results from a private practice.

This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants were < or =11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or length of the rehabilitations was no specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2-4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead os surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bon grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners.

Adolescent↗
PubMed2003

The physiotherapy experience in private practice: the patients' perspective.

The aim of this study was to identify the qualities of a "good" physiotherapist and to ascertain the characteristics of good and bad experiences in private practice physiotherapy from the patients' perspective. The nominal group technique was implemented with separate groups of patients (n = 26) and revealed that communication ability, professional behaviour and organisational ability, and characteristics of the service provided were the main qualities of a "good" physiotherapist. In particular, communication ability of the physiotherapist was ranked first or second in importance by all groups of patients. Good experiences in physiotherapy were most often attributed to effective communication by the physiotherapist, while bad experiences most often related to dissatisfaction with the service followed by poor physiotherapist communication. Based on the findings from this study, we suggest physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patient-centred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.

Adult↗
PubMed1989

Private practice in the United Kingdom: a growing concern.

During the past decade private medical insurance in the United Kingdom grew first rapidly and then steadily. Once almost entirely non-profit, half the private beds and 10% of the private insurance market are now in the for-profit sector. Apart from abortions, cold or elective surgery is the chief private sector service. Average annual consultant income from private practice is now approximately 19,000 pounds sterling. Recent growth of the private sector has been fanned by the present Conservative government's support of privatization generally, by limited levels of National Health Service (NHS) funding, and by vigorous advertising by private insurance companies which plays on the concerns of British consumers. The private medical sector is largely unregulated. Present government policies make its reduction or elimination unlikely. To make it possible for the public sector to compete more equally, a strategy which requires the same levels of regulations, quality assurance, accountability and public scrutiny for the private sector and the NHS is proposed.

Adolescent↗
PubMed1986

Community psychology as a model for the new private practice of psychology.

The continuing increase in graduates from training programs in psychology when coupled with the decline of publicly supported mental health facilities or funds will lead more psychologists to offer services privately. At the same time, the private practice of psychology is changing, and a community psychology model may be useful in the development and offering of services. The community concepts of prevention, crisis intervention, and consultation can be related to family, work, and health in the development of some of the services that will become more prevalent in private practice.

Community Mental Health Services↗
PubMed2000

Immunization levels and risk factors for low immunization coverage among private practices.

OBJECTIVES: Previous studies have indicated that provider characteristics are an important determinant of immunization coverage. The objectives of this study were to: 1) assess immunization coverage levels among 2-year-old children receiving care in private practices in 3 California counties; and 2) evaluate practice and patient risk factors for low immunization coverage. STUDY DESIGN: Cross-sectional chart review of immunization histories and provider survey of immunization policies. SETTING: Forty-five randomly selected, private medical practices in 3 counties in California. PATIENTS: Children 12 to 35 months old, followed by the participating practices. METHODS: Providers underwent a detailed assessment of their immunization coverage and completed a questionnaire describing their immunization policies and procedures. Immunization data were abstracted from randomly selected medical charts of children 12 to 35 months old. Only patients who met the criteria for active status (>/=2 visits and >/=1 visit during the preceding 18 months) were included in analyses. Immunization coverage levels were calculated and logistic regression was used to estimate the risk of underimmunization associated with different practice and child characteristics. RESULTS: Of the 72 eligible practices that were contacted, 45 participated in the study, yielding a participation rate of 62%. The median immunization coverage of participating offices was 54% (range: 0%-91%). Multivariate analysis revealed 5 independent risk factors for underimmunization. The strongest predictors were having fewer than 50% active children in the practice and children having fewer than 8 visits to the provider. Other significant predictors were the percentage of patients in the practice on Medicaid, administering diphtheria-tetanus-pertussis 4 at a separate visit from the Haemophilus influenzae type b booster, and practice location. CONCLUSIONS: These data provide new insights into immunization practices in an important clinical setting that has been poorly characterized previously. Immunization coverage levels were found to be low and significant risk factors for underimmunization were identified. Recommendations are made for immunization policy changes and targeting of immunization improvement interventions at practices that may be at risk for low immunization coverage. immunization, vaccination, immunization programs, primary prevention, private practice, child, preschool, pediatrics, family practice.

