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Sample records for emergency referrals safer

  1. Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

    PubMed Central

    2010-01-01

    Background Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care trial will provide

  2. Consultation and referral patterns from a teaching hospital emergency department.

    PubMed

    Cortazzo, J M; Guertler, A T; Rice, M M

    1993-09-01

    The objective of this study was to describe consultation and referral patterns from a military emergency department (ED). The design of the study consisted of a prospective analysis of consultations and referrals from Madigan Army Medical Center ED during April 1990, an Army Medical Center with multiple residencies, including emergency medicine (EM). Patient population included active and retired military personnel, their families, and civilian emergency medical system-transported patients. ED visits averaged 60,000 per year. The overall rate of consultation and referral was 39.9%; 10.7% were consultations, whereas 29.2% were referrals. PGY-2 and -3 EM residents consultation rates were higher than average. Of all ED visits, 19.7% resulted in consultations or referrals to surgical services, 13.6% to medical services, and 2.8% to pediatrics. ED patients frequently are referred to or result in consultations with non-EM physicians. Differences in consultation by level of training and the impact of consultation on consulting services both deserve further investigation. Review of EM resident use of consultation and referral may focus evaluation of ED care in teaching hospitals. PMID:8395848

  3. SAFER - Services and Applications For the Emergency Response: en route for a safer world with the GMES operational services

    NASA Astrophysics Data System (ADS)

    Denis, G.; Hello, D.

    2009-04-01

    In the frame of GMES, SAFER prepares the implementation of operational versions of the Emergency Response Core Service. SAFER is a large integrated project which has been selected by the European Commission (FP7 call GMES). SAFER will reinforce European capacity to respond to emergency situations: fires, floods, earthquakes, volcanic eruptions, landslides, humanitarian crisis. The main goal of SAFER is the upgrade of the service and the validation of its performance with 2 priorities: - First priority is the improvement of response when crisis occurs, with the rapid mapping capacity after disastrous events, including the relevant preparatory services. For validation purposes, the project will deliver services at full scale for real events or during exercises. The main performance criterion is the response time. - The second priority is the extension to core service components before and after the crisis. It targets the longer term service evolution, through the provision of thematic products, to be added in the portfolio of services. The main performance criterion is the added-value of products with risk-specific information. Coordinated by Infoterra, the consortium is built around a core team of European service providers. A wide network of scientific partners and service providers will extend the European dimension. The presentation will highlight: - The heritage and foundations. - The expected contribution to the implementation of the operational Emergency Response Core Service. - The key challenges to move from the research and development and project-driven logic to the sustainable operations. - The possible synergies with other services.

  4. Adherence to Referral Criteria for Burns in the Emergency Department

    PubMed Central

    Chipp, Elizabeth; Walton, Jules; Gorman, David; Moiemen, Naiem S

    2008-01-01

    Objective: To audit the referral patterns of burns in an emergency department compared with national referral guidelines. Methods: A retrospective case note audit of patients attending an emergency department with a diagnosis of “burn” in a 1-year period. Results: Only one quarter of the patients were managed according to the suggested national referral criteria for burns. Large and full thickness burns were managed appropriately but those at important anatomical sites and in patients at the extremes of age were managed less well. Conclusion: Increased awareness of the national referral guidelines, along with further education of staff within this department, may improve management of burn injuries. It is likely that referral patterns are similar in other emergency departments and may be improved by training staff in the assessment and management of burns. Increased adherence to the guidelines is likely to improve patient outcome at the expense of increased patient numbers and workloads in regional burns units that have implications for funding and service provision. PMID:18536778

  5. Understanding the Impact of Residents' Interpersonal Relationships During Emergency Department Referrals and Consultations

    PubMed Central

    Chan, Teresa; Sabir, Kameron; Sanhan, Sarila; Sherbino, Jonathan

    2013-01-01

    Background Communicating with colleagues is a key physician competency. Yet few studies have sought to uncover the complex nature of relationships between referring and consulting physicians, which may be affected by the inherent relationships between the participants. Objective Our study examines themes identified from discussions about communications and the role of relationships during the referral-consultation process. Methods From March to September 2010, 30 residents (10 emergency medicine, 10 general surgery, 10 internal medicine) were interviewed using a semistructured focus group protocol. Two investigators independently reviewed the transcripts using inductive methods and grounded theory to generate themes (using codes for ease of analysis) until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. Measures for ensuring trustworthiness of the analysis included generating an audit trail and external auditing of the material by investigators not involved with the initial analysis. Results Two main relationship-related themes affected the referral-consultation process: familiarity and trust. Various subthemes were further delineated and studied in the context of pertinent literature. Conclusions Relationships between physicians have a powerful influence on the emergency department referral-consultation dynamic. The emergency department referral-consultation may be significantly altered by the familiarity and perceived trustworthiness of the referring and consulting physicians. Our proposed framework may further inform and improve instructional methods for teaching interpersonal communication. Most importantly, it may help junior learners understand inherent difficulties they may encounter during the referral process between emergency and consulting physicians. PMID:24455004

  6. Quality improvement in emergency obstetric referrals: qualitative study of provider perspectives in Assin North district, Ghana

    PubMed Central

    Afari, Henrietta; Hirschhorn, Lisa R; Michaelis, Annie; Barker, Pierre; Sodzi-Tettey, Sodzi

    2014-01-01

    Objective To describe healthcare worker (HCW)-identified system-based bottlenecks and the value of local engagement in designing strategies to improve referral processes related to emergency obstetric care in rural Ghana. Design Qualitative study using semistructured interviews of participants to obtain provider narratives. Setting Referral systems in obstetrics in Assin North Municipal Assembly, a rural district in Ghana. This included one district hospital, six health centres and four local health posts. This work was embedded in an ongoing quality improvement project in the district addressing barriers to existing referral protocols to lessen delays. Participants 18 HCWs (8 midwives, 4 community health officers, 3 medical assistants, 2 emergency room nurses, 1 doctor) at different facility levels within the district. Results We identified important gaps in referral processes in Assin North, with the most commonly noted including recognising danger signs, alerting receiving units, accompanying critically ill patients, documenting referral cases and giving and obtaining feedback on referred cases. Main root causes identified by providers were in four domains: (1) transportation, (2) communication, (3) clinical skills and management and (4) standards of care and monitoring, and suggested interventions that target these barriers. Mapping these challenges allowed for better understanding of next steps for developing comprehensive, evidence-based solutions to identified referral gaps within the district. Conclusions Providers are an important source of information on local referral delays and in the development of approaches to improvement responsive to these gaps. Better engagement of HCWs can help to identify and evaluate high-impact holistic interventions to address faulty referral systems which result in poor maternal outcomes in resource-poor settings. These perspectives need to be integrated with patient and community perspectives. PMID:24833695

  7. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India - A Systematic Review.

    PubMed

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M; Mathew, Manu; Murthy, G V S

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  8. It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians

    PubMed Central

    Lawrence, Sean; Spencer, Lyndall M.; Sinnott, Michael; Eley, Robert

    2015-01-01

    Background The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. Methods To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used. Results All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication. Conclusion Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the

  9. The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

    PubMed Central

    Hussein, Julia; Kanguru, Lovney; Astin, Margaret; Munjanja, Stephen

    2012-01-01

    Background Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made. Methods and findings Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis. Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained. Conclusions Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects

  10. Emergency Department Referral Process and Subsequent Use of Safety-Net Clinics.

    PubMed

    Ruben, Kathleen; Mortensen, Karoline; Eldridge, Barbara

    2015-10-01

    We analyzed data on 10,761 low-income emergency department (ED) patients participating in the Emergency Department-Primary Care Connect program to identify successful methods of disseminating information on availability of primary care clinics. Data were obtained from all five hospitals in Montgomery County, Maryland, four participating county clinics, and from patient navigators. A two-part negative binomial model estimated factors associated with the probability of a clinic visit following a referral, and factors associated with the frequency of subsequent clinic visits. Twenty-one percent of patients had a subsequent clinic visit, and two-thirds of these patients returned for a second clinic visit. Patients were more likely to make the initial clinic visit if the referral was made by both the ED Provider and the patient navigator, relative to referral by the ED provider only. ED providers and patient navigators helped patients gain access to primary care services by referring them to safety-net clinics. PMID:25236770

  11. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    PubMed Central

    Ryoo, Hyeon-Ju; Choo, Esther K.

    2016-01-01

    Introduction Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02–1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15–1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17–1.43]). This significant association prevailed after controlling for “seeking detox.” Conclusion Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes. PMID:27330662

  12. Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

    PubMed Central

    Okafor, II; Arinze-Onyia, SU; Ohayi, SAR; Onyekpa, JI; Ugwu, EO

    2015-01-01

    Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before

  13. Barriers to knowledge sharing in Chinese healthcare referral services: an emergent theoretical model

    PubMed Central

    Nunes, Miguel Baptista

    2016-01-01

    Background This paper reports on a research study that aims to identify and explain barriers to knowledge sharing (KS) in the provision of healthcare referral services in Chinese healthcare organisations. Design An inductive case study approach was employed, in which 24 healthcare professionals and workers from four healthcare organisations in the province of Hubei, Central China, were interviewed using semi-structured scripts. Results Through data analysis, 14 KS barriers emerged in four main themes: interpersonal trust barriers, communication barriers, management and leadership barriers, and inter-institutional barriers. A cause–consequence analysis of the identified barriers revealed that three of them are at the core of the majority of problems, namely, the absence of national and local policies for inter-hospital KS, lack of a specific hospital KS requirement, and lack of mutual acquaintance. Conclusions To resolve KS problems, it is of great importance that healthcare governance agencies, both at the national and regional levels, take leadership in the process of KS implementation by establishing specific and strong policies for inter-institutional KS in the referral process. This paper raises important issues that exceed academic interests and are important to healthcare professionals, hospital managers, and Information communication technology (ICT) managers in hospitals, as well as healthcare politicians and policy makers. PMID:26895146

  14. The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department

    PubMed Central

    Vaca, Federico E.; Winn, Diane

    2007-01-01

    Nearly eight million emergency department (ED) visits are attributed to alcohol every year in the United States. A substantial proportion is due to trauma. In 2005, 16,885 people were killed as a result of alcohol-related motor vehicle crashes. Patients with alcohol-use problems (AUPs) are not only more likely to drive after drinking but are also at greater risk for serious alcohol-related illness and injury. Emergency departments have an important and unique opportunity to identify these patients and intervene during the “teachable moment” of an ED visit. The American College of Emergency Physicians, Emergency Nurses Association, American College of Surgeons-Committee on Trauma, American Public Health Association, and the National Highway Traffic Safety Administration, have identified Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) as a pivotal injury- and illness-prevention strategy to improve the health and well-being of ED patients. We provide a general overview of the basis and need for integrating SBIRT into EDs. Models of SBIRT, as well as benefits and challenges to its implementation, are also discussed. PMID:19561690

  15. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India – A Systematic Review

    PubMed Central

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M.; Mathew, Manu; Murthy, G. V. S.

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  16. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

    PubMed

    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere. PMID:25833654

  17. Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

    PubMed Central

    Raj, Sunil Saksena; Manthri, Suneedh; Sahoo, Pratap Kumar

    2015-01-01

    Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion: The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major

  18. Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: contextualizing the choice to stay at home.

    PubMed

    Berry, Nicole S

    2006-04-01

    Maternal mortality is highest in those countries whose health budgets are restricted. Practical strategies employed in the International Safe Motherhood Initiative, therefore, must be both effective and economical. Investing in emergency obstetric care resources has been touted as one such strategy. This investment aims to insure significant improvements are made in regional health centers, and a chain of referral is put into place so that only problem cases are attended by the most skilled health workers. This article examines how this model of referral functions in Sololá, Guatemala, where most Kaqchikel Mayan women give birth at home with a traditional midwife, and no skilled biomedical attendant is available at the birth to make a referral. Ethnographic data is used to explore reasons why women do not go to the hospital at the first sign of difficulty. I argue that the problem frequently is not that Mayan midwives, their clients and families fail to understand the biomedical information about dangers in birth, but rather that this information fails to fit into an already existing social system of understanding birth and birth-related knowledge. PMID:16225975

  19. DESIGN OF NIDA CTN PROTOCOL 0047: SCREENING, MOTIVATIONAL ASSESSMENT, REFERRAL, AND TREATMENT IN EMERGENCY DEPARTMENTS (SMART-ED)

    PubMed Central

    Donovan, Dennis M.; Adinoff, Bryon; Crandall, Cameron; Forcehimes, Alyssa A.; Lindblad, Robert; Mandler, Raul N.; Oden, Neal; Perl, Harold I.; Walker, Robrina

    2011-01-01

    Background Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) models have been extensively studied and are considered effective for individuals with alcohol problems presenting in emergency departments and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs. Objectives This paper describes the design of a NIDA Clinical Trials Network protocol testing the efficacy of an SBIRT model in medical EDs, highlighting considerations that that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings. Methods The protocol is described, and critical design decisions are discussed. Results Design challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis. Conclusion Many of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings. Scientific Significance Optimal trial design is critical to determining how best to integrate substance abuse interventions into medical care. PMID:21854285

  20. Safer Bridges

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Safer bridges are among a number of spinoff benefits from NASA procedures for testing 'cfracture toughness" of a structural part, meaning its ability to -siscracktsh at might cause failure. The New River Bridge in West Virginia, shown under construction, is the world's largest single span bridge. U.S. Steel fracture toughness requirements for such bridges include NASA-developed test procedures. Bridge materials and other metal structures may develop flaws during their service lifetimes. Such flaws can affect the structural integrity of the part. Thus, it is important to know the "fracture toughness" of a structural part, or its ability to resist cracks. NASA has long experience in developing fracture toughness tests for aerospace hardware. Since 1960, NASA-Lewis has worked closely with the American Society for Testing & Materials. Lewis and NASA-funded industrial contractors have made many important contributions to test procedures, now recommended by ASTM, for measuring fracture toughness.

