Private General Practices Research Articles

Feasibility Study for Randomised Control Trial for Topical Treatment of Impetigo in Australian General Practice.

Context Impetigo affects millions of children worldwide. Most guidelines recommend antibiotics as first-line treatment however topical antiseptics present a potentially valuable, understudied, antibiotic-sparing treatment for mild impetigo. Objective We aimed to determine the feasibility of a randomized controlled trial (RCT) comparing efficacy of soft white paraffin (SWP), hydrogen peroxide (H2O2) and mupirocin for mild impetigo. Study Design The study was designed in keeping with the SPIRIT statement and designed in accordance with the CONSORT statement for pilot RCTs Setting, population studied Consecutive patients presenting with mild impetigo were recruited from two private general practices in North Queensland, Australia. Intervention: Participants were randomly assigned to one of three treatments: soft white paraffin (SWP), hydrogen peroxide (H2O2) and mupirocin ointment. Outcome measures: Size and number of lesions were measured at the initial consultation and day six. Post-recruitment, interviews with General Practitioners were transcribed and themes identified to determine protocol acceptability, recruitment barriers and avenues to improve delivery. Results Two participants received SWP (n=1) and mupirocin (n=1). Both commenced oral antibiotics following failure of topical treatment. Recruitment barriers included reduced presentation of impetigo due to COVID-19, pre-treatment with existing at-home medications and moderate/severe infection. Childcare centers and pharmacies were identified as alternative venues to improve recruitment rate. Conclusions Valuable insight was gained into the practicality of conducting a RCT of impetigo treatments in general practice. Future trials should consider recruiting outside of general practice clinics to capture patients at earlier, more mild stages of infection. Further investigation into the prevalence and impact of use of at-home expired antibiotics may be beneficial.

Patient-reported oral hygiene and implant outcomes in general dental practice.

This study investigated the possible correlations between patient-performed implant hygiene and peri-implant success and disease, as well as patient-reported outcomes, in a community-based cohort. Fifty-one patients (78 implants) from two private general practices were surveyed on their dental implant treatment history, oral hygiene instructions (OHI) received, home hygiene habits and current implant concerns. Their dentition, plaque/calculus scores and clinical implant parameters were examined. Correlations between hygiene habits, risk factors, implant success and peri-implant disease rates were assessed. Implants had a patient-reported mean time in function of 6.7years. Floss (74.4%), interdental brushes (IDB) (44.9%) and mouthwash (39.7%) were commonly used, while 7.7% of implants were only cleaned by brushing. Over half (56.4%) of implants fulfilled the success criteria, 61.5% had peri-implant health, 24.4% had mucositis and 7.7% had peri-implantitis. Only brushing (P<0.001) and detectable plaque/calculus (P<0.001) were significantly associated with more peri-implant disease. Local prosthetic factors affecting cleaning accessibility significantly reduced implant success (P<0.001). Patients reported mixed recall of implant OHI, 7.7% of implants were aesthetically unsatisfactory and 9.0% had peri-implant symptoms. Lack of interproximal cleaning and the presence of plaque/calculus were significantly associated with peri-implant disease in a community-based general practice setting, and patients reported mixed recall of OHI.

A Survey of the Implementation and Usage of Electronic Dental Records in Private Dental Practices in Mississippi

Implementation of electronic health records by the Health Information Technology for Economic and Clinical Health has led to the implementation of electronic dental records in dental offices. The study was conducted to determine the state of implementation and usage of electronic dental records by the private general and pediatric dental practices in Mississippi as well as reasons why the dental practices are not moving forward with the advanced technology. A survey consisting of six research questions was emailed via SurveyMonkey to 712 private general and pediatric dental practices in Mississippi with an invitation to participate in the study: 116 responded (16% response rate) and 104 consented to participate (89.66%). The data collection process transpired over a six-week period (September 18 – October 29, 2017). Results of the survey indicated dental practices in Mississippi using electronic dental records were 46.07%, electronic dental records with paper records were 42.70%, and only paper records were 11.24%. Dissemination of the study results among medical and dental practitioners may raise awareness and thus encourage more dentists to embrace EDRs. The response rate was affected by the number of dental practices that chose not to participate or did not open the survey email as well as the number of emails that were undeliverable. A second limitation was the lack of certainty of collecting all email addresses through the collection method. Third, there was no certainty that the person who responded knew the correct answers.

