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At least 397 records · Page 22Linked to original sources
PubMed1998

Evaluation of atypical and low-grade cervical cytology in private practice.

OBJECTIVE: To evaluate the adequacy of cytology alone for diagnosis of grade of cervical intraepithelial neoplasia (CIN) and to study performance of cytology, human papillomavirus (HPV) testing, and colposcopy in the evaluation of cytologic findings suggesting low-grade squamous intraepithelial lesions (SIL), or atypical squamous (ASCUS) or atypical glandular (AGCUS) cells of undetermined significance. METHODS: Standard gynecologic and cytologic evaluation and colposcopic inspection as an additional screening approach were performed on women with no prior hysterectomies screened in a private practice between January 1, 1993, and August 1, 1995. Among these 7651 women, 367 had ASCUS, AGCUS, or SIL cytology or clinically or colposcopically visible cervical lesions. Sensitivity, specificity, and relative risk of CIN in the 367 women were compared by colposcopic, cytologic, histologic and virologic diagnoses. RESULTS: The sensitivity of all non-negative Papanicolaou smears for CIN 2-3 and cancer was 92%, combined cytologic categories of high- and low-grade SIL were 59%, and high-grade SIL alone was 22%. Colposcopy was performed in all 367 patients, and positive findings led to biopsies in 48%. Colposcopy of patients with ASCUS increased detection of CIN 2-3 by 32% and CIN 1 by 48%. Cervical cytology was false negative in 8% of patients with CIN 2-3 and in 14% of those with CIN 1. These cases of CIN were detected by screening colposcopic inspection. High-risk HPV DNA was positive in 41% of women with CIN 2-3, and in 25% of those with CIN 1. The positive predictive value of ASCUS cytology increased from 5% to 42% for CIN 2-3 and from 30% to 85% for all grades of CIN in patients carrying high-risk HPV DNA. Virologic studies did not add to an increase in the sensitivity for CIN 2-3 among women in the low- and high-grade SIL cytology groups. CONCLUSION: Because of the limited sensitivity of the high-grade SIL cytologic category for CIN 2-3, we recommend that all women with ASCUS, AGCUS, low- or high-grade SIL cytology be recalled for colposcopy, with biopsy only when indicated by colposcopic findings.

Adolescent↗
PubMed2006

The diagnosis of periodontal disease in private practice.

BACKGROUND: Periodontal disease is an inflammatory reaction to the bacteria in dental plaque. The present study compared the prevalence of periodontal disease in patients using as a diagnostic either probing depth measurements, an inflammatory marker such as numbers of white blood cells in plaque samples, or microbiological markers such as the microscopic count and the benzoyl-DL-arginine naphthylamide (BANA) test. METHODS: Teeth with the most inflammation and/or deepest pockets in each quadrant were probed and subgingival plaque was sampled from 1,043 consecutive new patients enrolled in a private practice. Multivariate "diagnostic" models were developed based upon the probing depth (general linear models), percentage of white blood cell-positive and percentage of BANA-positive plaques (logistic regression models) to determine the prevalence of patients with periodontal disease. RESULTS: Plaque samples were removed from 3,694 sites. Fifty-two percent of sampled pockets were >4 mm; 49% of sites were inflamed, using the presence of white blood cells, and 28% were infected using the BANA test. Diagnostic models were highly significant at P<0.0001. The white blood cell model was the most parsimonious as demonstrated by the lowest Akaike information criteria statistic and had the highest receiver operator characteristic (ROC) curve relative to the probing depth and BANA models. CONCLUSIONS: Periodontal disease can be diagnosed chairside by the presence of white blood cells in plaque samples, a finding that reflects the inflammatory nature of the disease process. This approach would reduce the misclassification of subjects as having periodontal disease (130 patients in the present study who had pockets) but minimal evidence of an inflammatory response.

Benzoylarginine-2-Naphthylamide↗
PubMed2000

Late-life chronic depression: a 399-case study in private practice.

OBJECTIVE: Aims of the study were to find the prevalence of chronic depression in elderly patients compared with younger patients, and to compare chronic depression between elderly and younger patients, to find if there were clinical differences. A major feature of the study was the inclusion of a large number of bipolar II patients, usually not included in previous studies. METHODS: Three hundred and ninety-nine consecutive unipolar (N=200) and bipolar II (N=199) depression outpatients were interviewed with the Structured Clinical Interview for DSM-IV and depression rating scales in a private practice. RESULTS: Chronic depression was more common in elderly patients than in younger patients (53.6% vs 40.1%, p=0.0299). Late-life chronic depression patients had later age at onset, longer duration of illness, fewer bipolar II cases, more unipolar cases and more relapses than younger chronic depression patients. CONCLUSIONS: Results suggest that late-life depression is more likely to be chronic than depression in younger patients. The subtyping of chronic depression according to age seems supported by a different age at onset and some clinical differences.