  1. Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

    PubMed

    Berge, T I

    1992-02-01

    A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated. PMID:1533083

  2. Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Lakshmi, P. V. M.; Mokashi, Tushar; Aggarwal, Arun Kumar; Kaur, Manmeet; Reddy, K. Rahul; Kumar, Rajesh

    2014-01-01

    Background Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. Methods Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. Results On an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled. Conclusion Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system. PMID:25360798

  3. Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy

    PubMed Central

    Toffanin, Roberto; Rigon, S; Sandonà, P; Carrara, T; Damiani, G; Baldo, V

    2016-01-01

    Background A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED. Methods This was an observational retrospective cohort study based on data collected in 2011 by the local health authority No. 4 in the Veneto Region (Italy). After distinguishing between patients contacting the OOH service who were or were not referred to the ED, and checking for patients actually presenting to the ED within 24 hours thereafter, these patients’ medical management was judged as potentially appropriate or inappropriate. Results The analysis considered 22 662 OOH service contacts recorded in 2011. The cases of potentially inappropriate non-referral to the ED were 392 (1.7% of all contacts), as opposed to 1207 potentially inappropriate referrals (5.3% of all contacts). Age, nationality, type of disease and type of intervention by the OOH service were the main variables associated with the appropriateness of patient management. Conclusions These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management by OOH services and thus contribute to improving the deployment of healthcare and the quality of care delivered by OOH services. PMID:27503862

  4. Quality of emergency medical care in Gondar University Referral Hospital, Northwest Ethiopia: a survey of patients’ perspectives

    PubMed Central

    2014-01-01

    Background Ethiopia has fairly good coverage but very low utilization of health care services. Emergency medical care services require fast, correct and curious services to clients as they present with acute problems. In Ethiopia and Gondar in particular, the quality of emergency medical care has not been studied. The main aim of this study was to assess the disease profile and patients’ satisfaction in Gondar University Referral Hospital (GURH). Methods A facility based cross-sectional study was conducted among patients visiting GURH for emergency care. Ethical clearance was obtained from the Institutional Review Board of University of Gondar. Patients were selected by systematic random sampling, using patient flow list in the day and night emergency services. Data were collected using a standard Press Ganey questionnaire by BSc health science graduates. Data were entered in to Epi Info 3.5.3 software and exported to SPSS version 20.0 for windows for analysis. Results A total of 963 patients (response rate = 96.8%) were studied. The mean (+ s.d.) age of patients was 28.4 (+17.9) years. The overall satisfaction using the mean score indicates that 498 (51.7%) 95%CI: (48.4% - 54.9%) were satisfied with the service, the providers and the facility suitability whereas 465(48.3%) 95%CI: (45.1%- 51.6%) were not satisfied. Seven hundred and six (73.3%) 95%CI: 70.4%-76.1%, patients reported that they have been discriminated or treated badly during the service provision in the hospital. OPD site visited (p < 0.0001), visiting days of the week (P < 0.049), medical condition on arrival (P < 0.0001), degree of confidence in the hospital (AOR = 1.9, 95%CI: 1.1, 3.1), reported discrimination/bad treatment of patients with service (AOR = 0.4, 95%CI: 0.2, 0.7), were significantly associated determinants of patient satisfaction. Conclusions Non-communicable disease emergencies like injuries and cardiovascular diseases are common. There is a low level of

  5. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital.

    PubMed

    Howell, A; Parker, S; Tsitskaris, K; Oddy, M J

    2016-01-01

    Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay. PMID:26688397

  6. The epidemiology and type of injuries seen at the accident and emergency unit of a Nigerian referral center

    PubMed Central

    Adoga, Adeyi A.; Ozoilo, Kenneth N.

    2014-01-01

    Background: A plethora of injuries present at any accident and emergency unit, but the pattern of the injuries varies from region to region especially in ours with the increased ethno-religious clashes and terrorist attacks. This study aims to determine the epidemiology and type of injuries presenting to our center with the possibility of developing injury surveillance initiatives in our center and Nigeria as a whole. Materials and Methods: Injured patients consecutively presenting to the accident and emergency department of the Jos University Teaching Hospital within the period February 2011 to January 2012 were prospectively recorded. Results: A total of 720 injured patients admitted with an age range of 8 months to 75 years (mean = 37.9; SD = ±52.4), which consists of 544 males and 176 females giving a male to female ratio of 3.1:1. Patients aged 20-29 years were in the majority (n = 220, 30.6%) with peak incidences in the period of communal clashes. Injuries sustained from motorcycles were the highest (n = 248, 34.4%). Others were 160 (22.2%) in other vehicular and pedestrian injuries, machete (n = 128), gunshots (n = 92), burns (n = 36), bomb blast injuries (n = 16), fall from heights (n = 32) and miscellaneous (n = 8). Injuries sustained in communal clashes and terrorist attacks accounted for 236 (32.8%) presentations. The most common site of injury was the head (n = 30 4, 42.2%). Relatives, passersby and law enforcement agencies brought patients to the hospital with times between injury and presentation ranging from 1 h to 3 weeks. 40 (5.6%) patients were brought in dead. Conclusion: A collective effort - on the part of the government and the citizenry is required to ensure better outcomes and a safer society for all. PMID:24812451

  7. Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

    PubMed Central

    de Lusignan, Simon; Chan, Tom; Tejerina Arreal, Maria C.; Parry, Glenys; Dent-Brown, Kim; Kendrick, Tony

    2013-01-01

    Background Referral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known. Method Routinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence. Results Overall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference −0.21, p = 0.003). Conclusions Referral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance. PMID:23639304

  8. Barriers to referral for elevated blood pressure in the emergency department and differences between provider-type

    PubMed Central

    Souffront, Kimberly; Chyun, Deborah; Kovner, Christine

    2015-01-01

    A multidisciplinary sample of ED providers across the United States (n = 450) were surveyed to identify barriers to referral for elevated blood pressure (BP) in the ED and differences between provider-type. RNs reported less knowledge of Stage I HTN (p = .043) and Pre-HTN (p<.01); were less aware of definitions for HTN (p<.001); reported more difficulty caring for patients who are asymptomatic (p = .007); required financial compensation to refer (p = .048); and perceived BP referrals are influenced by the medical director (p<.001). MDs reported more skills to refer (p = .008) and time as a barrier (p = .038); PAs were more likely to report patients are not aware of health benefits (p = .035) and doubted their concern for their BP (p = .023); and felt emotionally uncomfortable when referring (p = .025). Despite these differences, there was no significant difference between provider-type and referral. PMID:25582763

  9. Refusing to Be Excluded: Finding Ways of Integrating Psychotherapeutic Modalities to the Emerging Needs of a Pupil Referral Unit

    ERIC Educational Resources Information Center

    Malberg, Norka T.

    2008-01-01

    This paper describes the application of child psychotherapy, its theory and practice, in a Pupil Referral Unit (PRU). It examines the importance of a flexible approach to outreach work and the implementation of interventions that take into consideration both the internal and the external world of the adolescent. Furthermore, the process of…

  10. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    PubMed Central

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  11. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    PubMed

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  12. Beware the Emergency Ankle Fracture Referral: An Unusual Case of Lateral Subtalar Joint Dislocation Secondary to Calcaneal Fracture with associated Lateral Malleolus Fracture

    PubMed Central

    Colegate-Stone, TJ; James, SE; Koka, SR

    2015-01-01

    Introduction: The referral of a lateral malleolus fracture is one of the commonest orthopaedic trauma presentations. Failure to fully assess the patient and radiography can lead to missing associated injuries in the hindfoot. Case Report: We describe an unusual hindfoot injury with an atypical combination of lateral subtalar dislocation and calcaneal fracture with associated lateral malleolus fracture that was initially not appreciated by the referring emergency department. This case is of particular interest as subtalar dislocation is a rare injury and lateral subtalar dislocation is even rarer. Conclusion: Failure to fully assess such injuries and manage non-operatively leads to early degenerative tibia-talar, hindfoot and midfoot changes and a difficult situation for the surgeon to salvage. We advocate early CT scan and open reduction with fixation for such cases. PMID:27299009

  13. SAFER Rescue System Tested

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red strip on suit) test the new Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles above Earth. The pair was actually performing an in-space rehearsal or demonstration of a contingency rescue using never-before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee anchored to the Space Shuttle Discovery's Remote Manipulator System (RMS) robot arm, took turns using the SAFER hardware during their shared space walk.

  14. Emergency room referral to internal medicine wards or to coronary care units of patients with first acute myocardial infarction. Israel Study Group on First Acute Myocardial Infarction.

    PubMed

    Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A

    2000-01-01

    The objective of the study was to assess factors associated with ward assignment in the emergency room for patients < or = 65 years old with first acute myocardial infarction. We analysed uni- and multivariate predictors for ward assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a < 10% chance when there were 0-3 risk factors. Exclusion of patients with thrombolysis had no effect on the results. The shortage of cardiac care unit beds apparently leads to emergency room selection acting in detriment of patients with poorest prognoses. Clear guidelines for decision making in the emergency room are needed to resolve this paradoxical situation. PMID:10998758

  15. Safer Head Start Playgrounds.

    ERIC Educational Resources Information Center

    Cunningham, Gayle; Hendricks, Charlotte

    1996-01-01

    Argues that there are three areas to evaluate when creating safer playgrounds for children: environment, supervision, and education. Discusses the importance of safe and properly installed equipment, resilient surfacing, removal of hazards, proper maintenance, appropriate adult-to-child ratio, and enforcement of proper playground safety and injury…

  16. [Negotiating safer sex].

    PubMed

    Gordon, G; Charnock, D

    1991-01-01

    Women have generally assumed responsibility for contraception since the appearance of oral contraceptives and IUDs. But AIDS prevention programs are now asking women to assume responsibility for safer sex through use of condoms, a male method. Women are being asked to carry condoms, to negotiate their use each time they have sex, and to insist if the partner resists. The problem with this strategy is that frequently it is the male partner who makes sexual decisions, and women have less negotiating power. Women are considered feminine if they assume a passive role in sexual activity. This work suggests strategies to improve the negotiating power of women. Options and problems of speaking about safer sex vary in accordance with the nature of the relationship. A woman with a new partner can try to ascertain his sexual history, but may gain no information on his probable health even if he tells her the truth. It may be easier to convince him to use a condom at least in the beginning of the romance. Women working in the sex industry often have greater trouble convincing their friends and lovers to use a condom than their clients. Some family planning workers have begun to speak of safer sex with all their clients. Role playing and workshops or discussions with small groups of women having similar problems may help women overcome their reticence about discussing sexual topics. Some general suggestions to help women negotiate safer sex include choosing an opportune moment and planning in advance what to say; daring to speak directly without beating around the bush (the partner may also be gathering courage to speak); practicing placing condoms on objects and if necessary placing one on the partner without speaking; being honest with the partner about sex, love, and fidelity; and remembering that protection from condoms is mutual given that it is not possible to know who is infected. Until now, programs to help women practice safer sex have concentrated on sex industry

  17. Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

    PubMed Central

    Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

    2016-01-01

    Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. PMID:27324707

  18. Incidence, aetiology and mortality secondary to hypertensive emergencies in a large-scale referral centre in Israel (1991-2010).

    PubMed

    Leiba, A; Cohen-Arazi, O; Mendel, L; Holtzman, E J; Grossman, E

    2016-08-01

    Hypertensive emergency (HE) is a life-threatening condition that requires immediate blood pressure (BP) reduction. Although it has been on the decline, the incidence of HE has recently increased in a few countries. The aim of the present retrospective study was to evaluate the incidence, aetiology and 1-year mortality of HE in a large medical centre over a 20-year period (1991-2010). The electronic medical records of all patient files who were hospitalized in the Chaim Sheba Medical Center in Israel from 1991 to 2010 with a primary diagnosis (at admission or discharge) of Malignant Hypertension, Hypertensive Emergency or Accelerated Hypertension were retrieved and analysed. The study interval was divided into four periods of 5 years each. Among 306 files reviewed, only 142 patients had a true HE. Average age at presentation was 63.3±16.5 years. Men were younger than women (59±16 vs 68±16 years; P<0.001). At presentation, most patients (80.3%) had been diagnosed with essential hypertension previously and were undertreated. Average maximum mean arterial pressure (MAP) was higher in men (169±22 mm Hg) than in women (161±17 mm Hg; P=0.026). The rate of HE decreased over the course of the study, from 12.7/100 000 admissions during 1991-1995 to 6.2/100 000 admissions (2006-2010). Similarly, 1-year mortality decreased from 16.7 to 3.6%. The rate of HE has decreased and the prognosis has improved over the last two decades. Appropriate BP control of patients with essential hypertension may further decrease the risk of HE. PMID:26674757

  19. Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

    PubMed

    Sullivan, Clair; Staib, Andrew; Eley, Rob; Griffin, Bronwyn; Cattell, Rohan; Flores, Judy; Scott, Ian

    2016-04-01

    Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17022) in 2011 to 1.2% (202/17162) in 2013 (P<0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P=0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P<0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P=0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P=0.038) in 2011 and 1.3% versus 1.1% (P=0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3

  20. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief...

  1. Safer sex in tourist resorts.

    PubMed

    Ford, N; Inman, M

    1992-01-01

    A survey in Torbay, England, indicated substantial sexual interaction of an unsafe kind between young residents and tourists. A pilot programme is described which sought to promote safer sexual behaviour: the attention of both tourists and local people who frequented nightclubs was engaged by peer groups who conveyed educational messages. PMID:1637480

  2. How to sell safer sex.

    PubMed

    Overs, C

    1991-09-01

    Social and economic factors determine the extent of the sex industry in societies. Despite AIDS, the sex industry will continue to thrive. Accordingly, health promotion strategies aimed at sex workers and their clients should not stem from the belief that the industry should cease to exist. This paper offers advice in developing and implementing programs to promote safer sex among sex workers. The social context is 1 element to consider in planning successful campaigns. Interventions must be combined with well-planned prevention campaigns aimed at entire populations. The opinions and participation of those involved in the industry should also be sought, while worker discussion and action upon other community issues should not be discouraged. Care should be given to target the numerous and diverse sex worker audiences in addition to other persons related to and involved in the industry. Programs should address the main obstacles to practicing safer sex, and attention should be given to ensure the provision of an adequate and regular supply of cheap or free condoms through varied distribution channels. In the area of service provision, sex workers need easy access to social support and health care services from which they are often excluded. Activities conducted around the world include the marketing of safer sex, distributing printed information on HIV and AIDS to clients, training sex workers to pass designated constructive ideas to others involved in the sex industry, referring sex workers to sex businesses supportive of safer sex practices, and developing street theater and cabaret shows in bars. PMID:12284682

  3. Safer Aviation Materials Tested

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2001-01-01

    A series of thermally stable polymer samples were tested. These materials are called low heat release materials and are designed for aircraft interior decorative materials. The materials are designed to give off a minimum amount of noxious gases when heated, which increases the possibility that people can escape from a burning aircraft. New cabin materials have suitably low heat release so that fire does not spread, toxic chemicals are not given off, and the fire-emergency escape time for crew and passengers is lengthened. These low heat-release materials have a variety of advantages and applications: interiors for ground-based facilities, interiors of space vehicles, and many commercial fire-protection environments. A microscale combustion calorimeter at the Federal Aviation Administration's (FAA) Technical Center tested NASA Langley Research Center materials samples. The calorimeter is shown. A sharp, quantitative, and reproducible heat-release-rate peak is obtained in the microscale heat-release-rate test. The newly tested NASA materials significantly reduced the heat release capacity and total heat release. The thermal stability and flammability behavior of the samples was very good. The new materials demonstrated a factor of 4 reduction in total heat release over ULTEM (a currently used material). This information is provided in the following barchart. In other tests, the materials showed greater than a factor 9 reduction in heat-release capacity over ULTEM. The newly tested materials were developed for low dielectric constant, low color, and good solubility. A scale up of the material samples is needed to determine the repeatability of the performance in larger samples. Larger panels composed of the best candidate materials will be tested in a larger scale FAA Technical Center fire facility. The NASA Glenn Research Center, Langley (Jeff Hinkley), and the FAA Technical Center (Richard Lyon) cooperatively tested these materials for the Accident Mitigation

  4. Five Steps to Safer Health Care

    MedlinePlus

    ... to Safer Health Care Five Steps to Safer Health Care: Patient Fact Sheet This information is for reference ... safety is one of the Nation's most pressing health care challenges. A 1999 report by the Institute of ...