Prospects of diabetes registry in suburban community of Nigeria: experience at a private general practice

Background: As part of series of advocacy on development of diabetes register, one of the target health facilities is private general practices. In suburban Kwale community Delta State, Donak hospital was chosen to study the process of developing and implementing diabetes register program. Specific objectives include to evaluate the extent of completeness of data for patients follow-up, diabetes services within the private practice based on data collection, prevalence of high blood pressure, and patients’ compliance with medical appointments.Methods: The study followed a clinical observational method and after necessary ethical considerations, medical information was gotten from the record unit Donak Hospital, Kwale. The patients identified as potential diabetes or prediabetes were contacted for follow-up and 113 (65 females and 48 males) participants consented, all adults. Data collection were those required for a diabetes register proforma and were analyzed using Microsoft Excel Analysis Tool-pack. Results: There was no dedicated diabetes register per se except for usual medical records. The private practice has 100% record of contact details and blood pressure completeness for the participants. The scope of service offered to the patients was basically primary healthcare services. Over 50% of the participants have high blood pressure. On the patients’ compliance with medical check-up; only 23% of the participants complied with check-up appointments.Conclusions: The development of diabetes register in private practices can improve services. These services include documentation of appointments to enable follow-up strategies to encourage compliance to medical check-ups and a record diabetes education that may be provided.

Development of diabetes register in low-mid income country VII: summary of series

Background: This is a summarizing discussion of the series. Six pieces of articles have been presented including two pilot studies and survey of the perception of healthcare professionals. The other four presented case observations from the different levels of health facilities.Methods: In this summary, a comparison between the four grades of facilities is presented with focus on completeness of patients’ contact details and clinical information regarding basic anthropometric data that can be easily collected anywhere.Results: It shows evidence that capacity and scope of diabetes services are in tandem i.e., least at the primary level and most at the tertiary facility. It also shows albeit anecdotal that the private general practices may be doing best in what they have capacity to do.Conclusions: The capacity for diabetes service in all tiers of the healthcare system. The need to advocate for diabetes register as a means to improve quality of service is highlighted.

Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial.

Preoperative skin antisepsis is routine practice. We compared alcoholic chlorhexidine with aqueous chlorhexidine for skin antisepsis to prevent surgical site infection after minor skin excisions in general practice. We conducted this prospective, multicentre, randomized controlled trial in 4 private general practices in North Queensland, Australia, from October 2015 to August 2016. Consecutive adult patients presenting for minor skin excisions were randomly assigned to undergo preoperative skin antisepsis with 0.5% chlorhexidine in 70% ethanol (intervention) or 0.5% chlorhexidine aqueous solution (control). Our primary outcome was surgical site infection within 30 days of excision. We also measured the incidence of adverse reactions. A total of 916 patients were included in the study: 454 underwent antisepsis with alcoholic chlorhexidine and 462 with aqueous chlorhexidine. Of these, 909 completed follow-up. In the intention-to-treat analysis of cases available at follow-up, there was no significant difference in the incidence of surgical site infection between the alcoholic chlorhexidine arm (5.8%, 95% confidence interval [CI] 3.6% to 7.9%) and the aqueous chlorhexidine arm (6.8%, 95% CI 4.5% to 9.1%). The attributable risk reduction was 0.010 (95% CI -0.021 to 0.042), the relative risk was 0.85 (95% CI 0.51 to 1.41), and the number needed to treat to benefit was 100. Per protocol and sensitivity analyses produced similar results. The incidence of adverse reactions was low, with no difference between groups (p = 0.6). There was no significant difference in efficacy between alcoholic and aqueous chlorhexidine for the prevention of surgical site infection after minor skin excisions in general practice. Trial registration: https://www.anzctr.org.au, no. ACTRN12615001045505.

How Do Sleep-Related Health Problems Affect Functional Status According to Sex?

