Private Practice Research Articles

Knowledge and perceived confidence of Brazilian psychiatrists about eating disorders´ diagnosis and treatment recommendations.

To investigate Brazilian psychiatrists ́ knowledge and perceived confidence, both in diagnosis and in evidence-based treatments for eating disorders (ED). In this cross-sectional study, 259 psychiatrists filled out an online form including: sociodemographic data, questions about ED diagnosis and management based on standard guidelines. Descriptive statistics described sample characteristics and levels of ED knowledge and perceived confidence. Sample was composed mainly by women (65,64%), with mean age of 42.86, from the Southeast of Brazil (56,37%), working predominantly in private practice (59,85%), with less than ten years of experience in Psychiatry (51,74%). We found that 33.21% of participants correctly chose diagnostic criteria for anorexia nervosa (AN); 29.73% for bulimia nervosa (BN), and 38.22% for binge eating disorder (BED). Correct answers for therapeutic options were similar in BN and BED (20.8%), being considerably lower for AN (2.7%). Additionally, reported ED training were: 15.1% during medical school; 59.8% during medical residency/postgraduate studies; 58.7% as complementary training. Only 8.89% felt satisfied with their ED training; 50.97% felt confident diagnosing ED and 37.07% in managing ED patients. These results demonstrated an important gap in ED knowledge of Brazilian psychiatrists, and its consequences on their confidence and competence in managing ED patients.

Demographic and mental health profile of youth in a gender service: An African case series.

Despite a massive global increase in research on gender-diverse youth, there have been no studies in Africa on gender-diverse children and adolescents presenting to health services. This study aimed to present the first African findings of the demographic and mental health profile of youth who have presented at a gender service in South Africa. A specialist mental health outpatient service, consisting of psychiatry, psychology and nursing input, for gender-diverse child and adolescent patients in the Western Cape. All consenting youth seen at a gender service, consisting of psychiatry, psychology and nursing input, in state and by the same clinician in private practice between January 2012 and May 2019 were participants of a retrospective, sequential case series study. Data of interest, including gender identity and sexuality, mental health history and social information, were extracted from the psychiatry files of participants. Thirty-nine participants were part of the registry and qualified for the study: 72% self-identified as white, 15% as coloured and 13% as black African. The rate of co-occurring psychopathology was high (64%) and included high rates of autism, particularly in trans males (26%), suicidal ideation in 31% and a history of suicide attempt(s) in 10%. This first study describing gender-diverse youth seeking support relating to their gender identity in Africa showed they had remarkable similarities to those studied internationally. Establishing that transgender youth of all major racial groups in the province with similar demographic profiles to other parts of the world are presenting to services in South Africa and in need of mental health support and interventions.

Fatores determinantes no reconhecimento de uma fonte usual de cuidado por adolescentes brasileiros

Abstract The present study aimed to analyze the demographic, socioeconomic, and health factors and risk behaviors associated with the recognition of a Usual Source of Care (USC), according to gender. This work was a cross-sectional study, based on the National Survey of School Health (2015), conducted with 100,464 Brazilian adolescents. Descriptive analyses were performed based on Pearson’s χ2, and the prevalence ratio (PR) through logistic regression models in Stata 14 for each type of USC (Primary Health Care (PHC), Private Practice, Hospital, and Emergency), stratified by sex. Recognition of a USC was reported by 55.5% of the adolescents, 58.6% of whom were female. In the multivariate analysis, the variables that present social, economic, and risk behavior inequalities showed positive associations for USC PHC for both genders. For the other types of USC, the demographic and socioeconomic characteristics showed negative associations. The results of this study showed that PHC is the service with the highest recognition among adolescents in conditions of social vulnerability. This reinforces the need to consolidate the PHC in order to favor the health care of adolescents, establishing bonds and improving access to health actions.

Primary Care Physician and Urologist Perspectives on Optimizing Active Surveillance for Low-Risk Prostate Cancer.