California↗
PubMed1987

[Social psychiatry in private practice].

Though in general the practice of Community Mental Health (or "Social Psychiatry") is a task of the State, the County or the City governments, the panel discussed two instances of sizeable contributions by private practices to the tasks of community mental health, such as crisis intervention or the care of the chronically psychiatrically handicapped, which are not commonly treated in psychiatrists' offices. The "Psychosoziale Arbeitsgemeinschaft" of Basle began in a psychiatric group practice through common sessions with public health nurses, social workers and other community helpers and served a workers' section of the city. In the course of five years several other services could be built up, such as a day-care center for psychically handicapped, a patient visiting program through voluntary helpers and a rehabilitation workshop. Ultimately subsidy from State and Federal funds could be obtained. Another program, in Zurich, started in a nonpsychiatric general practice, also in a workers' section. The physicians of that group hired, at their own expense, a social worker-educator and psychotherapist with a five year experience in community mental health work to care for the social and psychological problems commonly found in every general practice. The costs of her work cannot be generally billed to the health insurance carriers, but it is possible for the therapist to negotiate case by case with the insurance, this with success in a good many cases. The discussion with the audience shows that, in spite of considerable difficulty, it appears that private practice and especially a group practice, can make a valuable contribution to the mental health care of a disadvantaged segment of the population.

Chronic Disease↗
PubMed2005

Implementation of outpatient treatment of deep-vein thrombosis in private practices in Germany.

OBJECTIVE: Implementation of outpatient treatment (OT) of deep-vein thrombosis (DVT) is slow despite clear evidence that it is effective, safe and cost-efficient. DESIGN AND METHOD: An initiative was launched with the help of the Professional Association of Phlebologists of Germany and the industry to familiarize physicians in private practice who had no prior experience with OT of DVT. Data on quality of treatment with the low-molecular-weight heparin tinzaparin and phenprocoumon, compliance, clinical outcome, venous ultrasound, patients' satisfaction and quality of life were collected in a registry, which was open from July 1999 to December 2000. The results were published and their impact on further management of patients was assessed in second survey reported here. Patients of both series were followed-up clinically and with ultrasound over the 1st month of treatment. RESULTS: Of 67 physicians entering 827 patients into the registry 26 answered a questionnaire on how they treated further patients. Their case load had increased by 450% and data were provided on 540 consecutive patients managed between January and June 2002. OT increased overall from 76 to 92%, that of popliteo-femoral DVT from 71 to 92%, and that of pelvic DVT from 38 to 65%. Medical reasons to decide against OT decreased from 89 to 56% (p<.01). Immediate leg compression was changed from bandaging to medical compression stockings in 20 of the 26 centres (p<.05). In total, data were gathered from OT of 1124 patients. No secondary hospitalisations were required and only one patient had a documented progression of the DVT. CONCLUSIONS: OT was successfully implemented in private practices through the initiative of individual physicians with support of the professional association and sponsoring by the industry-to the benefit of the providers but as much of the patients and their cost bearers.

Ambulatory Care↗
PubMed2006

Reaction to universal patient acceptance: The perspective of a private practice dentist.

The purpose of this article is to respond to the theories of Acceptance and Universal Patient Acceptance and their relationship to the American Dental Association's Principles of Ethics and Code of Professional Conduct (ADA Code). Universal Patient Acceptance (UPA) requires the dentist to communicate in some fashion with each patient who attempts to enter his or her practice to determine needs, desires, and financial ability to access dental care. The dentist must then help the patient gain entry into his or her practice or make appropriate referrals based on the patient's desires, needs, and financial status. The theory of UPA proposes that this action will alleviate some portion of the access problem. This article explores the notion of access as articulated in the ADA Code. The theory of UPA is explored from the view of the practicing dentist, noting the difficulties encountered when incorporating this theory into private practice. The conclusion is that the ADA Code offers appropriate guidance for ADA members regarding the ethical treatment of the underserved. Without further study, the inclusion of UPA in the ADA Code is not desirable. The author also concludes that support systems for the practicing dentist are necessary before UPA could be considered a reasonable way to practice dentistry.

