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Private Practice (private + practice)
Terms modified by Private Practice Selected AbstractsPrivate Practice of Prosthodontists: Current Conditions of Practice in the United StatesJOURNAL OF PROSTHODONTICS, Issue 3 2010Kent D. Nash PhD Abstract Purpose: The purpose of this article is to examine data and results from the 2008 Survey of Prosthodontists. Survey results are used to examine current trends and characteristics of prosthodontists in private practice. Materials and Methods: Characteristics of prosthodontists and conditions of private practice are based on surveys conducted in 2002, 2005, and 2008 sponsored by the American College of Prosthodontists. Survey results are used to estimate several characteristics including age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists). Results: The average age of a private-practicing prosthodontist reached 51 years in 2007; 12.3 is the number of years in the current practice; and most prosthodontists (71%) are solo private practitioners. The average amount of time per week by prosthodontists in the practice averaged 36.1 hours, and prosthodontists treated an average of 44.1 patient visits per week. The largest source of patient referrals is the patient themselves. The largest percentage of a prosthodontist's treatment time is spent rendering procedures in fixed prosthodontics, but this percentage has declined since 2001. In 2007, the average gross billings of a practicing prosthodontist reached $805,675; average total practice expenses were $518,255; the mean net earnings of practitioners were $268,930. Conclusion: In 2007, prosthodontists in private practice paid out about $1.4 billion in practice expenses to provide $2.2 billion dollars in prosthodontic care. Based on survey results from 2007 and the previous 6 years, specialization in prosthodontic care continues to be an economically attractive and productive healthcare profession in the United States. [source] Prosthodontists in Private Practice: Current and Future Conditions of Practice in the United States (Part I)JOURNAL OF PROSTHODONTICS, Issue 4 2007Kent D. Nash PhD Purpose: The purpose of this study was to use data from surveys of prosthodontists to examine the current conditions and characteristics of prosthodontists in private practice in the United States. Materials and Methods: Characteristics of prosthodontists and conditions of practice are based on the 2002 Survey of Prosthodontists and the 2005 Survey of Prosthodontists. Both surveys were conducted by the American College of Prosthodontists. Several characteristics of private practice/practitioners are estimated including age, gender, number of patient visits, hours in the practice, employment of staff, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists) Results: In 2004, the average age of private practitioners was 50 years. Years since graduation from dental school averaged 23.4 years, and years since completion of residency was 18.3 years. Prosthodontists spent an average of 35.7 hours per week in the office and 29.5 hours treating patients. In 2004, the average gross revenue per owner of a private practice reached $782,130, and mean net income was $258,490. The largest percentage of prosthodontist time was spent providing six procedures including fixed prosthodontics, implant services, complete dentures, operative care, diagnosis, and partial dentures. Conclusion: The United States spends about $1.8 billion on prosthodontic services provided by prosthodontists in private practice. Prosthodontists spend $1.1 billion dollars in expenses and treat an estimated 1.1 million patients per year. [source] The Present and Future of Clinical Psychology in Private PracticeCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2006Lillian Comas-Diaz This article discusses clinical psychologists' current concerns, challenges, and opportunities in private practice. The future of clinicians in independent practice is presented within two paradigms, namely, psychology as a health profession, and psychology as life enhancement. Finally, the author argues that psychotechnology, corporate clinical psychology, and psychology as life enrichment will evolve within the future of clinical psychological independent practice. [source] Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating bracketsORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 4 2008N Pandis Structured Abstract Authors,,, Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T Objectives,,, To explore whether the use of self-ligating brackets is associated with better values for periodontal indices because of the lack of elastomeric modules and concomitantly, reduced availability of retentive sites for microbial colonization and plaque accumulation. Setting and Sample Population,,, Private practice of the first author. Patients were selected using the following inclusion criteria: age range 12,17 years, fixed appliances on both arches, aligned mandibular arch, and absence of oral habits and anterior crossbites. Materials and Methods,,, Prospective cohort investigation. Participants were grouped for bracket type, thus 50 patients formed the conventional bracket cohort and 50 patients the self-ligating bracket cohort. Both cohorts were followed with the purpose to examine periodontal status. Average length of follow-up was 18 months. This time period was considered adequate for a proportion of study participants to experience the outcome of interest. Outcome variables were plaque index, gingival index, calculus index, and probing depth for the two