We conducted a study to understand primary care physician (PCP) and urologist perspectives on determinants of active surveillance care delivery for men with low-risk prostate cancer. We conducted in-depth, semistructured, virtual interviews with a purposive sample of 19 PCPs and 15 urologists between June 2020 and March 2021. We used the behavioral theory-informed Theoretical Domains Framework to understand barriers to and facilitators of active surveillance care delivery. Interviews were recorded, transcribed, and deductively coded into framework domains and constructs by 3 independent coders. Participant recruitment continued until data saturation by group. Our study included 19 PCPs (9 female; 4 in community practices, 15 in academic medical centers) and 15 urologists (3 female; 5 in private practice, 3 in academic medical centers). The most commonly reported Theoretical Domains Framework domains affecting active surveillance care were (1) knowledge and (2) environmental context and resources. Although urologists were knowledgeable about active surveillance, PCPs mentioned limitations in their understanding of active surveillance (eg, what follow-up entails). Both groups noted the importance of an informed patient, especially how a patient's understanding of active surveillance facilitates their receipt of recommended follow-up. Physicians viewed patient loss to follow-up as a barrier, but identified a favorable organizational culture/climate (eg, good communication between physicians) as a facilitator. With patients increasingly involving their PCPs in their cancer care, our study presents factors both PCPs and urologists perceive (or identify) as affecting optimal active surveillance care delivery. We provide insights that can help inform multilevel supportive interventions for patients, physicians, and organizations to ensure the success of active surveillance as a management strategy for low-risk prostate cancer.

Awareness on Recent Guidelines for Rabies Prophylaxis among Healthcare Professionals in Rewa District, Madhya Pradesh, India: A Questionnaire-based Cross-sectional Study

Introduction: Rabies is a zoonotic disease that can be fatal and continues to impose a significant financial burden on developing countries. Recently, there have been advancements in the introduction of cell culture vaccines and immunoglobulin, as well as the approval of Intradermal (ID) schedules for vaccine administration. Aim: To assess the knowledge of doctors in Rewa District regarding the National Guidelines for Rabies Prophylaxis in 2019. Materials and Methods: A cross-sectional study was conducted, involving doctors from tertiary healthcare centres, district hospitals, and private practices. Data were collected over a period of one month from 206 doctors using a Google form, which included information about their field of practice and their knowledge of recent guidelines on Rabies prophylaxis. Data analysis was performed using the Chi-square test. Results: Out of the 206 doctors surveyed, 92 (44.7%) were male. A 56.7% of the doctors were aware of the regimen and dosage for ID administration of the Anti Rabies Vaccine, (ARV) and 44.6% were knowledgeable about the modification of PostExposure Prophylaxis (PEP) to Pre-Exposure Prophylaxis (PrEP) in the Essen regimen. Furthermore, 70.9% of the doctors were familiar with the dosage of Human Rabies Immunoglobulin (HRIG), while 42.7% knew how to manage animal bites in immunocompromised patients. Conclusion: The study revealed a lack of sufficient knowledge on various aspects of rabies management among the doctors surveyed. This underscores the need for reorientation programs and Continuing Medical Education (CMEs) training to be provided to doctors to enhance their knowledge of rabies and improve the effective management of animal bites.

A decade after establishing a hepato-pancreato-biliary surgery program in private practice in Greece: hurdles surpassed

A decade after establishing a hepato-pancreato-biliary surgery program in private practice in Greece: hurdles surpassed

Survival analysis of dental implants placed in a private practice. A multicenter prospective cohort study

Survival analysis of dental implants placed in a private practice. A multicenter prospective cohort study

Determinants factors in the recognition of a usual source of care by Brazilian adolescents.

