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1.
Prax Kinderpsychol Kinderpsychiatr ; 73(5): 416-431, 2024 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-39221945

RESUMO

Autism in Systemic Group Psychotherapy: "Strong Together" a Care Model for Children and Adolescents from Practice Awareness of people with autism in our society is constantly increasing. Nevertheless, ambiguities and caution in dealing with autistic clients are still tangible. Due to the growing demand, there is a shortage of care for clients on the autism spectrum. This applies in particular to group therapy services in German-speaking countries. However, the international AWMF guidelines state that group therapy is the therapy method of choice for children and adolescents with autistic perception. In order to counteract this gap in care, this article presents a systemic group therapy for autistic people. It explains the extent to which the systemic approach in combination with a multimodal approach is a beneficial approach. It also highlights the importance of expanding the range of care services, interdisciplinary cooperation, and exchange. The compatibility of practice and research in systemic psychotherapy will be explained, teamwork in private practice will be emphasized, therapeutic experiences will be shared and an outlook on ongoing evaluation research will be presented.


Assuntos
Transtorno do Espectro Autista , Colaboração Intersetorial , Psicoterapia de Grupo , Humanos , Psicoterapia de Grupo/métodos , Criança , Adolescente , Transtorno do Espectro Autista/terapia , Transtorno do Espectro Autista/psicologia , Comunicação Interdisciplinar , Terapia Combinada , Alemanha , Comportamento Cooperativo , Equipe de Assistência ao Paciente , Prática Privada
2.
Arq Bras Oftalmol ; 88(1): e20220367, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39319840

RESUMO

PURPOSE: This study aimed to examine the prevalence of myopic eyes over 11 years (2008-2018) in a private clinic and a public assistance service. METHODS: We retrospectively evaluated 6332 individuals (12,664 eyes) between 5 and 25 years old, seen at a private clinic-CEMO (2,663 individuals) and a public service-HOIP (3,669 individuals) from 2008 to 2018. We evaluated the prevalence of myopic eyes (EE ≤-0.50) and high myopic eyes (EE ≤-6.00). RESULTS: Sex and services did not show statistical differences. The variation in the prevalence of myopic and high myopic eyes showed a random pattern during the study period (this prevalence could not be increased). Prevalences ranged from 20.7% (in 2017) to 32.4% (in 2015) for myopic eyes and from 1.6% (in 2009 and 2016) to 3.3% (in 2015) for eyes with high myopia. The prevalence of myopia showed a statistically significant increase based on the age group. CONCLUSION: The prevalence of myopic eyes did not increase in our study. The mean prevalence of myopic eyes was similar in the private clinic and public service.


Assuntos
Miopia , Prática Privada , Humanos , Brasil/epidemiologia , Estudos Retrospectivos , Masculino , Feminino , Adulto , Prevalência , Miopia/epidemiologia , Adolescente , Criança , Adulto Jovem , Prática Privada/estatística & dados numéricos , Pré-Escolar , Distribuição por Idade , Distribuição por Sexo , Setor Público/estatística & dados numéricos
3.
Ann Med ; 56(1): 2399755, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39317935

RESUMO

OBJECTIVE: To explain how Dutch novice physical therapists experience their transition from student to physical therapist in private practice. METHODS: A qualitative, phenomenological study was performed in The Netherlands to collect personal experiences from novice physical therapists who graduated <1 year ago. Data were collected with semi-structured interviews and analyzed using interpretative phenomenological analysis. RESULTS: The transition experience from student to novice physical therapist is a personal, complex, and context-dependent phenomenon. Sixteen novice physical therapists (of whom 10 were still working in private practice) said their transition was liberating, stressful, insecure, unexpected, chaotic, and challenging. The variety in experiences occurred from the fact that the impact of an experience varies from one individual to the other, depending on their previous (life) experiences, uncertainty tolerance, coping, and personal and professional environment. Four overarching themes emerged: (1) 'Suddenly, I was on my own', (2) 'I was unprepared for the hassle and demands of clinical practice', (3) 'I couldn't make the impact I expected', and (4) 'I had to find a new me'. CONCLUSIONS: A novice physical therapist's transition is a context-related phenomenon, unique for each individual and determined by individual experiences and coping strategies. Novice physical therapists described a feeling of 'faking': they had to pretend to know what they were doing [while treating a patient] while in reality, they felt like they did not. For some novice physical therapists, a primary reason to leave the profession.


