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PubMed1998

Detection and measurement of hypercholesterolaemia in South Africans attending general practitioners in private practice--the cholesterol monitor.

BACKGROUND: This paper reports data on the detection and management of hypercholesterolaemia in patients attending general practitioners in private practice in South Africa. METHODS: The frequency of cholesterol testing and the level at which active therapeutic intervention occurred at medical practices were monitored over a 2-year period. A sample of 200 medical practitioners was selected from private practices in major cities. Data on patients seen by the selected doctors during a 5-day monitoring period were recorded on a standardised form. RESULTS: 12,842 patients were seen by the 200 private practice GPs. More men (18.7%) than women (10.4%) had coronary heart disease (CHD), and their mean total cholesterol (TC) levels were 5.9 mmol/l and 6.0 mmol/l, respectively. Only 3.1% of the patients were reported to have familial hypercholesterolaemia (FH) and 12.8% were reported to have a family history of CHD. Reported smoking rates were exceptionally high (77.5% of women and 64.4% of men). The most commonly prescribed group of lipid-lowering agents was HMG-CoA reductase inhibitors. CONCLUSIONS: Inadequate management of hypercholesterolaemia leaves many patients with a high risk of CHD mortality in South Africa. Appropriately investigated patients with hypercholesterolaemia should receive treatment to reduce cardiovascular disease using more effective TC control programmes than are currently used in South Africa.

Adult↗
PubMedDate not supplied

Clinical trials of antiepileptic drugs performed in the private practice setting.

Clinical trials of antiepileptic drugs (AEDs) are usually performed only in major teaching centers, thus ignoring the very real contribution available from private practice. The relation between the consultant and the referring family physician is often much closer in private practice, allowing much earlier recruitment of de novo patients into clinical trials. Between October 1988 and February 1992, 50 subjects were entered into various clinical trials including gabapentin (both an open add-on trial and parallel-arm add-on study in generalized epilepsies), vigabatrin (placebo-controlled cross-over study in focal epilepsies), and lamotrigine (both placebo-controlled cross-over add-on studies and parallel-arm comparative monotherapy study in newly diagnosed patients with epilepsy). All these trials were coordinated in private neurologic practice in Sydney, Australia, as part of either national or international multicenter AED studies. The experience demonstrated the improved ease of recruitment and patient liaison available in the private sector. It also highlighted the very real logistic problems, such as the need for a noninstitutional-based ethics committee, the training of support staff and a modified primary information resource system. Inclusion of private practice centers in clinical trials demonstrates the potential for improved patient recruitment and administrative management, especially in studies requiring newly diagnosed patients.

Acetates↗
PubMed1991

Practical clinical applications of sports dentistry in private practice.

Preparing a practice to become "trauma-ready" involves more than educating the dentist and the staff in the proper management of dentofacial trauma. All members of the office should understand their roles in preventing and treating trauma. They must be willing to provide care after hours when called upon to do so. Dentists who want to be more involved might wish to volunteer their services as sports dentists for local school or recreational league teams. The dentist who is conscious of his or her patients who are at risk for sports-related trauma will also find others in the practice who might benefit from many of the same protective devices that are being constructed for athletes. These include children involved in higher-risk activities, developmentally disabled patients, patients undergoing general anesthesia, and others. Being trauma-ready may open up several rewarding activities for the practice because of the many spin-off applications. The trauma-ready practice must also be cognizant of the some-times perplexing legal and insurance issues with regard to preventing and treating sport-related injuries. In addition to lowering the risk exposure to the practice, the dentist can help ensure the maximum third-party benefits for the patient.

Humans↗
PubMed2001

Alcoholic liver disease: a clinical series in an Australian private practice.