  5. Making motherhood safer in Bolivia.

    PubMed

    Blaney, C L

    1994-02-01

    The Bolivian government and other organizations aim to reduce maternal deaths and improve maternal health through a variety of initiatives. The goal is to reduce infant mortality by 1997 from 480 to 250 per 100,000 births. In a rural area of Inquisivi, maternal mortality in 1990 was 1400 per 100,000 births. Hospital and family planning service improvements are targeted, as well as increases in prenatal visits and training of birth attendants. The Protection a la Salud (PROSALUD) is concerned with improvements in technical, managerial, and interpersonal quality of care. The complaint has been difficulties with access and availability of services, and poor quality of services. PROSALUD centers have a referral system aimed at reducing maternal death. Training is provided in family planning counseling, because preventing unwanted pregnancies reduces complications from unsafe abortions that cause 27% of maternal mortality nationally. Lack of knowledge about contraception was reported by many women who were hospitalized for complications from unsafe abortion. Modern contraceptive usage is 12%, compared to 57% in Brazil and 55% in Colombia. Contraceptives only recently have become available in public facilities, but availability is still limited. Women avoid hospitals because of fears that their traditional practices will not be respected. Quechua and Aymara women deliver their children in upright positions, because of the ease of delivery. The placenta is delivered carefully, because it is viewed as a body combining the spirits of the mother and infant and deserving a proper burial. The traditional hospital delivery requires lying down in a cold room with unfamiliar attendants, and the patients complain of having to walk too early and leave the hospital too early. In rural areas, modern and traditional approaches that are put into action with the participation of the community work best. Mothercare and Save the Children/Bolivia have been successful in encouraging

  6. The business case for transitioning to safer chemicals.

    PubMed

    McFadden, Roger D

    2011-01-01

    Emerging domestic and international chemical regulations and a heightened consumer awareness of chemicals of concern in products is challenging American businesses to reevaluate and reconsider their approaches to supply chain management and product design. Some of these companies recognize business opportunities and are responding proactively with innovative strategies and tactics. This article describes steps that Staples Inc., the world's largest office products provider, is taking to meet demand for products that are safer and more sustainable. In trying to meet the demand for safer products, Staples faces significant barriers, including the complexity of supply chains, data gaps, and confidential business information. New collaborations between companies, government, and advocates, and improved tools and criteria for defining safer products enhance the ability of businesses, like Staples, to meet new consumer demands. PMID:22001038

  7. The Moorfields Safer Surgery System

    PubMed Central

    Dhingra, Sumit; Khaw, Peng T.

    2009-01-01

    This review presents the ‘Moorfields Safer Surgery System’, which is designed to improve the consistency and outcomes of trabeculectomy surgery. Evidence-based recommendations are made for each step of the surgery. This system requires a minimum of equipment and can be easily implemented by most surgeons. The system is ultimately designed to preserve the vision in our patients by minimising complications while maintaining a desired intraocular pressure. PMID:20142973

  8. HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study

    PubMed Central

    Sawe, Hendry R; Mfinanga, Juma A; Ringo, Faith H; Mwafongo, Victor; Reynolds, Teri A; Runyon, Michael S

    2016-01-01

    Objectives To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country. Setting The ED of a large east African national referral hospital. Participants This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male. Primary and secondary outcome measures The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive. Results Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge. Conclusions Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care. PMID:26880672

  9. Predictors of Safer Sex Intentions and Protected Sex Among Heterosexual HIV-Negative Methamphetamine Users

    PubMed Central

    Mausbach, Brent T.; Semple, Shirley J.; Strathdee, Steffanie A; Patterson, Thomas L.

    2009-01-01

    The purpose of this study was to test a version of the Theory of Planned Behavior (TPB) for predicting safe sex behavior in a sample of 228 HIV-negative heterosexual methamphetamine users. We hypothesized that, in addition to TPB constructs, participants’ amount of methamphetamine use and desire to stop unsafe sex behaviors would predict intentions to engage in safer sex behaviors. In turn, we predicted that safer sex intentions would be positively correlated with participants’ percentage of protected sex. Hierarchical linear regression indicated that 48% of the total variance in safer sex intentions was predicted by our model, with less negative attitudes toward safer sex, greater normative beliefs, greater control beliefs, less methamphetamine use, less intent to have sex, and greater desire to stop unsafe sex emerging as significant predictors of greater safer sex intentions. Safer sex intentions were positively associated with future percent protected sex (p<.05). These findings suggest that, among heterosexual methamphetamine users, the TPB is an excellent model for predicting safer sex practices in this population, as are some additional factors (e.g., methamphetamine use). Effective interventions for increasing safer sex practices in methamphetamine user will likely include constructs from this model with augmentations to help reduce methamphetamine use. PMID:19085216

  10. Referral expectations of radiology.

    PubMed

    Smith, W; Altmaier, E; Berberoglu, L; Morris, K; O'Halloran, C

    1992-08-01

    In summary, the data suggest that the traditional role of the radiologist as an expert consultant who provides an accurate written report is still the dominant perception. This study emphasizes the importance of development of communication skills and communication standards, with particular emphasis on written data as the single most important factor in keeping a strong clinician referral base. PMID:10121759

  11. Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London

    PubMed Central

    McDonnell, Sian; Chandraharan, Edwin

    2015-01-01

    Objectives. To review the determinants for a failed operative vaginal delivery and to examine associated fetal and maternal morbidity. Design. Retrospective observational study. Setting. Large London Teaching Hospital. Method. A retrospective review of case notes during a 5-year period was carried out. Results. Overall 119 women (0.44%) out of 26,856 births had a caesarean section following a failed instrumental delivery, which comprised 5.1% of all operative vaginal births. 73% had a spontaneous onset of labour and 63% required syntocinon at some time prior to delivery. 71.5% of deliveries were complicated by malposition. Only 20% of deliveries were attended by a consultant obstetrician. Almost 50% of women and 8.4% of neonates sustained trauma at the time of either their failed instrumental delivery or the caesarean section. Conclusions. Emergency caesarean section during the second stage of labour is associated with maternal and fetal complications. A ‘failed instrumental delivery score' (FIDS) may aid practitioners in predicting an increased likelihood of a failed operative vaginal birth and therefore to consider a trial of operative vaginal delivery in the theatre. Senior input should also be sought because a failed operative vaginal birth is associated with increased maternal and fetal morbidity. PMID:26078882

  12. Anger as a Moderator of Safer Sex Motivation among Low Income Urban Women

    PubMed Central

    Carey, Michael P.

    2005-01-01

    Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision-making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational-decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median-split). The theoretically expected “rational pattern” was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an “irrational pattern” emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge and risk-based decisions regarding safer sex may be limited to low-anger women. PMID:16247592

  13. Safer work clothing for fishermen.

    PubMed

    Geving, Ingunn Holmen; Reitan, Jarl; Sandsund, Mariann; Faerevik, Hilde; Reinertsen, Randi Eidsmo; Aasjord, Halvard

    2006-01-01

    The fisherman's work environment consists of many potential risks. A study of occupational accidents in the Norwegian fishing industry in the nine-year period from 1998 to 2006 shows that more than 3/4 of the deaths were caused by loss of fishing vessel or man-overboard accidents. Furthermore, the greatest risk of drowning is found in the smallest fleet. The aim of our project was to develop safer work clothing and through this contribute to a reduction in work accidents and injuries in the fishing fleet. We considered that it is possible to produce protective work clothing that satisfies a specification of requirements covering the fishermen's needs for protection and comfort during work. An end user-centred process including twenty-three personal interviews and a questionnaire was used to clarify the fishermen's needs and wishes before detailed design and product development. We identified an overview of all the fishermen's needs for protection during work, and produced a prioritised list of functional requirements for the clothing. The results show that the clothing previously preferred by fishermen does not satisfy all the users' demands for safety, functionality and comfort. These demands have been taken into consideration when designing improved work clothing for the fishing fleet. A selected number of prototypes were developed on the basis of the established specification of requirements. The prototypes were evaluated according to the users' requirements through tests in SINTEF's Work Physiology Laboratory and on board fishing vessels. The results demonstrate that the new protective clothing satisfies the fishermen's requirements. PMID:17312698

  14. Astronauts Meade tests SAFER system during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronaut Carl J. Meade tests the new Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles above Earth. The end of the Remote Manipulator System's (RMS) robot arm, with an unoccupied foot restraint attached, is at frame's edge.

  15. Exploring referral systems for injured patients in low-income countries: a case study from Cambodia.

    PubMed

    Nakahara, Shinji; Saint, Saly; Sann, Sary; Ichikawa, Masao; Kimura, Akio; Eng, Lycheng; Yoshida, Katsumi

    2010-07-01

    Injury is a growing public health concern worldwide. Since severe injuries require urgent treatment, involving smooth, timely patient referral between facilities, strengthening of the referral system would reduce injury mortality. Smooth referral consists of identification of severe cases, organization of transportation, communication between facilities and prompt care at the receiving facility. This study examined these components of referral of injured patients in a representative sample of health centres (HCs) and referral hospitals (RHs) in Cambodia. We analysed data from a survey carried out in 80 HCs and 17 RHs by interview or mailed questionnaire from December 2006 to April 2007. Collected information on referral included the presence of referral guidelines for injured patients, distance of referral, commonly used transportation and its cost, communication with receiving facilities, and fast-tracking at receiving facilities. Formal referral systems were not functioning well in some areas (insufficient communication and underutilization of ambulances), and informal systems were frequently involved (patient transfer by taxi or referral by community volunteers, and treatment by traditional healers) but were not fully integrated into the referral network (traditional healers seldom referred patients to public facilities). The referral distance was long for most of the surveyed facilities and transportation costs were high when transferring from remote areas, even by ambulance. This study identified the weaknesses and strengths of the emergency referral system in Cambodia. Streamlining referral mechanisms will require organization of each component of the referral mechanism by strengthening the existing system and mobilizing local resources, which would allow Cambodia to develop an efficient system at reasonable cost, though it may differ from Western models. Guidelines including these components along with training and supervision, and expansion of the system to

  16. Greener is Cleaner, and Safer

    ERIC Educational Resources Information Center

    Science Scope, 2005

    2005-01-01

    One easy way to reduce the number of accidents in the lab is to go "green." Green chemistry, or sustainable chemistry, emerged about a decade ago, but the concept has been practiced for centuries by indigenous people of many continents. The basic principles of green chemistry are that you should use only what you need and recycle what you can.…

  17. Team training for safer birth.

    PubMed

    Cornthwaite, Katie; Alvarez, Mary; Siassakos, Dimitrios

    2015-11-01

    Effective and coordinated teamworking is key to achieving safe birth for mothers and babies. Confidential enquiries have repeatedly identified deficiencies in teamwork as factors contributing to poor maternal and neonatal outcomes. The ingredients of a successful multi-professional team are varied, but research has identified some fundamental teamwork behaviours, with good communication, proficient leadership and situational awareness at the heart. Simple, evidence-based methods in teamwork training can be seamlessly integrated into a core, mandatory obstetric emergency training. Training should be an enjoyable, inclusive and beneficial experience for members of staff. Training in teamwork can lead to improved clinical outcomes and better birth experience for women. PMID:25979351

  18. SAFER Tests by Meade and Lee

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red stripe on suit) test the Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles from Earth. The pair were actually performing an in-space rehearsal or demonstration of a contingency rescue using the never- before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee, anchored to Discovery's Remote Manipulator System (RMS) robot arm, took turns using the SAFER hardware during their shared space walk of September 16, 1994.

  19. Using Technology to Create Safer Schools.

    ERIC Educational Resources Information Center

    Townley, Arthur J.; Martinez, Kenneth

    1995-01-01

    Although classes to create student self-esteem and antigang programs are gaining in popularity, most school districts have not used available technology to help create safer campuses. Increased availability of telephones and two-way radios would enhance school security, along with incorporation of newer technologies such as computers, digitized…

  20. Urban Middle Schools Become Safer, More Effective.

    ERIC Educational Resources Information Center

    Schools in the Middle, 1992

    1992-01-01

    Through the Safe Schools project, initiated by the Education Development Center, Inc., and funded by the Office of Juvenile Justice and Delinquency Prevention, two urban middle schools in the northeast became safer, more effective places of learning over three-year period. This article describes the process. (MLH)

  1. Lost Opportunities to Reduce Periconception HIV Transmission: Safer Conception Counseling By South African Providers Addresses Perinatal but not Sexual HIV Transmission

    PubMed Central

    Milford, Cecilia; Kaida, Angela; Ehrlich, Matthew J.; Ng, Courtney; Greener, Ross; Mosery, F. N.; Harrison, Abigail; Psaros, Christina; Safren, Steven A.; Bajunirwe, Francis; Wilson, Ira B.; Bangsberg, David R.; Smit, Jennifer A.

    2014-01-01

    Introduction: Safer conception strategies create opportunities for HIV-serodiscordant couples to realize fertility goals and minimize periconception HIV transmission. Patient–provider communication about fertility goals is the first step in safer conception counseling. Methods: We explored provider practices of assessing fertility intentions among HIV-infected men and women, attitudes toward people living with HIV (PLWH) having children, and knowledge and provision of safer conception advice. We conducted in-depth interviews (9 counselors, 15 nurses, 5 doctors) and focus group discussions (6 counselors, 7 professional nurses) in eThekwini District, South Africa. Data were translated, transcribed, and analyzed using content analysis with NVivo10 software. Results: Among 42 participants, median age was 41 (range, 28–60) years, 93% (39) were women, and median years worked in the clinic was 7 (range, 1–27). Some providers assessed women's, not men's, plans for having children at antiretroviral therapy initiation, to avoid fetal exposure to efavirenz. When conducted, reproductive counseling included CD4 cell count and HIV viral load assessment, advising mutual HIV status disclosure, and referral to another provider. Barriers to safer conception counseling included provider assumptions of HIV seroconcordance, low knowledge of safer conception strategies, personal feelings toward PLWH having children, and challenges to tailoring safer sex messages. Conclusions: Providers need information about HIV serodiscordance and safer conception strategies to move beyond discussing only perinatal transmission and maternal health for PLWH who choose to conceive. Safer conception counseling may be more feasible if the message is distilled to delaying conception attempts until the infected partner is on antiretroviral therapy. Designated and motivated nurse providers may be required to provide comprehensive safer conception counseling. PMID:25436820

  2. Rural Hospitals Often Safer, Cheaper for Common Surgeries

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_158884.html Rural Hospitals Often Safer, Cheaper for Common Surgeries: Study Major ... may be safer when done in a rural hospital compared to a suburban or city hospital, a ...

