Private Practice Experience Research Articles

S518 Quality of Bowel Prep in Patients Undergoing Direct Access Colonoscopy Using OTC Bowel Preps - A Private Practice Experience

S518 Quality of Bowel Prep in Patients Undergoing Direct Access Colonoscopy Using OTC Bowel Preps - A Private Practice Experience

S312 Glucagon-Like Peptide -1 Receptor Agonists Significantly Affects Quality of Prep in Screening Colonoscopies- A Private Practice Experience

S312 Glucagon-Like Peptide -1 Receptor Agonists Significantly Affects Quality of Prep in Screening Colonoscopies- A Private Practice Experience

Radiography students' knowledge, attitude and practice relating to infection prevention and control in the use of contrast media injectors in computed tomography.

Radiography students complete professional placements in various clinical settings and must adhere to distinct infection prevention and control (IPC) protocols. The aim of this study was to explore radiography students' training, knowledge, attitudes, and practice (KAP) relating to IPC in the use of contrast media injectors in computed tomography (CT). An online survey study was undertaken with radiography students enrolled at two Australian universities. Survey questions related to contrast media training and KAP regarding IPC in CT. Data was summarised using descriptive statistics, with comparisons between experience in public and private practice. One free-text response question focused on non-adherence to IPC best practice, analysed using content analysis. In total, 40 students completed the survey (9% response rate). Reports of IPC and contrast media equipment training was high, with disposition for further training. Regarding IPC knowledge, 65% of students responded correctly to all 'knowledge' items (individual scores range: 60-100%). Low consensus was observed regarding whether gloves replace the need for hand hygiene and if CT contrast tubing poses risk to healthcare workers (85% each). Mean scores ranged from 41% to 100% regarding identification of sterile syringe and tubing components. Responses to the open-ended question were categorised into four themes: 'High non-adherence risk working conditions', 'attitudes and practice', 'knowledge', and 'prioritise good IPC practice'. Radiography students demonstrate varied comprehension of IPC regarding contrast media equipment, and results suggest need for collaborative efforts between academic institutions and clinical training sites to integrate IPC protocols into curricula and on-site training.

Technical and Professional Components in Pathology Practices – Business and Educational Opportunities for Community Based Pathologists

Abstract Introduction/Objective Community based Pathologists (CBPs) are challenged by limited resources, decreasing revenue, continuous learning, workload burnout and acquisition by corporate health care groups. Pathology residency programs (PRPs) are traditionally offered at academic centers and are focused on teaching, research, clinical work, and residents are graduated with core diagnostic competencies. Upto 60% graduates usually join private practices, therefore, understanding the business aspects of pathology and abreast with innovative technologies continue to be challenge among CBPs. We conducted and presented our survey to evaluate opportunities and challenges for CBPs for adopting various technical and professional components (TC and PC) in their practices. Methods/Case Report Survey was conducted via interview for a total of 42 CBPs. Questions related to TC and PC were divided into 1) Immunohistochemical stains (IHC); 2) Flow cytometry (FC); 3) Fluorescence in-situ hybridization (FISH); and 4) Clinical pathology professional component (CPPC). Results (if a Case Study enter NA) CBPs understands the importance of TC and PC services, however 25/42 (60%) have been using it to some extent. Of those that are utilizing such TC services, 10/25 (40%) were using IHC and FC; 4/25 (16%) were using FISH. The CPPC was used by 26/42 (61%) Conclusion We concluded that there are several reasons for CBPs who are not utilizing TC and PC services to its full capacity such as 1) not trained well enough to read TC of IHC, FL and FISH; 2) No formal educational opportunities available to train CBPs; 3) Cumbersome lab portals to access data; 4) Billing of such services becomes complicated; 5) Workload burnout and no added incentives by practices; and 6) Limited resources to capture CPPC due to interface and integration of billing software’s. We suggest PRPs to offer electives and incorporate private practice experience for trainees, so they are prepared to embrace such business and educational opportunities.

Do United States Tax Court judge attributes influence the resolution of corporate tax disputes?