Adult↗
PubMed1999

Home-based leg strengthening for older adults initiated through private practice.

BACKGROUND: Leg strength correlates with functional ability in the frail elderly, many of whom can be reached through a private practice setting. The purpose of this study was to demonstrate the feasibility of physician-prescribed, home-based, clinic-monitored, high-intensity leg-strengthening treatment among elderly patients with a variety of medical problems. METHODS: Twenty-two elderly patients with a variety of chronic medical conditions were invited to participate during regularly scheduled office visits if they had difficulty rising from a chair and an unsteady, cautious gait (age 85.1 +/- 5.7, 14 female). Physical therapists (PT) instructed patients to lift ankle weights at home, three times per week. Patients visited PT five times over a 12-week period. Weights were increased at each visit. RESULTS: Patients' one-repetition maximum increased (right leg 13 to 21 lb, P = 0.00; left leg 15 to 22 lb, P = 0.00). Patients also improved in habitual (18 to 12 s, P = 0.01) and tandem (38 to 26 s, P = 0.00) 20-foot walking times and sit-to-stand time (5 to 3 s, P = 0.01). CONCLUSION: The primary care physician can initiate a home-based leg-strengthening program that is practical for and well tolerated by the frail elderly.

Aged↗
PubMed2006

The duration of hypomania in bipolar-II disorder in private practice: methodology and validation.

BACKGROUND: DSM-IV 4-day minimum hypomania duration is not evidence-based. Epidemiologic data suggest that briefer hypomanias are prevalent in the community. We sought to find out the relative prevalence of short (2-3 days) versus long (>/=4 days) hypomanias in private practice. METHODS: 206 bipolar-II (BP-II) depressed outpatients (group B) and a group of 140 remitted BP-II (group R) were assessed with the DSM-IV Structured Clinical Interview, as modified by the authors. BP-II with short vs. longer hypomania were compared on such bipolar validators as early age at onset, depressive recurrence, atypical feature specifier, depressive mixed state and bipolar family history. In addition, to ascertain the bipolar status of depressed patients with brief hypomanias, we included a comparison group of 178 major depressive disorder (MDD) patients assessed when depressed. RESULTS: 27-30% of hypomanias (depending on whether assessment occurred when patients were depressed or in remission) had 2-3-day duration; 72% lasted less than 4 weeks. Except for the atypical feature specifier, BP-II with short vs. BP-II with longer hypomania were not significantly different on bipolar validators. Moreover, BP-II with short, like its longer hypomanic counterpart, was significantly different from the comparison MDD group on all bipolar indicators. LIMITATIONS: Single interviewer and retrospective evaluation of duration of hypomania. CONCLUSIONS: As BP-II patients almost never present clinically in a hypomanic episode, the retrospective assessment of the duration of these episodes is clinically unavoidable. Most hypomanias last from 2 days to a few weeks. BP-II with shorter vs. longer hypomanias had significantly higher rates of females, comorbidity and atypical features, but were otherwise indistinguishable on crucial bipolar validators. Furthermore, such validators, including bipolar family history, robustly distinguished BP-II with short hypomanias from the MDD group. The conservative 4-day threshold would misclassify one out of three BP-II as MDD. Such misclassification has relevant implications for treatment and outcome, as well as clinical research methodology for depressive and bipolar disorders.

Adult↗
PubMed2000

Long-term treatment of panic disorder with agoraphobia in private practice.

The author followed 67 patients with panic disorder with agoraphobia (PDA) for a minimum of 5 years in a private practice setting. They were treated with a combination of pharmacotherapy (antidepressants or benzodiazepines) and cognitive-behavioral psychotherapy. The author examines outcomes for three groups: A) 11 male patients, 10 of whom had comorbid conditions; B) 21 female patients with comorbid conditions; and C) 35 female patients without comorbid conditions. Symptom severity was assessed using the Panic Disorder Severity Scale (PDSS). Patients in all groups showed marked improvement in all the domains measured by the PDSS, with the greatest improvement in PDSS scores occurring during the first year in all three groups. Patients in groups A and B tended to plateau after 5 years of treatment and show no additional improvement thereafter, whereas patients in group C (women with "pure PDA") continued to improve, although at a gradually slower rate. However, after an average of 11 years of treatment, the majority of patients remained symptomatic. The presence of comorbid alcohol abuse or depression was associated with poorer outcomes. The results in this effectiveness study are generally not as good as the outcomes of published PDA follow-up efficacy studies, but appear to be superior to outcomes in cohorts of chronically anxious patients treated decades ago.

Journal Article↗
PubMed1994

Use of fissure sealants by dentists in private practice in Mexico City.