Assuntos
Adaptação Psicológica , Fisioterapeutas , Pesquisa Qualitativa , Humanos , Países Baixos , Fisioterapeutas/psicologia , Fisioterapeutas/educação , Incerteza , Feminino , Masculino , Adulto , Prática Privada , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Entrevistas como Assunto
4.
Health Aff (Millwood) ; 43(8): 1082-1089, 2024 08.
Artigo em Inglês | MEDLINE | ID: mdl-39102603

RESUMO

Over the course of the past twenty years, private equity (PE) has played a role in acquiring medical practices, hospitals, and nursing homes. More recently, PE has taken a greater interest in acquiring dental practices, but few data exist about the scope of PE activity within dentistry. We analyzed dentist provider data for the period 2015-21 to examine trends in PE acquisition of dental practices. The percentage of dentists affiliated with PE increased from 6.6 percent in 2015 to 12.8 percent in 2021. During this period, PE affiliation increased particularly among larger dental practices and among dental specialists such as endodontists, oral surgeons, and pediatric dentists. PE-affiliated dental practices were more likely to participate in Medicaid than practices not affiliated with PE. Future research should investigate whether PE's role in dentistry affects the affordability and quality of dental services.


Assuntos
Odontólogos , Humanos , Estados Unidos , Odontólogos/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Setor Privado , Prática Privada/estatística & dados numéricos
6.
Can Med Educ J ; 15(3): 6-17, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39114783

RESUMO

Background: The transition from residency training into practice is associated with increasing risks of litigation, burnout, and stress. Yet, we know very little about how best to prepare graduates for the full scope of independent practice, beyond ensuring clinical competence. Thus, we explored the transition to independent practice (TTP) experiences of recent Obstetrics and Gynaecology graduates to understand potential gaps in their perceived readiness for practice. Methods: Using constructivist grounded theory, we conducted semi-structured interviews with 20 Obstetricians/Gynaecologists who graduated from nine Canadian residency programs within the last five years. Iterative data collection and analysis led to the development of key themes. Results: Five key themes encompassed different practice gaps experienced by participants throughout their transition. These practice gaps fit into five competency domains: providing clinical care, such as managing unfamiliar low-risk ambulatory presentations; navigating logistics, such as triaging referrals; managing administration, such as hiring or firing support staff; reclaiming personhood, such as boundary-setting between work and home; and bearing ultimate responsibility, such as navigating patient complaints. Mitigating factors were found to widen or narrow the extent to which new graduates experienced a practice gap. There was a shared sense among participants that some practice gaps were impossible to resolve during training. Conclusions: Existing practice gaps are multi-dimensional and perhaps not realistically addressed during residency. Instead, TTP mentorship and training opportunities must extend beyond residency to ensure that new graduates are equipped for the full breadth of independent practice.


Contexte: Le passage de la résidence à la pratique est associé à des risques croissants de litiges, d'épuisement professionnel et de stress. Pourtant, nous savons très peu de choses sur la meilleure façon de préparer les diplômés à l'ensemble du champ d'application d'une pratique indépendante, au-delà de veiller à la compétence clinique. Nous avons donc exploré les expériences de transition vers la pratique indépendante de récents diplômés en obstétrique et gynécologie afin de comprendre les lacunes potentielles dans leur perception de leur préparation à la pratique. Méthodes: En utilisant la théorie constructiviste ancrée, nous avons mené des entrevues semi-structurées avec 20 obstétriciens et gynécologues diplômés de neuf programmes de résidence canadiens au cours des cinq dernières années. La collecte et l'analyse itératives des données ont permis de dégager des thèmes clés. Résultats: Cinq thèmes clés englobaient différentes lacunes dans la pratique rencontrées par les participants tout au long de leur transition. Ces lacunes s'inscrivent dans cinq domaines de compétences : la prestation de soins cliniques, comme la gestion de modes de présentation ambulatoires peu familiers et à faible risque; la gestion de la logistique, comme le triage des demandes de consultation; la gestion de l'administration, comme l'embauche ou le licenciement du personnel de soutien; la récupération de l'identité personnelle, comme l'établissement de limites entre le travail et la maison; ainsi que le fait d'assumer la responsabilité ultime, comme la gestion des plaintes des patients. On a constaté que certains facteurs accroissaient ou réduisaient la la perception des nouveaux diplômés d'une lacune dans leur pratique. Les participants étaient tous d'avis qu'il était impossible de combler certaines lacunes dans la pratique au cours de la formation. Conclusions: Les lacunes existantes dans la pratique sont multidimensionnelles et ne peuvent peut-être pas être comblées de manière réaliste pendant la résidence. Les possibilités de mentorat et de formation en ce qui a trait à la transition vers la pratique doivent plutôt s'étendre au-delà de la résidence afin de veiller à ce que les nouveaux diplômés soient préparés à tous les aspects d'une pratique indépendante.