The present study aimed to analyze the demographic, socioeconomic, and health factors and risk behaviors associated with the recognition of a Usual Source of Care (USC), according to gender. This work was a cross-sectional study, based on the National Survey of School Health (2015), conducted with 100,464 Brazilian adolescents. Descriptive analyses were performed based on Pearson's χ2, and the prevalence ratio (PR) through logistic regression models in Stata 14 for each type of USC (Primary Health Care (PHC), Private Practice, Hospital, and Emergency), stratified by sex. Recognition of a USC was reported by 55.5% of the adolescents, 58.6% of whom were female. In the multivariate analysis, the variables that present social, economic, and risk behavior inequalities showed positive associations for USC PHC for both genders. For the other types of USC, the demographic and socioeconomic characteristics showed negative associations. The results of this study showed that PHC is the service with the highest recognition among adolescents in conditions of social vulnerability. This reinforces the need to consolidate the PHC in order to favor the health care of adolescents, establishing bonds and improving access to health actions.

Vaccine hesitancy among physicians: a qualitative study with general practitioners and paediatricians in Austria and Germany

ObjectiveThis study aims to understand reasons for vaccine hesitancy (VH) among general practioners (GPs) and paediatricians. We aim to analyse how and when the healthcare workers (HCWs) developed vaccine-hesitant views...

Comparative evaluation of multiple nomograms for predicting postoperative vault after implantable collamer lens surgery.

To compare the vault predictability of most available implantable collamer lens (ICL) sizing nomograms and identify which preoperative measurements are predictive of vault. Private practice in Draper, Utah. Retrospective chart review. This study was a retrospective analysis of 209 eyes of 106 patients who underwent STAAR Surgical ICL implantation. Analyses were performed based on the availability of preoperative parameters, varying the number of eyes for each test. Mean absolute error (MAE) of predicted vs actual postoperative vault was calculated for each nomogram. The frequency of Kim, Rocamora (least absolute shrinkage and selection operator-optical coherence tomography), Russo, and Reinstein recommending the correct ICL size in instances when Parkhurst, optimized white-to-white (WTW), and STAAR could not recommend a definitive ICL size was determined. Univariate and multivariate linear regression analysis was performed between preoperative measurements and vault. The Kim, Rocamora, Russo, and Reinstein nomograms had significantly lower MAE of predicted vs actual postoperative vault than the KSV2 and Nakamura V3 nomograms. The Russo formula most frequently recommended the correct ICL size when the Parkhurst, Optimized WTW, and STAAR nomograms could not provide ICL size recommendations. At the 0.05 significance level, anterior chamber depth (ACD), ciliary body inner diameter (CBID), and pupil diameter were the parameters found to have significant correlation with postoperative vault. The Kim, Rocamora, Russo, and Reinstein nomograms were the most predictive of vault. Additionally, ACD, CBID, and pupil diameter were found to be significantly correlated with vault and should be considered for use in future ICL sizing nomograms.

Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study

Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study

2023 Prentice Medal Award lecture: Ocular surface-related symptoms of discomfort and other stories.

I have been fortunate to spend portions of my career in each of private practice, industry, and academia. At some times, these occupations have dictated the research direction, whereas, at others, curiosity has been allowed to dominate. This has resulted in multiple avenues of inquiry (some might say, too many), along which I have traveled with a rich and varied cast of collaborators, who have all taught me a great deal. The privilege of being awarded the Charles F. Prentice medal provides me an opportunity to summarize some of these activities. Beginning with an attempt to use contact lenses to solve a problem for those affected by albinism, the story shifts to addressing some of the wider deficiencies of contact lenses, in particular the consequences of their oxygen permeability and tendency to induce discomfort toward the end of the day. After briefly considering some aspects of meibomian gland function, the narrative concludes with the latest investigations of neurological links between the cornea and migraine.

Effectiveness of, and Satisfaction with, a Microsurgical Testicular Sperm Extraction Knowledge and Skills Masterclass for a World-Wide Audience.