bracket cohorts. Results,,, No difference was found in the indices recorded between the two bracket cohorts studied. Conclusion,,, Under the conditions as applied in this study, the self-ligating brackets do not have an advantage over conventional brackets with respect to the periodontal status of the mandibular anterior teeth. [source] Hand eczema: causes, course, and prognosis ICONTACT DERMATITIS, Issue 6 2008Niels K. Veien Background:, Hand eczema is a common dermatosis. The course is often protracted. The prognosis is not well described. Objective:, To describe in detail a consecutive cohort of hand eczema patients with regard to aetiology and morphology as well as the dynamics of the hand eczema. Patients and Methods:, This prospective study included 522 consecutive patients (175 men and 347 women with hand eczema) seen in 1 year in a private practice of dermatology. 425 (81%) of the patients were patch tested in relation to the current study. Most of the remainder had been previously patch tested. Results:, 38% had mild dermatitis, 49% had dermatitis of moderate severity, and 11% had severe dermatitis. 23% had had dermatitis for more than 10 years. 33% had irritant contact dermatitis, 13% of the men and 20% of the women had allergic contact dermatitis, and 15% of the men and 16% of the women had atopic dermatitis. For 34% of the men and 29% of the women, the dermatitis was certainly or possibly occupational. There was no relationship to smoking. Conclusions:, The majority of this cohort of hand eczema patients had long-standing disease. Irritant contact dermatitis was the most common aetiological diagnosis. [source] So You Want to Be a Dermasurgeon: How to Get Training or Choose a FellowshipDERMATOLOGIC SURGERY, Issue 9 2006MURAD ALAM MD BACKGROUND There are many routes to obtaining training in dermasurgery. OBJECTIVE The objective is to discuss some considerations that may guide selection of dermasurgery training. METHODS Current training options are reviewed. RESULTS Some considerations that may guide selection of type of dermasurgery training include: (1) individual temperament; (2) the subtype of dermasurgery in which training is desired (Mohs, cosmetic surgery, laser); (3) family and geographic factors; (4) preference for private practice versus academic career; and (5) proportion of future practice to be devoted to dermasurgery. CONCLUSIONS There are a growing number of training choices for budding dermasurgeons, with multiple options available for each set of particular circumstances. [source] Treatment planning in cutaneous T-Cell lymphomaDERMATOLOGIC THERAPY, Issue 4 2003Eric C. Vonderheid ABSTRACT:, Effective long-term management of cutaneous T-cell lymphoma (CTCL) requires administration of skin-directed therapies such as topically applied nitrogen mustard or photochemotherapy to achieve a complete response in clinically early disease (patch and thin-plaque-phase mycosis fungoides, MF) and often the concomitant administration of well-tolerated drugs with systemic effects such as interferon alfa, bexarotene, methotrexate or extracorporeal photopheresis in more advanced, but not highly aggressive/nontransformed disease (thick plaque or tumor phase MF or erythrodermic CTCL). The author's approach is provided as a guide for dermatologists in private practice. [source] What becomes of dental research trainees once they leave the Dental Research Institute?EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2008An analysis over 53 years Abstract The careers of 131 dental research trainees were followed (1954,2007) to establish whether and how they utilised their research training in keeping with clinical research workforce needs. The Dental Research Institute database was used to obtain trainee demographic, teaching and research outputs which were examined according to degree types: PhD (18); MSc (55); MDent (42) and dropout (16). Current careers show that 48% are in exclusive private practice and 15% in exclusive academia with further 15% practitioners having academic links via sessional teaching or research at a dental school. Most (63%) have remained in South Africa but emigration is high amongst the PhD and MSc groups. Forty-one per cent of the cohort is of age ,55 years and 16% <40 years old. The 131 trainees have published 2287 peer-reviewed journal papers over their careers: quantity of research output is skewed towards degree type (PhD) and individuals (10% trainees produced 65% of all publications). Recent trainees have little research experience prior to their training and a lower subsequent research output than earlier trainees. PhDs have participated in research for the greatest length of time (29.1 years). Academic teaching is heavily reliant on older and PhD trainees. It is proposed that a threshold of four publications be used to indicate minimum research skills and a period of formal academic teaching taken into account when advocating criteria to assess clinical research workforce requirements. [source] The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontistsINTERNATIONAL ENDODONTIC JOURNAL, Issue 7 2008D. E. Bierenkrant Abstract Aim, To investigate the technical quality of nonsurgical root canal treatment performed by endodontists in Melbourne, Australia. Methodology, Clinical and radiographic records of 100 sequential nonsurgical patients were obtained from each of six endodontists working in private practice. The following variables were analysed: proximity of root filling to radiographic apex; homogeneity and radiodensity of root filling; lateral adaptation of the root filling to the canal