Tomorrow's medicine? Private practice.
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A double-blind, random design, parallel group, four-week study of prazepam, diazepam, lorazepam, and placebo was conducted in diverse private outpatient practices (surgeon, internist, and obstetrician-gynecologist) using a common protocol, in order to evaluate their comparative efficacy in these settings. In addition, the effects of these anxiolytics on depressive symptoms in patients with anxiety were studied. Results showed that the non-psychiatric practitioners used lower dosages than psychiatrists in previous reports, and perception of anxiety levels of their patients were lower than the psychiatric raters. When patients were divided into two groups (1. predominantly depressed with anxiety, and 2. predominantly anxious with depression), differences between the benzodiazepines were shown. In the high depression-low anxiety group, all four treatment methods were effective in alleviating both anxiety and depression. In the high anxiety-low depression group, only prazepam and placebo were effective in alleviating both anxiety and depression, while diazepam and lorazepam decreased anxiety levels, but not depression.
Evaluation and management services provided by the practicing urologist have changed dramatically during the last few years. This is particularly evident in the approach to men with bladder outlet symptoms and in those in whom the diagnosis of prostate cancer is a distinct possibility. The impact of medical management/observation of symptomatic benign prostatic hypertrophy, as well as the influence of prostate specific antigen, transrectal ultrasound and biopsy, radical prostatectomy and hormonal agents in a 3-man private clinical practice is analyzed. The records of 2,206 patients new to the practice who presented with a variety of prostate-related complaints from July 1, 1986 to June 30, 1991 were reviewed. Of these patients 1,822 (82%) were evaluated for presumed benign bladder outlet symptoms. During year 1 of the study, ending on June 30, 1987, 28% of the presumed benign prostatic hypertrophy patients were treated with transurethral prostatectomy, compared to only 8% of such patients in 1991. In contrast, alpha-blocking agents were used to treat 21% of these patients in 1991. Transrectal ultrasound biopsy currently accounts for 87% of all prostatic biopsies, increasing 4-fold during 5 years. Radical prostatectomy has increased 6-fold during the course of the study. Administration of a luteinizing hormone-releasing hormone analogue has supplanted orchiectomy and estrogen therapy for the treatment of disseminated disease, as witnessed by a 4-fold increase in its use. While it is recognized that these trends are presently applicable to our local metropolitan region, they may reflect practice patterns in similar demographic groups, as well as predict future tendencies nationwide.
A recent Swiss opinion poll has revealed that the medical profession is still enjoying a high prestige. The large majority of the surgeons in free practice has an optimistic view of the future of private medicine. Abdominal and peripheral vascular surgery as well as the surgery of the extremities belong also in smaller hospitals. About 75% of the surgeons feel that 10 years of postgraduate training is sufficient. A theoretical final examination is rejected. For further professional training, lectures, various courses and congresses are very popular. Compulsory examinations by the Swiss Medical Association (FMH) are undesirable.
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