Corporate taxpayers can have economically meaningful disputes with the United States Internal Revenue Service (IRS) that ultimately involve the federal judiciary. In an attempt to reduce the number of corporate tax disputes going to trial and reduce the amount of time between when corporate taxpayers file a petition with the United States Tax Court (USTC) and resolution of the case, politicians and judges have placed greater emphasis on negotiated settlements as opposed to Tax Court trials. In this paper, we investigate whether the personal attributes of the Tax Court judge assigned to the case (political ideology, tenure on the bench and professional experience) influence corporate taxpayers and the IRS to reach a negotiated settlement or proceed to trial. Overall, our results show that Tax Court judges who are conservative, have private practice experience, have governmental legislative experience, and have longer tenure on the Tax Court bench are more likely to preside over disputes resolved through a negotiated settlement as opposed to going to a trial.

Mediating role of communion, agency, and private practice on the relationship of spiritual experience and prosocial behavior of the Catholic Youth in the Philippines

ABSTRACT Previous research has shown associations between spiritual experience and prosocial behaviour. However, the mechanism between spiritual experience and prosocial behaviour has not been thoroughly studied. We argue that communion, agency, and private practice explain their relationship. Spiritual experience cultivates communion by forming a connection with others. Spiritual experience increases the sense of self or agency, which leads to prosocial behaviour by being more sensitive to one’s sense of self. Private practice mediates between spiritual experience and prosocial behaviour. We tested the model by evaluating the responses of 1316 participants who completed the prosocial behaviour, communion, agency, private practice, and spiritual experience scale. Process macro model 4 was used to analyse the mediation. The results show that agency, communion, and private practice partially mediate between spiritual experience and prosocial behaviour. Emphasis is placed on the value of positive interaction, sense of self, and personal spiritual activities in expressing prosocial behaviour.

Religious Moderation in Indonesian Muslims

Indonesia receives a high religious harmony index every year; however, intolerance and religious radicalism threaten this harmony. Moderate Islam (Islamic religious moderation) has become a national policy as a solution to prevent intolerance and radicalism. In this study, we aimed to determine the factors influencing religious moderation. We examined the variables of religiosity and demographics, which play essential roles in forming religious moderation. A total of 578 students at state Islamic universities in Indonesia participated in this research. We measured religiosity with the Centrality of Religiosity Scale (CRS-5) by Huber and Huber. The CRS-5 consists of five dimensions: intellect, ideology, public practice, private practice, and religious experience, which we adapted to the Indonesian language. The Religious Moderation Scale consists of three dimensions: national commitment, rejecting violence, and accommodating culture. We collected data through questionnaires that we distributed online, and we analyzed the responses using multiple regression analysis. The results show that religiosity positively affected religious moderation, meaning that religious intellectuality, ideology, public practice, private practice, and religious experience supported a person in being moderately religious and might prevent intolerance and radicalism. Socioeconomic factors (sex and parents’ income) also strongly affected religious moderation.

Enhanced Recovery Pathway Reduces Hospital Stay and Opioid Use in Microsurgical Breast Reconstruction: A Single-Center, Private Practice Experience.

This study aimed to determine benefits of the Enhanced Recovery After Surgery (ERAS) pathway implementation in free flap breast reconstruction related to postoperative narcotic use and health care resource utilization. A retrospective analysis of consecutive patients undergoing deep inferior epigastric perforator flap breast reconstruction from November of 2015 to April of 2018 was performed before and after implementation of the ERAS protocol. Four hundred nine patients met inclusion criteria. The pre-ERAS group comprised 205 patients, and 204 patients were managed through the ERAS pathway. Mean age, laterality, timing of reconstruction, and number of previous abdominal surgical procedures were similar ( p > 0.05) between groups. Mean operative time between both groups (450.1 ± 92.7 minutes versus 440.7 ± 93.5 minutes) and complications were similar ( p > 0.05). Mean intraoperative (58.9 ± 32.5 versus 31.7 ± 23.4) and postoperative (129.5 ± 80.1 versus 90 ± 93.9) morphine milligram equivalents used were significantly ( p < 0.001) higher in the pre-ERAS group. Mean length of stay was significantly ( p < 0.001) longer in the pre-ERAS group (4.5 ± 0.8 days versus 3.2 ± 0.6 days). Bivariate linear regression analysis demonstrated that operative time was positively associated with total narcotic requirements ( p < 0.001) and length of stay ( p < 0.001). ERAS pathways in microsurgical breast reconstruction promote reduction in intraoperative and postoperative narcotic utilization with concomitant decrease in hospital length of stay. In this study, patients managed through ERAS pathways required 46 percent less intraoperative and 31 percent less postoperative narcotics and had a 29 percent reduction in hospital length of stay. Therapeutic, III.