Assuntos
Competência Clínica , Ginecologia , Internato e Residência , Obstetra , Pesquisa Qualitativa , Adulto , Feminino , Humanos , Masculino , Canadá , Teoria Fundamentada , Ginecologia/educação , Entrevistas como Assunto , Obstetra/educação , Obstetra/psicologia , Prática Privada
7.
AJNR Am J Neuroradiol ; 45(9): 1202-1205, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39089874

RESUMO

BACKGROUND AND PURPOSE: The neuroradiology job market is constantly changing along with the skill sets needed by fellowship graduates to participate successfully in the job market. This study aimed to establish a baseline of employer requirements in the neuroradiology job market within the study timeframe. MATERIALS AND METHODS: The American Society of Neuroradiology and American College of Radiology job boards were queried for neuroradiology positions between August 12, 2022, and December 31, 2022. The positions and requirements were categorized into academic versus private practice, general diagnostic radiology, full-subspecialized neuroradiology, hybrid remote/onsite, outpatient, inpatient/emergency, general interventional radiology procedures, and neuroradiology procedures. Exclusion criteria included neurointerventional only, remote-only, pediatric-only, no preference for neuroradiology, and duplicate posts within and between the job boards. RESULTS: Of 1777 total job posts, 179 were neuroradiology-specific and the remainder were general. Of the 179 neuroradiology-specific jobs, 55 neuroradiology jobs were academic and 124 jobs were private practice. A higher proportion of private practice jobs required general diagnostic interpretations (83% versus 26%), a higher proportion of academic jobs required neuroradiology procedures (56% versus 31%), and a higher proportion of private practice jobs required general interventional radiology procedures (22% versus 0%). Thirty-nine percent of all neuroradiology-specific onsite jobs required neuroradiology procedures, and 15% required general interventional radiology procedures. CONCLUSIONS: Because there was a sizable difference between general radiology and procedure requirements between academic and private practice positions, tailoring fellowship training for career aspirations of neuroradiology fellows should be considered to adapt to the skills needed for the evolving job market. In the queried timeframe, 61% of neuroradiology-specific onsite jobs did not have a specific procedure skill requirement for job applicants. This article serves as a single snapshot of the job market and its requirements for neuroradiologists, to aid in planning training to meet the needs of employers.


Assuntos
Neurorradiografia , Humanos , Estados Unidos , Prática Privada , Radiologia/educação , Emprego , Publicidade
8.
JAMA ; 332(11): 871-872, 2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39172475

RESUMO

This Viewpoint explores the shift from fee-for-service to value-based payment models and the resulting trend of physician employment moving away from independent practices toward corporate health institutions.


Assuntos
Prática Privada , Aquisição Baseada em Valor , Humanos , Prática Privada/economia , Prática Privada/estatística & dados numéricos , Prática Privada/tendências , Estados Unidos
9.
Tech Vasc Interv Radiol ; 27(1): 100951, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-39025614

RESUMO

Owning and operating an Office-Based Lab (OBL) creates a unique career, combining the privilege of practicing Interventional Radiology (IR) with the creativity and excitement of running a complex business. No business is more complicated than the American Healthcare system, with a combination of necessary operational systems, government and commercial reimbursement, local and national regulations, an ever-changing landscape, and various patient populations; the business is always shifting. No field is as complex and exciting as Interventional Radiology, with advanced clinical and technical expertise, device development, rocedural ingenuity, and the ability to solve complex medical problems with elegant solutions. A sole owner and operator in an OBL has full autotomy, and thus full responsibility for the medical and business aspects of the practice.


Assuntos
Radiografia Intervencionista , Humanos , Prática Privada , Radiologistas , Radiologia Intervencionista
10.
Tech Vasc Interv Radiol ; 27(1): 100948, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-39025610

RESUMO

The decision to change your career path from a hospital-based practice, whether it's from being a hospital employee or a member of a private practice, can be an emotionally draining choice that is complex and overwhelming to say the least. There are many factors to consider before making this switch, but most importantly, one must realize it may be the hardest but most rewarding work in your career. While the physical, emotional and financial stresses placed on you while developing a practice can be rather demanding, on the flip side, if done correctly and the practice thrives, it can be a change that will bring you great pride and satisfaction, as well as personal reward and freedom.