American Dental Association↗
PubMed1998

Fine needle aspiration of breast masses: an analysis of 1533 cases in private practice.

The diagnostic efficacy of fine needle aspiration cytology of breast masses and the causes for unsatisfactory specimens in private practices were investigated in Hong Kong. All specimens that were submitted to the histopathology unit at the Canossa Hospital between 1 January 1996 and 30 April 1997 formed the basis of this report. A total of 1533 specimens were received from 1447 patients; 274 (17.8%) cases were unsatisfactory for assessment, 1080 (70.4%) were benign, 51 (3.3%) atypical, 19 (1.2%) suspicious, and 67 (4.4%) malignant. The specimens were submitted by 105 doctors, who each performed between 1 and 561 smears. The proportion of unsatisfactory samples was high for doctors who performed an occasional fine needle aspiration (48%; overall mean, 25%). Histological correlation was available in 165 cases. The overall sensitivity was 79%, specificity 98%, positive predictive value (including the 'suspicious' category) 92%, and negative predictive value 94%. Two false positive cases that were reported as suspicious were found to be fibroadenomata following subsequent excision biopsy. No adverse clinical outcomes were recorded for the false positive cases. There were six false negative cases (reported as a cyst in one case, benign in two cases, and atypical in three cases). The results compared favourably with published data and affirmed the effectiveness of the test in private practice.

Journal Article↗
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↗
PubMed1997

Long-term drug treatment of obesity in a private practice setting.

This study evaluated the long-term efficacy and safety of the combination of phentermine and fenfluramine for the treatment of obesity in a private practice setting. A total of 1388 consecutive, qualified patients presenting to a private general internal medicine practice in Charlotte, NC, were enrolled with eligibility criteria including: age 18 years to 60 years, 20% over "desirable" bodyweight or body mass index > 27, no serious medical or psychiatric disease, and no contraindications to drug therapy. Patients were instructed in diet, exercise, and behavior modification techniques and received phentermine (15 mg/day to 30 mg/day) and fenfluramine (20 mg/day to 60 mg/day) continuously for over 3 years. Average duration of treatment was 15.9 months, and average weight loss at the last visit was 11.6 kg, or 11.7% of initial bodyweight. For patients completing 1 year of drug treatment, mean weight loss was 16.5 kg, or 16% of initial weight. Weight loss persisted for 2 years, but partial regain was seen at 3 years. The dropout rates were 18% at 6 months, 39% at 1 year, 68% at 2 years, and 78% at 3 years. At 1 year, blood pressure of hypertensive patients fell from 151/95 mm Hg to 127/78 mm Hg, and serum cholesterol and triglycerides of hyperlipidemic patient fell by 0.750 mmol/L (29 mg/dL) and 0.937 mmol/L (83 mg/dL), respectively. Adverse events were modest. We conclude that, in a private practice setting, long-term treatment of obesity with the combination of phentermine, fenfluramine, and a weight maintenance program is generally safe and effective. More research is needed to determine efficacy and safety for longer than 3 years.

Adolescent↗
PubMed1981

Psychoanalytic group therapy in clinic and private practice.

The author reviews the process of psychoanalytic group psychotherapy in private practice and in the clinic setting. He describes the patients who are most likely to be referred for such therapy, most of whom have "failed" in other types of therapy. The group therapist begins with an empathic diagnostic evaluation of the patient's difficulty. As the patient engages in the group, he or she can compensate his or her ego; at the same time the patient develops a transference that is the main source of future work. In time, ego analysis and analysis of the infantile neurosis can be done. Finally, all the analytic work is consolidated during the process of termination.

Borderline Personality Disorder↗
PubMed1995

100 laparoscopic hysterectomies in private practice and visiting professorship programs.