"Dietitians May Only Have One Chance"-The Realities of Treating Obesity in Private Practice in Australia.

Introduction: Overweight and obesity are the leading contributors to non-fatal burden of disease in Australia. Very low energy diets (VLEDs) comprising of meal replacement products (MRP) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. Dietitians in private practice are perfectly placed to administer treatments for obesity; however, little is known about the preferred interventions used or their attitudes to incorporating VLEDs and MRPs into their treatments for overweight and obesity. Methods: This study used descriptive qualitative methods to explore accredited practicing dietitians’ (APDs’) perspectives and practices regarding obesity and obesity interventions, including the use of VLEDs and MRPs. Qualitative in-depth semi-structured interviews were conducted with 20 dietitians who had experience in private practice and in treating obesity. Transcribed interviews were analysed thematically using the technique of template analysis. Results: In the context within which dietitians’ practice was found to be a barrier to using evidence-based practice (EBP) for obesity treatment, four overarching themes were found. These were: (1) patient-centred care is the dietitians’ preferred intervention model; (2) VLEDs promote weight loss in specific situations; (3) systemic barriers constrain effective dietetic practice and equitable access to all, and (4) successful outcomes are predicated on working outside of systemic barriers. Conclusion: Dietitians in private practice are well placed and able to provide life-enhancing and evidence-based treatments for overweight and obesity and associated chronic disease in the community. However, systemic barriers need to be addressed to provide equitable access to effective care irrespective of socio-economic status.

Are "Free Flaps" "Free" Flaps?

Even standard microvascular tissue transfers are time consuming, require great skill and intensity, and can be stressful. Not surprisingly, work-related relative value units are considered by many microsurgeons to be suboptimal. Some might even say that "free flaps" indeed really are "free" flaps. A retrospective review of related finances was undertaken for all free flaps performed in a single surgeon private practice during the latest possible year (2014) that included a complete 5-year follow-up to insure receipt of all expected reimbursements from accounts receivable. There were 61 free flaps available; but arbitrarily 12 free flaps were excluded since postmastectomy breast reconstruction always received mandatory insurance payment, as were additional two cases done pro bono as part of an international educational service. This left 47 free flaps to permit determination of gross payments, if any. Compensation summated for three distinct time intervals for all free flaps was preoperative: $10,855.92 (mean: $230.98/flap); intraoperative: $117,015.46 (mean: $2,489.69/flap); and postoperative: $45,296.28 (mean: $963.75/flap). Range of gross payment for the free flap portion only was 529.65 to $4,503.71. Total overall revenue received was $173,167.66 (mean: $3,684.42/flap). A true benefit cost-analysis even if microsurgery specific expenses could be estimated would be inaccurate, so that mean net income for each free flap could not be determined. Albeit a minimal gross payment was obtained for some free flap procedures, in no instance was there zero reimbursement. Based on that fact, there were no truly "free" free flaps in this private practice experience, which should encourage the younger surgeon to realize that economic viability is possible so that their enthusiasm for reconstructive microsurgery can be sustained.

Work Readiness of New Graduate Physical Therapists for Private Practice in Australia: Academic Faculty, Employer, and Graduate Perspectives.