BACKGROUND AND AIM: The published literature on alcoholic liver disease (ALD) in Australia lacks a large clinical series out of private practice as distinct from hospital-based hepatology referral units. This series describes the presentation and clinical features of ALD in a consecutive series out of metropolitan private practice in Australia. METHODS: A retrospective descriptive study by case-note review found 297 cases of ALD at a Brisbane practice over 20 years. The main outcome measures were: clinical features and stage at presentation, reasons for referral, and the predictive value of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio. RESULTS: Most patients (57.9%) had no symptoms of liver disease and 29 patients (9.8%) had neither symptoms nor signs. Cirrhosis was found in 41% of patients and hepatitis-fibrosis was found in 26% of patients. The male to female (M : F) ratio was 4.7:1. The AST/ALT ratio was not reliably predictive of ALD stage. The average reported daily alcohol intake was 131 g. Females drank less on average and presented a more vigorous clinical picture. CONCLUSIONS: This series presents the spectrum of ALD in a metropolitan Australian private practice. Many patients are asymptomatic on presentation. All heavy drinkers should be targeted for early investigation without waiting for volunteered symptoms or abnormal physical signs. The male to female ratio in ALD is higher than hitherto reported. The AST/ALT ratio is not generally applicable in the staging of ALD. The differences from hospital series data suggest the demography and epidemiology of ALD in Australia are incomplete, and further study is warranted.

Adult↗
PubMed1983

The role of Chinese traditional medical practice as a form of health care in Singapore--IV. Physicians in private practice.

Although the government of the Republic of Singapore do not give official recognition to the estimated 1000 Chinese physicians in the country, these practitioners of traditional herbal medicine still enjoy the patronage of a certain segment of the population, 76% of whom are ethnically Chinese. In an earlier paper, we have reported on the characteristics of Chinese physicians who volunteer their service for institutions that provide Chinese traditional health care in Singapore. This complementary paper reports the findings of a survey of 55 physicians who run their own private practice about whom, prior to our study, very little was known.

Adult↗
PubMed1989

Clinical use of multiple nonsteroidal antiinflammatory drug preparations within individual rheumatology private practices.

The clinical use of nonsteroidal antiinflammatory drugs (NSAID) was studied in 15 rheumatology private practices in the USA (in California, the District of Columbia, Florida, Idaho, Minnesota, Pennsylvania and Tennessee). Among 1,423 patients with rheumatoid arthritis (RA) under care in these 15 practices, the most extensively used NSAID preparation within any of the 15 individual practices was taken by a median of 19.5% of patients (mean 20.7%, range 8-36%), and the 3 most extensively used preparations by a median of 45.9% (mean 47.7%, range 34.7-63.5%). The median number of NSAID preparations used (singly) in each of the individual practices was 15 (range 8-20), including a median of 7 (range 4-10) used by more than 5% of the patients with each practice. The NSAID usage of these patients with RA seen in private practice settings was met by 8 preparations for 70%, by 10 preparations for 80%, and by 14 preparations for 90% of the 1,423 patients.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1975

Establishing a private practice in neurological surgery; preparations, problems and pitfalls.

In summary, the young neurosurgeon entering private practice will find he will have to make many non-medical decisions for which he has had little or no preparation during the course of his lengthy training. Just as one spends time planning a careful curriculum in leading to the specialty of neurological surgery, he must also dedicate many hours to establishing a private practice in that specialty. The time spent in investigating these problems in advance will minimize the frustrations in attaining the goal which we are all striving to achieve-personal satisfaction in the delivery of excellent health care.

Neurosurgery↗
PubMedDate not supplied

Geographic distribution of pediatric dentists in private practice in the United States.

PURPOSE: The objectives of this study were to: (1) determine the geographic distribution of pediatric dentists in private practice across the United States; and (2) compare state-based pediatric dental practitioner-to-children ratios. METHODS: Enumeration of pediatric dental practitioners was derived from the American Academy of Pediatric Dentistry's 2000-01 Membership Directory by including all active and fellow members who were in private practice in the United States. Population information for the 50 states and District of Columbia was obtained from Census 2000 data available on the US Census Bureau's Web site. RESULTS: A total of 2,913 pediatric dentists were in private practice in the United States, with the largest number located in California (333), Texas (238), and New York (202), and the smallest number located in Maine (3) and North Dakota (4). There were 4.03 pediatric dental practitioners for every 100,000 US children younger than 18 years of age. Connecticut and Massachusetts had almost twice (7.7) as many pediatric dental practitioners per 100,000 children as the national average. On the other hand, Maine had only one fourth (1) the number of pediatric dental practitioners per 100,000 children as the national average. CONCLUSIONS: Marked differences exist between the various states in their pediatric dental practitioner-to-children ratio.

Adolescent↗
PubMed2004

Clinical education in private practice: an interdisciplinary project.

Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

Attitude of Health Personnel↗
PubMed2003

[Experience with a quality control system for mammography in a private practice setting].