walls; taper; extrusion of material; small, appropriate or excessive apical enlargement; presence of lateral canals; transportation; procedural errors. The radiographs were assessed by three independent evaluators. Exploratory data analysis was undertaken using simple frequencies and cross-tabulations. A generalised linear mixed model (GLMM) was used for the formal statistical modelling. Results, Of the 1351 canals that were examined, 91.7% were filled within 2 mm of the radiographic apex and 74% were within 1 mm. Homogeneity and adequate density were found along the entire length of the canal in 86.1% and 88.6% of cases respectively. Lateral adaptation was adequate in 95.6% of cases and the taper was ,smooth and continuous' in 83.8% of roots. No and/or small extrusion of sealer was noted in 98.3% of cases. Apical enlargement was ,appropriate' in 85% of roots. Both transportation (1.1%) and procedural errors (1.3%) were rare occurrences. Conclusions, The technical quality of root fillings performed by endodontists in Melbourne, Australia complied with current guidelines in 77.4%,91.0% of roots. All variables examined confirmed high levels of technical proficiency. There were very few instances of canal transportation and/or procedural errors. [source] Using patient-focused research in evaluating treatment outcome in private practiceJOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2002Ted P. Asay The increasing emphasis on therapist accountability and empirical demonstration of psychotherapeutic treatment effectiveness points to the need for practicing therapists to integrate treatment evaluation methods into routine clinical practice. Unfortunately, most private practitioners have little involvement in carrying out evaluation procedures. In this study we demonstrate how patient-focused research was used to track the progress and outcome of patients seen by a clinical psychologist in private practice. Twenty-nine adults and 40 children/adolescents were evaluated on a weekly basis to assess the number of sessions required to reach improvement (reliable change) and recovery (clinically significant change). Dose-response survival analysis results indicated that 50% of adults reached clinically significant change in 54 sessions, and 50% of youth met the same standard in 14 sessions. These results were compared with outcome in large-scale studies. Implications of this study for integrating treatment evaluation methods into clinical practice are discussed. © 2002 Wiley Periodicals, Inc. J Clin Psychol 58: 1213,1225, 2002. [source] Immediate effect of a stabilization splint on masticatory muscle activity in temporomandibular disorder patientsJOURNAL OF ORAL REHABILITATION, Issue 9 2002V. F. FERRARIO Summary Surface electromyography (EMG) allows the quantification of the occlusal equilibrium in dysfunctional patients, for instance in those with temporomandibular disorders (TMD). Fourteen patients (ten women, four men) with internal derangement type I were selected among the TMD patients referred to a private practice in Milan. A stabilization splint with posterior contacts was made for each patient. To verify the static neuromuscular equilibrium of occlusion, EMG activity of left and right temporal and masseter muscles was recorded in all patients and the activity (ratio between the activities of the temporal and masseter muscles) index was computed over a maximum voluntary clench test of 3 s. Muscular waveforms were also analysed by computing a percentage overlapping coefficient (POC, an index of the symmetric distribution of the muscular activity determined by the occlusion). The total electrical activity was measured by calculating the area under the entire muscular waveforms. In all patients EMG was performed just before and immediately after the insertion of the splint and data were compared by paired Student's t -tests. Overall, the splint reduced the electrical activity of the analysed muscles (P < 0·005) and made it more equilibrated both between the left and right side (larger symmetry in the masseter muscle POC, P < 0·05) and between the temporal and masseter muscles (activity index, P < 0·01). [source] The contribution of MD,PhD training to academic orthopaedic facultiesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2001John M. Clark Little is known about the distribution of research-trained physicians across the various specialties. To document the extent to which MD,PhD programs are a source of research-trained faculty for orthopaedic departments, this study examined the specialty choices of graduates of the Medical Scientist Training Program (MSTP) from 1964 to 1994. The MSTP, a combined MD,PhD program supported by the National Institute of General Medical Sciences, (NIGMS), produces roughly 25% of all MD,PhDs in the US. Methods. Copies of the appendices from training grant applications containing information on MSTP graduates were obtained from the NIGMS. Also, a questionnaire was mailed to 116 university-affiliated orthopaedic surgery departments asking how many faculty were MD's, PhDs or MD,PhDs. Results. Records were obtained for all MST programs. Information on postdoctoral training and/or a current position was reported for 1615 graduates who earned both MD and PhD. Of these graduates, 277 chose non-clinical paths. The other 1338 entered a residency or internship. Of these, 593 were still in residency training, 566 were academic faculty members and 130 were in private practice. In the records, 12 (0.9%) were listed as orthopaedic surgical residents (6) or faculty (6). At this time, all 12 have completed