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PubMed2006

Efficacy and safety of lamotrigine for adults with bipolar disorder in a private practice setting.

INTRODUCTION: Lamotrigine is approved by the Food and Drug Administration for maintenance therapy in patients with bipolar I disorder. However, several studies of acute-phase and maintenance treatment support the efficacy of lamotrigine for bipolar I and bipolar II disorders. This chart review was performed to assess the efficacy and safety of lamotrigine in the treatment of bipolar disorder in a private psychiatric practice setting and to investigate differences in response among patients with different diagnostic subtypes of bipolar disorder. METHODS: The charts of 587 adult outpatients with a primary diagnosis of bipolar disorder who received treatment with lamotrigine in a private practice setting between July 1998 and May 2004 were reviewed retrospectively. Treatment response was assessed with the Clinical Global Impression-Improvement scale and was defined as achievement of a score of <2. RESULTS: Three hundred forty-nine patients (59.5%) responded to lamotrigine. Response rates were comparable among patients with bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise specified, and among patients with bipolar I disorder who presented with depressive, manic, or mixed episodes. Nonserious rash (12.8%) and headache (2.9%) were the most frequently reported adverse events. CONCLUSION: These results suggest that lamotrigine is effective and well-tolerated in the treatment of bipolar disorder across the spectrum of subtypes of the illness.

Adolescent↗
PubMed1992

Experience with mepivacaine paracervical block in an obstetric private practice.

OBJECTIVE: The objective of this study was to determine the efficacy and safety of mepivacaine paracervical block in term, low-risk obstetric patients. STUDY DESIGN: Over a 3-year period all term, low-risk obstetric patients in the author's private practice were offered mepivacaine paracervical block anesthesia. One hundred eighty-two patients received 200 mg mepivacaine with each block. The patients who declined paracervical block were used as a control group to compare Apgar scores, subject to chi 2 analysis. RESULTS: Initial injections were 97.3% successful. Average duration of anesthesia was 59.7 minutes with the first injection. Fetal bradycardia occurred in 13.2% with an average duration of 4.5 minutes. The slightly higher incidence of low Apgar scores at 1 and 5 minutes in the study group was not statistically significant. One neonatal death occurred secondary to group B streptococcal sepsis in the study group. CONCLUSION: Mepivacaine paracervical block remains an anesthetic option in low-risk patients. The high success rate is limited by its short duration of action and the incidence of fetal bradycardia.

Anesthesia, Obstetrical↗
PubMed2005

Characteristics and control of severe hypertension in a specialist, private practice in Jamaica.

OBJECTIVE: To determine the characteristics of patients with severe uncontrolled hypertension, in a Jamaican specialist practice; the level of blood pressure control achieved in routine clinical practice, and the number/type of antihypertensive medications required for blood pressure control. DESIGN: This was a retrospective analysis of the medical records of 500 consecutive patients presenting to a consultant physician private group-practice between January and December 2000. Data were extracted from the records of the 48 patients with severe (Grade III) hypertension (WHO/ISH). RESULTS: Fifty per cent (252) werefound to be hypertensive, 19% (48) had Grade III hypertension. The patients with severe uncontrolled hypertension were of mixed ethnicity, predominantly African. Most were less than 65 years old, never smoked cigarettes and were overweight/obese. Nearly one-half had LDL cholesterol >3.4 mg/dL. Diabetes (31%) and congestive heart failure (21%) were the most common comorbid conditions. Fifteen per cent had no illnesses other than severe hypertension. Cardiovascular symptoms were predominant, followed by dizziness. Only 19% of patients were asymptomatic. More than half of the patients achieved blood pressure > 140/90 mm Hg during the study period. Most patients received four drugs and the number of drugs prescribed increased with duration of follow-up. The antihypertensive medications most prescribed at one year were--angiotensin converting enzyme inhibitors (87%), diuretics (78%), calcium channel blockers (63%) and beta-blockers (69%). CONCLUSION: Severe hypertension was a common problem in the specialist private practice in Jamaica. Most patients had cardiovascular symptoms, were dyslipidaemic and required four or more antihypertensive drugs for adequate long-term control.

Adult↗
PubMed2001

A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years.

BACKGROUND: When faced with a furcated molar, today's clinician must decide between a number of treatment options, including root resection, tooth removal, and implant placement. This paper assesses the results in one private clinical practice of root resection and subsequent restoration or molar implant placement and subsequent restoration. Clinical considerations in treatment selection are discussed. METHODS: A retrospective analysis of treated patients was carried out by examining active and inactive patient charts. When patients had discontinued therapy, every effort was made to determine the reason for leaving the private practice, so as to assess the impact of previously undocumented treatment failure on the statistics in question. RESULTS: A total 701 root resected molars and 1,472 molar implants were evaluated after > or = 15 and 13 years in function, respectively. Resection of the distal root of a mandibular molar demonstrated the lowest success rate (75%). All other success rates for various root resected molars in function ranged from 95.2% to 100%. Lone standing implants in second molar positions demonstrated the lowest success rate (85%). All other implant use in molar positions demonstrated a success rate ranging from 97.0% to 98.6%. Root resected molars and molar implants demonstrated the highest degree of failure when they were lone standing terminal abutments. Seven out of 23 (30.4%) root resected molar failures, and 17 of 45 (37.8%) of the molar implant failures were associated with untreated parafunction. Cumulative success rates were 96.8% for root resected molars and 97.0% for molar implants. Success and failure are discussed by tooth and/or implant position, and resected root, where applicable. Possible ramifications of these findings upon treatment planning are also reviewed. CONCLUSIONS: Both molar root resection and appropriate restoration and molar implant placement and restoration demonstrated a high degree of success in function. However, this success rate is markedly affected when either the root resected molar or molar implant is a lone standing terminal abutment. Care must be taken to choose the appropriate treatment modality for a given patient scenario.

