Advanced marketing strategies to build the esthetic dental practice

Esthetic dentistry is truly a major part of the future of the fee-for-service practice. There are still many patients who seek high-quality elective care and these individuals need to be swayed to make an initial appointment with you. Whether you reach them through your present patients or through outreach to the community, the important key is your method of handling each of these patients as they join your practice. Customer service needs to be stronger and more obvious than ever before in order to differentiate your practice from others and to attract more referrals. The days of waiting for patients to arrive have clearly come to an end. Managed care and a decline in the need for traditional services has eroded a significant component of the dental market. When you combine that with the realization that only 50% of the population visits the dentist even once a year (and far less in many countries outside the United States), then it becomes obvious that the total available market for the elective services of esthetic dentistry has declined. Esthetic dentistry programs must be better defined, with an ongoing focus to educate present patients and to attract new patients. As I state in my seminars, I firmly believe that any practice today can still be highly successful. I do not feel that I will be making that statement three to five years from now. The time to begin positioning your practice for future growth of esthetic dentistry is now. As managed-care programs increase, it will become more difficult to turn around a declining practice. Having a quality marketing program already in place will make the difference for your esthetic practice. The new patient phone call is critical. It is there that you will begin to help patients understand fully the overall attitude and policies of your office. Successful management of new patients is to win their trust by giving them ultimate customer service while convincing them to fit your present system and schedule. When a new patient calls the practice, you want to get them scheduled within a reasonable time frame while their motivation is still positive. Remember, you only get one first chance to make a great impression. Each office should decide which questions are appropriate to ask. The front desk coordinator should ask these questions calmly and clearly so that the new patient has an opportunity to answer them without feeling that they are going through the inquisition. At the same time, the more information you have about this patient, the easier it will be to gain treatment acceptance because of your understanding of the new patient's needs. Many offices will ask new patients how they came to choose their particular office. Since many practices gain new patients from existing patients, it is appropriate to know when this has occurred and properly thank the referral patient. By thanking the patient who referred the new patient, you will encourage further referrals.     

Nursing records for discharge. Report of the nursing history

The quality of care within our health care system depends upon an active and dynamic communication which bridges the different levels of care (primary and hospital) and will permit a continuity of services between the distinct parts. To insure this success, the authors propose an outpatient nursing record that will follow the patient upon his or her discharge. This record, to be called the "Discharged Patient Report", will be directed to other medical professionals so that they can be informed of previous treatments that the patient has received. Included in the report will be items such as; the previous nursing interactions that were used on the patient, how problems were resolved, possible other solutions, and health care information given to the patient. Using the report in this way will give us a great tool to know our patients and better understand how to serve them.     

Cancer precursors

Body/mind medicine is rapidly becoming one of the catalysts that will integrate conventional and complementary health care. Interactive Imagery, in particular, offers many potent healing opportunities for nurses and patients in the perioperative continuum. Within this holistic approach, nurses play a pivotal part in providing to patients self-care tools that can be applied in and out of the hospital. Imagery adds value to the health care system by offering nurses and other health care practitioners a way to empower themselves and their patients. It is harmless, time and cost-effective, and often fun, and it focuses on patient satisfaction.     

EPR evidence for the involvement of free radicals in the iron-catalysed decomposition of qinghaosu (artemisinin) and some derivatives; antimalarial action of some polycyclic endoperoxides

The role of pharmacies that specialize in the treatment of specific chronic diseases in the alternate-site health care setting is discussed. The optimal use of medications through disease management programs can improve patient outcomes and lower overall health care costs. The increase in disease management programs has spawned the growth of disease-specific pharmacies in the home care and other alternate-site health care settings. These pharmacies usually operate from a single location or are regionalized operations that deliver pharmaceutical products to patients throughout the United States. The pharmacies employ clinicians who specialize in a particular disease. These clinicians conduct comprehensive patient education programs, drug-use review, and compliance monitoring. Disease management pharmacies focus on chronic, expensive diseases; costs related to inventory, equipment, and storage can be very high. Many disease management pharmacies are involved in preferred-distribution or closed-distribution arrangements with pharmaceutical manufacturers. Pharmacists involved in disease management programs routinely send compliance information about their patients to pharmaceutical companies, managed care organizations, or prescribing physicians. Disease management pharmacies act as advocates for patients with particular chronic diseases. Various foundations and patient advocacy and research groups have created their own disease management pharmacies. Disease management has also reached the community pharmacy practice setting. Pharmacies specializing in the treatment of specific chronic diseases in the alternate-site health care setting can improve health care and promote efficient use of health care dollars.     