To measure differences in functional status between men and women presenting with sleep-related health problems. A retrospective clinical audit of 744 Australian patients across 7 private general practices between April 2013 and January 2015 was conducted. Patients completed an electronic survey as part of their routine consultation, which included the Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire 10 (FOSQ-10), and other questions relating to the effect of their sleep problem. The proportion of males and females with ESS and FOSQ-10 scores associated with disorders of daytime sleepiness and burden of symptoms due to sleepiness, respectively, were compared, as well as reported differences between the sexes in memory, concentration, issues with relationships, feeling depressed, and trouble sleeping. On presentation, females were more likely to have sleeping disorders associated with daytime sleepiness (median ESS score of 9 for females versus 8 for males, P = .038; proportion ESS > 9 was 49.0% for females versus 36.9% for males, P = .003). Women were also more likely to report an increased burden of symptoms due to sleepiness compared to men, as shown by lower FOSQ-10 scores (P < .001). Secondary outcome measures showed that females were more likely to feel excessively tired and depressed, have difficulties with memory and concentration, and have trouble sleeping at night. Snoring kept partners awake in roughly the same proportion of males and females, and a larger proportion of the partners of males were forced out of the room. Sleep-related health issues both manifest in and affect the lives of males and females differently. Sleep health professionals should recognize these differences on all levels of disease prevention and health promotion from patient education, to diagnosis and management to improve quality of life for those with sleep-related health problems.

Nurse practitioners as a solution to transformative and sustainable health services in primary health care: A qualitative exploratory study

ObjectiveTo consider the alignment of the Nurse Practitioner (NP) role in NZ with the goals and aspirations of the many countries facing challenges to maintaining health service delivery and reducing health disparities. MethodsData was collected as a component of a larger institutional ethnography but for this paper was thematically analysed to answer specific questions about NP practice alignment with a transformative service agenda. Interviews were conducted with NPs and management staff in private general practices, health clinics operated by District Health Boards (DHBs), and not for profit health providers, including Primary Health Organisations (PHOs), and community/indigenous health clinics. ResultsThe findings demonstrate that NPs have competently taken on a range of previously deemed medical tasks but also practice congruently with a nursing approach to practice. They provide comprehensive person and family centred care, focussing on seamless and integrated service delivery. Because their role is often regarded as only a substitute for medicine they are often employed in ways that limit their full potential. Conclusion and implicationsNPs can provide a service that closely replicates the goals of the NZ Health Strategy (2016) and the current aspirations of many countries concerned to provide sustainable health services.

The Caries Management System: are preventive effects sustained postclinical trial?

ObjectivesTo report, at two and 4 years post‐trial, on the potential legacy of a 3‐year randomized controlled clinical trial (RCT) of the Caries Management System (CMS) at private general dental practices. The CMS was designed to reduce caries risk and need for restorative care.MethodsNineteen dental practices located in city, urban, and rural locations in both fluoridated and nonfluoridated communities participated in the RCT. Eight practices were lost to follow‐up post‐trial; however, baseline mean DMFT balance between CMS and control practices was maintained. At the control practices, caries management following usual practice continued to be delivered. The patient outcome measure was the cumulative increment in the DMFT index score, and the practice outcome measures included the practice‐mean and practice‐median increments of patient DMFT index scores. In covariable analysis (patient‐level unit of analysis), as the patients were clustered by practices, mean DMFT increments were determined through multilevel modeling analysis. Practice‐mean DMFT increments (practice‐level unit of analysis) and practice‐median DMFT increments (also practice level) were determined through general linear modeling analysis of covariance. In addition, a multiple variable logistic regression analysis of caries risk status was conducted.ResultsThe overall 4‐year post‐trial result (years 4–7) for CMS patients was a DMFT increment of 2.44 compared with 3.39 for control patients (P < 0.01), a difference equivalent to 28%. From the clinical trial baseline to the end of the post‐trial follow‐up period, the CMS and control increments were 6.13 and 8.66, respectively, a difference of 29% (P < 0.0001). Over the post‐trial period, the CMS and control practice‐mean DMFT increments were 2.16 and 3.10 (P = 0.055) and the respective increments from baseline to year 7 were 4.38 and 6.55 (P = 0.029), difference of 33%. The practice‐median DMFT increments during the 4‐year post‐trial period for CMS and control practices were 1.25 and 2.36 (P = 0.039), and the respective increments during the period from baseline to year 7 were 2.87 and 5.36 (P < 0.01), difference of 47%. Minimally elevated odds of being high risk were associated with baseline DMFT (OR = 1.17). Patients attending the CMS practices had lower odds of being high risk than those attending control practices (OR = 0.23, 95% CI = 0.06, 0.88).ConclusionIn practices where adherence to the CMS protocols was maintained during the 4‐year post‐trial follow‐up period, patients continued to benefit from a reduced risk of caries and, therefore, experienced lower needs for restorative treatment.

