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PubMed1993

The results of efforts to improve compliance with supportive periodontal treatment in a private practice.

Patients who receive routine supportive periodontal treatment (SPT) tend to keep their teeth longer and enjoy greater periodontal health than those individual who do not receive this therapy. Previous studies have found less than optimal compliance to suggested SPT. The study reported in this paper covered 5 years of patient data and measured the effects of efforts to improve compliance in a private periodontal practice. These efforts included attempts at simplifying compliance, maintaining records of compliance, informing patients of the consequences of noncompliance, and attempting to identify noncompliers before active periodontal therapy was initiated. The results were measured against a similar group studied in previous work within the same office published in 1984. The main finding of the present study was an increase in complete compliance from 16% in 1984 to 32% in 1991. This increase came largely at the expense of the noncompliant group. The reason for the increase in compliance is likely due to efforts to increase compliance carried out in the office. However, other factors such as change in the hygiene practice law, increased public awareness of dental needs, and economic depression may also have affected compliance. This information suggests that noncompliance can be reduced if the problem is recognized and efforts are made to increase compliance.

Adolescent↗
PubMed2003

The effects of deep diaphragmatic breathing and focused attention on dental anxiety in a private practice setting.

PURPOSE: High dental anxiety is pervasive and associated with treatment avoidance and poor oral health. Ideally, anxiety reduction techniques should be easy to use, low in cost, non-pharmacological, comfortable, and effective. This study compared the effectiveness of two self-taught anxiety reduction techniques--breathing and focused attention--with a control group. METHODS: Anxiety was assessed in 272 adult private dental practice patients with a modified dental anxiety scale-revised. Frequency of oral health care visits in the last 10 years to all dentists, including the current dentist, was collected. Immediately prior to the dental procedure, participants in the two experimental groups were given written instructions outlining the respective anxiety reduction technique they were to use. Efficacy of technique was assessed by subjective comparison to anxiety during previous oral health treatment. Participants also listed techniques that they believed to be effective for anxiety reduction. RESULTS: Twenty-six participants (9.56%) scored high in dental anxiety. High anxiety was associated with infrequent oral health care visits. Compared to the recall of anxiety experienced during prior treatment, there were no significant differences in anxiety between breathing, focusing, and control groups. But there was a trend toward decreased anxiety overall. Controls who reported infrequent visits and use of their own anxiety reduction technique showed significantly reduced anxiety. CONCLUSION: Dental patients employ numerous strategies for anxiety reduction. Anxiety reduction techniques not yet practiced may place unwanted expectations on patients. It is suggested that oral health care practitioners be aware of the patient's preferred technique for coping with anxiety and encourage them to use self-help techniques.

Adolescent↗
PubMed1990

Conservative management of temporomandibular disorders: a posttreatment comparison between patients from a university clinic and from private practice.

Long-term (1 to 7.5 years) follow-up evaluations of 110 adult patients who were seen for diagnosis and treatment of symptoms related to myofascial problems (MP), internal derangement (ID), or both were conducted by means of telephone interview. One half of the patients were seen at the Northwestern University Dental School TMJ Clinic, while the other half were seen in the private office of one author (H. T. P.). The purpose of this study was to evaluate patient response to conservative therapy combined with advice about self-management, as compared with the response to advice only. Further, we desired to compare treatment outcomes among (1) diagnostic categories ID, MP, and ID plus MP, (2) clinic patients and private patients, and (3) patients with acute disease and those with chronic disease. Chronic disease was identified as that in which pretreatment symptoms had persisted for more than 4 months. The ridit analysis was used to assess differences in outcomes for patients in the three diagnostic categories and for clinic patients compared with private patients. The results revealed no significant differences. There was a trend for patients with acute conditions to improve more than those with chronic problems; however, further research is needed to determine whether a correlation exists between symptom duration and treatment outcome. At the time of the follow-up evaluation, 88% of all patients reported substantial or total improvement in their symptoms of pain and dysfunction. Therefore, conservative therapy, including advice about self-management, was found to be both adequate and appropriate for most of these patients.

Acute Disease↗
PubMed2005

Optimizing the detection of bipolar II disorder in outpatient private practice: toward a systematization of clinical diagnostic wisdom.

BACKGROUND: We review a clinical diagnostic approach to validate a redefinition of bipolar II disorder (BPII), which bypasses several conservative steps in the DSM-IV Mood Module of the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV) to make detection of BPII more "clinician-friendly." METHOD: 563 consecutive private outpatients presenting with a DSM-IV-diagnosed major depressive episode (MDE) were included in the analyses. We used a modified SCID-CV in a semistructured way, used a duration of hypomania > or =2 days (rather than the 4-day floor cutoff recommended), did not follow the SCID-CV's stem (mood) skip-out instruction, focused more on past history of overactive behavior rather than mood change, and assessed hypomanic features both outside and during index MDE. Validation of BPII so-defined against major depressive disorder (MDD) was undertaken in the Washington University tradition. The study was conducted from June 1999 to December 2003. RESULTS: BPII occurred in 56.8% of patients. Compared with MDD, BPII had a significantly earlier index age and age at onset of first MDE and higher rates of atypical features, depressive recurrences, hypomanic symptoms during MDE, trait mood lability, and bipolar family history (p = .0000 for all variables). CONCLUSIONS: Our experience suggests that when probing history for past hypomanic episodes, behavioral activation should be inquired first, thereby facilitating the patient's subsequent recall of euphoria and/or irritability during such activated periods. Information from significant others or past records is also crucial. In light of these clinical procedures, BPII emerged as more prevalent than MDD. We submit that clinicians have the distinct advantage of intimate knowledge of their patients, which, coupled with the procedures outlined herein, can maximize the yield of BPII diagnoses.

Adult↗
PubMedDate not supplied

The private practice nurse practitioner.

Nurse practitioners have endless possibilities for innovative practice. Deciding on provision of independent practice, suggestions for implementation and service, possible barriers, and solutions are discussed. Future directions for services are outlined.

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PubMed1992

[Community-acquired pneumonia in healthy adults: 188 patients treated with spiramycin in private practice].

One hundred and eighty eight outpatients with community acquired pneumonia have been treated by spiramycin in general practice. Community acquired pneumonia was defined by the association of fever > or = 38 degrees C, respiratory symptoms as cough, sputum production, dyspnea or thoracic pain, and pulmonary opacity on the chest X-Ray. The mean age of patients was 44.7 +/- 16.6 and few of them had concomitant chronic illness, as cardiovascular (9%) or bronchopulmonary disease (9%). Twenty one percent of patients have been included after a previous antibiotherapy failure. In 92% on these cases, prior antibiotherapy was a beta lactam. At inclusion, the fever was greater than 39 degrees C in 56% of patients, 58% had localized crepitations at the chest auscultation. The chest X-Ray was performed 1.4 +/- 2.1 days after inclusion and showed a lobar consolidation in 77%. One third of patients presented a clinical picture evoking acute bacterial pneumonia. One hundred and seventy one patients have been reviewed for a second evaluation 4 +/- 1.5 days after inclusion. One hundred and eighty seven patients have visited for the long term follow up 19 +/- 6.5 days after the onset of treatment. Ninety six per cent of them have consulted with a control chest X-ray. At this visit, the antibiotherapy was changed in 2 other patients with of failure. Overall, 83% of patients were clinically and radiologically cured by Spiramycin 3 MU twice a day for 13 +/- 3.5 days. Fourteen percent of patients were improved without necessity of changing the antibiotic regimen. This study confirms the efficacy of spiramycin in the management of community acquired pneumoniae in general practice, either in first line therapy of after the failure of beta lactam.

Adult↗