This paper presents findings on the use of pit and fissure sealants by dentists working in private practice in Mexico City. A total of 386 dentists participated in the study. Dentists working in high, middle, and low socioeconomic areas of the city were personally interviewed and their patients' records of the last 5 working days were reviewed. 45% of the dentists indicated that they used sealants and 10% used them during the 5 days studied. A greater proportion of recent dental graduates used sealants compared with older graduates. The dentists who utilized sealants were more likely to apply fluoride treatments in their practice than dentists who did not utilize sealants. The proportion of sealants in relation to all treatments provided was low (0.8%), and even lower in the low socioeconomic areas (0.02%). Considering the high dental caries experience of Mexican children, the use of dental sealants should be promoted by Mexico City dentists. In addition, school-based sealant programmes should be established, particularly in low socioeconomic areas.

Adolescent↗
PubMedDate not supplied

Use of the Frialit-2 Implant System in private practice: a clinical report.

This retrospective study presents the results of the use of the Frialit-2 System in a private practice setting. A total of 802 implants, both threaded and press-fit, were placed between February 2, 1996, and March 6, 2002. The overall success rate was 97%, and the cumulative survival rate using life table analysis was 96.1%. The statistical breakdown and an analysis of the results of the treatment of this patient population are presented.

Adolescent↗
PubMed1985

The irritable bowel syndrome--a study from private practice.

The clinical features of 150 consecutive patients with irritable bowel syndrome are reported. All patients were referred to a private practice. There was a marked female preponderance and a wide range of ages. Diarrhoea was predominant in 61,3%. The common symptoms were altered bowel habit, abdominal pain, emotional disturbance, flatulence and distension. Fatigue, weight loss, upper gastrointestinal symptoms, backache and urinary symptoms were frequent. The rectum showed nonspecific loss of vascular pattern, oedema and congestion in 11,4% of patients, but this was readily distinguished from inflammatory bowel disease on histological examination. The incidence of non-smokers in the group was 78,1%. The overall appendicectomy rate was 34%, and 65% of the 92 women had had gynaecological operations. A positive diagnosis was made on a typical history and simple basic investigations. More extensive investigations were required for those patients with markers of organic disease, but these yielded few associated lesions.

Adult↗
PubMed1980

Pit and fissure sealants in private practice and public health programmes: analysis of cost-effectiveness.

Most studies of fissure sealants have concentrated on their ability to prevent caries of occlusal surfaces. The cost-effectiveness of the procedure has been generally ignored and even in those reports where values for the cost of sealant applications are given they tend to be overstated. In the majority of studies all sound teeth in one half of the subject's mouth were sealed, the other side acting as a control. Since only a proportion of the teeth sealed would have become carious this could be held to be wasteful and in a private practice where the caries profile of the subject was known, a more economical regimen could have been adopted. When sealants are applied by a dentist the cost appears likely to exceed the potential cost of restorations saved, but this could be altered if it were possible for the procedure to be carried out by auxiliaries. It is concluded that fissure sealants have a worthwhile contribution to make when used as an integral part of a total preventive regime which includes the use of professionally and self-applied fluorides. With their intelligent use it should be possible to preserve many more dentitions free of caries into adult life.

Adolescent↗
PubMed2001

Buprenorphine treatment of heroin dependence (detoxification and maintenance) in a private practice setting.

At the conclusion of a 3-year demonstration project in a medical setting in which refusal to accept methadone was an inclusion criterion, 12 subjects were unable to detoxify from buprenorphine and remained adamant in their refusal to enroll in a MMTP. In order to study the feasibility of expanding opportunities for treatment previously unavailable to this under-served population of heroin addicts, these 12 subjects plus an additional 11 subjects (N = 23) were recruited for a 12 months trial of buprenorphine treatment conducted in an office-based setting on a fee-for-service basis. An additional cohort of 40 heroin dependent subjects were entered in a protocol for detoxification only. The findings demonstrate both feasibility and patient acceptance of office based fee-for-service buprenorphine treatment, supporting the need for (1) additional studies of this population and (2) changes in government regulations to reintroduce addiction treatment under physician auspices in private practice settings.

Adult↗
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↗
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↗
PubMed2006

Does the FDA proposed list of possible correlates of suicidality associated with antidepressants apply to an adult private practice population?