Implementing Kanyini GAP, a pragmatic randomised controlled trial in Australia: findings from a qualitative study

BackgroundPragmatic randomised controlled trials (PRCTs) aim to assess intervention effectiveness by accounting for ‘real life’ implementation challenges in routine practice. The methodological challenges of PRCT implementation, particularly in primary care, are not well understood. The Kanyini Guidelines Adherence to Polypill study (Kanyini GAP) was a recent primary care PRCT involving multiple private general practices, Indigenous community controlled health services and private community pharmacies. Through the experiences of Kanyini GAP participants, and using data from study materials, this paper identifies the critical enablers and barriers to implementing a PRCT across diverse practice settings and makes recommendations for future PRCT implementation.MethodsQualitative data from 94 semi-structured interviews (47 healthcare providers (pharmacists, general practitioners, Aboriginal health workers; 47 patients) conducted for the process evaluation of Kanyini GAP was used. Data coded to ‘trial impact’, ‘research motivation’ and ‘real world’ were explored and triangulated with data extracted from study materials (e.g. Emails, memoranda of understanding and financial statements).ResultsPRCT implementation was facilitated by an extensive process of relationship building at the trial outset including building on existing relationships between core investigators and service providers. Health providers’ and participants’ altruism, increased professional satisfaction, collaboration, research capacity and opportunities for improved patient care enabled implementation. Inadequate research infrastructure, excessive administrative demands, insufficient numbers of adequately trained staff and the potential financial impact on private practice were considered implementation barriers. These were largely related to this being the first experience of trial involvement for many sites. The significant costs of addressing these barriers drew study resources from the task of achieving recruitment targets.ConclusionsConducting PRCTs is crucial to generating credible evidence of intervention effectiveness in routine practice. PRCT implementation needs to account for the particular challenges of implementing collaborative research across diverse stakeholder organisations. Reliance on goodwill to participate is crucial at the outset. However, participation costs, particularly for organisations with little or no research experience, can be substantial and should be factored into PRCT funding models. Investment in a pool to fund infrastructure in the form of primary health research networks will offset some of these costs, enabling future studies to be implemented more cost-effectively.Trial registrationACTRN126080005833347Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0956-y) contains supplementary material, which is available to authorized users.

The eCollaborative: using a quality improvement collaborative to implement the National eHealth Record System in Australian primary care practices.

Quality problemThe new national patient-controlled electronic health record is an important quality improvement, and there was a pressing need to pilot its use in Australian primary care practices. Implementation of electronic health records in other countries has met with mixed success.Initial assessmentNew work was required in general practices participating in the national electronic health record. National implementers needed to engage with small private general practices to test the changes before general introduction.Choice of solutionThe National E-health Transition Authority contracted the Improvement Foundation Australia to conduct a quality improvement collaborative based on 9 years of experience with the Australian Primary Care Collaborative Program.ImplementationAims, measures and change ideas were addressed in a collaborative programme of workshops and supported activity periods. Data quality measures and numbers of health summaries uploaded were collected monthly. Challenges such as the delay in implementation of the electronic health summary were met.EvaluationFifty-six practices participated. Nine hundred and twenty-nine patients registered to participate, and 650 shared health summaries were uploaded. Five hundred and nineteen patient views occurred. Four hundred and twenty-one plan/do/study/act cycles were submitted by participating practices.Lessons learnedThe collaborative methodology was adapted for implementing innovation and proved useful for engaging with multiple small practices, facilitating low-risk testing of processes, sharing ideas among participants, development of clinical champions and development of resources to support wider use. Email discussion between participants and system designers facilitated improvements. Data quality was a key challenge for this innovation, and quality measures chosen require development. Patient participants were partners in improvement.

Catchments of general practice in different countries--a literature review.

The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus.Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area.This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK.Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the allocation of resources so that opportunities for good health outcomes for all groups within society, especially those who have been systematically denied equitable access, are maximised.

Using GIS to analyse dental practice distribution in Indiana, USA.

