Private Office Practice Research Articles

Percepção das alterações no plano gengival na estética do sorriso

OBJETIVO: esse estudo analisou a percepção de 80 profissionais de Odontologia e 80 indivíduos leigos, pacientes de consultórios particulares e da Faculdade de Odontologia da Universidade Federal do Espírito Santo, quanto à presença de alterações no plano gengival. MÉTODOS: a fotografia de uma mulher jovem sorrindo foi digitalmente modificada, produzindo alterações simétricas na altura gengival dos incisivos centrais e incisivos laterais, tornando o plano gengival progressivamente ascendente. Foi solicitado que os indivíduos escolhessem a foto mais agradável e, depois disso, o entrevistador questionava o indivíduo para verificar se o mesmo sabia o que estava sendo alterado na sequência de fotos, ou seja, se identificava as alterações feitas no plano gengival. RESULTADOS: os resultados mostraram que houve uma prevalência significativa na seleção do plano gengival harmonioso no grupo de dentistas e de pacientes (p<0,001; p<0,05, respectivamente) e que não houve diferenças significativas entre as especialidades integrantes do grupo de dentistas (p=0,538), o que aconteceu no grupo de leigos (p=0,05), demonstrando maior percepção do grupo de pacientes de consultório. A identificação da alteração no plano gengival foi significativa no grupo de dentistas (p<0,001) sem diferenças significativas dentre as especialidades do grupo, e não foi significativa no grupo de leigos (p=0,100). Foi evidenciada também uma identificação do problema significativamente superior no grupo de dentistas em relação ao grupo de leigos (p<0,001). CONCLUSÃO: concluiu-se, portanto, que alterações simétricas acima de 2mm podem ser percebidas por dentistas e leigos, que não existem diferenças nessa percepção entre as especialidades odontológicas estudadas e que o grupo de pacientes de consultório foi significativamente mais perceptivo que os pacientes da UFES.

Clinical Profile of the Adolescent/Adult Fontan Survivor

The study aims to describe the clinical profile of the adult Fontan survivor and identify the worries, symptoms, and the impact of cardiac surveillance most commonly experienced. A descriptive, cross-sectional design was used. The study was performed in outpatient adult and pediatric cardiology clinics in university-affiliated and private practice offices. Fifty-four adolescent and adult patients with single ventricle congenital heart disease who have undergone the Fontan procedure participated in the study. The mean age was 26 ± 9 years with 52% female and 63% Caucasian. Demographic and clinical data were obtained by a standard intake form and retrospective chart reviews. The Congenital Heart Disease TNO/AZL Adult Quality Of Life questionnaire was completed to assess worries, symptoms, and the impact of cardiac surveillance. The majority were single (73%), employed or full-time students (93%), with health insurance (94%), had a single left ventricle (78%), the diagnosis of tricuspid atresia or double inlet left ventricle (59%), lateral tunnel Fontan type (44%), history of arrhythmias (76%), left ventricle ejection fraction percentage >50 (66%), oxygen saturations >90% (70%), frequent headaches (50%), scoliosis (22%), varicose veins, ascites, and liver cirrhosis (46%), normal body mass index (59%), and New York Heart Association class I (48%) and II-III (52%). Primary worries related to current health (83%), job/employment (69%), ability to work, (61%) and living independently (54%). The most bothersome symptoms were shortness of breath with ambulation (69%), dizziness (61%), and palpitations (61%). Fontan survivors experience residua and sequelae from multiple surgical procedures and the natural disease course. Our results support the need for ongoing assessment of both physical symptoms and psychosocial concerns, and suggest the need for multiple risk factor intervention strategies that improve physical and emotional health in Fontan survivors.

Adherence to adjuvant endocrine therapy in estrogen receptor-positive breast cancer patients with regular follow-up.