training, and 11 are in academic practice. Eighty-three departments replied to the questionnaire. In that sample of 1761 faculty positions, 1478 were MDs, 217 were PhDs and 36 (2.0%) were MD-PhDs. Conclusion. Despite robust support of MD,PhD programs, the number of dual degree recipients on orthopaedic faculties is small when compared to the relative size of the specialty. Other sources of research-trained staff should perhaps be developed. © 2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Efficient Resource Use in Simplified Complete Denture FabricationJOURNAL OF PROSTHODONTICS, Issue 7 2010MMedSci, Yasuhiko Kawai DDS Abstract Purpose: Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures,the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality. Materials and Methods: Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t -tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis. Results: The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes. Conclusions: The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings. [source] Private Practice of Prosthodontists: Current Conditions of Practice in the United StatesJOURNAL OF PROSTHODONTICS, Issue 3 2010Kent D. Nash PhD Abstract Purpose: The purpose of this article is to examine data and results from the 2008 Survey of Prosthodontists. Survey results are used to examine current trends and characteristics of prosthodontists in private practice. Materials and Methods: Characteristics of prosthodontists and conditions of private practice are based on surveys conducted in 2002, 2005, and 2008 sponsored by the American College of Prosthodontists. Survey results are used to estimate several characteristics including age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists). Results: The average age of a private-practicing prosthodontist reached 51 years in 2007; 12.3 is the number of years in the current practice; and most prosthodontists (71%) are solo private practitioners. The average amount of time per week by prosthodontists in the practice averaged 36.1 hours, and prosthodontists treated an average of 44.1 patient visits per week. The largest source of patient referrals is the patient themselves. The largest percentage of a prosthodontist's treatment time is spent rendering procedures in fixed prosthodontics, but this percentage has declined since 2001. In 2007, the average gross billings of a practicing prosthodontist reached $805,675; average total practice expenses were $518,255; the mean net earnings of practitioners were $268,930. Conclusion: In 2007, prosthodontists in private practice paid out about $1.4 billion in practice expenses to provide $2.2 billion dollars in prosthodontic care. Based on survey results from 2007 and the previous 6 years, specialization in prosthodontic care continues to be an economically attractive and productive healthcare profession in the United States. [source] Prosthodontists in Private Practice: Current and Future Conditions of Practice in the United States (Part I)JOURNAL OF PROSTHODONTICS, Issue 4 2007Kent D. Nash PhD Purpose: The purpose of this study was to use data from surveys of prosthodontists to examine the current conditions and characteristics of prosthodontists in private practice in the United States. Materials and Methods: Characteristics of prosthodontists and conditions of practice are based on the 2002 Survey of Prosthodontists and the 2005 Survey of Prosthodontists. Both surveys were conducted by the American College of Prosthodontists. Several characteristics of private practice/practitioners are estimated including age, gender, number of patient visits, hours in the practice, employment of staff, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists) Results: In 2004, the average age of private practitioners was 50 years. Years since graduation from dental school averaged 23.4 years, and years since completion of residency was 18.3 years. Prosthodontists spent an average of 35.7 hours per week in the office and 29.5 hours treating patients. In 2004, the average gross revenue per owner of a private practice reached $782,130, and mean net income was $258,490. The largest percentage of prosthodontist time was spent providing six procedures including fixed prosthodontics, implant services, complete dentures, operative care, diagnosis, and partial dentures. Conclusion: The United States spends about $1.8 billion on prosthodontic services provided by prosthodontists in private practice. Prosthodontists spend $1.1 billion dollars in expenses and treat an estimated 1.1 million patients per year. [source] Doctors' professional values: results from a cohort study of United Kingdom medical graduatesMEDICAL EDUCATION, Issue 8 2001Lorelei Cooke Objectives To examine young doctors' views on a number of professional issues including professional regulation, multidisciplinary teamwork, priority setting, clinical autonomy and private practice. Method Postal survey of 545 doctors who graduated from United Kingdom medical schools in 1995. Results Questionnaires were returned by 95% of the cohort (515/545). On issues of professional regulation, teamwork and clinical autonomy, the majority of doctors held views consistent with current General Medical Council guidance. The majority supported the right of doctors working in the NHS to engage in private practice. Most respondents thought that public expectations of doctors, medicine and the NHS were too high, and that some form of rationing was inevitable. On many issues there was considerable variation in attitudes on the basis of sex and intended branch of medicine. Conclusions