This is the first study to assess the impact of an online microsurgical testicular sperm extraction (mTESE) masterclass. We: 1) describe the masterclass's scientific content; 2) appraise the participants' acquisition of knowledge; 3) gauge whether the extent of improvement of the participants' knowledge/skills was influenced by demographic/professional attributes; and 4) evaluate the participants' satisfaction. This masterclass comprised five didactic lectures followed by 4 case discussions. Online surveys assessed the above objectives using a baseline questionnaire including demographics and past mTESE experience/training, a 24-question pre- and post-quiz, and a satisfaction questionnaire. Participants were between 20-70 years old, with 80.37% males, mainly from Asia, Africa, and Europe, from clinical backgrounds (69.3%), and in public practice (64.4%). Half the sample reported no past mTESE training and very low skills, ≈60% wanted considerably more training, and 50% felt that good training was not readily available. Satisfaction was 98% to >99%. Pre- and post-quiz comparisons confirmed remarkable improvements in knowledge/skills, exhibiting five striking characteristics. Improvements were a) Broad i.e., across 19 of the 24 mTESE questions; b) Deep, of magnitude, as pre-/post-quiz scores improved from mean 13.71±4.13 to 17.06±4.73; c) Highly significant, consistently with p-values <0.001; d) Inclusive i.e., all participants enhanced their mTESE knowledge/skills regardless of demographic/professional attributes; and, e) Differential, e.g., non-clinical/clinical participants improved, but the former improved relatively significantly more, those with ≤5-year experience improved significantly more than those with >5-year, those in public practice significantly more than private practice participants, and those with lower self-rating in performing mTESE significantly more than those with higher self-rating. The masterclass was successful with very high satisfaction levels, and markedly improved mTESE knowledge/skills among the participants. Global Andrology Forum's model can be adopted by organizations with similar goals. Future research needs to evaluate such training to develop a practically non-existent evidence base.

Knowledge of the high-sensitivity cardiac troponin assay among medical officers in Gampaha District, Sri Lanka

Introduction: The high-sensitivity cardiac troponin (hs-cTn) assay is a crucial diagnostic test that is obligatory in the triage of patients presenting with chest pain. It is essential for medical officers to have adequate knowledge regarding the procedures for testing and the interpretation of test outcomes to deliver optimal healthcare for patients. It has been observed that medical officers are lacking in awareness regarding this testing method, resulting in a greater likelihood of errors in testing and interpretation. This study aims to evaluate the level of understanding among medical officers regarding the hs-cTn assay in relation to the most recent European Society of Cardiology guideline released in 2020.Methodology: We conducted a cross-sectional study at two government hospitals in Gampaha District in June 2022. A self-administered e-questionnaire was used to assess knowledge regarding hs-cTn. Knowledge was measured by calculating a cumulative score for the answers to a questionnaire and categorised into good or poor knowledge. A score less than 60% was categorized as poor and vice versa. Descriptive statistics were used to summarize the data.Results: Of the 227 medical officers, only 14.5% (n=33) had good knowledge of the analytical component while 41.9% (n=95) had good knowledge on the clinical component. A score ≥60% on the analytical component knowledge was significantly associated with designation being a senior registrar or consultant (p&lt;0.001), postgraduate enrolment (p&lt;0.001), participation in continuous professional development programmes (p&lt;0.001), and employment in a teaching hospital (p=0.025), but not with age (p=0.066) or private practice (p=0.118). Clinical component knowledge score ≥60% was significantly associated with age between 25 and 35 years (p=0.006), designation being a consultant (p&lt;0.001), postgraduate enrolment (p&lt;0.001), participation in continuous professional development programs (p&lt;0.001), and employment in a teaching hospital(p=0.001) but not with doing private practice (p=0.170).Conclusions: In Sri Lanka, medical officers’ general knowledge on the hs-cTn assay seems lacking. There is a need for continuous training to improve knowledge on hs-cTn testing among medical officers.

OVERVIEW OF THE DEVELOPMENT OF HEALTH COOPERATIVES IN THE TERRITORY OF SERBIA AND MODERN ASPECTS

Health cooperatives were initiated in Serbia in the late 19th century, while a fully developed model of modern health cooper atives was in 1921, providing a model for other countries. Today, there are currently very few health cooperatives in Serbia. An initiative was submitted in 2020 to promote their re-establishment and recommend that the government consider public-cooperative partnership forms to enhance healthcare accessibility and quality. Health coop eratives could address challenges in organizing preventive activities, health education, services not covered by health insurance or expensive in private practice, rural health development, reduction of emigration of health personnel, profiling and complication of health services, and development of medical research, among other sectors.