Withholding medical care as a physical injury--homicide from the viewpoint of the physician

Limitation and termination of intensive care and in particular life support in patients who do not have a chance to recover from their illness has become a widely accepted approach in intensive care medicine. In well defined situations, life support can be withheld or withdrawn without the risk of becoming a criminal case. Frequently, the physician must base his/her decision on the presumed will of the patient which can be difficult to assess. Existing guidelines of the Society of physicians of Germany, which are partly preliminary, are helpful for the decision process of the physicians as well as of the relatives of the patients.     

Changing technology in health: product liability

Greater health consumer awareness and increasing levels of concern for the rights of patients have led to patient care technology being more strictly regulated. This article analyses both the general law issues and the particular statutes that will be of relevance to those involved in evaluating and implementing such technologies. There are three main elements to this analysis. Firstly, there is the issue of liability for a product fault, which will in many cases be directed by legislation back to the manufacturer of the goods. Secondly, those involved in placement of patient care technology should be aware of anti-discrimination legislation when making placement decisions. Finally, occupational health and safety legislation sets minimum standards for technology used in healthcare facilities. The author suggests ways of complying with the laws for each regulatory regime.     

Refractoriness to mammary carcinogenesis in the parous mouse is reversible by hormonal stimulation induced by pituitary isografts

As scientific advances in biochemistry shaped the health-care system since World War II, the projected advances in molecular biology will drive the system of the future. With each scientific advancement or new technology there will continue to be the need for efficient organizations to provide acute care to the patients who will benefit most. Despite numerous projections about the viability of the acute care hospital as we know it and vigorous redirection of services to the patient at home in ambulatory settings or in their community, it is crucial for nurses to take a leadership role in developing long-term approaches to patient care delivery systems for the acute care hospital of the future.     

The Internet as a resource for healthcare information

The Internet provides an additional means for healthcare providers to reach their patients. As more and more healthcare providers and patients get on-line and learn to use the Internet, the value of being on-line will increase. The Internet and other healthcare computing technologies will challenge us to look to the future for new ways to create partnerships with our patients. On-line skills and technological literacy will not replace more traditional approaches to patient care, but they most likely will change the model of how care is provided. Technology is an adjunct that will serve us well if it is incorporated as part of a multidimensional patient care environment. Above all, we will need to continue to foster good interpersonal relationships with patients to encourage ongoing dialogues about information obtained from all resources.     

Carbon dioxide volume and intra-abdominal pressure determination before the creation of a pneumoperitoneum

The associated stress of an ostomy experience can threaten a patient's security and sense of control. One major stressor is the influence of uncertainty, when patients lack a clear perception of what will happen and are unable to define meaning or personally interpret information bombarding them from the complex health care system. Mishel's Uncertainty in Illness Theory offers the ET nurse a practical framework for understanding how the patient attaches meaning to illness cues and how the ET nurse can positively affect the desired adaptation process. Because the patient trusts the ET nurse's expertise and experience, the nurse can help the patient to understand the ostomy experience and perceive its structure. As a credible authority, the ET nurse has the expert power to facilitate patient coping and adaptation by minimizing ambiguity through individualized education, counseling, and support while simultaneously constructing a sense of order and predictability for both patient and family.     

Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, recommendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.     

Youth suicide

Despite these recognised constraints, increased knowledge of individual and family health problems in Australia will enable nurses to make a valuable contribution to this important Australian public health issue. However, the use of primary care or public health approach alone cannot ensure patient or community involvement in changing the various social structures that cause certain groups to be at high risk for a particular health problem. The world today needs nurses who can diagnose community health problems and institute measures to protect, advance, and monitor the health of populations as a whole, nurses who can care for the sick or the disabled, nurses who can teach people to care for themselves. By understanding and integrating these concepts with the illness prevention/ health promotional tenets of primary health care. Australian nurses will become the future leaders in individual, family, and community health and also have a substantial impact on the problem of adolescent suicide in Australia.     