The purpose of this study is to explore academic faculty, employer, and recent graduate perspectives of the work readiness of Australian new graduate physical therapists for private practice and factors that influence new graduate preparation and transition to private practice. This study used a mixed-methods design with 3 surveys and 12 focus groups. A total of 112 participants completed a survey, and 52 participated in focus groups. Descriptive statistics were used to summarize the quantitative data, and thematic analysis was used to analyze the qualitative data. Triangulation across participant groups and data sources was undertaken. Australian new graduate physical therapists were perceived to be "somewhat ready" for private practice and "ready" by their third year of employment. Participants proposed that new graduates bring enthusiasm, readiness to learn, and contemporary, research-informed knowledge. New graduates were also perceived to find autonomous clinical reasoning and timely caseload management difficult; to have limited business, marketing, and administration knowledge and skills; and to present with underdeveloped confidence, communication, and interpersonal skills. Factors perceived to influence graduate transition included private practice experience, such as clinical placements and employment; employer and client expectations of graduate capabilities; workplace support; university academic preparation and continuing education; and individual graduate attributes and skills. Australian new graduate physical therapists have strengths and limitations in relation to clinical, business, and employability knowledge and skills. New graduate work readiness and transition may be enhanced by additional private practice experience, employer and client expectation management, provision of workplace support, and tailored university and continuing education. The number of new graduate physical therapists employed in private practice in Australia is increasing; however, until this study, their work readiness for this setting was unknown. This exploration of new graduate performance in private practice and transition can help to increase understanding and enhancement of work-readiness.

Centrality of Buddhist Religiosity Scale: Adaptation and Validation of the Centrality of Religiosity Scale in a Buddhist Sample in Vietnam

This paper describes an adaptation of the Centrality of Religiosity Scale to the Buddhist religious tradition (CBRS) and a validation in Vietnam. The sample included data from 421 Vietnamese Buddhists (300 females, 121 males), aged 17 to 71 years (M=35.03, SD=13.09). The results provided evidence for good psychometric properties of the short, intermediate, and long version: CBRS-5, CBRS-10, and CBRS-15 respectively. Specifically, exploratory and confirmatory factor analyses supported the measure’s original five-factor structure: intellect, ideology, public practice, private practice, and religious experience. Furthermore, the Centrality of Buddhist Religiosity has proven to be a stable psychological construct across the three versions of CBRS and was associated strongly with the Gordon Allport’s notion of the intrinsic religious orientation. The results also suggested that the Stefan Huber’s centrality of religiosity model can capture the Buddhist religiosity and that the CBRS can be used to measure the five theoretical defined core dimensions of religiosity in Buddhism.

Preferred and actual methods of hysterectomy: A survey of current practices among members of the South African Society of Obstetricians and Gynaecologists

Background. Hysterectomy remains one of the most common operative procedures for benign uterine diseases. Total abdominal hysterectomy (TAH) constitutes the most common approach despite the advantages of minimally invasive hysterectomy (MIH). Objectives. To explore the current opinion on hysterectomy choices amongst members of the South African Society of Obstetricians and Gynaecologists (SASOG), as well as the perceptions and potential barriers that may inhibit gynaecologists from offering MIH to their patients. Methodology. An anonymous survey designed to explore the preferences of practising obstetrician gynaecologists regarding the optimal hysterectomy procedure, and perceived barriers towards MIH. Results. The average age of the respondents ( N =152) was 45.7 years, with 88.2% having &gt;5 years’ experience in private practice. When asked about the preferred route of hysterectomy for themselves or their relatives, 46.2% chose vaginal hysterectomy (VH), 25.4% chose total laparoscopic hysterectomy (TLH), 15% chose laparoscopic assisted vaginal hysterectomy (LAVH) and 8.5% chose TAH. However, the most commonly performed hysterectomy procedure undertaken by the respondents in the last year was TAH. Only half of the respondents wished to increase their rate of VH and a lesser number to extend their laparoscopic hysterectomy rates. Conclusion. Although the majority of the respondents preferred the minimally-invasive VH or TLH for themselves or their relatives, TAH remains the most common hysterectomy method among SA gynaecologists. This difference could present an ethical dilemma for the gynaecologist. The desire of a minority to change their approach to VH indicates the difficulty in changing attitudes and the need to promote VH as a technique within SASOG.