e11039 Background: Non-adherence (NAdh) rate to hormonal treatment (HT) has been reported to reach 60%. The goal of this study was to evaluate the level of adherence (Adh) to HT in patients followed in a surgeon's private practice. Methods: From November 2008 to April 2009, all patients with estrogen receptor-positive breast cancer were interviewed at their follow-up visit to the surgeon's office. They were checked for Adh to HT and were asked to detail the reasons for Adh or Nadh. Records were also reviewed for demographics, cancer and treatment characteristics. Qualitative and correlative analyses were carried out. Adh was considered when 100% compliance was reached. Results: Among 398 patients with breast cancer, 161 were eligible: 81% (n = 130) had complete Adh to HT. In patients with Adh, 5 years of HT was completed in 26% (n = 42) and at least 48 months in 36% (n = 58); 52% (n = 88) were ongoing HT at the time of the interview. Median duration on HT was 25 months. Patients reported a unique reason for NAdh (n = 31): forgetting (n = 17); side effects (n = 7); absence of conviction (n = 4); financial problems (n = 1); other acute diseases (n = 1); metastatic disease (n = 1). Patients reported various reasons for Adh: importance of the diagnosis of cancer (100%), fear of recurrence (100%), regular follow-up and supervision by physician and/or nurse (61%), meticulous personality (22%), use of helping device (18%), other medication and/or other medical problems (13%), history of cancer in family and circle (11%), working in the medical or paramedical field (8%), influence of friends and family (5%), inclusion in a research project (3%), and the presence of young children (3%). Multivariate analysis showed that HER2 positivity and postoperative chemotherapy were significantly associated with NAdh (p < 0.05). Conclusions: Adh to HT can be evaluated in a private office practice. Fear of cancer and/or recurrence along with regular follow-up appear to influence Adh to HT. The use of a specific interview to evaluate Adh proved to be a useful tool. Further follow-up and studies should be done to evaluate the relationship between the data and the contribution of regular follow-up by cancer specialist in the Adh to HT. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca, Genomic Health, Novartis

Bacterial resistance in French acne patients

The percentage of strains of Propionibacterium acnes resistant to antibiotics in acne is increasing in many countries, raising the question of the risks associated with bacterial resistance. Numerous series of cases have been published on European populations of acne patients, but at the moment we still have very few data regarding France. The aim of this study was to evaluate the prevalence of P. acnes resistant strains to erythromycin, tetracycline, and doxycycline in a population of French acne patients. Specimens were collected from 273 patients in 43 centers located throughout France (12 hospitals and 31 private office practices). 75.1% of the patients were carriers of P. acnes strains resistant to erythromycin and 9.5% to tetracycline. One hundred percent of strains resistant to tetracycline were also resistant to doxycycline. There was no significant difference among the regions and between patients followed in hospital or private office. It clearly appears that the percentage of patients with P. acnes strains resistant to erythromycin is similar to that in other countries, but lower for tetracycline or doxycycline in comparison to other European countries.

Pratiques vaccinales déclarées suite à la levée de l’obligation de vaccination généralisée par le BCG. Enquête auprès des médecins généralistes et des pédiatres

Tuberculosis prevention has been based on generalized BCG vaccination in France since 1949. The aim of this cross-sectional survey was to assess the impact of the change in BCG administration (in January 2006) and the end of compulsory vaccination (in July 2007).A self-administered postal questionnaire was sent to a random sample of 2248 physicians practicing in 6 departments in the Rhône-Alpes region in 2008.Overall, 923 questionnaires were analyzed. The median age of the respondents was 52 years, 67 % were male, 93 % were general practitioners, and 91 % practiced in private practice offices. The median number of BCG vaccines administered on a quarterly basis was 5 (interquartile range [IQR], 3-10) before January 2006, one (IQR, 0-3) between January 2006 and July 2007, and zero (IQR, 0-1) after July 2007 (P<0.001). The rate of BCG vaccination was significantly lower for male physicians, physicians older than 50 years, general practitioners, practitioners working in private offices, and for some departments. Thirty-nine percent of the physicians were informed of the national program against tuberculosis 2007-2009, and 41 % wished to be trained in the practice of intradermal vaccination.This survey suggests that the withdrawal of Monovax and the lifting of generalized vaccination requirements were followed by a substantial decrease in the number of BCG vaccinations. The intradermal route constitutes an obstacle for BCG vaccination that might be overcome by specific training.

Imaging of Optic Nerve Head Drusen

To demonstrate a new algorithm that can determine the shape, location, and volume of optic nerve head drusen (ONHD), which were imaged with spectral domain optical coherence tomography (SDOCT). One exenteration patient and 4 glaucoma patients with bilateral ONHD were recruited from the Massachusetts Eye and Ear Infirmary and from a private practice office. Images were obtained using an experimental SDOCT system developed at the Wellman Center for Photomedicine, Massachusetts General Hospital. With axial resolutions of about 6 mum, SDOCT can obtain 2-dimensional images in 1/29 of a second, compared with commercially available time domain OCT instruments with 10 mum resolution images in 1.28 seconds. The volumes of ONHD were calculated with a new algorithm and were then correlated with visual field mean deviation. SDOCT can display 2-dimensional images comparable with histology and 3-dimensional videos of ONHD. ONHD are signal-poor regions with high-signaled borders. Larger ONHD volumes are directly correlated with larger mean deviation absolute values on Humphrey visual field testing. SDOCT is a potentially better technique for ONHD imaging and may improve the diagnosis and management of patients with both OHND and glaucoma.