Adult↗
PubMed2000

The use of dreams in psychotherapy: a survey of psychotherapists in private practice.

Since the publication of Sigmund Freud's The Interpretation of Dreams, dream interpretation has been a standard technique often used in psychotherapy. However, empirical studies about the frequency of working on dreams in therapy are lacking. The present study elicited, via a self-developed questionnaire, various aspects of work on dreams applied by psychotherapists in private practice. The findings indicate that dreams were often used in therapy, especially in psychoanalysis. In addition, a significant relationship was found between the frequency of the therapists' working on their own dreams and frequency of work on dreams in therapy. Because work on dreams was rated as beneficial for the clients, further studies investigating the effectiveness and the process of working on dreams will be of interest.

Behavior Therapy↗
PubMed1989

[Studies on respiratory infections in the field of primary care (I). Correlation between viral infection and secondary bacterial infection in patients visiting a doctor in private practice].

We attempted to find out whether there is a correlation between viral infection and secondary bacterial infection on the basis of the analysis of the results of the culture of virus and bacteria in the same specimen from the throat swabs of 95 patients who had an acute upper respiratory inflammation when they visited a doctor in private practice in Sendai city during the epidemic caused by influenza virus. Viral culture was performed by a microplate-method devised originally by Numazaki. The influenza virus was recovered from 56 cases (59%) consisting of 43 cases of type A (Hong-Kong) and 13 cases of type B. From 73 cases, (77%), 79 strains of possibly pathogenic bacteria were recovered, consisting of 43 strains of H. influenzae, 18 strains of S. aureus, seven strains of S. pneumoniae, four strains each of C. freundii and S. liquefaciens and one strain each of beta-haemolytic Streptococcus and B. catarrhalis. The incidence of positive culture of both virus and possibly pathogenic bacteria was high already at the early stage (2-3 days) of the disease. We found no correlation between the type of virus and the species of the microbial isolates. There was no difference in the incidence of positive bacterial culture in relation to age group. We suggest that a secondary bacterial infection occurs already at the early stage of the disease after viral infection because the incidence of positive culture of possibly pathogenic bacteria was high at the above stage.

Adolescent↗
PubMed1999

Chronic atypical major depressive episode in private practice: unipolar and bipolar II.

OBJECTIVE: The aims of the study were to determine whether chronicity was more common in atypical vs. non-atypical unipolar/bipolar II major depressive episode (MDE), whether atypical unipolar and bipolar II MDE had same chronicity, and to compare chronic with non-chronic atypical MDE. METHOD: A total of 326 unipolar/bipolar II MDE private practice outpatients were interviewed with the DSM-IV Structured Clinical Interview. RESULTS: Chronicity was not significantly different in atypical compared to non-atypical MDE. Unipolar atypical MDE showed more chronicity than bipolar II atypical MDE and unipolar non-atypical MDE. Chronicity was not significantly different in atypical compared to nonatypical bipolar II MDE. Compared to non-atypical MDE, atypical MDE had significantly lower age at onset, more recurrences and more bipolar II patients. Chronic compared to non-chronic atypical MDE had significantly longer duration, more recurrences and more unipolar patients. CONCLUSION: Unipolar atypical MDE is more chronic than unipolar nonatypical MDE. Bipolar II atypical MDE is not more chronic than bipolar II non-atypical MDE.

Adult↗
PubMed2000

Fluoride use by gender, age and dental fear among patients in a private practice.

The present study involved 145 consecutive self-referred patients (89 women, 56 men) at a private general practice, aimed at identifying whether differences in anxiety levels between women and men were related to self-administered fluoride prevention. Use of fluoride was assessed using a questionnaire to the use of tablets, rinse or other methods in addition to fluoride toothpaste. In logistic regression models, with fluoride use as the dependent variable, neither dental anxiety, measured by the Dental Anxiety Scale or by the Dental Fear Survey, nor age, were related to the use of fluorides. However, there was an association with gender. Thus, women used prophylactics 3.5-3.9 times as often as men. Women also expressed higher overall levels of dental fear. The probability in logit calculations for use of fluoride was highest (18%) for 30 year old women with a high DAS score. Additional surveys and research are needed in relation to the patient's cognition, attitude and behaviour towards oral disease, in order to enhance the success of preventive methods of oral disease and management of dental fear.

Adolescent↗