Colposcopy in private practice

The clinical results of 162 operations performed with combined-acupuncture-analgesia are reported. The experiences so collected are satisfying. This method seems suitable for anaesthetic practice. Total absence of toxity good analgesia and the negligible circulatory reactions give this method advantages in the anesthetic treatment of old and poor risk patients. A heavy disadvantage is that the method in time consuming is expensive in personnel.     

Bacteremia in private pediatric practice

The capillary white blood cell count and differential, a test easily done in office practice, was used in unexplained febrile illness of infants and toddlers to help distinguish those babies most likely to have bacteremia who would benefit from blood culture and early bacteriologic diagnosis. Four criteria were used as indicators suggestive of bacterial infection: white blood cell count greater than or equal to 15,000/cu mm, total segmented neutrophils greater than or equal to 10,000/cu mm, total band cells greater than or equal to 500/cu mm, and total polymorphonuclear leukocytes (segmented neutrophils plus band cells) greater than or equal to 10,500/cu mm. These measurements were found helpful in separating a small group of bacteremic babies at high risk of complications from a large group of babies who recovered without antibiotic treatment and without complications. There were 146 febrile illnesses recorded in babies 3 to 24 months of age; bacteremia was proven in eight of these. Three or four blood cell count criteria were fulfilled in seven of the eight bacteremic babies and in only ten (7.2%) of the remaining 138 febrile illnesses (P < .001 by chi 2 test).     

Demythologizing private practice.

Contrasts the author's experiences practicing clinical psychology with accounts from other perspectives, giving examples of problems encountered and the nature of their continuing challenge to professional skills. Private practice is not a luxury catering to the whims and eccentricities of the economically privileged. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contrast between physicians seen by the medical board and those seen in private practice

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at H?tel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.     

Doctor-patient communications in a private family practice

One hundred fifty-five randomly selected patients in a private family physician's office were interviewed immediately before and immediately after their visit with the doctor in an attempt to assess the degree of misunderstanding that occurs in doctor-patient communications. Fifty-four percent of these patients either forgot to mention all their medical problems to the physician or they confused or forgot certain instructions concerning their diagnosis or treatment. A X2 analysis failed to reveal any significant sex or age differences in the proportions of misunderstandings. There was also no correlation between the number of misunderstandings, the amount of time the doctor spent with the patients, the patient's rating of their own health on a scale of one to ten, and the patients' complaints or praises about their medical treatment. The number of years of formal education completed by the patient showed a direct relationship to the number of misunderstandings. Patients on their first three visits to this office tended to misunderstand more of their medical instructions. Furthermore, the study suggested that patients with chronic internal diseases and those who express excessive trust in their physician might have an increased proportion of misunderstandings.     

Women as clinicians in private practice.

Based on questionnaire data, personal characteristics, income level, and clientele of private clinicians in southeastern cities are described, with emphasis on sex differences. There were fewer females in private practice, and no female therapist reported adult males as the primary clientele. Females experienced less full-time work and economic growth than males. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of psychotherapy in private practice.

Categorical approaches to psychotherapy on 4 bipolar dimensions are presented, including emotional intensity, location of problem, location of therapy, and location of responsibility. By means of a questionnaire, 142 psychotherapists in private practice were surveyed regarding types of patients treated, techniques utilized, clinical specialty areas, and self-ratings on the 4 dimensions. Of the 142 Ss, 41% were psychologists; 32% were marriage, family, and child counselors; 14% were psychiatrists; 9% were social workers; and 4% were psychological assistants or other specialists. Therapists whose theoretical orientation suggested conceptual clarity produced more discriminating responses on the dimensions, whereas therapists with conflicting orientations made less discriminating responses. Practitioners appeared to differ most along those dimensions over which they had practical control. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malingering in vascular disease

BACKGROUND: Antioxidant enzymes (AEs), which catalyze the conversion of reactive oxygen species (ROS) to water, include catalase (CAT), manganese-containing superoxide dismutase (MnSOD), and copper and zinc-containing superoxide dismutase (CuZnSOD). Previous work has indicated that MnSOD, CAT, and CuZnSOD levels are nearly always low in cancer cells. METHODS: Formalin-fixed, paraffin-embedded tissue from 31 radical prostatectomy specimens was immunohistochemically stained with polyclonal antibodies to CAT, MnSOD, and CuZnSOD. RESULTS: Malignant glands are typically stained with less intensity than benign/ hyperplastic glands. Marked heterogeneity of staining intensity was seen in the malignant glands for each of the three enzymes. A similar, though less marked, spectrum of heterogeneity of staining intensity was observed in the benign/hyperplastic epithelium contained in the specimens. No statistically significant correlation was found between intensity of staining for any of the three antioxidant enzymes and Gleason score, tumor stage, or preoperative prostate-specific antigen (PSA). CONCLUSIONS: Cellular levels of CAT, MnSOD, and CuZnSOD in prostatic adenocarcinoma reveal that many tumors appear to have decreased levels of expression. The finding that malignant prostate epithelium may have lowered expression of AEs suggests that further study of the role of AEs in malignant transformation in the prostate is warranted.     