This Issue: Dispelling Myths and Misdiagnoses in Pediatric Dermatology

&lt;P&gt;When I finally completed my residency training in pediatrics and dermatology, my father — an internist himself — presented me with a copy of Eduard Ahlswede’s &lt;cite&gt;The Practical Treatment of Skin Diseases&lt;/cite&gt;. It was a dog-eared volume that had been published in 1932. He had discovered the edition in the library of his private practice office and thought it a fitting gift upon my graduation.&lt;/P&gt; &lt;h4&gt;ABOUT THE GUEST EDITORS&lt;/h4&gt; &lt;P&gt;Albert C. Yan, MD, is Associate Professor of Pediatrics and Dermatology at University of Pennsylvania School of Medicine, and is Section Chief of Pediatric Dermatology at Children’s Hospital of Philadelphia.&lt;/P&gt; &lt;P&gt;Dr. Yan received his undergraduate degree in philosophy from Princeton University, and his medical degree from University of Pennsylvania School of Medicine. He then completed categorical residencies in pediatrics at the University of Washington and Seattle Children’s Hospital and categorical residencies in dermatology at the Hospital of the University of Pennsylvania, where he also served as Chief Resident. He is board certified in pediatrics, dermatology, and pediatric dermatology.&lt;/P&gt; &lt;P&gt;He is Director of the Pediatric Dermatology Fellowship Program and has been honored with teaching awards from both pediatrics and dermatology residency training programs..&lt;/P&gt; &lt;P&gt;Dr. Yan’s research interests have focused on atopic dermatitis, genetic skin diseases, and vascular anomalies. He lectures locally, nationally, and internationally; has written more than 90 peer-reviewed articles, book chapters, and editorials; sits on the editorial boards of &lt;cite&gt;Pediatric Dermatology&lt;/cite&gt; and &lt;cite&gt;Cutis&lt;/cite&gt;; and currently serves on the Executive Committee of the American Academy of Pediatrics (AAP) Section of Dermatology and on the Executive Board of the Society for Pediatric Dermatology.&lt;/P&gt;

Infection control resources in New York State Hospitals, 2007

In July 2005, New York State legislation requiring the mandatory reporting of specific hospital-associated infections (HAIs) was passed by the legislature and signed by the governor. In an effort to measure the impact of this legislation on infection control resources, the New York State Department of Health (NYSDOH) conducted a baseline survey in March 2007. This report presents an overview of the methods and results of this survey. An electronic survey of infection control resources and responsibilities was conducted by the NYSDOH on their secure data network. The survey contained questions regarding the number and percent time for infection prevention and control professional (ICP) and hospital epidemiologist (HE) staff members, ICP/HE educational background and certification, infection control program support services, activities and responsibilities of infection prevention and control program staff, and estimates of time dedicated to various activities, including surveillance. Practitioners in 222 of 224 acute care hospitals (99%) responded. The average number of ICPs per facility depended on the average daily census of acute care beds and ranged from a mean of 0.64 full-time equivalent (FTE) ICP in facilities with an average daily census of < or = 100 beds to 6.5 FTE ICPs in facilities with an average daily census of > or = 900 beds. Averaging the ICP resources over the health care settings for which they were responsible revealed that the "average full-time ICP" was responsible for 151 acute care facility beds, 1.3 intensive care units (ICUs) (average, 16 ICU beds), 21 long-term care facility beds, 0.6 dialysis centers, 0.5 ambulatory surgery centers, 4.8 ambulatory/outpatient clinics, and 1.1 private practice offices. The ICPs reported that 45% of their time is dedicated to surveillance. Other activities for which ICPs reported at least partial responsibility include staff education, quality assurance, occupational health, emergency preparedness, construction, central supply/processing, and risk management. This survey was designed to monitor and assess infection prevention and control resources and activities in hospitals as New York State embarks on mandatory public reporting of HAI rates. Monitoring infection control resources and activities will be important as HAI reporting moves forward. The information collected will serve as a baseline, and repeat surveys will be conducted to determine which, if any, of the various indicators correlate with the completeness and accuracy of HAI reporting.