  3. Gynaecological referrals to Baragwanath Hospital.

    PubMed

    Buchmann, E; Ephraim, G; Kathawaroo, S

    1994-04-01

    Three hundred and fifty-nine consecutive referral letters to Baragwanath Hospital's gynaecological outpatients' department were analysed. Letters from private doctors contained significantly less clinical information than those from clinics. Only 11% of referring private doctors mentioned what treatment they had given patients before sending them to hospital. Soweto clinic nurses tended to include more information in their letters than clinic doctors. There were no significant differences in the number of appropriate referrals and incorrect diagnoses from private doctors, clinic doctors and clinic nurses respectively. The poor communication, especially between general practitioners and the hospital, is probably the result of overwork and lack of time. Hospital doctors should reply to well-written referral letters, and liaison between clinics and the hospital ought to be improved and expanded. PMID:7974041

  4. Under construction: building a safer industry.

    PubMed Central

    Tibbetts, John

    2002-01-01

    A revolution in the building industry over the past decade has spawned a new generation of safer materials and practices, decreasing some health risks for construction workers. Concerned consumers, builders, materials manufacturers, and government regulatory agencies have all contributed to a turn toward "green" building materials and practices, meaning that homeowners and office workers now are better able to live and work in healthier environments, and many construction workers are handling and installing less-toxic materials. PMID:11882489

  5. Haemorrhage after home birth: audit of decision making and referral.

    PubMed

    Smit, Marrit; Dijkman, Anneke; Rijnders, Marlies; Bustraan, Jacqueline; van Dillen, Jeroen; Middeldorp, Johanna; Havenith, Barbara; van Roosmalen, Jos

    2013-11-01

    In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care. PMID:24371910

  6. Emerging technologies and challenges for better and safer drugs.

    PubMed

    Theodosiou, Maria; Amir-Aslani, Arsia; Mégarbane, Bruno

    2014-04-01

    Regardless of stringent safety regulations and increased compound selectivity by pharmaceutical companies, prediction of toxicity in humans is still far from perfect and adverse drug reactions are still detected after drug marketing. High costs of failures due to toxicity has led pharmaceutical companies to search for screening methods that would allow detection of toxicity issues at an early stage and improve their preclinical and clinical toxicology. Thanks to the last decade's biotechnology revolution, new technologies like toxicogenomics have demonstrated the capacity to improve toxicity assessment. However, our understanding of toxicological mechanisms is still incomplete and a wide range of approaches must be used to gain insight into toxicity issues. Consequently, an array of in silico, in vitro and in vivo methods is utilized to predict toxicity and its causative mechanisms, improving drug development processes and minimizing costs of failure. PMID:24243233

  7. Referral Handbook of Community Services.

    ERIC Educational Resources Information Center

    Myers, Renny J.; And Others

    This guide to community services is designed to assist financial counseling agencies in the development of community service handbooks with comprehensive listings of community resources and referral centers. The handbook is organized into sections according to problem areas and includes the following: (1) alcohol and drug treatment; (2) child…

  8. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34 Referrals. (a) General. Referrals are...

  9. Understanding hospital referral rates: a user's guide.

    PubMed Central

    Roland, M O; Bartholomew, J; Morrell, D C; McDermott, A; Paul, E

    1990-01-01

    Detailed referral information from one practice was used to investigate the effect of calculating referral rates in several different ways. Referral rates for individual general practitioners should be related to the number of consultations carried out and not to the number of registered patients; for whole practices list size may be used as the denominator. Most doctors will not need to control for age and sex of patients when comparing referral rates but may need to control for case mix when comparing referral rates to individual specialties. In addition, a method is described for distinguishing systematic variation between the referral rates of individual doctors from the random variation that may arise from data based on fairly small numbers of referrals. The method indicates whether systematic variation is greater than would be expected by chance, and it can be extended to indicate whether variability in referral rates is greater in one specialty than another. Because of random variation with time a year's data may not be sufficient to allow reliable interpretation of referral rates to individual specialties, except for the largest. At present there is no known relation between high or low referral rates and quality of care. Nevertheless, if doctors are to interpret their own rates of referral they need those rates to be reliable and valid. Use of the 10 guidelines described in this paper will help to prevent unwarranted conclusions being drawn from information on general practitioners' rates of referral to hospital. PMID:2390594

  10. 38 CFR 1.950 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Prompt referral. 1.950 Section 1.950 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.950 Prompt referral. (a) VA shall promptly refer...

  11. 38 CFR 1.950 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Prompt referral. 1.950 Section 1.950 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.950 Prompt referral. (a) VA shall promptly refer...

  12. Safer Systems: A NextGen Aviation Safety Strategic Goal

    NASA Technical Reports Server (NTRS)

    Darr, Stephen T.; Ricks, Wendell R.; Lemos, Katherine A.

    2008-01-01

    The Joint Planning and Development Office (JPDO), is charged by Congress with developing the concepts and plans for the Next Generation Air Transportation System (NextGen). The National Aviation Safety Strategic Plan (NASSP), developed by the Safety Working Group of the JPDO, focuses on establishing the goals, objectives, and strategies needed to realize the safety objectives of the NextGen Integrated Plan. The three goal areas of the NASSP are Safer Practices, Safer Systems, and Safer Worldwide. Safer Practices emphasizes an integrated, systematic approach to safety risk management through implementation of formalized Safety Management Systems (SMS) that incorporate safety data analysis processes, and the enhancement of methods for ensuring safety is an inherent characteristic of NextGen. Safer Systems emphasizes implementation of safety-enhancing technologies, which will improve safety for human-centered interfaces and enhance the safety of airborne and ground-based systems. Safer Worldwide encourages coordinating the adoption of the safer practices and safer systems technologies, policies and procedures worldwide, such that the maximum level of safety is achieved across air transportation system boundaries. This paper introduces the NASSP and its development, and focuses on the Safer Systems elements of the NASSP, which incorporates three objectives for NextGen systems: 1) provide risk reducing system interfaces, 2) provide safety enhancements for airborne systems, and 3) provide safety enhancements for ground-based systems. The goal of this paper is to expose avionics and air traffic management system developers to NASSP objectives and Safer Systems strategies.

  13. Space Station Live: FLEX in Space for Safer Combustion

    NASA Video Gallery

    Flame Extinguishment Experiment (FLEX) Principal Investigator Mark Hickman, from Glenn Research Center, discusses why scientists study flames in space. One reason is to create a safer environment t...

  14. Referrals to a facial pain service.

    PubMed

    Lang, M; Selvadurai, T; Zakrzewska, J M

    2016-04-01

    Aim To assess the quality of referral letters to a facial pain service and highlight the key requirements of such letters.Method The source of all referral letters to the service for five years was established. For one year the information provided in 94 referrals was assessed. Using a predetermined checklist of essential information the referral letters were compared to these set criteria.Results The service received 7,001 referrals and, on average, general dental practitioners (GDPs) referred 303 more patients per year than general medical practitioners (GMPs). Seventy-one percent of all referrals were from primary care practitioners, the rest were from specialists. Over 70% of GMP and 52% of GDP letters included a past medical history, with GMPs more likely to suggest a possible diagnosis and include previous secondary care referrals. The mean score for GMP referrals compared to the standard proforma (maximum of 12) was 5.6 and for GDP referrals 5.0. A relevant drug history was included by 75.6% GMP compared to 38.7% of GDPs. GMPs were more likely to include any relevant mental health history.Conclusions The overall quality of referral letters is low which makes it difficult for the specialists to provide robust treatment plans. PMID:27056518

  15. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

    In a critique of the existing literature, the author found that most studies simply calculate referral rates and count letters between referring physicians and specialists. Longitudinal studies that consider all participants' views and place referral in a broader context could reveal more about this complex process. This article is the first of a six-part series reporting on a longitudinal study of 50 referrals in Ontario and Manitoba. PMID:21229088

  16. Protecting children in research: Safer ways to research with children who may be experiencing violence or abuse.

    PubMed

    Randall, Duncan; Anderson, Anna; Taylor, Julie

    2016-09-01

    Children participating in research, like other children, may be being maltreated. There is also potential for exposure to abuse during research. Research training, practices and protocols to respond to disclosure and discovery of abuse to protect both researchers and children may not be sufficiently robust. Our aim was to compare and contrast research practices reported in the literature related to protecting children and to recommend safer ways to conduct research. The simultaneous increase in research with children, along with an increased willingness to listen to child victims of abuse, means that researchers must consider the protection of children in the research setting. Twenty-three papers were identified in a literature review. These studies reported a wide variation of ethical considerations, methods, methodology and came from different disciplines. From the 23 papers, two overarching themes were identified: social justice and research and safer research. To make research safer teams should consider training, safety protocols and support for child protection, which includes support to report safeguarding concerns to social care. Further work is required to ensure that training, protocols and support are effective in facilitating researchers to identify and make appropriate child abuse referrals. Ethics practices in abuse research need further debate. PMID:26105062

  17. Determinants of Safer Sex Behaviors among College Students

    ERIC Educational Resources Information Center

    Kanekar, Amar; Sharma, Manoj

    2010-01-01

    Safer sex behaviors (monogamy, sexual abstinence, correct and consistent condom usage) are important for prevention of sexually transmitted diseases and HIV/AIDS among college students. The purpose of this article was to review studies addressing determinants of safer sex behaviors among college students. In order to collect materials for this…

  18. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 2 2011-07-01 2011-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  19. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 2 2013-07-01 2013-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  20. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  1. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 2 2012-07-01 2012-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  2. Advancing safer alternatives through functional substitution.

    PubMed

    Tickner, Joel A; Schifano, Jessica N; Blake, Ann; Rudisill, Catherine; Mulvihill, Martin J

    2015-01-20

    To achieve the ultimate goal of sustainable chemicals management policy–the transition to safer chemicals, materials, products, and processes–current chemicals management approaches could benefit from a broader perspective. Starting with considerations of function, rather than characterizing and managing risks associated with a particular chemical, may provide a different, solutions-oriented lens to reduce risk associated with the uses of chemicals. It may also offer an efficient means, complementing existing tools, to reorient chemicals management approaches from time-intensive risk assessment and risk management based on single chemicals to comparative evaluation of the best options to fulfill a specific function. This article describes a functional approach to chemicals management we call “functional substitution” that encourages decision-makers to look beyond chemical by chemical substitution to find a range of alternatives to meet product performance. We define functional substitution, outline a rationale for greater use of this concept when considering risks posed by uses of chemicals, and provide examples of how functional approaches have been applied toward the identification of alternatives. We also discuss next steps for implementing functional substitution in chemical assessment and policy development. PMID:25517452

  3. Safer Electrolytes for Lithium-Ion Cells

    NASA Technical Reports Server (NTRS)

    Kejha, Joe; Smith, Novis; McCloseky, Joel

    2004-01-01

    A number of nonvolatile, low-flammability liquid oligomers and polymers based on aliphatic organic carbonate molecular structures have been found to be suitable to be blended with ethylene carbonate to make electrolytes for lithium-ion electrochemical cells. Heretofore, such electrolytes have often been made by blending ethylene carbonate with volatile, flammable organic carbonates. The present nonvolatile electrolytes have been found to have adequate conductivity (about 2 mS/cm) for lithium ions and to remain liquid at temperatures down to -5 C. At normal charge and discharge rates, lithiumion cells containing these nonvolatile electrolytes but otherwise of standard design have been found to operate at current and energy densities comparable to those of cells now in common use. They do not perform well at high charge and discharge rates -- an effect probably attributable to electrolyte viscosity. Cells containing the nonvolatile electrolytes have also been found to be, variously, nonflammable or at least self-extinguishing. Hence, there appears to be a basis for the development of safer high-performance lithium-ion cells.

  4. Using Discipline Referrals To Make Decisions.

    ERIC Educational Resources Information Center

    Tobin, Tary; Sugai, George; Colvin, Geoff

    2000-01-01

    Computerized discipline referral data are a valuable resource in identifying at-risk students and staff development needs. Graphing referral data according to grade level, types of problem behavior, gender, or other features can facilitate decisions about applicable types of prevention programs and schoolwide strategies. (Contains 44 references.)…

  5. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  6. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  7. 48 CFR 919.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 919.602-1 Section 919.602-1 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 919.602-1 Referral....

  8. 48 CFR 619.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Referral. 619.602-1 Section 619.602-1 Federal Acquisition Regulations System DEPARTMENT OF STATE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 619.602-1 Referral....

  9. 49 CFR 1018.70 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... referral. (a) A claim which requires enforced collection is referred to GAO or DOJ for litigation. A... GAO for resolution and instruction prior to proceeding with collection actions and/or referral to DOJ for litigation. (c) The Board may refer a claim to GAO or DOJ even though the termination...

  10. 49 CFR 1018.70 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... referral. (a) A claim which requires enforced collection is referred to GAO or DOJ for litigation. A... GAO for resolution and instruction prior to proceeding with collection actions and/or referral to DOJ for litigation. (c) The Board may refer a claim to GAO or DOJ even though the termination...

  11. A Conceptualization of the Referral Process

    ERIC Educational Resources Information Center

    Corazzini, John G.; Shelton, John

    1974-01-01

    This article discussed the roles of the various participants in the referral process as well as several other of its dimensions including the holistic/atomistic, the horizontal/vertical, and the personal/institutional. It is suggested that referral be seen in human terms and as a "transfer of trust." (Author)

  12. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... violation of State or local criminal law, the institution shall notify the appropriate State or local law... SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a..., appropriate investigation, and reporting of criminal activity. Within 30 calendar days of determining...

  13. Inappropriate circumcision referrals by GPs.

    PubMed Central

    Griffiths, D; Frank, J D

    1992-01-01

    One hundred and twenty boys were referred by GPs over a 12-month period to a paediatric urologist for circumcision. The reasons for referral were: ballooning in 36, non-retraction in 28, balanoposthitis in 36 or a combination in 15. On examination 53% had a retractile, 21% a partially retractile and 21% a non-retractile foreskin. Six patients had obvious balanitis xerotica obliterans. Only one quarter of the patients required a circumcision. The penis was not examined by the referring doctor in 15 patients. The implications of this survey are that a large proportion of general practitioners have difficulty in discriminating between a true phimosis and a developmentally non-retractile foreskin. This diagnostic inaccuracy was greatest when the referring doctor did not examine the patient. PMID:1625262

  14. Graduated driver licensing and safer driving.

    PubMed

    McKnight, A James; Peck, Raymond C

    2003-01-01

    Graduated Driver Licensing (GDL) inserts between the leaner permit and full licensure an intermediate or "provisional" license that allows novices to drive unsupervised but subject to provisions intended to reduce the risks that accompany entry into highway traffic. Introduction of GDL has been followed by lowered accident rates, resulting from both limiting exposure of novices to unsafe situations and by helping them to deal with them more safely. Sources of safer driving include extended learning, early intervention, contingent advancement, and multistage instruction. To extend the learning process, most GDL systems lengthen the duration of the learner phase and require a specified level of adult-supervised driving. Results indicate that extended learning can reduce accidents substantially if well structured and highly controlled. Early intervention with novice traffic violators have shown both a general deterrent effect upon novice violators facing suspension and a specific effect upon those who have experienced it. Making advancement to full licensure contingent upon a violation-free record when driving on the provisional license has also evidenced a reduction in accidents and violations during that phase of licensure. Multistage instruction attempts development of advanced skills only after novices have had a chance to master more basic skills. Although this element of GDL has yet to be evaluated, research indicates crash reduction is possible in situations where it does not increase exposure to risk. While the various elements of GDL have demonstrated potential benefit in enhancing the safety of novice drivers, considerable improvement in the nature and enforcement of GDL requirements is needed to realize that potential. PMID:12535910

  15. Newer Epilepsy Drugs May Be Safer During Pregnancy

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_160751.html Newer Epilepsy Drugs May Be Safer During Pregnancy Small British ... 2016 (HealthDay News) -- Women who take the new epilepsy drugs levetiracetam and topiramate during pregnancy don't ...