The results highlight the heterogeneity of the profession and the influence of specialty and gender on professional values. Doctors' attitudes had also been shaped by broader social changes, especially debates surrounding regulation of the profession, rising public expectations and the need for rationing of NHS care. [source] Physiotherapists in Balint group trainingPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2000Dr Madeleine Abrandt Dahlgren Abstract Background and Purpose Balint group training (BGT) is a method widely used for enhancing understanding of the relationship and communication between health professionals and their patients. Participants meet in small groups, on a regular basis, with a tutor to discuss their experiences of problem cases. The method was originally developed in the 1950s for enhancing understanding of the doctor,patient relationship. Few studies have focused on BGT and physiotherapists. The aim of the present study was to describe and analyse physiotherapists' experiences of participation in BGT as a means of learning and understanding the physiotherapist,patient relationship. Method Semi-structured, in-depth interviews were conducted with three physiotherapists working in private practice, all participating in BGT. The intervews were transcribed and subjected to a qualitative analysis. Results The results are presented in a sequential model, featuring eight themes in which the physiotherapists' experiences of the training process are portrayed. Conclusions The results suggest that BGT and sharing the experiences of others may be considered a way of enhancing understanding of the patient encounter in clinical practice, possibly to the benefit of physiotherapists and their patients. Copyright © 2000 Whurr Publishers Ltd. [source] Unipolar depression with racing thoughts: A bipolar spectrum disorder?PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2005FRANCO BENAZZI md Abstract Major depressive disorder (MDD) with racing/crowded thoughts is understudied. Kraepelin classified ,depression with flight of ideas' in the mixed states of his manic-depressive insanity. The aim of the study was to test whether MDD with racing/crowded thoughts was close to bipolar disorders. Consecutive 379 bipolar-II disorder (BP-II) and 271 MDD depressed outpatients were interviewed using the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen, by a senior psychiatrist in a private practice. Intra-depression hypomanic symptoms were systematically assessed. Mixed depression was defined as a major depressive episode (MDE) plus three or more intra-MDE hypomanic symptoms. MDD with racing/crowded thoughts was compared to MDD without racing/crowded thoughts on classic bipolar validators (young onset age, many recurrences, atypical and mixed depression, bipolar family history). Frequency of MDD with racing/crowded thoughts was 56.4%. MDD with racing/crowded thoughts, versus MDD without racing/crowded thoughts, had significantly lower age at onset, more MDE severity, more psychotic, melancholic, atypical, and mixed depressions, and more bipolar family history. Of the intra-MDE hypomanic symptoms, irritability, psychomotor agitation and distractibility were significantly more common in MDD with racing/crowded thoughts. Compared to BP-II on bipolar validators, validators were less common in MDD with racing/crowded thoughts. MDD with racing/crowded thoughts seemed to be a severe variant of MDD. MDD with racing/crowded thoughts versus MDD without racing/crowded thoughts, and versus BP-II, had significant differences on bipolar validators, suggesting that it may lie along a continuum linking MDD without racing/crowded thoughts and BP-II. [source] Urologist Practice Patterns in the Management of Premature Ejaculation: A Nationwide SurveyTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2008Alan Shindel MD ABSTRACT Introduction., Contemporary U.S. urologist's "real world" practice patterns in treating premature ejaculation (PE) are unknown. Aim., To ascertain contemporary urologist practice patterns in the management of PE. Method., A randomly generated mailing list of 1,009 practicing urologists was generated from the American Urologic Association (AUA) member directory. A custom-designed survey was mailed to these urologists with a cover letter and a return-address envelope. Responses were compared with the AUA 2004 guidelines for the treatment of PE. Main Outcome Measures., The survey assessed several practice-related factors and asked questions of how the subject would handle various presentations of PE in their practice. Results., Responses from practicing urologists totaled 207 (21%). Eighty-four percent of the respondents were in private practice and 11% were in academics. Most urologists (73%) saw less than one PE patient per week. On-demand selective serotonin reuptake inhibitor (SSRI) therapy was the most commonly selected first line treatment (26%), with daily dosing a close second (22%). Combination SSRI therapy, the "stop/start" technique, the "squeeze" technique, and topical anesthetics were favored by 13, 18, 18, and 11% of the respondents, respectively. If primary treatment failed, changing dosing of SSRIs, topical anesthetics, and referral to psychiatry were increasingly popular options. Ten percent of urologists would treat PE before erectile dysfunction (ED) in a patient with both conditions, with the remainder of the respondents treating ED first, typically with a phosphodiesterase type 5 inhibitor (78% of total). Fifty-one percent of urologists report that they would inquire about the sexual