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At least 1,495 records · Page 83Linked to original sources
PubMed1998

Observations on pathology trends in 62,537 prostate biopsies obtained from urology private practices in the United States.

OBJECTIVES: To evaluate pathology trends of 62,537 first-time prostate needle-core biopsies submitted by office-based urologists, processed at a single pathology laboratory. METHODS: Prostate biopsy cases obtained over a 2-year period were assessed. Patient information included age, digital rectal examination (DRE) status, and prostate-specific antigen (PSA) serum levels. Biopsy pathology results included the number of tissue samples per case, Gleason score, presence of Gleason grades 4 or 5, percent of biopsy length with evidence of cancer, number of samples with cancer per biopsy, and determination of DNA ploidy status using microspectrophotometry. RESULTS: Adenocarcinoma, suspicious lesions, and isolated high-grade prostatic intraepithelial neoplasia (PIN) were diagnosed in 38.3%, 2.9%, and 4.1% of the biopsies, respectively. For each serum PSA and age range assessed, the positive biopsy rate and incidence of critical pathologic features increased consistently. The average percentage of biopsy length with evidence of tumor, the percentage of cases with Gleason grades 4 or 5, and the percentage of cases with an abnormal DNA ploidy all decreased significantly over the 2-year period (P <0.01). CONCLUSIONS: The number of tissue cores and anatomic sites (locations) being sampled per biopsy are increasing. The tumor size detected and percentage of cases with Gleason grades 4 and 5 are decreasing. There has been a slight increase in the number of biopsies performed on men younger than 60 years of age and a slight decrease in biopsies performed on men older than 70 years of age. The decline in meaningful pathologic features observed in biopsies over time may be clinically relevant to improved disease management.

Aged↗
PubMed1994

[Scanner and mechanical lumbar diseases in private practice. Apropos of 106 patients covered by the Caisse Maladie Régionale du Nord].

The aim of this study was to prospectively evaluate use of computed tomography (CT) of the lumbar spine in office practice. The "Caisse Maladie Régionale du Nord" provides health insurance to self-employed retailers and craft persons (92,500 people at the end of 1991). The authors prospectively studied 106 patients insured by this organisation (60 males, 46 females, mean age: 51.27 years) who underwent CT of the lumbar spine between August 2, 1991 and January 23, 1993. They examined all insurance claims (physician visits, surgery, drugs, physiotherapy, laboratory tests, imaging studies, and hospitalizations) filed by each study patient during the 4 months before and the 4 months after the index CT. Reason for the CT, specified on 65 of the 106 radiologist reports, were isolated low back pain and nerve root pain in 26.2% and 56.9% of the patients respectively. CT findings were discal prolapse in 27 patients (25.5%), facet joint osteoarthritis in 33 patients (31.3%), discal protrusion in 29 patients (27.4%) and were considered as normal in 19 patients (18%). CT was preceded by plain radiographs in 50% of patients, by a rheumatologist visit in 31%, by a visit to the sole general practitioner in 51%, by local steroid injection in 15%. During the 4 months subsequent to the index CT, 14 (13.2%) patients had surgery and one underwent chemonucleolysis. These findings suggest that consensus conference recommendations concerning lumbar spine CT are not currently being followed in France.

Adult↗
PubMed2004

The effect of curtailed hospitalization on the management and outcome of lumbar discectomy patients in a private practice setting.

With the accelerated development of managed care systems in the 1990s, physician practices experienced curtailed authorization for length of stay (LOS) for in-patient care. Using lumbar discectomy (CPT 63030) as a surgical model, we reviewed records of patients from 1994 and 1996 as these two years were within the period of accelerated managed care penetration in our state. The Chi Square and Fisher Exact tests were used to explore statistical significance and differences in population characteristics, management and outcome in the two years. Factors including age, sex, associated medical conditions, other presenting symptoms and signs, cause of disc herniation, and duration of symptoms were not significantly different. We demonstrated that the shortened LOS did not adversely influence the medical or functional outcome from lumbar discectomy but that there appeared to be a shift of the burden of care to the postoperative outpatient setting. Functional outcome was not significantly different between the two years when assessed by either Prolo Outcome or return-to-work rate. These findings were corroborated with a more recent review of patients operated upon in 2000. As spinal surgery grows in complexity, managed care companies should initiate programs that routinely assist physician offices in accelerating postoperative rehabilitation. In addition, as emphasis grows for evaluation and management services, surgical outcome studies should document the intensity of postoperative management to document better the overall nonoperative care that surrounds any spinal surgery.