Dentistry across the globe faces significant workforce issues with mal-distribution at most levels of analysis being a substantial issue. This study was the first to apply high resolution Geographic Information Systems (GIS) tools to map every private dental practice in the State of Indiana against a backdrop of population demographics. The hypothesis tested in the study is that there is an even density distribution of dental practices across Indiana. Adult population data were obtained from the United States Census of Population and divided by census tracts. The physical address for each dental practice in Indiana was collated from a comprehensive web-based search and the two datasets were integrated using GIS tools. The whole adult population of Indiana (5 million) was distributed across 1,511 census tracts. Across these tracts a total of 2,096 separate private general dental practices were distributed. There were a total of 679 tracts (45%) without a dental practice while 2.5% of tracts had 8 or more practices. The practice to population ratio (1:2,384) for the whole State was not significantly different for those living within 50km (31 miles) or 25km (15 miles) of the seven major city centers, and mean personal income (by residency location) did not appear to significantly influence practice location.

Impact of Dental Therapists on Productivity and Finances: I. Literature Review

This study examined the financial impact of dental therapists on Federally Qualified Health Center dental clinics (treating children) and on private general dental practices (treating children and adults). This article, the first of four on this subject, reviews the dental therapy literature and the dental access problem for low-income children. Dental therapists now practice in many developed countries, tribal areas of Alaska, and Minnesota. These allied dental professionals vary in their training and required dentist supervision, but all provide routine restorative and other related services to children and adults. The limited literature on the impact of dental therapists suggests that they work mainly in school and community clinics and some private practices, are well accepted by patients, provide restorations that are comparable in quality to those of dentists, expand the supply of services, do not increase private practices' net revenues, and in school programs decrease the number of untreated decayed teeth. Of the approximately 33.8 million children enrolled in Medicaid and the Children's Health Insurance Program (CHIP), some 40 percent now receive at least one annual dental visit. To increase utilization for all children to 60 percent--the rate seen in children from upper-income families--another 6.7 million children need to receive care; dental therapists may help to accomplish that objective.

Ethnicity and attitudes to deceased kidney donation: a survey in Barbados and comparison with Black Caribbean people in the United Kingdom

BackgroundBlack minority ethnic groups in the UK have relatively low rates of deceased donation and report a higher prevalence of beliefs that are regarded as barriers to donation. However there is little data from migrants' countries of origin. This paper examines community attitudes to deceased kidney donation in Barbados and compares the findings with a survey conducted in a disadvantaged multi-ethnic area of south London.MethodsQuestionnaires were administered at four public health centres in Barbados and at three private general practices. Adjusted odds ratios were calculated to compare attitudinal responses with a prior survey of 328 Caribbean and 808 White respondents in south London.ResultsQuestionnaires were completed by 327 respondents in Barbados (93% response); 42% men and 58% women, with a mean age of 40.4 years (SD 12.6). The main religious groups were Anglican (29%) and Pentecostal (24%). Educational levels ranged from 18% not completing 5th form to 12% with university education. Attitudes to the notion of organ donation were favourable, with 73% willing to donate their kidneys after their death and only 5% definitely against this. Most preferred an opt-in system of donation. Responses to nine attitudinal questions identified 18% as having no concerns and 9% as having 4 or more concerns. The highest level of concern (43%) was for lack of confidence that medical teams would try as hard to save the life of a person who has agreed to donate organs. There was no significant association between age, gender, education or religion and attitudinal barriers, but greater knowledge of donation had some positive effect on attitudes. Comparison of attitudes to donation in south London and Barbados (adjusting for gender, age, level of education, employment status) indicated that a significantly higher proportion of the south London Caribbean respondents identified attitudinal barriers to donation.ConclusionsCommunity attitudes in Barbados are favourable to deceased donation based on a system of informed consent. Comparison with south London data supports the hypothesis that the relatively high prevalence of negative attitudes to deceased donation among disadvantaged ethnic minorities in high income countries may reflect feelings of marginalisation and lack of belonging.

Angina in primary care in Goa, India: sex differences and associated risk factors

BackgroundLittle is known about the prevalence of angina in people seen in Indian general practices. The authors assessed the prevalence of angina and its associated risk factors in Goan general...