A randomized trial comparing 2 outpatient educational settings for clerkship students: private practice office vs hospital clinic

The purpose of this study was to compare medical students' experiences in 2 outpatient educational settings. For their 2-week ambulatory rotation, all 76 medical students were randomized to either a hospital clinic or a private office. Seventy students completed the survey. When compared to students working in a private office setting, hospital clinic students reported more breast exams, speculum exams, uterine fundal height measurements, wet mount reading, contraceptive counseling, and first obstetrical and gynecologic patient visits. Students in the hospital clinic were more likely to report having educationally valuable opportunities to interview and examine patients and to discuss the differential diagnosis with their preceptor. Nevertheless, medical students randomized to the private office were more likely to report considering obstetrics and gynecology as a career. The hospital clinic provided students with more clinical experiences. Medical students assigned to a private office, however, were more likely to consider obstetrics and gynecology as a career.

Clinical Trial Investigator Status: You Need to Earn It

Clinical Trial Investigator Status: You Need to Earn It

The Diagnostic Performance of Expert Dermoscopists vs a Computer-Vision System on Small-Diameter Melanomas

To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter </= 6 mm) compared with an automatic multispectral computer-vision system. Blinded comparison study. Dermatologic hospital-based clinics and private practice offices. Patients From a computerized skin imaging database of 990 small (</= 6-mm) pigmented skin lesions, all 49 melanomas from 49 patients were included in this study. Fifty randomly selected nonmelanomas from 46 patients served as a control. Ten dermoscopists independently examined dermoscopic images of 99 pigmented skin lesions and decided whether they identified the lesions as melanoma and whether they would recommend biopsy to rule out melanoma. Diagnostic and biopsy sensitivity and specificity were computed and then compared with the results of the computer-vision system. Dermoscopists were able to correctly identify small melanomas with an average diagnostic sensitivity of 39% and a specificity of 82% and recommended small melanomas for biopsy with a sensitivity of 71% and specificity of 49%, with only fair interobserver agreement (kappa = 0.31 for diagnosis and 0.34 for biopsy). In comparison, in recommending biopsy to rule out melanoma, the computer-vision system achieved 98% sensitivity and 44% specificity. Differentiation of small melanomas from small benign pigmented lesions challenges even expert physicians. Computer-vision systems can facilitate early detection of small melanomas and may limit the number of biopsies to rule out melanoma performed on benign lesions.

Success Rate of Immediate Nonfunctional Loaded Single-Tooth Implants: Immediate Versus Delayed Implantation

The aim of this study was to evaluate the success rate of maxillary immediate nonfunctional single-tooth loaded implants used into fresh extraction sites (immediate placement condition) or healed ridge (delayed placement condition). Eighty-two dental implants were placed in the maxilla of 64 consecutive patients from private practice office and from a specialization course in Implantology. Forty-six implants were inserted under immediate placement condition, and 36 were inserted under delayed placement condition. The criteria used to evaluate success rate were those previously described by Albrektsson and Zarb (Int J Prosthodont. 1993;6:95-105), and follow-up period ranged from 18.0 to 39.7 months. Seventy-nine implants fulfilled the success rate criteria (96.3%). Moreover, differences concerning implantation condition were not significant (P = 0.33, Qui-square test): three of the failed implants were from immediate placement group (success rate of 93.5%), and none was from delayed placement group (success rate of 100.0%). In the present sample, no statistically significant differences were detected for immediate nonfunctional single-tooth loaded implants under immediate placement condition in comparison with those inserted under delayed placement condition; both protocols had high success rate in maxillary incisors, canines, and premolars areas.

A Case Study of an Emerging Community-Based Early Hearing Detection and Intervention Program: Part I. Parents’ Compliance

This is the first of a 2-part series of articles that describe and assess an emerging community-based early hearing detection and intervention program. This study investigated parents' compliance for accessing services for their infants at 5 levels in the process from referrals through subsequent follow-up during a 3-year period. Compliance was defined as parents' follow-through with professionals' recommendations and appointments for their infants' hearing health care. Investigators retrospectively reviewed the charts of 51 infants who were referred from a regional hospital's newborn hearing screening program to a private practice office and were seen from March 2000 to February 2003. Compliance was 100% for initial hospital inpatient screening and for outpatient rescreening but decreased throughout the referral process. All of the parents of babies with hearing loss complied, and their infants were diagnosed by age 3 months and received audiologic or otologic intervention by age 6 months. Only half of those who needed and opted for hearing aids complied and began habilitative intervention by age 6 months. Although compliance for initial and follow-up screening was excellent and met goals for national benchmarks, compliance for intervention services showed room for improvement.