Assuntos
Satisfação no Emprego , Humanos , Atitude do Pessoal de Saúde , Escolha da Profissão , Mobilidade Ocupacional , Emoções , Prática Privada , Radiografia Intervencionista , Radiologistas/psicologia
11.
Ann Fam Med ; 22(4): 347-349, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39038975

RESUMO

Over the past century, family physicians have moved from small independently owned practices, many of them solo, to being employed by large hospital systems, corporate entities, or health systems. Today, almost three-quarters of all physicians are employed and the highest percentage of employed physicians are family physicians.This essay contrasts the elements of independent practice with employed practice as part of what has been lost in the past half century, but what might be regained if physicians demanded more autonomy and control over their practices.


Assuntos
Medicina de Família e Comunidade , Atenção Primária à Saúde , Humanos , Médicos de Família , Autonomia Profissional , Estados Unidos , Prática Privada , História do Século XX
12.
Artigo em Inglês | MEDLINE | ID: mdl-39058643

RESUMO

BACKGROUND: Nail excisions are indicated for onychocryptosis and nail spicules. They are technically demanding and require a refined skill set. We aimed to characterize practice patterns of US providers performing nail excisions. METHODS: We conducted a retrospective analysis of Medicare provider use and payment data, part D, for all claims of partial or complete nail/nail matrix excision with/without nail plate removal/destruction (current procedural terminology code 11750). High performers were defined as providers performing annual nail excisions 2 standard deviations above the mean. We analyzed demographic risk factors for nail excision high performers, including practice location, years of experience, household median income, practice type, and provider gender. Statistical analysis was conducted in SAS v9.4, with values of P < .05 considered statistically significant. RESULTS: Providers (n = 32,279) and high performers (n = 942) performed mean 34.7 and 173 nail excisions annually. Unsurprisingly, podiatrists constituted 99.7% of all nail excision performers. Providers in the South versus Midwest and Northeast were more often nail excision high performers (odds ratio [OR], 1.95; P < .0001, and OR, 1.46; P < .0001). Solo versus group practitioners were more likely, respectively, to be nail excision high performers (OR, 2.15; P < .0001). With linear regression analysis, for every 10-year increase in years of provider experience, there was an increase of 1.2 nail excisions annually per provider (P < .0001). For every $100,000 increase in household median income of practice location, there was a decrease of 9.9 nail excisions annually per provider. CONCLUSIONS: Southern podiatrists, podiatrists with more years of experience, solo practitioners, and those practicing in regions with lower household median incomes were more likely to perform higher numbers of nail excisions. Identifying performance trends among podiatrists can help podiatrists understand how their performance of nail excisions compares to other podiatrists across the country.


Assuntos
Podiatria , Prática Privada , Humanos , Estudos Retrospectivos , Masculino , Feminino , Estados Unidos , Prática Privada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Unhas/cirurgia , Medicare , Unhas Encravadas/cirurgia , Competência Clínica
13.
Viruses ; 16(6)2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38932179

RESUMO

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol.


Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Humanos , Feminino , México , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Técnicas de Diagnóstico Molecular/métodos , Teste de Papanicolaou/métodos , Biomarcadores Tumorais , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Inibidor p16 de Quinase Dependente de Ciclina/genética , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Esfregaço Vaginal , Colposcopia , Ginecologia , Adulto , Pessoa de Meia-Idade , Antígeno Ki-67/metabolismo , Antígeno Ki-67/análise , Reação em Cadeia da Polimerase/métodos , Detecção Precoce de Câncer/métodos , Prática Privada
14.
J Prim Health Care ; 16(2): 143-150, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38941259

RESUMO

Introduction Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-to-face semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.


Assuntos
Prática Privada , Pesquisa Qualitativa , Humanos , Nova Zelândia , Prática Privada/organização & administração , Masculino , Feminino , Fisioterapeutas/psicologia , Adulto , Entrevistas como Assunto , Profissionalismo , Atitude do Pessoal de Saúde , Atenção Primária à Saúde/organização & administração , Pessoa de Meia-Idade , Confiança , Comportamento Cooperativo , Cultura Organizacional , Modalidades de Fisioterapia/organização & administração , Comportamento Competitivo
15.
Physiotherapy ; 124: 40-50, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-38870621

RESUMO

AIM: To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business. DESIGN: A hermeneutic phenomenological approach. PARTICIPANTS: Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. METHODS: In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed. RESULTS: Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff. CONCLUSIONS: Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER.