  16. Salmonella Is a Sneaky Germ: Seven Tips for Safer Eating

    MedlinePlus

    ... our food safer to eat focuses on reducing contamination from Salmonella. Don't let Salmonella sneak up ... used to be a common cause of Salmonella contamination. To counter that, stringent procedures for cleaning and ...

  17. [Body packer: review and experience in a referral hospital].

    PubMed

    Madrazo, Zoilo; Silvio-Estaba, Leonardo; Secanella, Luis; García-Barrasa, Arantxa; Aranda, Humberto; Golda, Thomas; Biondo, Sebastiano; Rafecas, Antoni

    2007-09-01

    Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients. PMID:17916283

  18. Safer Vehicles for People and the Planet

    SciTech Connect

    Wenzel, Thomas P; Wenzel, Thomas P; Ross, Marc

    2008-03-01

    those riding in them is flawed. For starters, all else is never equal; other aspects of vehicle design appear to control what really happens in a crash, as reflected in the safety record of different kinds of vehicles. What's more, the use of high-strength steel, light-weight metals such as aluminum and magnesium, and fiber-reinforced plastics now offers automotive engineers the means to fashion vehicles that are simultaneously safer and less massive than their predecessors, and such designs would, of course, enjoy the better fuel economy that shedding pounds brings.

  19. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2010-10-01 2010-10-01 false Referral, evaluation, and treatment....

  20. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2013-10-01 2013-10-01 false Referral, evaluation, and treatment....

  1. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2014-10-01 2014-10-01 false Referral, evaluation, and treatment....

  2. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  3. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  4. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  5. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  6. 32 CFR 701.9 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... DoD/DON FOIA referral policy is based upon the concept of the originator of a record making a release... outside the Executive Branch of Government (e.g., Congress, State and local government agencies,...

  7. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  8. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  9. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  10. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  11. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  12. Severe systolic hypertension and the search for safer motherhood.

    PubMed

    Martin, James N

    2016-03-01

    Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all

  13. A proposed referral centre based on HL7/XML.

    PubMed

    Chen, T S; Liao, B S; Lee, C H; Gough, T G

    2002-01-01

    With the growth of the Inteernet, hospitals have also applied HL7 (Health Level Seven) to exchange data between them. The referral system is identified as an appropriate application system. The effect of referral is to transfer the patient to a suitable hospital in a timely fashion, and to arrange appropriate treatment for the patient. Taking advantage of the Internet to exchange referral data can, not only accelerate the process of patient referral, but also avoid the unnecessary repeat examinations to decrease the waste of medical resources. This article builds up a referral-related message according to the HL7 standard, and develops a referral centre using the Internet environment, making use of XML (eXtensible Markup Language) standard to transform the referral-related data to XML format and exchange referral data between platforms. This electronic referral mechanism is expected to offer other hospitals experience of improved referral practice. PMID:15460680

  14. The Nature of All "Inappropriate Referrals" Made to a Countywide Physical Activity Referral Scheme: Implications for Practice

    ERIC Educational Resources Information Center

    Johnston, Lynne Halley; Warwick, Jane; De Ste Croix, Mark; Crone, Diane; Sldford, Adrienne

    2005-01-01

    Objective: The aim of this study was to evaluate the impact of a centralised referral mechanism (CRM) upon the number and type of "inappropriate referrals" made to a countywide physical activity referral scheme. Design: Case study. Method: Phase 1: Hierarchical Content Analysis of 458 "inappropriate referrals" made to a countywide scheme over a…

  15. Safer Aircraft Possible With Nitrogen Generation

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2001-01-01

    A system named On-Board Inert Gas Generation System/On-Board Oxygen Generation System (OBIGGS/OBOGS) was studied with Boeing. The study established the requirements for nitrogen purge (for fuel tank inerting and cargo compartment fire suppression) and oxygen (for passengers and crew). The nitrogen would be used for suppressing fires and fuel tank explosions on the aircraft, and the oxygen would be used for breathing gas during high-altitude or emergency operations.

  16. Analysing general practitioners' referral decisions. II. Applying the analytical framework: do high and low referrers differ in factors influencing their referral decisions?

    PubMed

    Bailey, J; King, N; Newton, P

    1994-03-01

    An analytical framework of the referral decision was applied to the question of whether general practitioners (GPs) with relatively high and relatively low referral rates differed in the types of factors that influenced their referral decisions. Interview data from six high referring and six low referring GPs were compared at all levels of the framework, using both quantitative and qualitative content analysis. High referrers were found to mention significantly more negative factors than low referrers, i.e. they referred 'in spite of' reasons against referral. In particular, they referred patients in spite of having doubts about treatment effectiveness. Low referrers mentioned factors related to interpersonal processes significantly more often than high referrers, for example, GP-patient communication as an influence. Possible interpretations of these findings are discussed. PMID:8034159

  17. Precautionary policies in local government: green chemistry and safer alternatives.

    PubMed

    Raphael, Debbie O; Geiger, Chris A

    2011-01-01

    Local governments like the City and County of San Francisco have shouldered the burden of toxic chemicals released into the environment through the substantial costs of health care, environmental cleanup, and infrastructure to purify drinking water, manage wastewater, and manage solid waste. Cities can no longer afford to wait for federal regulation to prevent toxic chemicals from appearing in products used locally. San Francisco's Precautionary Principle Policy calls on the City to act on early warning signs of harm and to use the best available science to identify safer alternatives. Under its umbrella, a wide array of policy tools have been utilized including financial incentives through procurement contracts, certification and promotion of safer business practices, requirements for information disclosure, and bans and restrictions on the sale of products when safer alternatives are readily available. These policies can often become the models for regional, state, and national change. PMID:22001035

  18. Astronauts Carl Meade and Mark Lee test SAFER during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Backdropped against the darkness of space some 130 nautical miles above Earth, astronaut Mark C. Lee (red stripe on EVA suit) tests the new Simplified Aid for EVA Rescue (SAFER) system. Astronaut Carl J. Meade, tethered to Discovery, at bottom center, got his turn later using the new SAFER hardware. The scen was captured with a 70mm handheld Hasselblad camera operated by a fellow crew member in the shirt-sleeve environment of the Space Shuttle Discovery's cabin. Part of the hardware for the Lidar-In-space Technology Experiment (LITE) is in left foreground.

  19. Astronauts Carl Meade and Mark Lee test SAFER during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red stripe on suit) test the Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles from Earth. The pair was actually performing an in-space rehearsal or demonstration of a contingency rescue using the never-before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee, anchored to Discovery's Remote Manipulator System (RMS) robot arm, took turns using the SAFER hardware during their shared space walk of September 16, 1994.

  20. Astronauts Meade and Lee test SAFER system during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red strip on suit) test the new Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles above Earth. The pair was actually performing an in-space rehearsal or demonstration of a contingency rescue using the never-before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee (anchored to the Space Shuttle Discovery's Remote Manipulator System (RMS) robot arm) took turns using the SAFER hardware during their shared space walk.

  1. Challenges and approaches for the development of safer immunomodulatory biologics.

    PubMed

    Sathish, Jean G; Sethu, Swaminathan; Bielsky, Marie-Christine; de Haan, Lolke; French, Neil S; Govindappa, Karthik; Green, James; Griffiths, Christopher E M; Holgate, Stephen; Jones, David; Kimber, Ian; Moggs, Jonathan; Naisbitt, Dean J; Pirmohamed, Munir; Reichmann, Gabriele; Sims, Jennifer; Subramanyam, Meena; Todd, Marque D; Van Der Laan, Jan Willem; Weaver, Richard J; Park, B Kevin

    2013-04-01

    Immunomodulatory biologics, which render their therapeutic effects by modulating or harnessing immune responses, have proven their therapeutic utility in several complex conditions including cancer and autoimmune diseases. However, unwanted adverse reactions--including serious infections, malignancy, cytokine release syndrome, anaphylaxis and hypersensitivity as well as immunogenicity--pose a challenge to the development of new (and safer) immunomodulatory biologics. In this article, we assess the safety issues associated with immunomodulatory biologics and discuss the current approaches for predicting and mitigating adverse reactions associated with their use. We also outline how these approaches can inform the development of safer immunomodulatory biologics. PMID:23535934

  2. Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals

    PubMed Central

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

    Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty. We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral. To increase the information available to foundation doctors, we set up a page on the staff intranet called ‘Referral Finder’. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals. When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information. This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral. Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project. PMID:27158494

  3. Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals.

    PubMed

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

    Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty. We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral. To increase the information available to foundation doctors, we set up a page on the staff intranet called 'Referral Finder'. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals. When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information. This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral. Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project. PMID:27158494

  4. Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

    PubMed Central

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated “red flags”, and appropriate referral are discussed in this short paper. PMID:24349804

  5. Paediatric orbital fractures: the importance of regular thorough eye assessment and appropriate referral.

    PubMed

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated "red flags", and appropriate referral are discussed in this short paper. PMID:24349804

  6. Astronaut Mark Lee test SAFER system during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Backdropped against the blue and white Earth, 130 nautical miles below, astronaut Mark C. Lee test the new Simplified Aid for EVA Rescue (SAFER) system. The scen was captured with a 70mm handheld Hasselblad camera with a 30mm lens attached.

  7. Exercise in the 70s--Implications for Safer Practices.

    ERIC Educational Resources Information Center

    Morehouse, Chauncey A.

    1981-01-01

    Precautionary measures that should be taken by individuals to provide for safer participation in a vigorous exercise program are outlined, including the need for physical examinations, physical conditioning and warm-up, proper clothing and equipment, and awareness of environmental hazards. (JMF)

  8. Safety Assessment for Explosive Risk (SAFER) peer review report.

    SciTech Connect

    Heimdahl, Olaf E. R.; LaHoud, Paul; Chapman, Leon Darrel

    2004-08-01

    At the direction of the Department of Defense Explosives Safety Board (DDESB), a Peer Review Team was established to review the status of development of the risk-based explosives safety siting process and criteria as currently implemented in the software 'Safety Assessment for Explosive Risk (SAFER)' Version 2.1. The objective of the Peer Review Team was to provide an independent evaluation of the components of the SAFER model, the ongoing development of the model and the risk assessment process and criteria. This peer review report addressed procedures; protocols; physical and statistical science algorithms; related documents; and software quality assurance, validation and verification. Overall, the risk-based method in SAFER represents a major improvement in the Department of Defense (DoD) approach to explosives safety management. The DDESB and Risk Based Explosives Safety Criteria Team (RBESCT) have made major strides in developing a methodology, which over time may become a worldwide model. The current status of all key areas of the SAFER code has been logically developed and is defensible. Continued improvement and refinement can be expected as implementation proceeds. A consistent approach to addressing and refining uncertainty in each of the primary areas (probability of event, consequences of event and exposure) will be a very beneficial future activity.

  9. Identifying Subtypes of Spousal Assaulters Using the B-SAFER

    ERIC Educational Resources Information Center

    Thijssen, Jill; de Ruiter, Corine

    2011-01-01

    In the present study, a structured risk assessment instrument for intimate partner violence, the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER), was coded for 146 files of spousal assault cases from the Dutch probation service, dating from 2004 and 2005. The aim of the study was twofold: (a) to validate Holtzworth-Munroe and…

  10. Safer Schools in the UK--A Case Study

    ERIC Educational Resources Information Center

    Hayden, Carol; Holt, Amanda; Martin, Denise; Nee, Claire

    2011-01-01

    This article reports a research that is based on a European Safer Schools Partnership that included ten countries and specifically the UK case study which was located in London. The initiators of this partnership had been involved in early SSPs in the UK and the educationalists were very much focussed on work that would address problematic…

  11. Elevated levels of serum creatinine: recommendations for management and referral

    PubMed Central

    Mendelssohn, D C; Barrett, B J; Brownscombe, L M; Ethier, J; Greenberg, D E; Kanani, S D; Levin, A; Toffelmire, E B

    1999-01-01

    BACKGROUND: The potential benefits of earlier referral to a nephrologist of patients with elevated levels of serum creatinine include identifying and treating reversible causes of renal failure, slowing the rate of decline associated with progressive renal insufficiency, managing the coexisting conditions associated with chronic renal failure and facilitating efficient entry into dialysis programs for all patients who might benefit. METHODS: A subcommittee of the Canadian Society of Nephrology, which included representatives from family practice and internal medicine, conducted a MEDLINE search for the period 1966 to 1998 using the key words referral and consultation, dialysis, hemodialysis, peritoneal dialysis, renal replacement therapy and kidney diseases. Where published evidence was lacking, conclusions were reached by consensus. GUIDELINES: Earlier referral to nephrologists of patients with elevated creatinine levels is expected to lead to better health care outcomes and lower costs for both the patients and the health care system. All patients with newly discovered renal insufficiency (as evidenced by serum creatinine elevated to a level above the upper limit of the normal range of that laboratory, adjusted for age and height in children) must undergo investigations to determine the potential reversibility of disease, to evaluate the prognosis and to optimize planning of care. All patients with an established, progressive increase in serum creatinine level should be followed with a nephrologist. Adequate preparation for dialysis or transplantation (or both) requires at least 12 months of relatively frequent contact with a renal care team. Nephrologists should provide consultation in a timely manner for any patient with an elevated serum creatinine level. In addition, they should provide advice about what aspects of the condition require particularly urgent or emergency assessment. SPONSORS: This clinical practice guideline has been endorsed by the Canadian

  12. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Referral, evaluation, and treatment. 655.62... OPERATIONS Consequences § 655.62 Referral, evaluation, and treatment. If a covered employee has a verified... and treatment programs....

  13. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 655.62... OPERATIONS Consequences § 655.62 Referral, evaluation, and treatment. If a covered employee has a verified... and treatment programs....

  14. Sources of referral information: a marketing analysis of physician behavior.

    PubMed

    Powers, T L; Swan, J E; Taylor, J A; Bendall, D

    1998-01-01

    The referral process is an important means of obtaining patients and it is necessary to determine ways of influencing the referral process to increase the patient base. This article reports research based on a survey of the referral habits of 806 primary care physicians. The results are examined in the context of physician receptivity to marketer-controlled versus health services sources of referral information. PMID:9702564

  15. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... alone or together with an inmate's prior history, may warrant consideration for a control unit...

  16. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and, in... Department of Justice of any payments credited by the Department to the debtor's account. Pursuant to 31 CFR... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to...

  17. Information and Referral Service, District Office Training.

    ERIC Educational Resources Information Center

    Health and Welfare Council of Central Maryland, Inc., Baltimore.

