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At least 523 records · Page 29Linked to original sources
PubMed1990

The intensive care unit--who's in charge? The private practice view.

In the past 10 years, a number of authors have expressed concern that surgeons are abdicating their traditional role of providing preoperative and postoperative care in surgical intensive care units. To study today's private practice environment, we took a survey. Questionnaires were sent to the chiefs of surgery and the nurse managers of the surgical intensive care units at 188 non-university-affiliated hospitals throughout the United States. Results show that surgeons do not have the principal managing role in the intensive care unit for surgical patients in 70% to 75% of the hospitals. Results also indicated that surgeons are relinquishing their responsibilities in the direct care of the preoperative and postoperative critically ill patients. Three main reasons are given for this: (1) an ever-increasing body of critical care knowledge plus complex technology, (2) a lack of economic incentive, and (3) professional liability. To reverse this trend, these three areas must be addressed.

Critical Care↗
PubMed2003

An assessment of consecutively presenting orthokeratology patients in a Hong Kong based private practice.

PURPOSE: The aim of this study was to collect objective, subjective and demographic data on consecutively presenting orthokeratology (ortho-k) patients who attended for routine follow-up examination in a Hong Kong based private practice in May 2001. METHOD: Sixty-nine patients who returned to the surveyed practice for follow-up visits during the study period (May 2001) were interviewed and relevant data extracted from their files. Data collected included identification and estimation of the extent of complications encountered by ortho-k patients and their satisfaction with the treatment. RESULTS: Among the 61 patients who had been wearing ortho-k lenses for at least one month, 50 patients were younger than 16 years old. Twelve children (24 per cent) had been reluctant to wear ortho-k lenses before undergoing the treatment but, after commencement of lens wear, only one child was not very willing to wear the ortho-k lenses. The mean pre-ortho-k spherical refractive error of these patients was -3.93 +/- 2.30 D (OS only). Of the 59 patients who wore ortho-k lenses for at least one month and who were on night therapy, 10 patients had to wear spectacles or contact lenses in the daytime due to significant residual myopia. There was no statistically significant correlation between post-ortho-k unaided visual acuity and pre-ortho-k refractive error (spherical, cylindrical or the equivalent sphere) in the 49 patients who did not need to wear any vision correction in the daytime. Of the 61 patients, four reported eye inflammation/infection during the treatment. All recovered their ocular health without any effect on their vision or corneal health. The incidence of corneal staining that required lens wear to be stopped appeared to increase with the duration of ortho-k lens treatment. The incidence of staining was not related to refractive error, unaided visual acuity or the age of the subjects. The most common problem reported by the patients was lens binding and there were also reports of increased redness, itching, light sensitivity and secretion of mucus in the morning after opening their eyes. More than 50 per cent of the patients experienced some distance vision blur, which was worse towards the end of the day. For most patients, these problems occurred only occasionally. Higher pre-ortho-k spherical refractive error was related to poor near and distance vision and worse distance vision towards the end of the day. CONCLUSION: The majority of the patients interviewed were children who reported being 'happy with the results of the treatment'. Night wear is the main wearing modality and in view of the increased risk of complications in overnight wear and the fact that a large number of the patients are children, the need for strict compliance with the practitioner's instructions for lens use and care cannot be overemphasised. With careful monitoring and good compliance, complications with overnight ortho-k wear can be minimised. In view of the high incidence of lens binding, it is essential that patients and parents of young patients know the correct method to free a bound lens.

Adolescent↗
PubMed2000

Academic and private practice medicine and health service delivery systems: a psychiatric commentary.

The author presents a commentary on the interactions and economic consequences of managed care, health service delivery systems, academic medicine, and psychiatry. The author recommends the creation of divisions of private practice psychiatry within academic psychiatry departments as a means to address the increasing financial pressures as well as to foster medical education, quality medical care, and clinical research.

Delivery of Health Care↗
PubMedDate not supplied

Private practice results of screw-type tapered implants: survival and evaluation of risk factors.

PURPOSE: The aims of this study were to examine the long-term survival and the prosthetic treatment outcome of screw-type, tapered implants placed in a private practice setting and to explore potential risk factors of implant failures. MATERIALS AND METHODS: In this retrospective analysis of patients treated with endosseous screw-type tapered implants, data relative to implant placement and failure, implant length, location, prosthetic treatment, medical history, smoking habits, and oral health behavior were gathered by chart review and questionnaire. An oral examination was also conducted. Cumulative survival rates were estimated through Kaplan-Meier methods. Comparisons between subgroups of patients were made using the log-rank statistical test. The association between several factors and implant failures was analyzed using Cox regression analyses (random and dependent models). Differences were considered significant when P < .05. RESULTS: The survival rate of 663 implants placed in 159 patients (65 men, 94 women; 80.7% of 197 eligible patients) was 91.8% after 120 months. Mandibular implants had a higher survival rate than maxillary implants (96% versus 89%, P = .011). The failure rates for implants were 15.0% among current smokers, 9.6% among former smokers, and 3.6% among nonsmokers. The differences between nonsmokers, former smokers, and current smokers were significant (nonsmokers versus former smokers: P = .036, nonsmokers versus current smokers: P < .001, former smokers versus current smokers: P = .003). Only number of years of smoking was significantly associated with an increased risk of implant failures (P = .036 using dependent estimation; P = .004 using independent estimation). The HR increased to 6.6 for patients who had smoked for 45 years. Loosening of prosthetic components were rare (n=12). No fractures of screws or implants were found. DISCUSSION: Higher failure rates for former smokers and a dose-response effect between duration of smoking and implant failure rates suggested that permanent tissue damage from smoking may occur in addition to immediate local and systemic effects. The frequency of prosthetic complications was comparable to other studies. CONCLUSIONS: Screw-type tapered implants placed in a private dental office demonstrated a cumulative survival rate of 91.8%. The relative risk of implant failure increased with the duration of smoking.

Adolescent↗