Spirituality in medical practice

Body, mind, and spirit are integrally connected. Medical training in the Western world has been strong concerning the more easily measured physical aspects, and on the mental needs it has been virtually mute on how to minister to the spiritual needs of our patients. Learning the spiritual aspects of medical care is not a typical part of the medical school curriculum, and yet it is emerging as something that our patients want and expect us to do as part of our caring for them. Herein I discuss the role of spirituality in medical practice, how it relates to alternative medical practices, methods to use to grow spiritually, and ways to apply your spirituality to medical practice.     

The private practice of misleading deflection.

Responds to L. S. Brown's (see record 84-26142) references to and citations of the author's works regarding repressed memories. The author argues that there was nothing in the citations Brown mentions that would indicate that Loftus believed that therapists should be prohibited from believing clients' memory of abuse in any way. Loftus contends that Brown's misleading and inaccurate statements regarding her views deflect readers from the fact that individuals have suffered great losses due to adult offspring undergoing extremely suggestive therapies. Loftus also argues that Brown's use of incomplete quotations and invented or distorted personal communications fall short of scholarly standards and that misrepresentation of critic's views regarding suggestive therapies does not help clients, victims, and reputations of mental health professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Forum: Corporate private practice.

Comments that J. Yeager's article ("Managing executive performance: The corporate private practice," Professional Psychology, 1982, 13, 587-593, see record 1983-04318-001), on clinicians practicing in corporate settings contained stimulating examinations of several factors affecting mode of operation. The present author adds some observations gleaned from his own experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

House calls in medical practice

The frequency of daily home visits by practicing physicians has been investigated. A multiple regression analysis indicates that the number of daily home visits is reduced linearly with decreasing age and with increasing specialization of the doctor. With these variables taken into account, urban-rural differences cannot be demonstrated.     

Computers in the medical practice

This article is part of a series covering the ever-expanding role of computers in the medical office and practice by Glenn L. Gordon, MD, FACIP. Dr. Gordon is Director, Center for Digestive and Liver Diseases, Clinical Instructor of Medicine at St. Louis University School of Medicine, President of Audrain County Medical Society, Immediate Past President of American Cancer Society-Audrain Unit, and State Council MSIM/ASIM Delegate. This is the first of a series of articles covering the expanding role of computers in our medical practice from office management programs to the Internet. This month's article covers the computerized medical record and what it can do for you.     

Peer review: A private practice model.

The Peninsula Hospital Community Mental Health Center in California, in collaboration with community private practitioners, instituted a peer review plan to meet fiscal problems while permitting quality patient care. The present paper describes the plan and the functioning of the peer review committee. There were initial objections to the plan by most of the private practicing professionals concerned. The attitudes of 76 practitioners, as well as those of 19 peer reviewers, were assessed in questionnaires 3 yrs after the start of the peer review plan. Results of the questionnaires are discussed. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Length of psychotherapy for clients seen in private practice.

Length of treatment for all clients (N?=?100) seen for psychotherapy during 1975 by 7 therapists in a private practice psychological clinic was examined to determine the relative frequency of long-term (>25 sessions) vs short-term (≤25 sessions) psychotherapy. Clients were young, middle class, intelligent, and mildly to moderately disturbed. The median length of treatment was 8 sessions. Fully 80% of the clients had left treatment before receiving 25 sessions. This finding mirrors the trend for public treatment settings. Results reaffirm the necessity of further research and development of short-term treatment techniques designed to effectively utilize the brief time even private clients spend in psychotherapy. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term drug treatment of obesity in a private practice setting

This study evaluated the long-term efficacy and safety of the combination of phentermine and fenfluramine for the treatment of obesity in a private practice setting. A total of 1388 consecutive, qualified patients presenting to a private general internal medicine practice in Charlotte, NC, were enrolled with eligibility criteria including: age 18 years to 60 years, 20% over "desirable" bodyweight or body mass index > 27, no serious medical or psychiatric disease, and no contraindications to drug therapy. Patients were instructed in diet, exercise, and behavior modification techniques and received phentermine (15 mg/day to 30 mg/day) and fenfluramine (20 mg/day to 60 mg/day) continuously for over 3 years. Average duration of treatment was 15.9 months, and average weight loss at the last visit was 11.6 kg, or 11.7% of initial bodyweight. For patients completing 1 year of drug treatment, mean weight loss was 16.5 kg, or 16% of initial weight. Weight loss persisted for 2 years, but partial regain was seen at 3 years. The dropout rates were 18% at 6 months, 39% at 1 year, 68% at 2 years, and 78% at 3 years. At 1 year, blood pressure of hypertensive patients fell from 151/95 mm Hg to 127/78 mm Hg, and serum cholesterol and triglycerides of hyperlipidemic patient fell by 0.750 mmol/L (29 mg/dL) and 0.937 mmol/L (83 mg/dL), respectively. Adverse events were modest. We conclude that, in a private practice setting, long-term treatment of obesity with the combination of phentermine, fenfluramine, and a weight maintenance program is generally safe and effective. More research is needed to determine efficacy and safety for longer than 3 years.     

Selling your medical practice

The examination of 52 patients with different forms of intestinal dysbacteriosis revealed a considerable decrease in the indices of immunity to endotoxin of gram-negative bacteria. In particular, a decrease in the content of antibodies to chemotype Re glycolipid, as well as in the content of polymorphonuclear leukocytes binding antibodies in the blood stream of the examined patients and leukocytes capable of binding endotoxin in endotoxin-treated blood smears, was registered, which was indicative of the loss of endotoxin binding reserves by leukocytes.