Commonly Practiced Physical Therapy Interventions for the Treatment of Knee Ostoearthritis; A Descriptive Study

Background: Knee Osteoarthritis (OA) is a leading cause of disability, with treatment approaches varying widely based on clinical judgment and patient-specific factors. Despite the availability of clinical guidelines, there is inconsistency in treatment preferences among physical therapists, which may influence patient outcomes. Objective: The study aimed to identify the commonly used treatment modalities for Knee OA by physical therapists in Punjab and to evaluate the adherence to clinical guidelines in practice. Methods: A cross-sectional survey was conducted involving 100 physical therapists from various cities in Punjab, who were selected using convenience sampling. Participants were provided with a standardized questionnaire to capture demographic data, clinical experience, and preferred treatment approaches for Knee OA. Data was collected in a one-time setting across government and private clinical environments over a four-month period. Therapists with a minimum of three years of clinical experience were included if they consented to participate. The data was analyzed using SPSS version 25.0. Results: Of the physical therapists surveyed, 54% were male and 46% were female. The majority (56%) worked in private/primary health centers, with lesser representation in general/specialist hospitals (19%), tertiary/teaching hospitals (17%), and secondary/federal medical centers (8%). Diagnostic preferences showed a reliance on Range of Motion assessments, with other methods such as muscle strength and radiographic findings also utilized. Treatment preferences indicated a predominant use of TENS (87 therapists), followed by ultrasound (61 therapists), and education regarding weight control (47 therapists). Less frequently used treatments included acupuncture (2 therapists) and aerobic exercises (4 therapists). Conclusion: The treatment preferences for Knee OA among physical therapists in Punjab do not consistently align with established clinical guidelines, indicating a need for enhanced guideline education and integration. The predominance of private practice settings may influence these preferences, suggesting a potential area for targeted guideline dissemination.

Data Privacy Practices of Private Higher Education Institutions in Malaysia: A Preliminary Study

Private higher education institutions as data users are subjected to the requirements of the Personal Data Protection Act 2010 (PDPA). These institutions process employee data as well as data of potential students, active students and alumni. They also deal with data of third parties such as vendors, visitors and contractors. Ten years after the coming into effect of the PDPA in 2013, the education sector has yet to develop their personal data protection code of practice as required by the Act. The General Code of Practice (CoP) of Personal Data Protection was introduced in December 2022 with the objective to provide guidelines to the Class of Data Users who have not prepared a Code of Practice and there is no data user forum to develop the relevant Code of Practice for the Class of Data Users. As the General CoP is legally binding, it is an offence punishable under the Act for any data user for failure to comply with any provision of this General CoP. As data users, private higher education institutions need to introduce certain mechanisms to adhere to the requirements such as privacy policy and procedure. This paper aims to compare the data privacy practices of private higher education institutions in Malaysia in order to determine to what extent the law has been complied with. Being a qualitative study, this paper applies content analysis technique. Data privacy policies of four private higher education institutions in Malaysia were examined to attain the objective. The four private higher education institutions are Universiti Tenaga Nasional (UNITEN), Universiti Teknologi PETRONAS (UTP), Taylor’s University and University of Nottingham Malaysia. The data privacy policies of the four institutions are accessible on the official website of the institutions. The study indicates that in the absence of a personal data protection code of practice for the education sector as a guideline, the data privacy practices of the institutions vary from one to another. While some of the privacy policies contain provisions which are general in nature which may lead to confusion to the data subjects, the data privacy policies show that the four institutions have, to a certain extent, complied with the requirements of the PDPA in general.