Ethical care at the end of life

In treating dying patients, who by virtue of their physical and emotional situation are frail and vulnerable, physicians must meet a high standard of professional, ethical care. Such a standard is based upon a philosophy of care that recognizes the patients' inherent worth as human beings and their uniqueness as individuals. The ethical and virtuous physician will practice in accordance with the principles of biomedical ethics that form the foundations of thought and treatment approaches in this area and will seek to do the best for the patient and the family. "Doing the best" includes respecting autonomy through gentle truth-telling, helping the patient and family to set treatment goals, and providing for symptom control, continuing attentive care and accompaniment throughout the course of the illness. Total care includes physical, emotional and spiritual aspects, is sensitive to cultural values and is best provided by an interdisciplinary team. Practices of symptom control in routine care and in crisis situations, as well as the cessation and non-initiation of treatment, will have as their goals the relief and comfort of the patient. The ethical physician will not act with the intention of bringing about the death of the patient, whether by ordering medication in excess of that required for symptom control, administering a lethal injection or any other means.     

Assessing myocardial perfusion in coronary artery disease with magnetic resonance first-pass imaging

MRFP perfusion imaging can now be used clinically on most MR scanner systems (1.0 to 1.5 T). The current experimental data demonstrate that MRFP imaging allows the quantitative assessment of myocardial blood flow changes and accurate measurements of collateral flow, including changes in the collateral dependent zones. Certain protocols, however, as outlined here have to be followed to obtain all the possible diagnostic information. Based on the current data on MRFP imaging, it is realistic to anticipate that MRFP imaging in combination with cine or tagging MR imaging will provide clinicians with better methods to distinguish stunned and hibernating, from nonviable myocardium and obtain better outcome data. Dedicated MR scanners are now being designed to meet the needs for MR imaging of patients with coronary artery disease. These scanners, small in size and with better patient access, make placement near the coronary care unit or catheterization laboratory feasible. This is a major step toward enhancing the utility of this new technique by providing the necessary infrastructure for scanning large numbers of patients. The main obstacle to wider use of these new diagnostic tools to assess perfusion is the lack of a large clinical database because there have not yet been major multicenter trials. With the development of novel intravascular contrast agents, however, larger trials are planned that should provide the clinical data mandatory for full integration of MRFP imaging into clinical practice. In particular, the development of dedicated and user-friendly perfusion analysis software will create the means to evaluate MR perfusion data accurately in large patient populations. These studies need to be conducted in a collaborative fashion by cardiologists, heart surgeons, and radiologists to be fully accepted by health care providers in an increasingly cost-averse and competitive health care environment.     

Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study

BACKGROUND: As more oncology care is moved to the outpatient setting, the need for a rapid means for oncologists to identify patients with significant distress has increased. Concurrent with this move has been the pressure to reduce time spent with each patient, adding to the likelihood that a distressed patient will not be recognized and will remain untreated in the current health care environment. METHODS: A pilot program was conducted in a prostate carcinoma oncology clinic to test the feasibility of a two-stage approach that identifies patients in significant distress and refers them for treatment. Two pencil and paper self-report measures were used to detect psychologic distress in patients over the previous week: 1) The Hospital Anxiety and Depression Scale (HADS) and 2) "The Distress Thermometer." Patients who scored above an agreed upon cutoff score on either measure (HADS = 15+; Thermometer = 5+) were referred to the psychiatric liaison in the clinic for evaluation. RESULTS: Compliance in filling out the measures was excellent; only 8 of 121 patients (6.6%) refused. Thirty-one percent of evaluable patients were referred based on elevated scores. Seventeen of 29 patients actually were evaluated. Eight of 17 patients met Diagnostic and Statistical Manual (of Mental Disorders)-IV criteria for a psychiatric disorder. CONCLUSIONS: This approach for rapid screening for distress was acceptable in prostate carcinoma patients, although these older men were reluctant to agree to evaluation and treatment. This simple screening method needs further testing and the identification of barriers on the part of the patient and oncologist that impede the identification of the most distressed patients.     