A 52-year-old Man With Long-term Recurrent Depression

&lt;blockquote&gt;&lt;i&gt;&lt;p&gt;Editor’s Note: This monthly presentation describes a case of a psychiatric disorder, discusses past treatment attempts, offers options for continuing treatment, and explains the reasons the solution was selected. Submissions of interesting psychiatric case reports are welcomed for this department. Please e-mail &lt;a href="mailto:soconnor@slackinc.com"&gt;soconnor@slackinc.com&lt;/a&gt; for further information.&lt;/p&gt;&lt;P&gt;This case is presented by Jan Fawcett, MD, editor of Psychiatric Annals and on faculty at the University of New Mexico School of Medicine, Albuquerque, NM.&lt;/P&gt;&lt;/i&gt;&lt;/blockquote&gt; &lt;P&gt;&lt;b&gt;PATIENT HISTORY&lt;/b&gt;&lt;br&gt; Mr. S, a 52-year-old man with a distinguished career, appears at your private practice office for an appointment dressed very well, polished and fashionable. He relates a history of very severe recurrent depression for the past 20 to 30 years, with many individual depressive episodes lasting from 3 to 6 months. At times, he says, he became so desperate that he put one of the guns from his gun collection in his mouth. However, he experienced periods of high functioning without depression between these episodes.&lt;/P&gt;

Pediatric Norms for Assessment of Upper Venous Post-Thrombotic Syndrome.

Local collateral vessel formation, increased arm circumference, and upper extremity pain are the most frequently used clinical criteria for upper venous system post-thrombotic syndrome (PTS), a potentially serious complication of central venous catheter-related deep venous thrombosis. However, norms for variation of arm circumferences and vessel prominence have not been established for either children or adults. The objective of this study was to define average arm circumference differences and upper body vein prominence in normal children. Healthy children were recruited for the study at both an inner city continuity care clinic and a suburban private practice office. Efforts were made to include age and race/ethnicity distributions similar to the US population. Children with serious medical conditions or history of central venous catheter use were excluded. After permission was obtained from a parent or guardian, bilateral upper arm circumferences were measured, and data were collected regarding hand dominance, race/ethnicity, gender, age, height, weight, and history of chronic or intermittent arm pain. To evaluate the superficial veins, we developed and utilized an objective 5-point scale of chest, upper arm, neck, and shoulder vein prominence. Two hundred fifteen normal children (age 3–18 yrs, median 7 yrs; 53% female; 47% Caucasian, 21% African American, 26% Hispanic, 6% Asian) were evaluated. The mean variation between arm circumferences was 0.4 ± 0.03 cm (mean± SEM, 95% CI 0.35–0.46), and the mean percent difference between arms was 1.93 ± 0.1% (95% CI 1.7%–2.2%). There was no correlation of arm circumference measurements with age, gender, race/ethnicity, handedness, or body mass index. Of the 215 children examined, 47 (22%) had veins that were more than minimally visible (grade ≥ 2), with 54% of those demonstrating asymmetry in vessel prominence. Race/ethnicity did influence vessel prominence (p = 0.02), with an apparent correlation between vessel prominence and skin pigmentation. Twenty-eight percent of Caucasian and 27% of Hispanic children had veins that were more than minimally visible, while only 9% of African American and 7% of Asian children had veins that were more than minimally visible. There was no correlation between vessel prominence and age, gender, handedness, or body mass index. Although a history of arm pain was reported by 29 children (13%), it was rarely validated by parents. Almost all reports of arm pain were easily explained as muscle strain, sprains, broken bones, or “sleeping wrong,” and only 1 child had parentally confirmed pain of unexplained etiology. In conclusion, arm circumference variation, reports of pain, and prominent superficial veins on the chest wall, neck, shoulder, or arm are encountered frequently in normal children. Caution should be used when applying these criteria for a diagnosis of upper venous system PTS in children with prior or current central venous catheters in place. These data should be employed to develop and validate a scale for more objective diagnosis of PTS.

Evaluating the quality of medical care. 1966.

Evaluating the quality of medical care. 1966.