The ethics of sex selection: a comparison of the attitudes and experiences of primary care physicians and physician providers of clinical sex selection services

To compare the perspectives of primary care physicians (PCPs) and physician sex-selection technology providers (SSTPs) about the ethics of sex selection. Qualitative interview study. Academic, private, and HMO-based infertility and general medical practices. Forty PCPs and 15 SSTPs. Semistructured interviews. Comparisons of bioethical attitudes towards sex selection. Primary care physicians and SSTPs had distinctly different perceptions of the ethical concepts of autonomy, beneficence, and nonmaleficence as applied to sex selection. Sex-selection technology providers argued that sex selection was an expression of reproductive rights, was initiated and pursued by women, and was a sign of female empowerment that allowed couples to make well-informed family planning decisions, prevented unwanted pregnancies and abortions, and minimized the abuse of wives and/or neglect of children. In contrast, PCPs challenged the concept of "family balancing" and questioned whether women could truly express free choice under family and community pressure. In addition, PCPs voiced the concerns that sex selection technologies led to invasive medical interventions in the absence of therapeutic indications, contributed to gender stereotypes that could result in neglect of children of the lesser-desired sex, and were not a solution to domestic violence. Primary care physicians and SSTPs had markedly different ethical perspectives on the provision of sex selection services that were informed by their professional and personal attitudes and experiences.

Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland

It has commonly been suggested that in modern cities individual or household deprivation (for example, low income or education) is amplified by area level deprivation (for example, lack of jobs or good schools), in ways which damage the health of the poorest and increase health inequalities. The aim of this study was to determine the location of a range of resources and exposures by deprivation in a UK city. We examined the location of 42 resources in Glasgow City, Scotland, in 2005–2006, by quintile of small area deprivation. Measures included number per 1000 population, network distance to nearest resource, and percentage of data zones containing at least one of each type of resource. Twelve resources had higher density in, and/or were closer to or more common in, more deprived neighbourhoods: public nurseries, public primary schools, police stations, pharmacies, credit unions, post offices, bus stops, bingo halls, public swimming pools, public sports centres, outdoor play areas, and vacant and derelict land/buildings. Sixteen had higher density in, and/or were closer to, or more common in, more affluent neighbourhoods: public secondary schools, private schools, banks, building societies, museums/art galleries, railway stations, subway stations, tennis courts, bowling greens, private health clubs, private swimming pools, colleges, A & E hospitals, parks, waste disposal sites, and tourist attractions. Private nurseries, Universities, fire stations, general, dental and ophthalmic practices, pawn brokers, ATMs, supermarkets, fast food chains, cafes, public libraries, golf courses, and cinemas showed no clear pattern by deprivation. Thus it appears that in the early 21st century access to resources does not always disadvantage poorer neighbourhoods in the UK. We conclude that we need to ensure that theories and policies are based on up-to-date and context-specific empirical evidence on the distribution of neighbourhood resources, and to engage in further research on interactions between individual and environmental factors in shaping health and health inequalities.

QUALITY‐OF‐LIFE EFFECT OF TONSILLECTOMY IN A YOUNG ADULT GROUP

To examine the quality of life after tonsillectomy in a young adult group with chronic or recurrent tonsillitis. Retrospective survey of patients aged 15-25 years who underwent tonsillectomy for chronic or recurrent tonsillitis in 2002 or 2003. The Glasgow Benefit Inventory was mailed to patients who were selected from two private general otolaryngology practices. Participants had an overall benefit from the procedure as well as improvement in their general well-being and physical health. A benefit in social function was not imparted. Tonsillectomy in a young adult group results in significant improvement in overall quality of life, physical health and general well-being.

A comparison of survival of teeth following endodontic treatment performed by general dentists or by specialists

Objective A chart review was performed at 3 private general practices in different regions of Alabama to compare success of endodontic treatment provided by specialists versus generalists. Study design To qualify for the study the general dentists had to perform some endodontic treatment and to refer some to endodontists. Success was defined as the treated tooth being present at 5 years after the date of treatment initiation. This criterion, was chosen because of its unequivocal categorization of results. Calibrated dentists reviewed over 3,000 charts. Results 350 met the inclusion criteria. 195 teeth were treated by generalists, with an 89.7% success rate. 155 teeth were treated by endodontists, with a 98.1% success rate. Conclusion In this limited survey, endodontic treatment by specialists was significantly more successful.