Validation of the Chinese Version of the Centrality of Religiosity Scale (CRS): Teacher Perspectives

This study applied the Centrality of Religiosity Scale (CRS) to the context of Hong Kong as a part of China with the focus on a specific target group of teachers in primary and secondary schools. For the validation of the scale in the Hong Kong context, the version of CRSi-20 was tested with data collected from local teachers (N = 671). For the validation of the scale, six versions were tested (CRSi-20, CRS-15, CRSi-14, CRS-10, CRSi-7, and CRS-5). Confirmatory Factor Analysis demonstrated that the single-factor solution of five items (CRS-5) had better fit indices than the seven-item version (CRSi-7), which, in turn, was better than CRS-15 with a five-factor solution (Intellect, Ideology, Private Practice, Public Practice, and Religious Experience). The other three versions encountered a problem with high correlations between factors. Multiple-indicators multiple-causes (MIMIC) analysis was used to test the effect of covariates on the established factor structure for CRS-5, CRSi-7, and CRS-15. The results indicated that gender and religious belief are significant predictors of the centrality of religiosity scores for CRS-5, CRSi-7, and CRS-15. In addition, age was a positive predictor for public practice, and teachers’ education level was positively related to private practice for CRS-15. Implications regarding understanding for the existing literature are discussed.

Life satisfaction of Taiwanese dental graduates received residencies in the U.S.: a cross-sectional study

BackgroundEach year, more than 200 international dental graduates start U.S. specialty trainings to become specialists. It is unknown if their life satisfaction is associated with any dental career-related factor before residencies (e.g. dental school class rank, research experience, or private practice experience) and after residencies (e.g. staying in the U.S., teaching status, workplace, or board certification). This cross-sectional study aimed to identify these potential factors by surveying Taiwanese dental graduates who pursued U.S. residencies.MethodsLife satisfaction was measured with a structured questionnaire, Satisfaction With Life Scale (SWLS), which includes five statements on a 5-point Likert scale. Online surveys were sent out to 290 Taiwanese dental graduates who were known to pursue U.S. residencies. T-test, one way analysis of variance, and multivariable adjusted generalized linear model (GLM) were used to assess the differences of mean SWLS scores from different variables.ResultsSurveys were completed by 158 dentists. Mean SWLS score of 125 specialists was higher (p = 0.0007) than the score of 33 residents. For the 125 specialists, multivariable adjusted GLM demonstrated better life satisfaction was positively associated with multiple independent factors, such as having research experience, being ranked in the top 26 ~ 50% of the class in dental school, starting U.S. residency within 4 years after dental school, starting residency before year 1996, and specializing in endodontics (vs. periodontics). Life satisfaction was not associated with any factors after residency (e.g. staying in the U.S. afterwards, teaching status, or workplace), but better mean life satisfaction score was significantly associated with being American specialty board certified (p < 0.001) for the specialists in the 26 ~ 75% of their class in dental school. For the 33 residents, better mean life satisfaction score was associated with better dental school class rank in both bivariate (p = 0.020) and multivariable adjusted GLM (p = 0.004) analyses.ConclusionsThe life satisfaction of Taiwanese dental graduates pursuing U.S. residencies might be associated with some professional factors, such as research experience, dental school class rank, residency timing, specialty type, and specialty board certification. We hope our results may provide some objective information on making career decisions for international dental graduates/students who are preparing for U.S. residency.

Private Practice Experience with Omalizumab for Chronic Urticaria

Private Practice Experience with Omalizumab for Chronic Urticaria

Endoscopic Stents in the Management of Bariatric Complications: Our Algorithm and Outcomes.