Assuntos
Fisioterapeutas , Humanos , Reino Unido , Fisioterapeutas/psicologia , Feminino , Prática Privada , Hermenêutica , Masculino , Adulto , Pesquisa Qualitativa , Propriedade
16.
Physiotherapy ; 124: 116-125, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-38878590

RESUMO

OBJECTIVES: To determine the prevalence of metabolic syndrome in clients presenting for primary care physiotherapy within private practice settings, and the factors that may be associated with metabolic syndrome. The secondary aim was to determine client's attitudes towards lifestyle change. DESIGN: A cross-sectional study in which self-report and biometric data were collected. The study was conducted in physiotherapy private practices across metropolitan and regional areas, Australia. PARTICIPANTS: 230 clients (mean age 54 (SD18) years, 64% women) presenting for physiotherapy participated. MAIN OUTCOME MEASURES: Participant socio-demographic and lifestyle characteristics were collected. Metabolic syndrome presence was determined by the existence of three or more risk factors on physical examination and capillary blood sample: abdominal obesity, hypertension, elevated random blood glucose, elevated triglycerides and/or reduced HDL cholesterol. RESULTS: Thirty-seven percent of participants had metabolic syndrome, but none knew they had it. Metabolic syndrome was associated with older age and poorer socio-economic status and may have been associated with lower levels of physical activity but not diet. Of those identified as having hypertension and elevated triglycerides, many were undiagnosed (56% and 29% respectively). CONCLUSION: Metabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy. Clients felt lifestyle change was important and they were willing to make changes. This study highlights the need for greater screening of metabolic risk factors in primary care and presents an opportunity for physiotherapists in private practice to identify risk and intervene to improve the overall health of their clients and contribute to chronic disease prevention. CONTRIBUTION OF THE PAPER.


Assuntos
Síndrome Metabólica , Prática Privada , Humanos , Síndrome Metabólica/epidemiologia , Estudos Transversais , Feminino , Pessoa de Meia-Idade , Masculino , Prevalência , Adulto , Idoso , Estilo de Vida , Modalidades de Fisioterapia , Fatores de Risco , Austrália , Atenção Primária à Saúde
17.
Sante Publique ; 36(2): 69-77, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38834526

RESUMO

INTRODUCTION: Demand for dental care in Basse-Normandie has been severely affected by the reduced availability of local services. One of the missions of hospital dental services is to respond to these difficulties in accessing care. PURPOSE OF THE RESEARCH: The objective of this study is to determine how hospital activity fits into the local dental care offer. To do this, we compared the activity of the dental service of the Caen hospital with that of private practices. RESULTS: The proportion of young patients, particularly those under fifteen, was greater at the university hospital than in private practice (20.9 percent vs 12.9 percent, p < 1.10 -5). The activity of private practices included a higher proportion of fixed prosthetic care and oral prophylaxis procedures, in contrast to surgical procedures, direct restorative care, and consultations, which account for a higher proportion of hospital activity (10 percent vs 22.5 percent, p < 1.10-5). CONCLUSIONS: The dental service at Caen hospital differs from private practices in Basse-Normandie in that its activity is oriented toward primary care or emergency care. This activity seems to reflect a high individual caries risk, probably associated with social vulnerability. The unit therefore seems to respond to a need for primary care.


Assuntos
Unidade Hospitalar de Odontologia , Humanos , Adulto , Adolescente , Feminino , Masculino , França , Adulto Jovem , Criança , Pessoa de Meia-Idade , Idoso , Pré-Escolar , Prática Privada , Área Carente de Assistência Médica
18.
J Dent Educ ; 88(8): 1029-1039, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38741343