Design and performance of a private audit of mammography utilizing the BI-RADS classification in a private practice setting are presented. By using a combination of physical examination,mammography and, whenever necessary, additional views and sonography, the goals of the BI-RADS audit were met. Practical issues of this audit are addressed.

Breast Neoplasms↗
PubMed1994

Patient interest in receiving audiotapes of information presented by their physicians. A survey of patients awaiting treatment in university and private practice settings.

OBJECTIVE: To investigate patient interest in, and willingness to pay for, tape recordings of physicians' explanations and recommendations. DESIGN: Survey. SETTINGS: An outpatient university-based practice and an outpatient private group practice of family physicians. SUBJECTS: A convenience sample of 425 patients. Of the 409 who agreed to complete the survey, 257 (63%) were awaiting treatment in a university practice and 152 (37%) were awaiting treatment in a private practice. RESULTS: Fifty-four percent of respondents believed that a tape would be helpful, 59.1% thought their family would ask to listen to it, and 77.5% said they would play it for family members. If asked to bring a blank tape, 84.5% indicated that they would do so. If recordings were available for purchase, respondents indicated they would be willing to pay a mean of $1.46 for them. CONCLUSIONS: If physicians offer recordings of their explanations and recommendations, patients are likely to want them. Investigations of actual compliance and health outcomes associated with the use of these recordings appear warranted.

Adult↗
PubMedDate not supplied

ITI implant use in private practice: clinical results with 5,526 implants followed up to 72+ months in function.

PURPOSE: To evaluate the success and failure rates over time of ITI implants placed in 3 private practices and used in a variety of clinical situations. MATERIALS AND METHODS: ITI solid-screw implants (n = 5,526) were placed in 3 private practices and restored by a variety of clinicians. Numerous clinical scenarios were treated with the implants, which were in function for between 0 and 72+ months. RESULTS: After 72+ months the cumulative success rates were 94.8% for maxillary implants and 97.5% for mandibular implants. The overall cumulative implant success rate was 96.1%. Implants that failed to osseointegrate were included in the data as failures in the 0- to 12-month interval. The criteria of Albrektsson and associates were used to assess implant success or failure. DISCUSSION: The results, which were achieved in conjunction with numerous restorative clinicians, were comparable to those reported by other authors. The clinical viability of ITI implant use was thus reinforced. CONCLUSION: ITI solid-screw implants were a predictable treatment modality in 3 private practices for a variety of clinical applications.

Dental Implantation, Endosseous↗
PubMed1999

Retirement savings of dentists in private practice.

BACKGROUND: Retirement planning is an issue that concerns all working people. In this article, the authors present their analysis of the results of a 1995 American Dental Association survey that asked dentists questions about their plans to finance their retirement. METHODS: The ADA's Survey Center conducts a periodic "Survey of Current Issues in Dentistry," which gauges dentists' opinions about a variety of topics of interest to dentistry. The authors analyzed the results of the 1995 survey in which retirement savings was one of the topics. RESULTS: The majority of responding owner/dentists whose primary occupation was private practice (40.7 percent) indicated that they were relying only "a little" on the sales of their practices to finance their retirements. Overall, dentists whose primary occupation was private practice reported saving an average of 10.5 percent of their income specifically for retirement. The average total amount of money dentists invested in various retirement plans increased with age and was highest for the 55 to 59 and the 60 to 64 years of age cohorts. The only exception was the 401(k) plan, in which the peak occurred in the 65 years of age and older cohort. CONCLUSIONS: Fifteen years ago most dentists retired between the ages of 60 and 69 years. Recent trends show that dentists are retiring at younger ages. This means that while in practice, dentists must save enough to support themselves for 20 or more years of retirement. PRACTICE IMPLICATIONS: The transition from private practice to retirement can be difficult. Therefore, planning for the future is important. Dentists can benefit from making appropriate decisions based on age, investment goals, risk tolerance, monetary constraints and time until retirement.

Adult↗
PubMed1986

Adolescent females' preferences regarding use of a chaperone during a pelvic examination. Observations from a private-practice setting.