Varied etiology in patients presenting with non-puerperal mastitis: an observational study

Abstract Introduction: The etiology of nonpuerperal mastitis is more diverse varying from infections to autoimmune disorders. Most of them are misdiagnosed as pyogenic mastitis and are treated with routine antibiotics. In this study the various causes of nonpuerperal mastitis which required surgical intervention were evaluated. It was observed that some of the pre-malignant and malignant conditions were also presented as nonpuerperal mastitis. Materials and methods: All non-lactating women who presented with symptoms and signs of mastitis and did not respond to single course of antibiotics (active against staphylococcus) treated in tertiary care Hospital and in private practice of primary author between June 2021 to December 2022 and in those in whom the ultrasound of breast was also suggestive of inflammatory breast disease were included in the study and rest were excluded from study. The final etiological diagnosis of these patients is given by the histopathological examination of tissue taken from the wall of abscess cavity or of breast mass. Results: Total 21 patients were included in the study of which 7 patients had nonspecific infection, 3 patients were diagnosed to have tuberculous mastitis, 3 patients with idiopathic granulomatous mastitis, 2 patients with periductal mastitis, 1 patient with fat necrosis, 3 patients with atypical ductal hyperplasia and 2 patients were diagnosed to have invasive duct cell carcinoma. Conclusion: The etiology of nonpuerperal mastitis is diverse. Not only the benign conditions but premalignant conditions like ADH, DCIS and even invasive carcinoma can present with clinical symptoms and signs of inflammatory breast disease.

Intellectual and Ideological Dimensions as Predictors of Inmates' Private Practice Religiosity

Religiosity is critical in improving a person's self-control ability and preventing a person from committing a crime. However, studies of the dimensions of religiosity that can play a role in private religious practice are still limited. This study aims to find the relationship between the dimensions of intellectual and ideology with private practice in religiosity. This study involved three hundred samples of prisoners with measurements of intellectual dimensions, ideology, and private practices using the Centrality of Religiosity Scale (CRS). The correlation test concluded that intellectual and ideology are significantly associated with private practice. The intellectual dimension shows a more potent effect size on private practice than the ideology dimension. This study recommends the need for intellectual and ideological religious guidance programs for inmates in correctional institutions as an effort to increase self-control and prevent the residivisme

Assessing National Trends and Perceived Safety of Off-Label Ciprofloxacin-Dexamethasone Use by Pediatric Otolaryngologists.

Off-label use of Ciprodex® (ciprofloxacin-dexamethasone: CPD), an antibiotic-steroid combination solution, in the airway has been reported by pediatric otolaryngologists with anecdotal success. We examined national trends regarding off-label CPD use including prevalence, common indications, prescriber patterns, adverse events, and accessibility. 15-item cross-sectional survey was distributed to American Society of Pediatric Otolaryngology members from January-April 2022. Univariate analyses were performed to compare responses for users of off-label CPD versus non-users. Ease of access was compared across geographies and practice types using multivariate logistic regressions. Of the 163 complete responses (26.6% response rate), 156 (95.7%) reported using off-label CPD. Most common indications for off-label CPD were tracheal granulation (87.8%, n = 137) and choanal atresia (82.1%, n = 128). Ease of access was significantly increased in the Midwest (OR:18.79, 95%CI:3.63-1.24, p = 0.001) and West (OR:29.92, 95%CI:3.55-682.00, p = 0.006). Ease of access was significantly lower at tertiary referral centers (OR:0.11, 95%CI:0.01-0.64, p = 0.041) and private practices (OR:0.04, 95%CI:0.002-0.33, p = 0.009) compared to academic free-standing children's hospitals. Two-thirds of respondents reported feeling "Very Comfortable" with the safety profile of off-label CPD; 99.4% (n = 156) felt that the benefits outweighed the risks of off-label use. Seven respondents (4.5%) reported adverse events (e.g., local allergic reaction, cushingoid symptoms) from off-label use. Our findings (26.6% response rate) suggest that off-label CPD is commonly used by pediatric otolaryngologists, many of whom reported feeling that the benefits of off-label CPD outweigh the risks. Our results establish a baseline for future efforts to assess the efficacy and safety of off-label CPD and to improve its accessibility. V Laryngoscope, 134:2922-2930, 2024.