RESUMO

AIMS: In the literature, it is still unclear if the decisions for selecting the type of implant crown-retaining system are based on scientific-based research or if the Universities' choices, Implant marketing trends, or finances could have a major influence on the private dentists' decisions. OBJECTIVES: Therefore, this study aimed to evaluate the crown-retaining system (cement- or screw-retained) used in dental schools and private dental practices. METHODS: A 13-item questionnaire was sent to Canadian dental schools (n = 10) and dental offices in London (n = 298), Canada. The questionnaire included demographic questions and questions to reveal the dentists' perspectives on prosthetic implant treatment between the two-retaining systems. Results were analyzed using descriptive statistics and multinomial logistic regression (p = 0.05). RESULTS: Twenty-four private dentists and five dental schools responded to the survey - 62.5% of private practitioners and 60% of universities reported using both systems. A trend was observed in using screw-retained systems by dentists who graduated 5-10 years ago. Straumann, Astra, and Nobel Biocare were the private practices and dental schools' preferred implant systems. The use of platform switching for all cases was selected by 54.2% of the private practitioners and 40% of the dental schools. Resin cement was the private practice's preferred cementation method; the dental schools used glass ionomer and zinc phosphate cement. The multinomial logistic regressions showed no statistical difference between the crown-retaining system chosen and the decision factors. The laboratory technician's recommendations and cost influenced the decision-making process for private dentists. For the universities, perio-restorative outcome, implant position, survival rates, institute preferences, and evidence-based research influenced the crown-retaining system's decision-making process.  CONCLUSION: The Canadian dental schools and private practice reported using both screw- and cement-retaining systems. However, there was a difference in the selection criteria as the universities showed a tendency towards a more research-based approach in their decision, while for the private practices, the technicians' recommendations and cost played a major role in the decision process. It was noted that the implant systems preconized by the Universities were observed to be used in private practices.


Assuntos
Prótese Dentária Fixada por Implante , Educação em Odontologia , Padrões de Prática Odontológica , Prática Privada , Faculdades de Odontologia , Humanos , Padrões de Prática Odontológica/estatística & dados numéricos , Coroas , Inquéritos e Questionários , Retenção em Prótese Dentária , Canadá , Cimentos Dentários , Implantes Dentários
19.
J Oral Maxillofac Surg ; 82(8): 895-901, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38750658

RESUMO

BACKGROUND: The safety of the anesthesia team model performed in oral and maxillofacial surgery (OMS) offices has been criticized by professional and mainstream media. PURPOSE: This study aims to assess the incidence of adverse anesthetic events (AEs) associated with the OMS anesthesia team model and identify risk factors associated with AEs. STUDY DESIGN, SETTING, SAMPLE: This was a retrospective cohort study utilizing a patient database from Paradigm Oral Health, Lincoln, Nebraska, a managed service organization (MSO). Subjects included were 14 and older, undergoing open-airway intravenous anesthesia for ambulatory OMS procedures using the OMS anesthesia team model at multiple private practices in the MSO network between June 30, 2010, and September 30, 2022. Exclusion criteria included patients younger than 14 or patients with incomplete medical records. PREDICTOR VARIABLE: Primary predictor variables were age, sex, American Society of Anesthesiologists physical status classification system (ASA) score, type of surgical procedure performed, and the types of medications administered during sedation. MAIN OUTCOME VARIABLE(S): The presence of an AE. The definition of an AE was modeled on the World Society of Intravenous Anesthesia definition. All AEs were identified through surrogate markers, which were identified through chart review. One example of an AE is ventricular fibrillation, which necessitates the application of medications; here the medication is the surrogate marker. COVARIATES: None. ANALYSES: The data were analyzed using t-tests and χ2 tests. P values ≤ .05 were considered statistically significant. RESULTS: Included in the study were 61,237 sedation cases (53.87% female and 46.13% male), for 56,076 unique patients ranging from 14 to 98 years of age (mean 33.26 ± 18.35). An AE incidence of 3 per 100,000 per year (25 total events) was observed. Neither age, sex, ASA score, nor type of surgical procedure exhibited statistically significant associations with AEs. A statistically significant association was found between AEs and fentanyl (P = .0008). CONCLUSION AND RELEVANCE: This investigation shows a smaller incidence of AEs than previous studies of the OMS anesthesia team model.


Assuntos
Procedimentos Cirúrgicos Bucais , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Incidência , Adolescente , Idoso , Prática Privada , Anestesia Dentária/efeitos adversos , Adulto Jovem , Fatores de Risco , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Idoso de 80 Anos ou mais
20.
Artigo em Inglês | MEDLINE | ID: mdl-38765518

RESUMO

Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.


Assuntos
Obstetrícia , Padrões de Prática Médica , Nascimento Prematuro , Humanos , Estudos Transversais , Feminino , Nascimento Prematuro/prevenção & controle , Adulto , Gravidez , Padrões de Prática Médica/estatística & dados numéricos , Masculino , Prática Privada , Pessoa de Meia-Idade , Inquéritos e Questionários
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