partner, but only 8, 7, and 4% would evaluate, refer, or treat the partner, respectively. Conclusions., The majority of our respondents diagnose PE by patient complaint, and treat ED before PE, as per the 2004 PE guidelines. Very few urologists offer referral or treatment to sexual partners of men suffering from PE. Additional randomized studies in the treatment of PE are needed. Shindel A, Nelson C, and Brandes S. Urologist practice patterns in the management of premature ejaculation: A nationwide survey. J Sex Med 2008;5:199,205. [source] Osteotome Technique for Removal of Symptomatic Ear Canal ExostosesTHE LARYNGOSCOPE, Issue S113 2007Douglas G. Hetzler MD Abstract Objectives/Hypothesis: This study was undertaken to assess a transcanal osteotome technique for removing symptomatic ear canal exostoses. Outcome measures included healing rates and the rate of complications. Study Design: Prospective study in a private practice. Methods: A straight 1-mm osteotome and a curved 1-mm osteotome were used by way of a transcanal approach to incrementally remove obstructive ear canal exostoses. If anterior or superior bone growths were closely approximating the tympanic membrane, they were partially removed with a 1.5 mm cylindrical end- and side-cutting burr. Healing rates were monitored with weekly postoperative visits. Results: Two hundred twenty-one ear canals (140 patients) were consecutively treated with this technique. Healing was achieved at 2 to 8 (average 3.50) weeks, with 90% healed by 4 weeks. There were 4 mobilizations of a full-thickness segment of anterior bony canal wall; 3 exposures of periosteum anterior to the anterior bony wall; 1 tear of the tympanic membrane requiring a tympanoplasty; 18 anterior and 11 posterior tympanic membrane tears that healed spontaneously; 3 instances of sensorineural hearing decrease; 3 cases of new-onset postoperative tinnitus; and 1 instance of postoperative positioning vertigo. There were no lacerations of the tympanic membrane by an osteotome, no facial nerve injuries, no soft tissue stenoses of an ear canal, and no skin grafting of an ear canal. Conclusions: The described technique of using osteotomes transcanal for removal of symptomatic obstructive ear canal exostoses promoted rapid healing and was effective and safe. [source] Moonlighting: public service and private practiceTHE RAND JOURNAL OF ECONOMICS, Issue 4 2007Gary Biglaiser We study job incentives in moonlighting, when public-service physicians may refer patients to their private practices. Some doctors in the public system are dedicated, and behave sincerely, but others,the moonlighters,are utility maximizers. Allowing moonlighting always enhances aggregate consumer welfare, but equilibrium public-care quality may increase or decrease; if quality increases, moonlighting improves each consumer's expected utility. Unregulated moonlighting may reduce consumer welfare as a result of adverse behavioral reactions, such as moonlighters shirking more and dedicated doctors abandoning their sincere behavior. Price regulation in the private market limits such adverse behaviors in the public system and improves consumer welfare. [source] Estimating hourly anaesthetic and surgical reimbursement from private medical insurers' benefit maxima: implications for pricing services and for incentivesANAESTHESIA, Issue 4 2010D. Stubbs Summary While some speculation surrounds annual private practice incomes of anaesthetists, little is known of the hours of work needed to generate any presumed income (the hourly rate). The benefit maxima of five private medical insurers are published in fee schedules and data on the duration of common operations are now also known. In this study we combined these to generate estimates for hourly rates of reimbursement across 78 common operations in eight surgical subspecialties, for anaesthetists and surgeons. We expected to find significant differences between insurers as a result of market competition, and we expected differences between anaesthetists and surgeons. The median (IQR [range]) rate of reimbursement for anaesthetists was £167 (132,211 [68,570]).h,1 with significant variation across subspecialties (p < 0.001); for example, cardiac surgery was best reimbursed at £283 (257,308 [229,398]).h,1 and orthopaedics the least at £146 (133,159 [81,246]).h,1. Contrary to expectations, the rates of payment to anaesthetists by insurers were similar (p > 0.17). Patterns of reimbursement for surgeons were similar to those for anaesthetists, except that surgeons were reimbursed at about twice the rate. We conclude there is a confluence of insurer reimbursement levels and we discuss potential implications of this finding. Our results also have implications for how incentives between the NHS and private practice, or within a private practice group, might be optimally managed. [source] Burnout in Australasian Younger FellowsANZ JOURNAL OF SURGERY, Issue 9 2009Sarah Benson Abstract Background:, Burnout is the state of prolonged physical, emotional and psychological exhaustion characteristic of individuals working in human service occupations. This study examines the prevalence of burnout among Younger Fellows of the Royal Australasian College of Surgeons and its relationship to demographic variables. Methods:, In March 2008, a survey was sent via email to 1287 Younger Fellows. This included demographic questions, a measure of burnout (Copenhagen Burnout Inventory), and an estimate of social desirability (Marlowe,Crowne Social Desirability Scale , Form C). Results:, Females exhibited higher levels of personal burnout (P < 