The American Counseling Association Practice Research Network (ACA-PRN): A New Research Tool

Although there are more than 79,000 licensed professional currently practicing in the United States, this figure is small when one considers there are 5 times this number of practicing in the United States. Despite the large number of practicing counselors, it is currently unclear as to the following: * Who are professional counselors? * How have professional been trained? * Where do professional work? * Who are the clients that professional serve? * What services do professional provide? * What are the effects/outcomes of the services? At first glance, the above questions seem simple; however, in reality, they are complex questions that are not easy to answer. One of the problems in characterizing professional is that work in a wide variety of settings in unique and profound ways (Engels & Bradley, 2001). For example, professional occurs in such settings as agencies, clinics, hospitals, private practice offices, K-12 schools, business and industrial settings, and college campuses. The problem of characterizing the professional counselor is made even more difficult because of variations in specializations, theoretical orientations, and postdegree professional development. Despite the complexity in answering the aforementioned six questions, they must be answered. In an era of increased accountability, researchers have pointed out that and clients have an interest in knowing what works (Lambert, 2001; Lambert, Hansen, & Finch, 2001; Lambert et al., 2002; Lueger et al., 2001; Sexton, 2001; Whipple et al., 2003). Stated slightly differently, the question of the efficacy of must be answered on the basis of research. Beyond that, have a moral and ethical responsibility to know whether is promoting the welfare of clients or harming clients (Heppner, Kivlighan, & Wampold, 1999; Lambert & Cattani-Thompson, 1996). Similarly, Gall, Borg, and Gall (1996) concluded that research (e.g., research) must be able to describe the phenomenon and predict its consequences. Hood and Johnson (1997) provided credence for evidence-based research when they posited, counselors need to evaluate the effectiveness of their endeavors (p. 7). Research that can answer the six questions listed earlier is vital to the American Counseling Association (ACA) in its quest to inform the general public and legislators not only about who are and what do but also why this research is vital in substantiating the claim that counseling works. Without additional current and ongoing research data, ACA and the profession are seriously hampered when they discuss outcomes. Without a sound, dynamic research base that better articulates the characteristics of practicing counselors, their respective practices, and outcomes, professional is unlikely to be competitive in the contemporary environment of increased accountability, managed care, and research-based practices (Sexton, Whiston, Bleuer, & Walz, 1997). Given the need for information about professional counseling, the American Counseling Association Practice Research Network (ACA-PRN) was established. The purpose of this article is to describe the ACA-PRN. Specifically in this article, we not only describe the makeup of the ACA-PRN, but, more important, we describe how the ACA-PRN offers a new research model designed to provide a better link between practice and research among professionals. * What Is a PRN? According to the American Psychiatric Association (APA; 1994), a Practice Research Network (PRN) is a group of practicing clinicians who cooperate to collect data and conduct research studies on a variety of service delivery issues (Zarin, Pincus, West, & McIntyre, 1997). …

Female Patientsʼ Sex Preferences in Selection of Gynecologists and Surgeons

In this study, the authors investigated sex preferences for gynecologists and surgeons among female patients, and explored potential contributing factors. One hundred forty-six female patients were surveyed in a private practice office concerning their sex preferences and past obstetric/gynecologic care. For data comparisons, chi2 or Fisher exact tests were used. Gynecologist sex preferences were similar between male (30%), female (35%), and no sex preferences (35%). Patients who had a female obstetrician at their first delivery or began their gynecologic care with a female were more likely to prefer a female gynecologist. Multiparous patients were more likely to state no preference for a gynecologist. There were no statistical differences in sex preferences when patients were stratified by age, race, educational background, age of first gynecologist visit, or the age at their first delivery. About half of the patients (51%) stated that they preferred a male surgeon; only 3% preferred a female surgeon, and 46% stated they had no preference. Our investigation demonstrated that women's preferences for a gynecologist were divided equally between preferring a male, a female, and having no preference. Our study did find, however, that about half of the female patients preferred a male surgeon.

A day in the life of a psychoanalyst: Part two

If the field of psychoanalysis is to sustain itself, which is not the case in current times, it will have to be more honest and open with the public and within its own professional circles about what it really means to be a practicing psychoanalyst. Continuing from Part One of this paper, the author provides more case material from an average day in his private practice office, providing psychoanalytic treatment to patients with a variety of clinical needs. Part One explored the first two cases on a given morning. Part Two begins with the third case seen that day and continues to the fifth case of the day. The last three cases of the day are not presented due to space limitations.

The “Minimizing Antibiotic Resistance in Colorado” Project: Impact of Patient Education in Improving Antibiotic Use in Private Office Practices

To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices. Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods. A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices. Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days. Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively). In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts.