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PubMed1996

Transition from NHS to private practice.

This article describes the process of change in a specialist orthodontic practice from NHS to private, the development of a business plan and its subsequent implementation. The very nature of change is variability and the unique personality of an orthodontic practitioner and the make-up of the regional orthodontic environment mean that this article cannot provide a definitive guide to change. However, the general principles are applicable to changes in most circumstances and are illustrated with reference to the author's own practice.

Dental Audit↗
PubMed1983

Vaginal delivery after cesarean section. Experience in private practice.

To test whether vaginal delivery after cesarean section (VDAC) is a safe alternative to repeated section, a retrospective chart review of 2,350 deliveries during a ten-year period in a private practice group committed to VDAC was studied. Eighty-five parturients met six predetermined safety criteria and were permitted a trial of labor. These criteria were (1) prior low-segment transverse uterine incision; (2) vertex presentation; (3) carefully monitored labor with obstetrician present; (4) availability of emergency facilities; (5) no administration of oxytocin; and (6) patients' consent and desire to pursue VDAC. Seventy-six labors (89%) managed expectantly were successful in VDAC. No maternal or fetal morbidity was detected. No uterine ruptures were detected on postpartum examination or at the time of cesarean section. These results support the 1980 report of the National Institute of Child Health and Human Development recommending that labor and VDAC are of low risk to mother and fetus in properly selected cases.

Cesarean Section↗
PubMed1988

The use of pit and fissure sealants in private practice: a national survey.

The slowness in the adoption of sealant use has been caused by many interrelated professional, scientific, social, and economic factors. To study these factors, data were collected by the use of mail questionnaires sent to a representative sample of 3,504 private practice general dentists. The average percent of patients 18 years of age and younger receiving sealants was 18.7. Nearly one-third of the respondents indicated that none of their patients received sealants. Data describing the following factors were obtained: demographic background, sealant awareness, attitudes and knowledge about sealants, and decision-making factors. We concluded that professional organizations should take a more active role in promoting sealants to dentists, professional organizations and governmental agencies should increase efforts to inform patients/consumers of the benefits of sealants, guidelines for sealant use should be developed, state boards should permit the delegation of sealants to trained auxiliaries, and sealant manufacturers should make more effort to advertise and promote sealants.

Adolescent↗
PubMed1998

The use of exfoliative cytology for the early diagnosis of oral cancers: is there a role for it in education and private practice?

BACKGROUND: Early detection of oral cancers is not easy, because oral precancerous lesions and early oral cancers can mimic many benign conditions in the mouth, leading to delays in diagnosis and treatment. There is a need to emphasize the early diagnosis of oral cancers in order to reduce the unacceptably high morbidity and mortality. METHODS: A survey regarding oral exfoliative cytology was completed by 132 dentists in Virginia who were randomly chosen from a mailing list. RESULTS: Less than half of the dentists (41.7%) had been taught how to obtain a cytologic smear, and only 26.0% knew the clinical indications for doing so. Only 9.2% of the dentists had ever obtained a cytologic smear in private practice. Of the 13 dentists in the survey who had done so, 12 had been trained in the technique. Interest in learning the cytologic technique and getting the needed supplies was indicated by 79.2% of the dentists. CONCLUSIONS: Diagnostic aids in the evaluation of oral mucosal lesions can serve an important role by identifying lesions that need to be biopsied in spite of a "benign" appearance. Exfoliative cytology, as well as vital staining, may aid in this goal. This has implications regarding undergraduate and postdoctoral education.

Cytodiagnosis↗
PubMed1985

Private practice: the first five years.

This is a longitudinal study of all patients seen in the first five years of a private psychiatric practice. At the present time, it is believed to be the only known complete study of patients in a typical private practice. The data from 486 patients has been collected and analyzed and some of the results have been compared to those obtained in other studies. Some significant findings emerged. Depression is the single commonest condition and its frequency was similar to that found in other studies. Psychoses were rare. A large category of patients was described as having a Personality Disorder. The implications of these and other findings are discussed. The data are relevant to aspects of clinical psychiatry, to the teaching of psychiatry, and to the financial insurance coverage of medical services.

Adult↗
PubMedDate not supplied

[Anxiety disorders in private practice psychiatric out-patients: prevalence, comorbidity and burden (DELTA study)].

Few data are currently available on the prevalence and associated characteristics of anxiety disorders in psychiatric out-patients in France, in particular in the private health-care. However, this represents one of the principal systems of care for patients suffering from anxiety disorders, with a possible direct access and several types of treatments available (pharmacotherapy but also different kinds of psychotherapy). The aim of our study was to describe the prevalence of anxiety disorders in a large sample of patients consulting in the private sector, and in addition to study the comorbidity, the severity of the disorders, their consequences on quality of life and health care consumption. The studied patients were included and assessed by 501 psychiatrists from all the country, at the time of a first visit. Inclusions were to be made in a consecutive way, but with the exclusion of psychotic disorders and dementia. A sample of 1 955 patients was obtained, and all subjects had a standardized diagnostic assessment with the Mini International Neuropsychiatric Interview (MINI) and with various dimensional scales of symptomatology severity, quality of life, and health care consumption. On the whole, at least one current anxiety disorder was found in 64.3% of the patients, while 55% had a depressive disorder. Individually, the prevalence rates are 29.4% for generalized anxiety disorder, 25.9% for agoraphobia, 19.2% for panic disorder, 15.3% for social phobia, 11.4% for obsessive-compulsive disorder, and 5.4% for post-traumatic stress disorder (PTSD). A history of suicide attempts was found in 12-20% of patients, and an elevated suicide risk was found for example in 25% of PTSD patients. The scores of the symptomatic scales, adaptation and quality of life measure show a very significant anxious symptomatology, with serious functional consequences. Approximately 75% of patients had another medical consultation during the three previous months, and 9% have been hospitalized. An interruption of work was found in 25% of the patients during the last three months, in average for 35 days. Concerning drug consumption before the visit by anxiety disorders patients, the preponderance of anxiolytic use is notable (85 to 98% according to categories of anxiety disorders) when compared to that of antidepressants (20 to 40%). Moreover, 38.4% of the whole sample took an anxiolytic once a day for at least three months and about 40% of them had dependence symptoms. In conclusion, this study showed the quantitative importance of anxiety disorders among psychiatric out-patients in the private practice sector in France, all the categories of anxiety being represented, and the high level of severity and burden of these disorders. Compared to some data published before, the prevalence rates of these anxiety disorders seem to be increasing.

Adolescent↗
PubMed1992

Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: I. Nonsteroidal antiinflammatory drugs.

The probability of continuation of a particular nonsteroidal antiinflammatory drug (NSAID) over 5 years was estimated for 1,775 courses taken by 532 patients with rheumatoid arthritis treated in 7 rheumatology private practices. Similar results were seen for 15 different NSAID--48% of courses were continued at 12 months, 36% at 24 months, and 20% at 60 months. Only acetylated salicylates, other than plain aspirin, were continued significantly longer than any of the other NSAID. The probability of continuation of plain aspirin was similar to other NSAID, including nonacetylated salicylates and nonsalicylate NSAID. The first NSAID taken by an individual patient was continued only marginally longer than the 4th NSAID taken by the same patient. While most NSAID courses were not continued for long periods, 20% were continued for longer than 5 years, suggesting effective longterm results in this minority of courses.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

[Comment on the cooperation between general practitioners and dermatologists in private practices].

From February until October 2003, the data of patients referred to four dermatologists in private practices, with a commuter belt of about 150 000 inhabitants in northwestern Switzerland, were collected prospectively. 20.5% (total 1691; F 55.9%, M 44.1%, mean age 45.9 years) of all patients, visiting the dermatologists with a new skin problem during this period, were referred, to 83.4% by GP's, to 16.6% by other specialists (OS). The GP's diagnostic accuracy was 54.3% (family physician), 52.3% (internist), 66% (pediatrician) and did not differ from the diagnostic accuracy of OS (53.4%). 42.3% of 274 patients referred for nonpigmented skin tumors and 5.8% of 243 referred for pigmented skin tumors revealed skin malignancy. The GP's accuracy in diagnosing BCC was 42.9%, in malignant melanoma 41.7%. There is an open cooperation between GP's dealing with skin disease and dermatologists. Limiting direct access to GP's or dermatologists would be followed by loss of quality in managing skin problems.