Endoscopic techniques can provide an alternative to surgery in the management of post-bariatric surgery complications such as leaks, strictures, fistulas, and erosion of transgastric and adjustable gastric bands. Endoscopically placed stents can also be used to manage gastric perforations secondary to NSAIDS or perforated marginal ulcers following gastric bypass surgery. Additionally, stents can be used in conjunction with operative intervention to decrease the risk of more deleterious complications that could require additional operations. The objective of this report is to describe our private practice experience in managing bariatric procedure complications with fully covered endoscopic stents. We present the algorithm we use in the application of endoscopic stents in the management of complications following bariatric surgery. Private practice, Single provider, Tertiary Referral Center, USA METHODS: Data for all patients who underwent endoscopic stent placement for complications after various bariatric surgeries (Roux-en-Y gastric bypass, gastric sleeve, lap band, and vertical banded gastroplasty) performed by several different surgeons between July 2015 and December 2018 at a single private practice were retrospectively reviewed. Patient's medical history, perioperative information, stent placement details, outcomes, and subsequent interventions were reviewed and analyzed. Thirty-five patients who were treated with endoscopic stents after bariatric surgery were identified. Complications after bariatric surgery treated with stenting included staple line leaks, anastomotic leaks, strictures, marginal ulcer perforations, gastrogastric fistula, and lap band erosion repairs. Mean duration of each stent round also varied. Resolution occurred in 33 patients (94.3%). Stent migration occurred in seven patients (20%) and in eight of 51 stents placed (15.7%). Two patients ultimately required revision surgery, though only one was related to stent (2.9%). Our findings suggest that foregut stents deployed according to our algorithm can facilitate healing of anastomotic leaks, staple line leaks, and marginal ulcer perforations. Furthermore, stent placement can also bolster tenuous repairs of band erosion sites, repairs staple line failure, and manages leaks at band erosion repair sites. Endoscopic stents can also be utilized to augment both balloon and savory dilation of gastric anastomoses and gastric sleeve strictures. Stents should be clipped proximally and distally to minimize the risk of migration.

Implementation of an EMR System for a Comprehensive Dental Service within a Large Regional Hospital Network: Challenges and Opportunities Presented by the Introduction of new Technology.

The development of new information technology has significant effects on the health care system, and its implementation and the associated change management process can bring some positive changes and gains in understanding, but there are challenges with making the transition. These benefits and challenges are explored in the context of a hospital based dental department. Additionally, the concept of the integration of oral health to overall systemic health is explored in context with an Electronic Medical Records system implementation, and the American Dental Association's recent recognition of dental anesthesiology as a clinical subspecialty. Qualitative survey of attending dental faculty members of the department, who represent a broad range of dental specialties and experience in private practice, hospital based practice, teaching, and public health practice. The faculty survey yielded some consistent themes, ranging from enhanced information to make better diagnoses, to challenges in transitioning to EMR, as well as concerns about data security and too much time and effort in front of a computer screen. A brief summary of the history of the stand-alone development of dentistry is given, which contributed to the separate development of dental EMRs from hospital EMRs. The various modalities of clinical care provided by the Department of Dentistry at Advocate Illinois Masonic Medical Center, Chicago, IL are presented to give a scope of the areas of need a successful EMR solution must meet in a hospital based dental setting. Public health aspects are included in the discussion. Macro level health data sets (ie NHANES, state level datasets) have the potential to be expanded to include more thorough data, combining medical health data and oral health data in the same datasets.

Brazilian Validation of Centrality of Religiosity Scale (CRS-10BR and CRS-5BR)

The centrality of religiosity scale (CRS), available in three versions (with 5, 10 and 15 items), is a measuring instrument that identifies the central importance of religiosity in the psychological construction and in the behavior of an individual. According to the literature, five components together express the centrality of religion in life: Public practice, private practice, ideological, intellectual, and religious experience. These components are the ground on which religious constructs are formed and activated. For the validation of the scale in the Brazilian cultural context, two versions were tested (CRS-10BR and CRS-5BR) with data collected from a general population (N = 687). Exploratory Factor Analysis (N = 334) resulted in a five-factor solution congruent to CRS-10BR. Confirmatory Factor Analysis (N = 353) demonstrated that a five-factor solution (Intellect, Ideology, Private Practice, Public Practice and Religious Experience) indicated better fit indexes than the single-factor solution of five items (CRS-5BR). Thus, CRS-10BR is recommended to capture CRS full construct. However, the CRS-5BR version can be considered suitable for use in the Brazilian population when the context is demanding simpler and faster data collection.

Profile of full-time family practice faculty with private practice experience.

Profile of full-time family practice faculty with private practice experience.