    Within a standard format the details of instruction and training in various areas (units) of information and referral (I and R) services are given for Social Security Administration workers. Each unit is specified by the following categories: objective, special consideration, background, presentation, participation, review, and examples. There are…

  18. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

    In a study of 50 referrals, family physicians were shown to choose consultants whom they trusted. They had previously worked with them or had indirect evidence, including patient reports, of their technical and communication skills and effectiveness with patients. By trial and error, “good” ones were retained and “bad” ones - including those not trusted by patients - were avoided. PMID:20469520

  19. Slowing the Flood of Special Education Referrals.

    ERIC Educational Resources Information Center

    Dauphinais, Paul

    2000-01-01

    Describes alternatives to the standard special education approach of assessment, referral, and placement. Provides three guiding principles that personalize the assessment process. Proposes solutions: meeting with parents to plan for student success, assembling a team of professionals to review and solve problems, and establishing formal…

  20. Gifted Girls: Gender Bias in Gifted Referrals

    ERIC Educational Resources Information Center

    Bianco, Margarita; Harris, Bryn; Garrison-Wade, Dorothy; Leech, Nancy

    2011-01-01

    The goal of this mixed-methods study was to explore the effect of gender on teachers' willingness to refer students to a gifted and talented program. Teachers (N = 28) were provided with one of two profiles (i.e., female or male) describing a gifted student. Results indicated that teachers' decisions for referral to gifted programs were…

  1. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Referral procedures. 303.303 Section 303.303 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES Child Find, Evaluations...

  2. 48 CFR 419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Referral. 419.602-1 Section 419.602-1 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility...

  3. 48 CFR 2819.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Referral. 2819.602-1 Section 2819.602-1 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE Socioeconomic Programs SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 2819.602-1...

  4. 48 CFR 1419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 1419.602-1 Section 1419.602-1 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility...

  5. 48 CFR 1319.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 1319.602-1 Section 1319.602-1 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determination of Responsibility...

  6. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda

    1991-01-01

    Fifty referrals from family physicians in Ontario were examined by interviewing the patients, referring physicians, consultants, and others involved at various points in the process. This, the second in a series of six articles, introduces the participants and describes how grounded theory methodology was used to analyze the approximately 3000 pages of field notes. PMID:21229052

  7. Behavior Analytic Consultation for Academic Referral Concerns

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

    2016-01-01

    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  8. Descriptive Analysis of Selected Data Referral Networks.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

    The National Environmental Data Referral Service (NEDRES) is being developed in response to a national need to improve the awareness of and access to a broad range of environmental data files. Two studies were conducted in support of this effort: a survey of prospective users confirming the need for and willingness to pay fees for the service and…

  9. PLEXUS--The Expert System for Referral.

    ERIC Educational Resources Information Center

    Vickery, A.; Brooks, H. M.

    1987-01-01

    Presents a description of PLEXUS, an expert system on gardening designed as a referral tool for public libraries by the University of London. Highlights include determining user characteristics, developing the problem statement, the use of semantic categories, and search strategies that modify the original problem statement using Boolean…

  10. Alternative Education's Impact on Office Disciplinary Referrals

    ERIC Educational Resources Information Center

    Gut, Eva; McLaughlin, John M.

    2012-01-01

    Disruptive behaviors negatively impact learning by taking time away from classroom instruction (Gottlieb and Polirstok 2005) and may also produce unsafe school environments. This study examined changes in the number of office disciplinary referrals (ODRs) received in public schools prior to and following the schools partnering with one particular…

  11. 34 CFR 303.206 - Referral policies for specific children.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Referral policies for specific children. 303.206... Referral policies for specific children. Each application must include the State's policies and procedures that require the referral for early intervention services under this part of specific children...

  12. Handedness, Birth Order, Reading Problems: Referrals to a School Psychologist.

    ERIC Educational Resources Information Center

    Altus, Grace T.; Altus, William D.

    To investigate the influence of handedness in the referral of elementary school students to a school psychologist, 120 left-handed referrals were matched with 120 right-handed referrals by sex, full-scale intelligence quotient, and chronological age. Comparison of the groups revealed that twins were more numerous among the left-handed students.…

  13. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids...: Referral centers. (a) Criteria for classification as a referral center: Basic rule. CMS classifies a hospital as a referral center only if the hospital is a Medicare participating acute care hospital...

  14. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2011-07-01 2010-07-01 true Information and referral programs. 361.37 Section...

  15. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2013-07-01 2013-07-01 false Information and referral programs. 361.37 Section...

  16. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2014-07-01 2013-07-01 true Information and referral programs. 361.37 Section...

  17. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2012-07-01 2012-07-01 false Information and referral programs. 361.37 Section...

  18. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2010-07-01 2010-07-01 false Information and referral programs. 361.37 Section...

  19. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Referral to Administrative Law Judge. 500.224 Section 500.224 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Referral for Hearing § 500.224 Referral to Administrative...

  20. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  1. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  2. Chicago's Safer Foundation: A Road Back for Ex-Offenders. Program Focus.

    ERIC Educational Resources Information Center

    Finn, Peter

    The Safer Foundation in Chicago, Illinois, is the largest community-based provider of employment services for ex-offenders in the United States. Established in 1972, Safer has a professional staff of nearly 200 in 6 locations. Safer runs a private school, called the PACE (Programmed Activities for Correctional Education) Institute, at the Cook…

  3. Integrating zebrafish toxicology and nanoscience for safer product development

    PubMed Central

    Kim, Ki-Tae; Tanguay, Robert L.

    2013-01-01

    The design, manufacture and application of safer products and manufacturing processes have been important goals over the last decade and will advance in the future under the umbrella of "Green Chemistry". In this review, we focus on the burgeoning diversity of new engineered nanomaterials (ENMs) and the prescient need for a nanotoxicology paradigm that quickly identifies potentially hazardous nanochemistries. Advances in predictive toxicological modeling in the developing zebrafish offer the most immediate translation to human hazard that is practically achievable with high throughput approaches. Translation in a vertebrate model that is also a low cost alternative to rodents for hazard prediction has been a desirable but elusive testing paradigm. The utility of zebrafish, if applied early in the ENM discovery pipeline, could greatly enhance efforts toward greener and more efficient nanoscience. Early pipeline detection of human and environmental health impacts will quickly inform decisions in the design and production of safer commercial ENMs. PMID:23772181

  4. Identifying subtypes of spousal assaulters Using the B-SAFER.

    PubMed

    Thijssen, Jill; de Ruiter, Corine

    2011-05-01

    In the present study, a structured risk assessment instrument for intimate partner violence, the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER), was coded for 146 files of spousal assault cases from the Dutch probation service, dating from 2004 and 2005. The aim of the study was twofold: (a) to validate Holtzworth-Munroe and Stuart's typology using the risk factors of the B-SAFER and (b) to examine the relationship between the subtypes found and recidivism rates. Four subtypes of assaulters were identified: family only, generally violent/antisocial, low-level antisocial, and psychopathology. These subtypes were comparable to the subtypes found in previous studies. The generally violent/antisocial subtype had the highest recidivism rate, although not significantly different from the other three subtypes. PMID:20522890

  5. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees.

    PubMed

    Shannon, Patricia J; Vinson, Gregory A; Cook, Tonya L; Lennon, Evelyn

    2016-07-01

    In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed. PMID:25735618

  6. Self-Assembly Protein Nanogels for Safer Cancer Immunotherapy.

    PubMed

    Purwada, Alberto; Tian, Ye F; Huang, Weishan; Rohrbach, Kathleen M; Deol, Simrita; August, Avery; Singh, Ankur

    2016-06-01

    Soluble antigen-based cancer vaccines have poor retention in tissues along with suboptimal antigen processing by dendritic cells. Multiple booster doses are often needed, leading to dose-limiting systemic toxicity. A versatile, immunomodulatory, self-assembly protein nanogel vaccine is reported that induces robust immune cell response at lower antigen doses than soluble antigens, an important step towards biomaterials-based safer immunotherapy approaches. PMID:27100566

  7. SAFER Inspection of Space Shuttle Thermal Protection System

    NASA Technical Reports Server (NTRS)

    Scoville, Zebulon C.; Rajula, Sudhakar

    2005-01-01

    In the aftermath of the space shuttle Columbia accident, it quickly became clear that new methods would need to be developed that would provide the capability to inspect and repair the shuttle's thermal protection system (TPS). A boom extension to the Remote Manipulator System (RMS) with a laser topography sensor package was identified as the primary means for measuring the damage depth in acreage tile as well as scanning Reinforced Carbon- Carbon (RCC) surfaces. However, concern over the system's fault tolerance made it prudent to investigate alternate means of acquiring close range photographs and contour depth measurements in the event of a failure. One method that was identified early was to use the Simplified Aid For EVA Rescue (SAFER) propulsion system to allow EVA access to damaged areas of concern. Several issues were identified as potential hazards to SAFER use for this operation. First, the ability of an astronaut to maintain controlled flight depends upon efficient technique and hardware reliability. If either of these is insufficient during flight operations, a safety tether must be used to rescue the crewmember. This operation can jeopardize the integrity of the Extra-vehicular Mobility Unit (EMU) or delicate TPS materials. Controls were developed to prevent the likelihood of requiring a tether rescue, and procedures were written to maximize the chances for success if it cannot be avoided. Crewmember ability to manage tether cable tension during nominal flight also had to be evaluated to ensure it would not negatively affect propellant consumption. Second, although propellant consumption, flight control, orbital dynamics, and flight complexity can all be accurately evaluated in Virtual Reality (VR) Laboratory at Johnson Space Center, there are some shortcomings. As a crewmember's hand is extended to simulate measurement of tile damage, it will pass through the vehicle without resistance. In reality, this force will push the crewmember away from the

  8. Assisting gay men to maintain safer sex: an evaluation of an AIDS service organization's safer sex maintenance program.

    PubMed

    Miller, R L

    1995-01-01

    As the second decade of the AIDS crisis unfolds, increasing concern has been raised that the widespread adoption of condom use that occurred among gay men in the 1980s is not being maintained. Most interventions to promote condom use among gay men are delivered by community-based organizations via programs that are virtually undocumented; little is known about their effectiveness, or the processes by which they may work. This study describes safer sex practices among self-identified gay men following their participation in an intervention developed and implemented by a community-based organization. The intervention was designed to enhance men's attitudes, beliefs, and self-efficacy expectations to maintain safer sex. Among 150 men with complete data at both assessments, self-reported condom use was low. Men reported using condoms more consistently for anal sexual behavior than oral sexual behavior, but there were men who reported consistent unprotected anal sexual intercourse. The intervention had little impact on patterns of behavior over time, although desired changes in attitudes, beliefs, and self-efficacy expectations were evidenced following the intervention. The results suggest the importance of assisting community-based organizations to document program models. Findings also suggest that community-based organizations can develop interventions to successfully enhance factors that theoretically support maintenance of safer sexual behaviors. PMID:8664098

  9. A mechanism of institutional isomorphism in referral networks among hospitals in Seoul, South Korea.

    PubMed

    Jung, Minsoo; Choi, Mankyu

    2010-01-01

    Hospitals engage in medical referral system relations voluntarily, by virtue of their own service capacities. These capacities include medical technology, equipment supply, and patient management, which are assessed individually by medical institutions in efforts to control costs and maintain efficiency in tertiary hospitals. This study assessed referral networks according to the institutional isomorphism theory of new economic sociology. As a result, the referral networks were shown to exhibit emergent structural hierarchy via cumulative clustering by established year and were not affected by attributive variables such as region, bed number, and year of establishment. In particular, the networks evidenced institutional isomorphism with certain central hospitals. As a consequence, personal indices were shown to decrease in accordance with its period, and only the structural index increased. Normative pressures cause organizations to become hierarchically homogenized, in accordance with the principle of organizational learning in specialized fields. Therefore, normative isomorphism on the basis of public domains should be considered an inherent factor in the development of referral networks. PMID:20436330

  10. Integrating MBSE into Ongoing Projects: Requirements Validation and Test Planning for the ISS SAFER

    NASA Technical Reports Server (NTRS)

    Anderson, Herbert A.; Williams, Antony; Pierce, Gregory

    2016-01-01

    The International Space Station (ISS) Simplified Aid for Extra Vehicular Activity (EVA) Rescue (SAFER) is the spacewalking astronaut's final safety measure against separating from the ISS and being unable to return safely. Since the late 1990s, the SAFER has been a standard element of the spacewalking astronaut's equipment. The ISS SAFER project was chartered to develop a new block of SAFER units using a highly similar design to the legacy SAFER (known as the USA SAFER). An on-orbit test module was also included in the project to enable periodic maintenance/propulsion system checkout on the ISS SAFER. On the ISS SAFER project, model-based systems engineering (MBSE) was not the initial systems engineering (SE) approach, given the volume of heritage systems engineering and integration (SE&I) products. The initial emphasis was ensuring traceability to ISS program standards as well as to legacy USA SAFER requirements. The requirements management capabilities of the Cradle systems engineering tool were to be utilized to that end. During development, however, MBSE approaches were applied selectively to address specific challenges in requirements validation and test and verification (T&V) planning, which provided measurable efficiencies to the project. From an MBSE perspective, ISS SAFER development presented a challenge and an opportunity. Addressing the challenge first, the project was tasked to use the original USA SAFER operational and design requirements baseline, with a number of additional ISS program requirements to address evolving certification expectations for systems operating on the ISS. Additionally, a need to redesign the ISS SAFER avionics architecture resulted in a set of changes to the design requirements baseline. Finally, the project added an entirely new functionality for on-orbit maintenance. After initial requirements integration, the system requirements count was approaching 1000, which represented a growth of 4x over the original USA SAFER system

  11. Airport baggage scanning technology makes flying safer for Americans

    SciTech Connect

    Martz, Harry

    2013-08-28

    Each time you step on a commercial flight, you can feel safer because of a researcher you've probably never heard of. His name is Harry Martz. He's a veteran scientist at the Lawrence Livermore National Laboratory (LLNL) who wakes up every day thinking how his research can advance X-ray imaging technology to thwart the next terrorist attack. "My job is to improve national security," Martz said. "That's why my research team exists. We have to outsmart the terrorists. It's a constant battle."

  12. Seismographs, sensors, and satellites: Better technology for safer communities

    USGS Publications Warehouse

    Groat, C.G.

    2004-01-01

    In the past 25 years, our ability to measure, monitor, and model the processes that lead to natural disasters has increased dramatically. Equally important has been the improvement in our technological capability to communicate information about hazards to those whose lives may be affected. These innovations in tracking and communicating the changes-floods, earthquakes, wildfires, volcanic eruptions-in our dynamic planet, supported by a deeper understanding of earth processes, enable us to expand our predictive capabilities and point the way to a safer future. ?? 2004 Elsevier Ltd. All rights reserved.