0.001) and work-related burnout (P < 0.025), but no significant difference in patient-related burnout. Younger Fellows in hospitals with less than 50 beds reported significantly higher patient-related burnout levels (mean burnout 37.0 versus 22.1 in the rest, P= 0.004). An equal work division between public and private practice resulted in higher work-related burnout than concentration of work in one sector (P < 0.05). Younger Fellows working more than 60 hours per week reported significantly higher personal burnout than those who worked less than this (P < 0.05). There was no significant correlation between age, country of practice, surgical specialty and any of the burnout subscales. Conclusion:, Female surgeons, surgeons that work in smaller hospitals, those that work more than 60 h per week, and those with practice division between the private and public sectors, are at a particularly high risk of burnout. Further enquiry into potentially remediable causes for the increased burnout in these groups is indicated. [source] Surgical workforce in New Zealand: characteristics, activities and limitationsANZ JOURNAL OF SURGERY, Issue 4 2009Antony Raymont Planning the future surgical workforce is a vitally important activity in which the Royal Australasian College of Surgeons is actively engaged. This paper reports on a survey, undertaken in late 2005, of all vocationally registered New Zealand surgeons. It describes their age and gender distribution, their workload, the distribution of their work hours and limitations on their activities. It is hoped that this will contribute to planning of surgical services for the future. Of surgeons surveyed, 452 (73%) responded. Their mean age was 51 years and 7% were female. Recruitment has been stable at approximately 20 per year since 1990. New Zealand surgeons worked, on average, 48 h per week and could accommodate additional work. Seventy-seven per cent of surgeons took after-hours calls and reported a 55% chance of returning to the hospital each week (30% in the main population centres and 70% in other districts). Overall, surgeons spent 50% of their clinical time in private practice. Most surgeons experienced significant resource constraints in providing surgical care. The current workload of surgeons in New Zealand is acceptable but after-hours duties, especially in secondary hospitals, may be unattractive. Surgical services are currently limited by institutional resources. If there is a substantial increase in the need for surgery in the future, surgical recruitment, which has been stable, should be increased. [source] Melanoma in private practice: Do dermatologists make a difference?AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2009Paul Cherian ABSTRACT Malignant melanoma is a major contributor to Australian morbidity and mortality. In this era of resource rationalisation, we seek to address the issue of whether routine full-skin examination by a dermatologist, rather than focussed examination of flagged lesions, will increase melanoma diagnosis. A retrospective chart review was undertaken between 1 July 2007 and 30 June 2008 in a private dermatology group practice in order to ascertain the number and characteristics of incidentally detected melanomas on routine skin examination. A total of 94 melanomas were detected during this 12-month period. Of these, 57 (60.6%) were incidentally detected by the dermatologist, 41 (71.9%) were in situ melanomas and 16 (28.1%) were invasive melanoma. Of the invasive lesions, 15 (94%) were ,thin' (less than 1.0 mm Breslow thickness). The majority of melanomas were found in men, and were distributed in areas of high cumulative sun exposure. Nine (9.6%) lesions were clinically misdiagnosed by the dermatologists and picked up on histopathology. This audit reaffirms the usefulness of routine full-skin examination by dermatologists in detecting de novo melanoma as part of the global strategy in reducing the burden of melanoma in Australia. [source] Cutaneous invasive squamous cell carcinoma: 10-year experience and recommendations for follow upAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2009Corinne Yoong ABSTRACT Currently, the National Health and Medical Research Council do not have any recommendations about the frequency of follow up after treatment of primary cutaneous invasive squamous cell cancer (SCC), due to a lack of data. The present study aimed to establish appropriate follow-up times and to determine the long-term risk of subsequent non-melanoma skin cancers and melanoma. Patients who had a primary invasive cutaneous SCC excised during 1996 were retrospectively identified from the databases of a dermatologist in private practice in south-east Queensland. Data on size, site, depth, differentiation, perineural involvement, lymphovascular involvement of the index SCC were obtained. The patients were regularly followed up and lymph-node involvement, patient immunocompetence, and the presence of local recurrences and subsequent SCC, basal cell carcinomas and melanoma were recorded. Forty patients were identified, comprising 25 men and 15 women with a mean age of 65 years. The majority (60%) of primary incident SCC were in the low-risk category. The median follow-up time was 7.5 years. One in two developed a second SCC within 5 years, a significant number had a second SCC detected only in 5,10 year follow up, and 72.5% had a BCC within 5 years, and 82.5% at 10 years. One in eight had a subsequent melanoma detected. [source] Evaluation of the treatment of non-melanoma skin cancers by surgical excisionAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2009Vernon