This study used a private-practice model to investigate teenagers' preferences regarding the presence of chaperones during the genitalia examination. One hundred adolescent female patients were asked to fill out a questionnaire listing their chaperone preference during the pelvic examination. During early adolescence (13-14 years), 60% of the adolescents preferred to be alone if they knew the male physician and 80% if they knew the female physician. Of those in midadolescence (15-17 years), 73% preferred to be alone with a known male physician and 79% with a known female physician. After age 19 years, 79% preferred to be alone either with a male or female physician, whom they knew. These data suggest that the sex of the physician makes little difference as to the mid- and late adolescent female's preference for a chaperone. Also, there seems to be a trend toward increased preference for the presence of a female nurse, and decreased preference for the mother's presence, with increasing age.

Adolescent↗
PubMed2006

[Management of presumed onychomycosis in private practice].

BACKGROUND: The aim of this cross-sectional epidemiological survey was to describe the demographic and clinical characteristics of patients consulting for presumed onychomycosis and methods of treatment used by dermatologists in private practice. PATIENTS AND METHODS: The study was conducted among 209 dermatologists in private practice, and involved 2 041 patients with dermatomycosis, from among whom we isolated a total of 531 subjects with onychomycosis. RESULTS: The most commonly affected site was the foot (92.3%), particularly the big toe (93.9%). Matrix involvement was seen in 46.9% of cases. The clinically suspected diagnosis was confirmed by mycological examination in just under half of these patients. The predominance of trichophyton species was confirmed in 64.4% of cases, with Trichophyton rubrum being the main agent (53.2%) followed by Trichophyton mentagrophytes (10.1%). Results were negative in 25.6% of cases. In most instances, treatment was initiated before the results for samples analysis were received. Oral treatment, either with or without topical therapy, was initiated in 85.3% of cases with matrix involvement and in 34% of cases without matrix involvement. DISCUSSION: This survey reveals a wide disparity in diagnostic criteria for onychomycosis as well as treatment methods among dermatologists in private practice. Mycological samples, which alone can confirm the fungal origin of onychopathy, were taken in less than half of all the cases studied. The most commonly prescribed oral treatment was terbinafine. This was frequently instituted in the absence of any matrix involvement and without confirmation of the diagnosis.

Cross-Sectional Studies↗
PubMed1986

Urinary response to oral potassium citrate therapy for urolithiasis in a private practice setting.

Oral potassium citrate therapy was recently approved for treatment of urolithiasis based on results of experiments in a university research setting. However, no supporting studies from private practice have been published. The present study was undertaken to assess the response to one week of oral potassium citrate therapy (60 mEq/day), with respect to urinary risk factors for kidney stones, in a private practice setting. A significant rise in urinary pH, citrate, and potassium excretion, accompanying a significant fall in calcium excretion, were observed. Urinary saturation of calcium oxalate was significantly reduced, as some risk factors in urolithiasis were corrected with oral potassium citrate therapy. The response to therapy in private practice was comparable to that observed in a university research setting.

Adolescent↗
PubMed2006

Parental perceptions and use of complementary and alternative medicine practices for children with autistic spectrum disorders in private practice.

The prevalence of autistic spectrum disorder (ASD) in the United States is approximately 1 in 150 children. Many health care providers are unaware of parental beliefs and treatments, both medical and complementary, that parents use for their child with ASD. Understanding these beliefs and practices concerning diagnosis, cause, and utilization of medical and complementary care may help physicians provide better comprehensive care. Parents of children with ASD from 2 private practices-one in New York and one in New Jersey-were mailed a 6-page, self-administered survey. In addition to demographics and ASD type, the survey asked parents who diagnosed their child and if there was a perceived delay in that diagnosis; whether they believed there was any causal reason for their child's autism; what chronic symptoms, if any, their child experiences; and, if they had used any complementary and/or alternative therapies and at whose recommendation. Respondents included 77 of the 150 parents (51%) contacted. Most children were diagnosed by a neurologist and/or developmental pediatrician (54% and 47%, respectively). Average perceived delay in diagnosis was 18 months. Parents most frequently cited immunizations (54%), genetic predisposition (53%), and environmental exposure (38%) as a cause of their child's autism. Approximately half of children were reported as having at least one gastrointestinal, neurological, and/or allergic symptom; more than a third had immunological symptoms. Almost all parents (95%) indicated some use of complementary and alternative medicine (CAM) therapies, with most of the self-reported referrals generated from a physician or nurse (44%). Systemic complaints, parental beliefs, and use of CAM practices warrant open discussion by all health care professionals who provide care to this population.

Asperger Syndrome↗