BACKGROUND: In issuing an advisory about a relationship of suicidality emerging during antidepressant use in mood and other psychiatric disorders in juvenile and, possibly patients of all ages, the FDA listed such warning symptomatologic correlates as psychomotor agitation, panic, insomnia, irritability, aggressiveness, and impulsivity, and additionally urged screening for personal and family history for bipolar disorder. It must be recalled that the FDA warning was based on post hoc examination of antidepressant trial data pertaining largely to emergent suicidal ideation rather than attempts. In this report we examine the relevance of the "FDA list" for adults. METHODS: Consecutive 650 outpatients presenting with a major depressive episode (MDE) in the second author's (FB) private practice were interviewed using the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen. The threshold for a bipolar II (BP-II) diagnosis was broadened by bypassing the stem-A probes on hypomanic mood, lowering the duration of hypomanic episodes to as short as 2 days and, most importantly, eliciting hypomanic intrusions into depressive episodes. Beyond the FDA proposed list and in line with previous work by us, we considered symptoms of depressive mixed state (DMX, an MDE plus 3 or more DSM-IV intradepressive non-euphoric hypomanic symptoms) as possible substrates for suicidality. RESULTS: Suicidal ideation was present in 49.3% of the sample, and significantly greater in BP-II versus MDD (OR=1.46). Odds ratio for patients with suicidal ideas, versus those without suicidal ideas in univariate analyses were as follows: irritability (1.32), psychomotor agitation (1.48) and racing/crowded thoughts (2.0). In DMX, irritability was present in 76.4% and in non-DMX in 23.8% (OR=10.3), psychomotor agitation in 51.3% versus 4.4%, (OR=22.6), and racing/crowded thoughts in 89.2% versus 45.3% (OR=9.9). Insomnia and family history for bipolarity were not associated with suicidal ideation. Racing/crowded thoughts emerged as the only significant independent predictor in multiple logistic regression. LIMITATION: Panic was not specifically tested, because it was not systematically entered into our clinical database. Furthermore, we studied a population which was not taking antidepressants. Our operating hypothesis was that the FDA listed correlates of suicidality are pre-existing baseline substrates that might be potentially further activated by antidepressants. CONCLUSION: Going beyond previous work by us, the present data further refine the "FDA list" under scrutiny. While not designed to test whether antidepressants induce suicidality, the present report shows that the type of depression associated with suicidal ideas is an agitated, irritable, and especially mentally overactive syndrome (i.e. a DMX). Bipolarity falling short of the DSM-IV schema (represented by BP-II with brief hypomania and DMX) appears to represent the main diagnostic substrate for the occurrence of suicidality. Although controlled trials of antidepressants in adults have not been specifically conducted in DMX patients, it would be clinically prudent to avoid the prescription of antidepressant monotherapy to such patients to avert any potential iatrogenic aggravation of their condition.

Adult↗
PubMed2005

Osseointegrated dental implants in private practice: a long-term case series study.

BACKGROUND: Osseointegrated dental implants have become a routinely recommended procedure in the clinical practice of dentistry and periodontics. Due to their predictability, they have changed the way many cases are treatment planned. The purpose of this paper is to report the results of a prospective study of factors affecting the successes and failures of a large group of dental implants and compare them to published literature. METHODS: A total of 1,003 consecutively placed pure titanium dental implants placed from August 1987 to January 2002 and followed to October 2003 are reported. All implants were placed in one private practice by the same surgeon. RESULTS: Success rates statistically were influenced only by the age of the implant, although when the raw data are examined, some trends are seen. Success was unaffected by patient age, gender, surface roughness of implant, site of placement, smoking, bone type, arch, screw versus press-fit, diameter, length, manufacturer, reason for tooth loss, site bony augmentation and timing, placement timing, one-versus two-stage placement, or torque testing of implants; 75% of failures occurred before restoration. CONCLUSIONS: Osseointegrated dental implants are a highly predictable procedure with proper case selection. Failure rates vary for a number of factors reviewed, although only the age of the implant was statistically important in predicting failure. Male smokers, maxillary first molars, and type 4 bone had increased failure rates. Threaded, surface-roughened implants had the highest success rates.

Adolescent↗
PubMed1981

The private practice of rheumatology. The first 1,000 patients.

Although this report of the first 1,000 patients in a rheumatologic consultative private practice cannot necessarily reflect the general experience of rheumatology, certain conclusions may be valid and may help to guide the rheumatologist-in-training. Approximately 70% of our patients were categorized as having "inflammatory" or "connective tissue' disorders, rather than degenerative disorders. Internists and general practitioners were the principal referral sources. Over 80% of referrals came from a relatively small geographic radius of 10-15 miles. A population base of perhaps 200,000 people, therefore, may be necessary to support a purely rheumatologic practice. A relatively steady flow of 2 new patients per day was not significantly influenced by subsequent additional rheumatologists moving into the area. However, the pattern of referrals clearly changed to include more patient-to-patient referrals (nearly 30%), perhaps reflecting both loss of physician referral sources and the increasing number of referrals from satisfied patients over a period of time.

Adolescent↗
PubMed1992

Stress and psychological disorders in Zimbabwe: a report on patients seen in private practice.

This report is based on the analysis of 326 case files of patients that I saw in part-time private practice over a period of five years. The aim of the investigation was to establish the stressful life events that are associated with psychological disorder. Thirteen categories of stressful events were identified. Statistical analyses revealed that these stresses were significantly associated with a number of demographic variables.

Adolescent↗