SC Pua ABSTRACT A retrospective study of all non-melanoma skin cancers excised by two dermatologists at a private practice in 2004 (excluding Mohs microscopic surgery cases) was conducted. Two hundred and forty-one patients were treated, with a total of 453 tumours excised. The overall incomplete excision rate was 2.2% (10/453). For basal cell cancers, the incomplete excision rate was 1.54% (5/324) and for squamous cell cancers including Bowen's disease the incomplete excision rate was 3.9% (5/129). The majority of repairs were primary closures (82.6%). Although a significant proportion of the tumours were from the head and neck region (45.9%), this study demonstrated that careful patient selection, experience of the surgeon and adherence to recommended excision margins can achieve a favourable incomplete excision rate. [source] Comparison of treatment modalities in burning mouth syndromeAUSTRALIAN DENTAL JOURNAL, Issue 4 2009KE Barker Abstract Background:, Burning mouth syndrome (BMS) is characterized by a spontaneous burning pain in the oral mucosa without known organic cause or standardized treatment. The aims of this study were to assess and compare the efficacy of clonazepam and diazepam in relieving the symptoms associated with BMS and evaluate for which patients this treatment might be effective by correlating treatment efficacy with underlying psychological status. Methods:, The medical records of BMS patients attending an oral medicine private practice (1999,2004) were reviewed. The patients were then contacted and asked to complete a short questionnaire regarding their response to diazepam/clonazepam drug therapies. A second group of patients attending the above clinic (n = 30) were asked to fill out a hospital anxiety and depression assessment form in an attempt to correlate treatment success with underlying psychological status. Results: A total of 71.4 per cent of patients treated with clonazepam had partial or complete resolution of their oral symptoms, while 55.1 per cent of patients treated with diazepam had improvement of their oral symptoms. There was no correlation between underlying anxiety or depression and efficacy of benzodiazepine medication. Conclusions:, A greater percentage of patients taking clonazepam reported either partial or complete relief of symptoms compared to diazepam. However, the differences were not statistically significant. There was no correlation found between underlying psychopathology and treatment success with benzodiazepines. [source] A retrospective analysis of 1000 consecutively placed implants in private practiceAUSTRALIAN DENTAL JOURNAL, Issue 2 2009KC Nixon Abstract Background:, There have been numerous reports evaluating clinical outcomes of implants placed in institutional settings, but there are few studies relating to implants placed in private practice. The aim of this retrospective study was to analyse the clinical outcomes of 1000 consecutively placed Straumann implants in private specialist periodontal practice. Methods:, A hand-search of patient records was undertaken to identify 1000 consecutively placed implants. Data extracted included patient demographics, details of implants placed, implant sites, timing of placement after extraction, hard and soft tissue augmentation procedures, loading protocols, type of prostheses and treatment outcomes (implant survival, implant success and complications). Results:, The majority of implants (71.5 per cent) placed in patients aged 40 to 69, and the majority of patients (88.6 per cent) received 1 or 2 implants. During the period of the study, 9 implants were lost and 45 presented with complications requiring chairside intervention. A life table analysis showed 5 and 10-year cumulative survival rates of 99.2 per cent and 98.4 per cent respectively, and 5 and 10-year cumulative success rates of 93.1 per cent and 90.9 per cent respectively. Conclusions:, With careful treatment planning and adherence to recommended surgical and prosthetic protocols, high implant survival and success rates can be achieved in a private practice setting. [source] The DriveABLE Competence Screen as a predictor of on-road driving in a clinical sampleAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2009Nicol Korner-Bitensky Background/aim:,There is growing concern regarding the need for screening of older drivers. The objective of this study was to determine whether the DriveABLE Competence Screen, a computerised test, predicts on-road driving outcome in clients referred for a driving assessment. Methods:,This retrospective study evaluated the predictive validity of pre-road testing using the DriveABLE Screen. Fifty-two clients with varying health conditions were consecutively referred to a private practice that conducts comprehensive driving evaluations. Screen results are classified as recommend cessation of driving, indeterminate (requires on-road evaluation), or no evidence of reduced competence. The DriveABLE Road Test classifies subjects as pass, borderline pass, or fail. Results:,Sensitivity, specificity, positive and negative predictive values were generated using the Road Test as the criterion outcome. The positive predictive validity of the Screen in identifying those who would fail the Road Test was 97% (n= 32 of 33). The negative predictive validity was 47%. The sensitivity was 76% with a corresponding specificity of 90%. Conclusion:,The DriveABLE Screen, when used as a case finding tool, is highly predictive of clients who will fail an on-road driving evaluation. [source] | |||||||||||||||||||||||||||||||