  13. Artificial Intelligence For A Safer And More Efficient Car Driving

    NASA Astrophysics Data System (ADS)

    Adorni, Giovanni

    1989-03-01

    In this paper a project, PROMETHEUS, is described in which fourteen of Europe's leading car manufacturers are to join with approximately forty research institutes and governmental agencies to make the traffic of Europe safer, more efficient and more economical. PROMETHEUS project is divided into seven areas. In this paper one of the seven areas, PRO-ART, is described. PRO-ART is aimed at clarifying the need for and the principles of the artificial intelligence to be used in the next generation automobile. After a brief description of the overhall project, the description of the seven years PRO-ART Italian research programme will be given.

  14. Paramedical risk framing during field referral of acute stroke and S-T elevation myocardial infarction patients.

    PubMed

    Campeau, Anthony Gerard

    2016-06-01

    Field referral of emergency ambulance patients by paramedics on a widespread basis is a relatively new aspect of paramedicine. Its implementation involves a significant revision to paramedics' clinical responsibilities and level of interaction with medical specialists. Using grounded theory methodology, this qualitative study uses interviews with paramedics from Ontario, Canada, to explore the framing of risk associated with these referrals in the context of caring for patients with two high-stakes medical conditions: acute stroke and S-T elevation myocardial infarction. The results outline how paramedics have incorporated risk framing into their practice. PMID:26819329

  15. Neurotology symptoms at referral to vestibular evaluation

    PubMed Central

    2013-01-01

    Background Dizziness-vertigo is common in adults, but clinical providers may rarely diagnose vestibular impairment and referral could be delayed. To assess neurotology symptoms (including triggers) reported by patients with peripheral vestibular disease, during the year just before their referral to vestibular evaluation. Methods 282 patients with peripheral vestibular disease and 282 control subjects accepted to participate. They had no middle ear, retinal, neurological, psychiatric, autoimmune or autonomic disorders. They reported their symptoms by a standardized questionnaire along with their anxiety/depression symptoms. Results Patients were referred after months or years from the onset of their symptoms, 24% of them reported frequent falls with a long clinical evolution; 10% of them reported no vertigo but instability related to specific triggers; 86% patients and 12% control subjects reported instability when moving the head rapidly and 79% patients and 6% control subjects reported instability when changing posture. Seven out of the 9 symptoms explored by the questionnaire allowed the correct classification of circa 95% of the participants (Discriminant function analysis, p < 0.001). High blood pressure, dyslipidemia and anxiety/depression symptoms showed a mild correlation with the total score of symptoms (multiple R2 =0.18, p < 0.001). Conclusions Late referral to vestibular evaluation may underlie a history of frequent falls; some patients may not report vertigo, but instability related to specific triggers, which could be useful to prompt vestibular evaluation. High blood pressure, dyslipidemia and anxiety/depression symptoms may have a mild influence on the report of symptoms of vestibular disease in both, patients and control subjects. PMID:24279682

  16. Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    Borus, Joshua; Parhami, Iman; Levy, Sharon

    2016-10-01

    Screening, Brief Intervention, and Referral to Treatment is a quick, effective technique with which to manage substance use in adolescents and young adults. Use of a validated measure for detecting substance use and abuse is significantly more effective than unvalidated tools or provider intuition. There are a variety of validated tools available to use in the adolescent/young adult population, and there are opportunities to increase the efficiency and scalability of screening by using computerized questionnaires. This area continues to evolve rapidly. PMID:27613340

  17. Understanding the referral services safe harbor.

    PubMed

    Tomes, J

    1994-02-01

    In today's competitive healthcare environment, healthcare facilities and individual providers must form new relationships to safeguard their market positions and compete efficiently. But while such relationships are necessary and serve legitimate goals, those entering into such arrangements must be concerned that in so doing they do not run afoul of the Medicare and Medicaid fraud and abuse statute. This article examines the potential dangers of remuneration for referrals, and explains how one of the many so-called "safe harbor" provisions of the fraud and abuse statute applies to this practice. PMID:10145951

  18. Development of Methods to Evaluate Safer Flight Characteristics

    NASA Technical Reports Server (NTRS)

    Basciano, Thomas E., Jr.; Erickson, Jon D.

    1997-01-01

    The goal of the proposed research is to begin development of a simulation that models the flight characteristics of the Simplified Aid For EVA Rescue (SAFER) pack. Development of such a simulation was initiated to ultimately study the effect an Orbital Replacement Unit (ORU) has on SAFER dynamics. A major function of this program will be to calculate fuel consumption for many ORUs with different masses and locations. This will ultimately determine the maximum ORU mass an astronaut can carry and still perform a self-rescue without jettisoning the unit. A second primary goal is to eventually simulate relative motion (vibration) between the ORU and astronaut. After relative motion is accurately modeled it will be possible to evaluate the robustness of the control system and optimize performance as needed. The first stage in developing the simulation is the ability to model a standardized, total, self-rescue scenario, making it possible to accurately compare different program runs. In orbit an astronaut has only limited data and will not be able to follow the most fuel efficient trajectory; therefore, it is important to correctly model the procedures an astronaut would use in orbit so that good fuel consumption data can be obtained. Once this part of the program is well tested and verified, the vibration (relative motion) of the ORU with respect to the astronaut can be studied.

  19. SAFER vehicle inspection: a multimodal robotic sensing platform

    NASA Astrophysics Data System (ADS)

    Page, David L.; Fougerolle, Yohan; Koschan, Andreas F.; Gribok, Andrei; Abidi, Mongi A.; Gorsich, David J.; Gerhart, Grant R.

    2004-09-01

    The current threats to U.S. security both military and civilian have led to an increased interest in the development of technologies to safeguard national facilities such as military bases, federal buildings, nuclear power plants, and national laboratories. As a result, the Imaging, Robotics, and Intelligent Systems (IRIS) Laboratory at The University of Tennessee (UT) has established a research consortium, known as SAFER (Security Automation and Future Electromotive Robotics), to develop, test, and deploy sensing and imaging systems for unmanned ground vehicles (UGV). The targeted missions for these UGV systems include -- but are not limited to --under vehicle threat assessment, stand-off check-point inspections, scout surveillance, intruder detection, obstacle-breach situations, and render-safe scenarios. This paper presents a general overview of the SAFER project. Beyond this general overview, we further focus on a specific problem where we collect 3D range scans of under vehicle carriages. These scans require appropriate segmentation and representation algorithms to facilitate the vehicle inspection process. We discuss the theory for these algorithms and present results from applying them to actual vehicle scans.

  20. Developmental Screening Referrals: Child and Family Factors that Predict Referral Completion

    ERIC Educational Resources Information Center

    Jennings, Danielle J.; Hanline, Mary Frances

    2013-01-01

    This study researched the predictive impact of developmental screening results and the effects of child and family characteristics on completion of referrals given for evaluation. Logistical and hierarchical logistic regression analyses were used to determine the significance of 10 independent variables on the predictor variable. The number of…

  1. Verification in referral-based crowdsourcing.

    PubMed

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through "referral-based crowdsourcing": the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

  2. Verification in Referral-Based Crowdsourcing

    PubMed Central

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R.

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

  3. A Safer Formulation Concept for Flame-Generated Engineered Nanomaterials

    PubMed Central

    Gass, Samuel; Cohen, Joel M.; Pyrgiotakis, Georgios; Sotiriou, Georgios A.; Pratsinis, Sotiris E.; Demokritou, Philip

    2013-01-01

    The likely success or failure of the nanotechnology industry depends on the environmental health and safety of engineered nanomaterials (ENMs). While efforts toward engineering safer ENMs are sparse, such efforts are considered crucial to the sustainability of the nanotech industry. A promising approach in this regard is to coat potentially toxic nanomaterials with a biologically inert layer of amorphous SiO2. Core-shell particles exhibit the surface properties of their amorphous SiO2 shell while maintaining specific functional properties of their core material. A major challenge in the development of functional core-shell particles is the design of scalable high-yield processes that can meet large-scale industrial demand. Here, we present a safer formulation concept for flame-generated ENMs based on a one-step, in flight SiO2 encapsulation process, which was recently introduced by the authors as a means for a scalable manufacturing of SiO2 coated ENMs. Firstly, the versatility of the SiO2-coating process is demonstrated by applying it to four ENMs (CeO2, ZnO, Fe2O3, Ag) marked by their prevalence in consumer products as well as their range in toxicity. The ENM-dependent coating fundamentals are assessed and process parameters are optimized for each ENM investigated. The effects of the SiO2-coating on core material structure, composition and morphology, as well as the coating efficiency on each nanostructured material, are evaluated using state-of-the-art analytical methods (XRD, N2 adsorption, TEM, XPS, isopropanol chemisorption). Finally, the biological interactions of SiO2-coated vs. uncoated ENMs are evaluated using cellular bioassays, providing valuable evidence for reduced toxicity for the SiO2-coated ENMs. Results indicate that the proposed ‘safer by design’ concept bears great promise for scaled-up application in industry in order to reduce the toxicological profile of ENMs for certain applications. PMID:23961338

  4. 49 CFR 1503.703 - Civil penalty letter; referral.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 false Civil penalty letter; referral. 1503.703 Section... AND ENFORCEMENT PROCEDURES Judicial Assessment of Civil Penalties § 1503.703 Civil penalty letter; referral. (a) Issuance. In a civil penalty action in which the amount in controversy exceeds the...

  5. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  6. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  7. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Referral to Dispute Resolution Committee... DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five person Dispute Resolution Committee membership shall be determined according to Compact Article VI (g). Should...

  8. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Referral to Dispute Resolution Committee... DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five person Dispute Resolution Committee membership shall be determined according to Compact Article VI (g). Should...

  9. 49 CFR 209.133 - Referral for prosecution.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Referral for prosecution. 209.133 Section 209.133... Penalties § 209.133 Referral for prosecution. If an inspector, including a certified state inspector under... case, and if it appears that assessment of a civil penalty would not be an adequate deterrent to...

  10. 49 CFR 1503.703 - Civil penalty letter; referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... civil penalty action and that the matter is closed. (e) Referral for prosecution and collection. If the... 49 Transportation 9 2010-10-01 2010-10-01 false Civil penalty letter; referral. 1503.703 Section... AND ENFORCEMENT PROCEDURES Judicial Assessment of Civil Penalties § 1503.703 Civil penalty...

  11. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  12. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for exemption under this subpart shall be transmitted...

  13. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  14. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 199.243... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... abuse professionals and counseling and treatment programs. (b) Each covered employee who engages...

  15. NETWORK. A History of the Scottish Telephone Referral Service.

    ERIC Educational Resources Information Center

    Smith, Vernon

    Since its beginnings in 1974 as an outgrowth of the BBC Adult Literacy project, NETWORK SCOTLAND LTD (formerly the Scottish Telephone Referral Service) has grown to play a key role in the provision of broadcast support and educational information services in the United Kingdom. The referral service was originally established to provide a mechanism…

  16. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  17. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  18. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  19. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49 CFR... 49 Transportation 3 2011-10-01 2011-10-01 false Referral, evaluation, and treatment. 199.243... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a)...

  20. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Referral of questions by superintendent. 217.3 Section... DISTRIBUTION CORP. § 217.3 Referral of questions by superintendent. The superintendent shall refer all questions and problems related to the management of the assets as they come to his attention, together...

  1. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Referral of questions by superintendent. 217.3 Section... DISTRIBUTION CORP. § 217.3 Referral of questions by superintendent. The superintendent shall refer all questions and problems related to the management of the assets as they come to his attention, together...

  2. 45 CFR 31.4 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Certification and referral of debt. 31.4 Section 31.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION TAX REFUND OFFSET § 31.4 Certification and referral of debt. (a) Certification. The Secretary shall certify to FMS...

  3. Accuracy of referrals for visual assessment in a stroke population

    PubMed Central

    Rowe, F J

    2011-01-01

    Purpose To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Patients and methods Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Results Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1–94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of −0.048, 0.019). Conclusion More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved. PMID:21127506

  4. 14 CFR 385.6 - Referral to the Reviewing Official.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Referral to the Reviewing Official. 385.6... Referral to the Reviewing Official. When the staff member finds that the public interest so requires, or... shall, in lieu of exercising the authority, submit the matter to the Reviewing Official for decision....

  5. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  6. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  7. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  8. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  9. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  10. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  11. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  12. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  13. 49 CFR 1018.71 - Referral of a compromise offer.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral of a compromise offer. 1018.71 Section... § 1018.71 Referral of a compromise offer. The Board may refer a debtor's firm written offer of compromise which is substantial in amount to GAO or to DOJ if the Board is uncertain whether the offer should...

  14. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  15. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  16. Decreasing Discipline Referrals for African American Males in Middle School

    ERIC Educational Resources Information Center

    Moore, Earl, Jr.; Ratchford, Vicky F.

    2007-01-01

    Brogden Middle School (BMS) is located approximately 15 miles south of Goldsboro, North Carolina, a city of approximately 40,000 citizens and the home of a military base. To decrease the number of discipline referrals of African American males, 10 students who had the most frequent discipline referrals during their seventh-grade year were…

  17. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Referrals to...

  18. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Referrals to...

  19. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Referrals to...

  20. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Referrals to...

  1. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Referrals to...

  2. National Environmental Data Referral Service (NEDRES) User Survey. Final Report.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

    A survey was conducted to assess environmental data users' interest in a referral system such as the National Environmental Data Referral Service (NEDRES) and to gauge user willingness to participate in a proposed NEDRES network and to comply with a system of NEDRES user fees. Twenty-one organizations were identified and 3,200 individuals were…

  3. Safer lithium ion batteries based on nonflammable electrolyte

    NASA Astrophysics Data System (ADS)

    Zeng, Ziqi; Wu, Bingbin; Xiao, Lifen; Jiang, Xiaoyu; Chen, Yao; Ai, Xinping; Yang, Hanxi; Cao, Yuliang

    2015-04-01

    The safety of lithium ion batteries has long been a critical obstacle for their high-power and large-scale applications because of the flammable nature of their carbon anode and organic carbonate electrolytes. To eliminate the potential safety hazards, lithium ion batteries should be built up with thermal-stable electrodes and nonflammable electrolytes. Here we report safer lithium ion batteries using nonflammable phosphonate electrolyte, thermal-stable LiFePO4 cathode and alloy anodes. Benefiting from the electrochemical compatibility and strong fire-retardancy of the phosphonate electrolyte, the cathode and anode materials in the nonflammable phosphonate electrolyte demonstrate similar charge-discharge performances with those in the conventional carbonate electrolyte, showing a great prospect for large-scale applications in electric vehicles and grid-scale electric energy storage.