Adolescent↗
PubMed1999

Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices.

OBJECTIVE: To shorten the period of carbohydrate intolerance preceding the diagnosis of IDDM in children. RESEARCH DESIGN AND METHODS: The incidence of diabetic ketoacidosis (DKA) was studied in newly diagnosed diabetic children aged 6-14 years, in the area of Parma, Italy, 8 years after an information program on DKA was introduced to teachers, students, parents, and pediatricians. Information was provided by displaying a poster with a few practical messages in 177 primary and secondary public schools. The pediatricians working in the same area were given equipment for the measurement of both glycosuria and blood glucose levels, as well as cards listing guidelines for the early diagnosis of diabetes, to be given to patients. A toll-free number was also provided. Clinical and laboratory features of 24 young diabetic patients diagnosed in the Parma area (group 1) were compared with those of 30 patients coming from two nearby areas in which no campaign for the prevention of DKA had been carried out (group 2). RESULTS: From 1 January 1991 to 31 December 1997, DKA was diagnosed in 3 children from group 1 (12.5%) and in 25 children from group 2 (83.0%) (chi 2 = 26.8; P = 0.0001). The three cases of DKA in group 1 were observed in 1991 (n = 1) and in 1992 (n = 2). No patients from the Parma area who had DKA were admitted to our unit after 1992. The duration of symptoms before diagnosis was 5.0 +/- 6.0 and 28.0 +/- 10.0 days (P < 0.0001), in groups 1 and 2, respectively, Metabolic derangements were less severe in patients of group 1 than in those of group 2. Hospitalization for the treatment of overt diabetes and for the teaching of self-management of the disease lasted 5.4 +/- 1.2 days in group 1 and 13.3 +/- 2.4 days in group 2 (P = 0.002). The total cost of the 8-year campaign was $23,470. CONCLUSIONS: The prevention program for DKA in diabetic children aged 6-14 years, carried out in the Parma area during the last 8 years, was successful. Thanks to this program, cumulative frequency of DKA in new-onset IDDM decreased from 78% during 1987-1991 to 12.5% during 1991-1997. None of the newly diagnosed diabetic children aged 6-14 years and from the Parma area were ever admitted to the hospital for DKA after 1992.

Adolescent↗
PubMed1999

Insulin lispro: experience in a private practice setting.

OBJECTIVE: To assess the benefits (or otherwise) of changing patients with unstable type 1 diabetes to insulin lispro (Humalog, Aza Research). PARTICIPANTS AND SETTING: 150 patients with type 1 diabetes treated in a private metropolitan physician practice. MAIN OUTCOME MEASURES: Glycohaemoglobin (%HbA1c) value; frequency of hypoglycaemia; patients' perceptions of the two regimens. RESULTS: 125 of 150 patients completed the study; 12 (8%) withdrew because they were dissatisfied with lispro. Including these 12 patients, 80/137 patients (58%) felt better physically and 98 (72%) were more satisfied with treatment with lispro. Of the 125 patients who completed the study, 65 (52%) achieved lower HbA1c values, with 22 (18%) experiencing a fall of 1% or more; 78 patients (62%) noted less daytime hypoglycaemia and 103 (82%) experienced less nocturnal hypoglycaemia. Thirty-nine patients (31%) with less daytime hypoglycaemia and 52 (42%) with less nocturnal hypoglycaemia also experienced a fall of more than 0.2% in HbA1c value (mean, 1.0%; range, 0.3%-3.2%). There was no change in body weight or in hypoglycaemia unawareness. CONCLUSION: Many patients with unstable type 1 diabetes, when changed to insulin lispro, experience significant clinical and biochemical benefits.

Adolescent↗
PubMed2000

Antibiotic rashes in children: a survey in a private practice setting.