Adolescent↗
PubMed2004

[Consensus double reading of mammograms in private practice].

PURPOSE: To evaluate retrospectively the results of consensus double reading of mammograms in a private practice for a period of 1.5 years (November 2001 to March 2003). MATERIALS AND METHOD: Two independent experts with dedicated training read all mammograms on a weekly basis. All mammograms including sonographic examinations were evaluated independently and categorized using the BI-RADS classification. The achieved consensus included a possible recommendation for recall or therapy. A total of 3936 mammograms and 1912 sonography studies were evaluated. All cases with BI-RADS 4 and 5 categories were compared with the histologic results. For a period of three months, the acceptance of double reading including a delay of the final report by one week was tested with a questionnaire and informed consent sheet. RESULTS: BI-RADS categories 4 and 5 were found in 57 cases, with 41 consensus results by two independent readers and 26 carcinomas verified by histology. No consensus could be reached in 16 patients, of which 10 had a final histologic result, with 5 benign lesions and 5 carcinomas of less than 1 cm in diameter. Clinical symptoms or alterations were absent in all patients. The 5 carcinomas were discovered by the double reading procedure. The result of the questionnaire (695 questionnaires) showed a refusal rate of 0.7 %, with only 5 women refusing the opportunity of double reading their mammograms. CONCLUSION: Double reading of mammograms by independent experts is feasible, shows a measurable increase in quality and is accepted by almost all women.

Breast↗
PubMedDate not supplied

Atypical depression in private practice depressed outpatients: a 203-case study.

The prevalence of DSM-IV atypical depression and comparisons between atypical and typical depression were studied in 203 consecutive unipolar and bipolar depressed outpatients presenting for treatment of depression in private practice. The prevalence of atypical depression was 31%. Of the variables investigated (unipolar/bipolar diagnosis, age at baseline/onset of first major depressive episode, gender, psychosis, comorbidity, chronicity, duration of illness, recurrence, and severity), a bipolar II diagnosis was significantly more common, the age at baseline and duration of illness were significantly lower, and the proportion of females and psychiatric comorbidity were significantly higher in atypical versus typical depression. Secondary analysis showed that bipolar II atypical depression had a significantly earlier age at baseline/onset and affected more females, but there were no other significant differences versus typical depression. The findings suggest important clinical differences between atypical and typical depression, and a bipolar II subtype may be separated from the broad category of atypical depression.

Ambulatory Care↗
PubMed2006

[Life satisfaction, health status, and professional satisfaction of urologists in private practice].

The medical profession still enjoys a high standing in the general population. It does, however, have considerable drawbacks. These include high levels of time expenditure and intense psychological stress, lower degree of life satisfaction, limited leisure time and private life, and immense physical stress in connection with increased health risk behavior. Between January 2004 and March 2006, a survey was conducted among urologists in private practice in the German states of Hesse, Lower Saxony, Saxony, and Thuringia concerning their life satisfaction, health status, and professional satisfaction. Of the 599 physicians contacted by mail, 194 returned the completed 14-page questionnaire. The rate of return was 30.8%. The questionnaire contained items on professional situation, wishes and plans, health, personal data, life situation, and attitude towards various aspects of life. The following questionnaires were employed: questions on professional self-efficacy according to Abele et al. (2000), on professional stress and life satisfaction according to Fahrenberg et al. (2000), and on professional gratification according to de Jonge et al. (2000). Physical complaints were assessed by the short form of the Giessen Complaint Questionnaire. When possible, the data were compared with those of a representative population sample. Analysis revealed that registered urologists considered bureaucratic administrative chores to cause the greatest strain, followed by an uncertain future and lack of a private life. Although >74.8% believed that their physical condition was good or very good, urologists suffer more frequently from cardiac and abdominal complaints than the average population and are exhausted to a considerably higher extent. With their above average willingness to overtax themselves, the imbalance between exhaustion and benefit is far greater than in the population sample. This could represent the cause of the psychosomatic complaints among the physicians.