Endometrial polyps: a comparison study of patients receiving tamoxifen with two control groups

OBJECTIVES: To provide a review of the unique features of both Hodgkin's and non-Hodgkin's lymphoma in pediatric and geriatric patient populations. Treatment approaches and nursing care interventions at the extremes of age will be discussed. DATA SOURCES: Review articles, research studies, and book chapters. CONCLUSIONS: Lymphoma is a highly heterogeneous malignancy whose classification and management have undergone significant evolution. Of particular concern has been lymphoma's prevalence and treatment at the extremes of age. Appropriate treatment by age and subtype remains controversial. IMPLICATIONS FOR NURSING PRACTICE: The nursing care of pediatric and geriatric patients with lymphoma presents numerous challenges in education, symptom management, and supportive care.     

The clinical significance of compliance

The authors deal with a particular type of working alliance, called "compliance", which may be defined as mutual agreement between patient and physician with respect to prevention and therapy. This type of compliance may be influenced by the kind of disease (e.g. low compliance in psychiatric illness), by the mode of referral (verbal or written), by the kind of hospital care (an individual appointment with one particular physician in an outpatient department makes for better compliance) and by medication (intravenous or oral administration and color and size of pills). The number of medicines prescribed is of particular importance for compliance, i.e. the greater the number of drugs prescribed per day, the more the patient tends to be unreliable in taking them. Furthermore, the time spent in the waiting room, the amount of information given to the patient and the clarity of the instructions given by the physician play an important role. Situational factors and interaction in the physician-patient relationship seem to be more relevant than specific personality traits.     

Sudden death

The threat of sudden death due to a myocardial infarct inevitably places a severe strain on the patient, who may realize the severity of his condition, on the family who are justifiably concerned about the life threatening situation the patient is in, and on the coronary care nurse who is involved in his care. Each one reacts to this stress in his own way. If the nurse can begin to understand her own reactions and the reactions of the family and patient, she will be better equipped to help them cope with this crisis situation.     

Villous and tubulovillous adenomas of the colon and rectum. Results in 30 patients

Health care is increasingly driven by information, and consequently, patient care will demand effective management of information. The report of the Priority Expert Panel E: Nursing Informatics and Enhancing Clinical Care Through Nursing Informatics challenges faculty to produce baccalaureate graduates who use information technologies to improve the patient care process and change health care. The challenge is to construct an evolving nursing informatics curriculum to provide nursing professionals with the foundation for affecting health care delivery. This article discusses the design, implementation, and evaluation of an innovative nursing informatics curriculum incorporated into a baccalaureate nursing program. The basic components of the curriculum framework are information, technology, and clinical care process. The presented integrated curriculum is effective in familiarizing students with informatics and encouraging them to think critically about using informatics in practice. The two groups of students who completed the four-course sequence will be discussed.     

The hospital treatment of alcoholism and drug addiction

Inpatient treatment of alcoholism is an option indicated by certain clinical criteria. The American Society of Addiction Medicine suggests four levels of care, and six assessment dimensions determine which level of care is indicated. An addiction medicine physician can consult with the primary care physician to recommend appropriate placement in difficult cases. Abstinence is a primary goal of treatment; for without abstinence, no other recovery will be possible. The remaining goals of recovery are detoxification, medical evaluation, stabilization of life-threatening emotional issues, education, identification of barriers to recovery, readjustment of behavior toward recovery, and orientation and membership in a self-help group. Successful family contributions can make the difference between success or failure of treatment goals; the role the family plays in recovery is discussed. Treatment for family members is important; the physical, emotional, and spiritual effects on family members can be just as profound on them as they are on the alcoholic. Continuing care maintains the link between the patient and the professional recovery community after discharge and is appropriate for all patients. Extended care allows for structured support of sobriety and often further progress through psychosocial issues identified during the initial treatment phase (i.e., abuse, molestation, unresolved grief). Extended care is indicated for patients requiring further structured assistance in early recovery. A large variety of treatment options are available once the decision has been made to hospitalize the patient.     

Hematologic emergencies in the intensive care unit

Hematologic emergencies in the oncology population may require an admission to the intensive care unit (ICU). Syndrome of inappropriate antidiuretic hormone, hypercalcemia, tumor lysis syndrome, and disseminated intravascular coagulation are diseases defined in this article. These are common conditions in oncology patients that are reduced or prevented with close monitoring and accurate assessments. The purpose of this article is to introduce intensive care nurses to these disease entities so they will have a better understanding of the care involved with an oncology patient in the ICU unit.