OBJECTIVE: To document the frequency and severity of various types of rashes seen with commonly used oral antibiotics in the pediatric outpatient setting. DESIGN: A retrospective review of 5923 patient records at a pediatric office. SETTING: A private group pediatric practice in northern Virginia with about 12,000 registered active patients. PATIENTS AND METHODS: Approximately 50% of the clinic medical records were reviewed. All children (defined as those aged 0-18 years in this study) identified on their medical records as having developed a rash following treatment with 1 or more of the commonly used oral antibiotics were included in the study. For further validation, a questionnaire about parental recollection of description of rash, other associated symptoms, physician verification, and outcome was mailed to families with children designated as being allergic to an antibiotic. RESULTS: On a prescription basis, significantly more rashes were documented for cefaclor (4.79%) compared with penicillins (2.72%), sulfonamides (3. 46%), and other cephalosporins (1.04%). Based on the number of patients for whom each group of antibiotic was prescribed, the documented frequencies of rashes were 12.3%, 7.4%, 8.5%, and 2.6% for cefaclor, penicillins, sulfonamides, and other cephalosporins, respectively. None of the children had rashes severe enough to require hospitalization. CONCLUSIONS: In a review of almost 6000 records in a private pediatric primary care setting, rashes occurred in 7.3% of children who were given the commonly used oral antibiotics. Significantly more rashes were documented with cefaclor use than with use of any of the other oral antibiotics.

Administration, Oral↗
PubMed1983

Unacceptable face of private practice: prescription of controlled drugs to addicts.

Self administered questionnaires completed by 69 out of 100 consecutive drug addicts attending two drug dependence clinics suggested that some private general practitioners were easily persuaded to prescribe controlled drugs. These drugs were usually methadone, dipipanone-cyclizine (Diconal), and methylphenidate (Ritalin). Numbers of new narcotic addicts notified to the Home Office confirmed the practice, which may lead to a severe spread of addiction, as occurred in the 1960s with heroin and cocaine. If the General Medical Council or a tribunal set up in accordance with the Misuse of Drugs Act 1971 cannot stop the practice, then the present licensing system should be extended to include all controlled drugs.

Cyclizine↗
PubMed1999

Open heart surgery in public and private practice.

OBJECTIVES: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. METHODS: Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. RESULTS: Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68; 95% CI from 0.94 to 3.0). CONCLUSIONS: Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.

Aged↗
PubMed2005

Private practice and the economic rate of return for residency training as a prosthodontist.

BACKGROUND: The authors used survey data to estimate the economic rate of return from undertaking an investment in residency training to become a practicing prosthodontist. METHODS: The authors estimated earnings of practicing prosthodontists using results from a survey of 2500 U.S. prosthodontists. Survey data were used to assess the total costs of prosthodontic residency and earnings of practicing general practitioners. The authors applied statistical methods to estimate the internal rate of return (IRR) for prosthodontic residency training. RESULTS: The estimated IRR ranged from 8.23 percent for private practitioners with no financial assistance during residency training to 12.18 percent for full-time private practitioners with stipends and loans. Total costs of residency ranged from 271,835 dollars to 441,321 dollars, depending on the amount of forgone earnings, time in practice and how soon practice began after the residency. CONCLUSIONS: All of the estimates of IRR in this study were positive, indicating that prosthodontic residency is a financially attractive investment. PRACTICE IMPLICATIONS: The positive IRR for prosthodontic residency indicates that the demand for advanced education in prosthodontics will continue, and that the amount of time spent in practice increases the rate of return.

Cost-Benefit Analysis↗
PubMed2005

Effectiveness of intensive outpatient programming in private practice: integrating practice, outcomes, and business.

The development of a model for treating acutely depressed patients on a frequent basis in an independent practice setting is described. Strategies to collaborate with managed care organizations, employee assistance programs, and local provider networks to recruit these patients are outlined. The patients treated in the intensive outpatient program described in this article were primarily depressed, were more acutely distressed than national and local inpatient samples, were often in suicidal crises, and had multiple comorbidities. Nonetheless, they demonstrated significant pre- and posttest improvements on a variety of client- and clinician-rated measures. A dose-response curve further illustrated that significant improvement in depressive symptoms was predictable. Private practitioners can expand their services through the development, implementation, delivery, management, and evaluation of mental health services that respond to market dynamics.

Ambulatory Care↗
PubMed1993

Ambulatory blood pressure monitoring to assess antihypertensive therapy in private practice.