Attitude of Health Personnel↗
PubMed2000

Survival of In-Ceram crowns in a private practice: a prospective clinical trial.

STATEMENT OF PROBLEM: Prior reports on some all-ceramic crown systems have indicated high failure rates through fracture. PURPOSE: This study prospectively evaluated the survival of infiltrated alumina crowns (In-Ceram) in a private practice. MATERIAL AND METHODS: All the In-Ceram crowns placed in a prosthodontic practice since its introduction in 1990 were serially included. Patients were recalled at 6 monthly intervals. Those who did not attend in the previous 6 months were contacted by telephone and a series of answers to standardized questions recorded. The few patients who were lost to follow-up or who died were removed from the study from the time of last contact. RESULTS: A total of 408 crowns in 107 patients were followed for periods from 1 to 86 months. As the 3-year data combined a meaningful period of service with a large sample size, these data were focused on. The 3-year survival rate was 96% for a sample size of 223. Three-year data indicated that core fracture and porcelain fracture occurred at rates of approximately 0.6% and 0.3% per year, respectively. Otherwise sound restorations were removed at a rate of approximately 0.3% per year for esthetic, endodontic, or prosthetic reasons. Anterior crowns tended to have a slightly higher 3-year survival rate (98%) than premolars or molars (94%). CONCLUSION: Clinical failure rate of In-Ceram crowns was low. Crowns were lost because of core fracture, porcelain fracture, and removal without failure. Failure tended to be more common for molar and premolar crowns than for anterior crowns.

Aluminum Oxide↗
PubMed1978

[A double-blind nomifensine-nortriptyline trial in ambulatory patients conducted by psychiatrists in private practice: results and comments].

Nomifensine and nortriptyline were compared in a collaborative trial by psychiatrists in private practice. The trial impiled:--selection of ambulatory depressed patients--randomization in parallel groups (respectively 31 and 34 subjects)--administration in double-blind condition of 4 capsuels daily of either compound during 4 weeks--quotation of depressvie syndrom with Hamilton depression scale before treatment after 2 and 4 weeks. The analysis of results shows clear improvment of depression scores, equivalent in both groups (non significant difference and posterior rejection of an alternative hypothesis). Practical problems encountered in controlled trials in psychiatrist's outpatients are discussed.

Adolescent↗
PubMed1985

Ten years of experience with 1,000 hyperactive children in a private practice.

A summary of the author's experience with 1,000 hyperactive children treated in a private practice over a period of 10 years is presented. Of 1,000 children entering the office, 872 were treated with stimulants for more than 6 months. Of these 872 children, 137 (16%) were considered as treatment failures; 735 (84%) had a positive response to medication. A follow-up of 197 patients in "remission," after treatment, suggested that symptoms had reappeared in 20% of the cases. The length of treatment in a group of 494 children still under observation on Dec 31, 1981, indicated that the majority of boys were treated for between 3 to 5 years; girls were treated for 2 to 3 years. Approximately 10% of the children received medication for 1 to 2 years, whereas about 20% were treated for more than 6 years. It was concluded that treatment with a stimulant for 5 to 10 years is a safe and efficient way to help hyperactive children during a difficult time of life.

Amphetamine↗
PubMed1994

Patient-carried card prompts vs computer-generated prompts to remind private practice physicians to perform health maintenance measures.