STUDY OBJECTIVE: To evaluate 100 laparoscopic hysterectomies and their variations in private practice and visiting professorship programs. DESIGN: A prospective observational study. SETTING: Gynecology departments of 17 teaching, community, and proprietary hospitals in the northeastern United States. PATIENTS: One hundred women who successfully underwent laparoscopic hysterectomy, 91 of whom were followed for 6 months. INTERVENTIONS: From July 1990 to August 1994, 108 women (mean age 41.6 yrs, range 38-68 yrs) for whom a vaginal hysterectomy was relatively contraindicated underwent a hysterectomy attempted by the laparoscopic route. The most common indications for hysterectomy were pelvic pain, chronic menorrhagia, and uterine leiomyomas. The women were classified according to hysterectomy, with groups comparable in age, weight, uterine size and weight, concomitant surgery performed, uterine and coexisting pathology, and history of pelvic surgery. Of the 108 women, 35 had laparoscopic hysterectomies (LH), 56 had laparoscopic-assisted vaginal hysterectomies (LAVH), and 9 had subtotal laparoscopic hysterectomies (SLH). Eight procedures were converted to laparotomy, two attempted LHs and six attempted LAVHs. In 22 cases, bipolar coagulation of vascular pedicles was done exclusively, in 58 the Endo GIA 30 stapler was used exclusively, and in 20 a combination of both modalities was used. Bilateral ureteral catheters were inserted 49 times. MEASUREMENTS AND MAIN RESULTS: There were eight complications (8.0%): two blood transfusions, two cases of transient, asymptomatic pyrexia, two abdominal wall hematomas, one Richter hernia, and one urinary tract infection. The hernia repair was the only delayed laparotomy. The mean (+/-SEM) surgical time was 123 +/- 8 minutes (range 45-235 min), and the mean hospital stay was 1.48 days +/- 0.4 (range 1-5 days). Ninety-five of the 100 women who successfully underwent a laparoscopic procedure returned to work within 2 weeks (range 4-14 days, range 15-53 days for the remaining 5). CONCLUSION: Hysterectomy performed or aided by the laparoscope, whether LH, LAVH, or SLH, is effective and safe as long as at least one member of the surgical team is an experienced and appropriately trained laparoscopic surgeon. Further studies are necessary to determine if the credentialing process for advanced laparoscopic surgery would be facilitated by a visiting professorship program.

Adult↗
PubMed2004

Patient questionnaires and formal education level as prospective predictors of mortality over 10 years in 97% of 1416 patients with rheumatoid arthritis from 15 United States private practices.

OBJECTIVE: To prospectively analyze patient questionnaire scores concerning functional disability as well as formal education level as potential predictors of premature mortality over 10 years in 1416 patients with rheumatoid arthritis (RA) from 15 private practice rheumatology settings in 11 diverse cities in the United States. METHODS: At baseline in 1985 and periodically over 10 years, patients completed mailed self-report multidimensional health assessment questionnaires (MDHAQ) that included functional disability scores, formal education level, and other demographic and clinical data. Vital status was determined 10 years after baseline. Potential predictors of 10 year mortality were analyzed using descriptive statistics and Cox proportional hazards models. RESULTS: Vital status was accounted for in 1378 patients, 97.3% of the cohort. The standard mortality ratio was 1.6, similar to most reported series of patients with RA, as 401 patients died versus 251 expected over 10 years. Evidence of "dose-response" relations was seen for age, formal education level, functional disability scores, and helplessness scores as predictors of mortality. In Cox proportional hazards models, age, sex, formal education level, functional disability, and helplessness scores remained significant independent predictors of 10 year mortality. CONCLUSION: Functional disability and low formal education level are significant predictors of premature mortality in people with RA under care in US private practice settings, as in most reported cohorts of patients with RA. This study shows that it is possible to account for more than 95% of patients over 10 years using mailed questionnaires to monitor patient status.

Adult↗
PubMed2001

Infection control among dentists in private practice in Durban.

The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infection control was undertaken in Durban to assess the current state of infection control procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infection control remain low amid a climate of an ever-increasing HIV pandemic.

Adult↗