Non-invasive ambulatory blood pressure monitoring has proved to be very useful in evaluating hypertensive patients. However, most previous studies were performed in specialised centres. Here the results of two trials are presented in which private physicians used ambulatory BP monitoring to assess the efficacy of antihypertensive drugs. The results were very similar to those observed previously in specialised clinics. In the individual patient, the level of ambulatory recorded pressure could not be predicted based on BP readings taken at the doctor's office. Also, the BP response to antihypertensive therapy was more reproducible when evaluated by ambulatory BP monitoring than by the doctor. Thus, the use of noninvasive ambulatory BP monitoring is also very appropriate in everyday practice for the management of hypertensive patients.

Ambulatory Care↗
PubMed2001

Microsurgery in private practice: is it feasible economically?

Microsurgical free tissue transfer and replantations have long been the bailiwick of academic training centers and tertiary referral centers. However, the authors' experience with more than 350 consecutive free tissue transfers during a span of 15 years in a purely private setting illustrates the changing economics of the medical environment in that time frame. These data provide insight into the feasibility and practicality of maintaining a microsurgical practice outside an academic medical center.

Adolescent↗
PubMed1984

Cutaneous leukocytoclastic vasculitis. Clinical and laboratory features of 82 patients seen in private practice.

Eighty-two patients, with pathologically confirmed cutaneous leukocytoclastic vasculitis (LV), were seen in private dermatology offices. An analysis of the group was made to determine the relationship of cutaneous to systemic disease, the incidence and importance of laboratory abnormalities, and the prognosis of patients with cutaneous LV and to compare these results with previously published data derived from medical centers. Systemic disease occurred in 42 patients, but was transient and mild in most. Two patients died as a result of systemic vasculitis. The morphologic type of skin lesions most commonly found were palpable purpura (51 patients), urticarial-like lesions (17 patients), ulcers (eight patients), erythematous plaques (five patients), and/or nodules (five patients). Possible causative agents could be identified in 38 patients and included drugs (eight patients), infections (eight patients), or collagen vascular disease (17 patients). The course of the disorder was acute in 46 cases, chronic in 24, and recurrent in 12. The patients described herein fared better and had less significant systemic disease than those described in studies from medical centers. The data support the usual benign course of cutaneous LV as seen by practitioners despite frequent systemic symptoms or findings.

Adolescent↗
PubMed1999

A Treatment Algorithm for Attention Deficit Hyperactivity Disorder in Cocaine-Dependent Adults: A One-Year Private Practice Study with Long-Acting Stimulants, Fluoxetine, and Bupropion.

A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeutic effect from cocaine during the initial phases of cocaine addiction and, also, met DSM-IV criteria for ADHD. We report evidence that study subjects probably medicated their ADHD symptoms with cocaine and describe a 1-year treatment algorithm featuring long-acting stimulants that was effective in the management of their ADHD and cocaine dependence. Nineteen stable patients in full remission from all substance dependence were entered into an open label, prospective, treatment trial for ADHD. The treatment schedule consisted of the progressive introduction-and discontinuation of ineffective medication-of each of several medications in the following order: fluoxetine, bupropion, pemoline, sustained-release methylphenidate, dextroamphetamine spansules, and methamphetamine gradumets. Treatment of ADHD was successful. Several treatment regimens, especially those including long-acting stimulants, alone or in combination with other agents, were highly effective. All but 1 of the 19 subjects had a fully effective response for at least 1 full year. Mean UTAH scale scores were 7.4 before any medications were administered and 1.6 at the end of the study. Treatment proved successful in suppressing ADHD symptoms, with minimal cocaine slips or side effects.

Journal Article↗
PubMedDate not supplied

Endodontic needs of geriatric patients in private practice.

Twenty-five (25) teeth of fifteen (15) elderly patients endodontically treated in a private clinic for the span of three (3) years were evaluated in terms of success and failure of treatment. The attitudes of the patients towards endodontics were determined. Also, medical, dental and radiographic records were reviewed. Of the fifteen (15) patients. 53.3% belonged to age group 60 to 69 years old and the other half belonged to the 70 years and above age bracket. Majority were female, married and college graduates. Premolars constituted 40% of the teeth treated. Post, core and PFM crowns were the most common restoration for both anterior and posterior teeth. Success rate of root canal treatment was a high 84%. Patients gave a more positive attitude to the endodontic treatment mentioning relief of pain, appreciation of better food and self-esteem. Calcification was the most common problem encountered during the treatment. Quality radiograph, proper instrumentation, appropriate techniques and chemical adjuncts are recommended. Likewise, proper patient management, needed rapport and patience have to be stressed.

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