BACKGROUND: We compared the efficacy of a computer-generated prompt sheet placed on the front of patients' charts with a patient-carried prompt card to remind physicians to perform selected health maintenance items. METHODS: A randomized prospective single-blind study was performed in private practice offices in rural eastern North Carolina, with 28 family practitioners and nine general internists participating. Twenty-two physicians were randomized to the computer prompt group and 22 to the card prompt group. Four physicians in the computer group did not complete the study because of computer software problems, and three physicians did not complete the study because their limited staff was unable to enter patient data into the computer. Before the intervention, 20 patient charts (10 males and 10 females) from each physician were audited for the performance of influenza vaccinations, stool for occult blood, pap smears, breast examinations performed by the physicians, and mammograms. One year after the intervention was instituted, chart audits for the above five items were done again on 20 different patient charts for each physician. RESULTS: There was a 7% increase in the performance of influenza vaccinations in the card group (17% vs 24%) compared with a 6% increase in the computer group (20% vs 26%). There was a 5% decrease in the performance of stool for occult blood in the card group (28% vs 23%) compared with a 1% increase in the computer group (30% vs 31%). There was an 11% decrease in the performance of pap smears in the card group (26% vs 15%) compared with a 3% increase in the computer group (23% vs 26%). There was a 2% decrease in the performance of breast examinations by the physician in the card group (35% vs 33%) compared with a 3% increase in the computer group (30% vs 33%). Finally, there was a 3% increase in the performance of mammograms in the card group (22% vs 25%) compared with an 11% increase in the computer group (15% vs 26%). CONCLUSIONS: Our data show a greater increase in performance of health maintenance items in the computer-prompted group. The performance of stool for occult blood, pap smears, breast examinations performed by the physician, and mammograms were increased more in the computer-prompted group than in the card group. However, there was not a statistically significant difference after intervention for any of the audited health maintenance items for either the computer group or the card group. Overall, health maintenance measures were performed in only a minority of appropriate patients.

Adult↗
PubMed1953

Cytologic detection of cervical cancer; four years' experience with routine smear examination in private practice.

Simplified Papanicolaou smear techniques appear to be adaptable to private clinical practice when experienced cytodetection laboratory facilities are available. A private physician's office seems potentially an efficient, economical and practical place for detection of cervical cancer by use of the smear technique as a routine part of examination of patients. In a series here reported upon, examination of 11,207 cervical smears taken at the first examination of patients of all ages led to diagnosis of unsuspected malignant disease in 80 cases-in all instances at a stage when it should be easily curable. Cancer was not detected in examination of 6,060 smears taken later from women who had had a "negative" smear at the time of first examination, which seems to indicate that the first screening was reasonably accurate. In a few cases, early cancer was detected when smears were reported as "atypical" or "suspicious." Such reports demand as careful follow-up as do "positive" reports. There are dangers and limitations in wide-spread clinical application of screening by this method. Care must be observed in the development of programs for its use lest the potential benefits in early detection be outweighed by the dangers from misuse.

Cervix Uteri↗
PubMed2002

Contemporary disease modifying antirheumatic drugs (DMARD) in patients with recent onset rheumatoid arthritis in a US private practice: methotrexate as the anchor drug in 90% and new DMARD in 30% of patients.

OBJECTIVE: To describe therapies with disease modifying antirheumatic drugs (DMARD) and biological agents in patients with early rheumatoid arthritis (RA) who were receiving routine clinical care in 2001 in a private practice of 5 rheumatologists in Nashville, TN, USA. METHODS: A cohort of 232 patients with initial symptoms of RA in 1998 or later were enrolled between February and October 2001 into a longterm observational study, designed to evaluate treatments and longterm outcomes of RA. The baseline evaluation included review of all DMARD that had been taken since disease onset, clinical measures on a multidimensional health assessment questionnaire, joint counts, and laboratory measures. RESULTS: Among the 232 patients, methotrexate (MTX) was the first DMARD used in 192 patients (82.8%), including 3 in combinations. Since initiation of the first DMARD to the study visit, over a median interval of 12.1 months, 125 (66.1%) patients of the 189 whose initial DMARD was MTX as a single DMARD continued MTX as a single DMARD, 43 (22.8%) had another DMARD or biological agent added in combination with MTX, and 21 (11.1%) discontinued MTX. Since the onset of RA, 89.2% of the patients had taken MTX, 15.9% hydroxychloroquine, 3.9% sulfasalazine, 22.0% leflunomide, 9.5% etanercept, 4.3 infliximab, and 87.0% prednisone. CONCLUSION: After a median duration of 12.1 months of DMARD therapy, almost 90% of patients with recent onset RA took MTX as the anchor drug. More than 60% took MTX as a single DMARD or in combination with traditional DMARD, while 30% took leflunomide, etanercept, or infliximab, usually in combination with MTX.

Adolescent↗