  4. Recommendations for safer radiotherapy: what’s the message?

    PubMed Central

    Dunscombe, Peter

    2012-01-01

    Radiotherapy, with close to a million courses delivered per year in North America, is a very safe and effective intervention for a devastating disease. However, although rare, several deeply regrettable incidents have occurred in radiotherapy and have rightly been the subject of considerable public interest. Partly in response to reports of these incidents a variety of authoritative organizations across the globe has harnessed the expertise amongst their members in attempts to identify the measures that will make radiotherapy safer. While the intentions of all these organizations are clearly good it is challenging for the health care providers in the clinic to know where to start with so much advice coming from so many directions. Through a mapping exercise we have identified commonalities between recommendations made in seven authoritative documents and identified those issues most frequently cited. The documents reviewed contain a total of 117 recommendations. Using the 37 recommendations in “Towards Safer Radiotherapy” as the initial base layer, recommendations in the other documents were mapped, adding to the base layer to accommodate all the recommendations from the additional six documents as necessary. This mapping exercise resulted in the distillation of the original 117 recommendations down to 61 unique recommendations. Twelve topics were identified in three or more of the documents as being pertinent to the improvement of patient safety in radiotherapy. They are, in order of most to least cited: training, staffing, documentation, incident learning, communication, check lists, quality control and preventive maintenance, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. This analysis provides guidance for the selection of those activities most likely to enhance safety and quality in radiotherapy based on the frequency of citation in selected recent authoritative literature. PMID:23061045

  5. Building Safer Communities: The Integrated Community Safety Approach

    SciTech Connect

    Fawcett, Ricky Lee; Kerr, Thomas A; Jordan, Steven Albert

    2001-03-01

    This paper discusses an integrated community safety approach to creating safer communities. It defines community broadly to include two categories of community members: “industry” and “neighbors.” Potential community members within the “industry” category include facilities, government/regulators, customers, stockholders, and suppliers. Within the “neighbors” category are towns, cities, counties, states; people/commodity flow systems; news media and special interest groups; environment; and families of employees. Each of these potential community members and its characteristics are discussed. The integrated community safety approach consists of three major activities: (1) define the boundaries of the community; (2) facilitate the sense of community; and (3) address the needs of the community. Defining the boundaries of the community includes determining the geographical and social boundaries; this is accomplished through conducting a hazard analysis and community involvement to identify all of the community members. Facilitating the sense of community includes conducting a capability/needs assessment and continuing community involvement to identify the issues and concerns of community members. Addressing the needs of the community involves master planning to consider safety issues in all community development actions and continuing community education and involvement. The integrated community safety approach is a workable approach for existing industries and their neighbors as well as new projects that industries and their neighbors might be considering. By using this socio-technical approach to integrating industry and all of its neighbors into a safer community, the integrated community safety approach will better assure the viability and safety of industry and its neighbors while maintaining or improving the overall quality of life.

  6. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

    ERIC Educational Resources Information Center

    Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman

    2008-01-01

    Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…

  7. 75 FR 71123 - Agency Information Collection Activities; Proposed Collection; Comment Request; Safer Detergent...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... organizations engaged in formulating, producing, purchasing, or distributing surfactants or products containing surfactants. Title: Safer Detergent Stewardship Initiative (SDSI) Program. ICR numbers: EPA ICR No. 2261.02... involved in the transition to safer surfactants. Surfactants are a major ingredient in cleaning...

  8. The SAFER Latinos Project: Addressing a Community Ecology Underlying Latino Youth Violence

    ERIC Educational Resources Information Center

    Edberg, Mark; Cleary, Sean D.; Collins, Elizabeth; Klevens, Joanne; Leiva, Rodrigo; Bazurto, Martha; Rivera, Ivonne; del Cid, Alex Taylor; Montero, Luisa; Calderon, Melba

    2010-01-01

    This paper describes the intervention model, early implementation experience, and challenges for the "Seguridad, Apoyo, Familia, Educacion, y Recursos" (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of…

  9. Keeping afloat: student nurses' experiences following assignment referral.

    PubMed

    Robshaw, Maxine; Smith, Joanna

    2004-10-01

    The retention of nursing students is an ongoing problem, both within the United Kingdom (UK) and internationally. While there is a plethora of literature relating to student attrition, there is an absence of evidence in relation to the experiences of those students who are struggling to meet the demands of nursing programmes. Using an inductive sociological enquiry based approach, this study sought to examine the experiences of student nurses after referral on the first attempt of a summative assessment. Nursing students who had failed an assignment (n=20) were invited to participate. Data was collected using focus groups, with the emergent themes collapsed into a concise format using thematic content analysis. Four key themes were identified: desire to succeed; acceptance of personal failure; recognition of personal attributes required for success; and responsibility for personal success and failure. Students remained on the programme, despite struggling with financial and personal difficulties, because the desire to become a qualified nurse outweighed transient hardships. This paper will illustrate the benefits of understanding the students' experiences, in order to ensure the support students receive is appropriate to their needs. Understanding the support strategies as perceived by the students may prevent further wastage from nursing programmes. PMID:15465166

  10. A Randomized Clinical Trial of the Health Evaluation and Referral Assistant (HERA): Research Methods

    PubMed Central

    Boudreaux, Edwin D.; Abar, Beau; Baumann, Brigitte M.; Grissom, Grant

    2013-01-01

    The Health Evaluation and Referral Assistant (HERA) is a web-based program designed to facilitate screening, brief intervention, and referral to treatment (SBIRT) for tobacco, alcohol, and drug abuse. After the patient completes a computerized substance abuse assessment, the HERA produces a summary report with evidence-based recommended clinical actions for the healthcare provider (the Healthcare Provider Report) and a report for the patient (the Patient Feedback Report) that provides education regarding the consequences of use, personally tailored motivational messages, and a tailored substance abuse treatment referral list. For those who provide authorization, the HERA faxes the individual’s contact information to a substance abuse treatment provider matched to the individual’s substance use severity and personal characteristics, like insurance and location of residence (dynamic referral). This paper summarizes the methods used for a randomized controlled trial to evaluate the HERA’s efficacy in leading to increased treatment initiation and reduced substance use. The study was performed in four emergency departments. Individual patients were randomized into one of two conditions: the HERA or assessment only. A total of 4,269 patients were screened and 1,006 participants enrolled. The sample was comprised of 427 tobacco users, 212 risky alcohol users, and 367 illicit drug users. Fourty-two percent used more than one substance class. The enrolled sample was similar to the eligible patient population. The study should enhance understanding of whether computer-facilitated SBIRT can impact process of care variables, such as promoting substance abuse treatment initiation, as well as its effect on subsequent substance abuse and related outcomes. PMID:23665335

  11. Impact of referral transport system on institutional deliveries in Haryana, India

    PubMed Central

    Prinja, Shankar; Jeet, Gursimer; Kaur, Manmeet; Aggarwal, Arun Kumar; Manchanda, Neha; Kumar, Rajesh

    2014-01-01

    Background & objectives: Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Methods: Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Results: Female gender (OR = 77.7), rural place of residence (OR = 5.96) and poor socio-economic status (poorest wealth quintile OR = 2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI= -137.4 to 146.4) district. Interpretation & conclusions: The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres. PMID:25109723

  12. Nuclear safety: In case of emergency

    SciTech Connect

    Clamp, A.

    1995-12-31

    With a land from their american colleagues, Russian and Ukranian member professionals are developing emergency procedures to make their plants safer. This report discusses how the United States are assisting their colleagues with computer generated simulation of reactor accident situations and with financial assistance.

  13. Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning.

    PubMed

    Pintye, Jillian; Ngure, Kenneth; Curran, Kathryn; Vusha, Sophie; Mugo, Nelly; Celum, Connie; Baeten, Jared M; Heffron, Renee

    2015-09-01

    HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIV-serodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions. PMID:26301703

  14. World Health Day is a day for safer motherhood.

    PubMed

    1998-01-01

    Every year, April 7 is kept as World Health Day. This year [1998] marks the 50th anniversary of the foundation of WHO. However, the day has a double significance because the theme of this year's World Health Day is safe motherhood. All around the world people will mark this day and remind communities and leaders that there is still much work to be done to make pregnancy and childbirth safer. World leaders in Washington will be doing their part on this day, for without high-level political commitment it is hard to get things done. However, this effort is not just for a day. The whole year is dedicated to the theme of safe motherhood. Please let us know about the initiatives taking place in your country, and do send photographs] We can all do something this year to make things better for women and their newborns. Please send your stories and photos to the Editor, Safe Motherhood (address on back page). As well as the 10 action messages that were developed at the technical consultation to mark the 10th anniversary of the Safe Motherhood Initiative, fact sheets and slides are also available either by writing to WHO or on the Internet. PMID:12293570

  15. Can we select health professionals who provide safer care.

    PubMed

    Firth-Cozens, J; Cording, H; Ginsburg, R

    2003-12-01

    In order to improve patient safety, health services are looking to other industries' experiences and as a result are adopting a systems approach to learning from error, rather than simply focusing the blame on the individual. However, in health care the individual will remain an important contributor to safety and this paper looks at other literatures besides health to consider a number of individual characteristics and the role they might play in terms of work practices that affect patient safety. It considers the effects of a variety of personality profiles including sensation seeking, Type A, and those with high self esteem; looks at our ability to select for psychological wellbeing; and discusses the ways that psychometrics have been used in medicine to predict performance. It concludes that although rarely used, psychometrics has been shown to be useful in predicting some aspects of performance in medicine and suggests that this is an area well worth further study for the benefit of patient care. Nevertheless, we are a long way away from being able to select safer staff and should instead be developing this knowledge to enable us to recognise and address potential difficulties. PMID:14645743

  16. New "safer sex initiative" stresses "it takes two".

    PubMed

    1994-11-01

    Until very recently, no major manufacturer of oral contraceptives was willing to provide concrete education about STDs. Wyeth-Ayerst Laboratories recently launched its Nordette Safer Sex Initiative: a pouch containing a pack of Nordette pills, illustrated educational materials about oral contraceptives including health benefits and use instructions, instructions for protection against sexually transmitted diseases (STD), a sample Ramses condom from Schmid Laboratories, and a discount coupon toward future condom purchases. Ortho subsequently released a patient education program/package including a Lifestyles condom. This latter kit includes self-assessment questionnaires designed to help women rate their risk for STDs, and videotapes for both the patient and the provider. The kit is a box containing the sample condom, a pack of pills, a reference card to explain start dates, a question and answer booklet, and an audiocassette describing how the pill works. These collaborative programs between oral contraceptive manufacturers and condom manufacturers is welcomed as a real breakthrough by numerous reproductive health organizations and providers. The Wyeth program is actually a pilot program offered to 16,000 office-based obstetrician/gynecologists, but it is being considered for distribution to federally-funded clinics. For its part, the entire Ortho kit is available only to physicians, but the company is offering some of the material free to federally-funded clinics. PMID:12289956

  17. How Can We Make PV Modules Safer?: Preprint

    SciTech Connect

    Wohlgemuth, J. H.; Kurtz, S. R.

    2012-06-01

    Safety is a prime concern for the photovoltaics (PV) industry. As a technology deployed on residential and commercial buildings, it is critical that PV not cause damage to the buildings nor harm the occupants. Many of the PV systems on buildings are of sufficiently high voltage (300 to 600 Volts dc) that they may present potential hazards. These PV systems must be safe in terms of mechanical damage (nothing falls on someone), shock hazard (no risk of electrical shock when touching an exposed circuit element), and fire (the modules neither cause nor promote a fire). The present safety standards (IEC 61730 and UL 1703) do a good job of providing for design rules and test requirements for mechanical, shock, and spread of flame dangers. However, neither standard addresses the issue of electrical arcing within a module that can cause a fire. To make PV modules, they must be designed, built, and installed with an emphasis on minimizing the potential for open circuits and ground faults. This paper provides recommendations on redundant connection designs, robust mounting methods, and changes to the safety standards to yield safer PV modules.

  18. The Nuclear Posture Review (NPR) : are we safer?

    SciTech Connect

    Brune, Nancy E.

    2010-07-01

    Nuclear Posture Review (NPR) is designed to make world safer by reducing the role of U.S. nuclear weapons and reducing the salience of nuclear weapons. U.S. also seeks to maintain a credible nuclear deterrent and reinforce regional security architectures with missile defenses and other conventional military capabilities. But recent studies suggest that nuclear proliferation is a direct response to the perceived threat of U.S. conventional capabilities not U.S. nuclear stockpile. If this is true, then the intent of the NPR to reduce the role and numbers of nuclear weapons and strengthen conventional military capabilities may actually make the world less safe. First stated objective of NPR is to reduce the role and numbers of U.S. nuclear weapons, reduce the salience of nuclear weapons and move step by step toward eliminating them. Second stated objective is a reaffirmation of U.S. commitment to maintaining a strong deterrent which forms the basis of U.S. assurances to allies and partners. The pathway - made explicit throughout the NPR - for reducing the role and numbers of nuclear weapons while maintaining a credible nuclear deterrent and reinforcing regional security architectures is to give conventional forces and capabilities and missile defenses (e.g. non-nuclear elements) a greater share of the deterrence burden.

  19. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  20. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  1. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  2. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  3. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  4. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  5. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  6. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  7. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  8. Effect of hospital referral networks on patient readmissions.

    PubMed

    Mascia, Daniele; Angeli, Federica; Di Vincenzo, Fausto

    2015-05-01

    Previous studies have shown that referral networks encompass important mechanisms of coordination and integration among hospitals, which enhance numerous organizational-level benefits, such as productivity, efficiency, and quality of care. The present study advances previous research by demonstrating how hospital referral networks influence patient readmissions. Data include 360,697 hospitalization events within a regional community of hospitals in the Italian National Health Service. Multilevel hierarchical regression analysis tests the impacts of referral networks' structural characteristics on patient hospital readmissions. The results demonstrate that organizational centrality in the overall referral network and ego-network density have opposing effects on the likelihood of readmission events within hospitals; greater centrality is negatively associated with readmissions, whereas greater ego-network density increases the likelihood of readmission events. Our findings support the (re)organization of healthcare systems and provide important indications for policymakers and practitioners. PMID:25795994

  9. How do obstetric providers discuss referrals for prenatal genetic counseling?

    PubMed

    Bernhardt, Barbara A; Haunstetter, Carrie Mastromarino; Roter, Debra; Geller, Gail

    2005-04-01

    To investigate referrals of pregnant women to genetic counseling, we analysed transcripts from audiotaped first prenatal visits of 104 patients (72 actual patient visits and 32 simulated patient visits) with 32 providers (obstetricians and nurse-midwives). All patients had at least one indication for referral. Only 10% of visits with actual patients included a genetic counseling referral. When genetic counseling was discussed, it was only briefly described, primarily as an information session. This study shows that the majority of pregnant women with an indication for referral for genetic counseling are not referred. In addition, obstetric providers' inadequate descriptions of prenatal genetic counseling may result in women being poorly prepared for genetic counseling sessions. PMID:15959642

  10. Treatment of hypertension in the emergency department.

    PubMed

    Baumann, Brigitte M; Cline, David M; Pimenta, Eduardo

    2011-01-01

    This review updates concepts of hypertension evaluation and management in patients presenting to the emergency department. It outlines the current challenges faced by emergency physicians in the identification and management of hypertensive patients: In spite of published emergency care guidelines, identification and referral rates remain low in patients presenting to the emergency department with moderate blood pressure (BP) elevations. In patients with severely elevated BP, the evaluation for acute end organ damage remains inconsistent and is symptom-based. Using current consensus guidelines, this review provides an algorithm for the management of the hypertensive emergency department patient. The final section of this review outlines management strategies for specific hypertensive emergencies. PMID:21719370