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Sample records for referral and consultation

  1. 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

  2. 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

  3. Survey of Mental Health Consultation and Referral Among Primary Care Pediatricians

    PubMed Central

    Guevara, James P.; Greenbaum, Paul E.; Shera, David; Bauer, Laura; Schwarz, Donald F.

    2008-01-01

    Objective To determine availability of and test whether on-site mental health providers (MHP) is associated with greater odds of reported mental health consultation and referral among primary care pediatricians. Methods Pediatricians were identified from the American Medical Association's 2004 Physician Directory, stratified by region, and 600 were randomly selected to receive a mail survey. The main independent variable was on-site MHP. The dependent variable was reported frequency (4-point rating) of mental health consultation and referral. Estimates were weighted to account for survey design and non-response. Results Overall response rate was 51%. The majority of respondents were male (56%), age ≥46 years old (59%), white (68%), and practicing in suburban locations (52%). Approximately half reported consultation with (44%) or referral to (51%) MHP always or often, but few (17%) reported on-site MHP. After adjustment for demographic and practice characteristics, pediatricians with on-site MHP were more likely to consult (Odds Ratio [OR] 6.58, 95% confidence interval [CI] 3.55-12.18) or refer (OR 4.25, 95% CI 2.19-8.22) than those without on-site MHP. Among those without on-site MHP, pediatricians with greater practice burden were less likely to consult (OR 0.69, 95% CI 0.48-0.99) or refer (OR 0.75, 95% CI 0.54-1.04) than those with lesser burden. Conclusions Most pediatricians in the U.S. experienced practice-related burdens that limit mental health collaboration, but those with collocated services reported a greater likelihood of consultation and referral. Policy changes that encourage collocation of mental health services and limit practice burden may facilitate mental health consultation and referral. PMID:19329104

  4. 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…

  5. High referral rates to secondary care by general practitioners in Norway are associated with GPs’ gender and specialist qualifications in family medicine, a study of 4350 consultations

    PubMed Central

    2013-01-01

    Background Referral rates of general practitioners (GPs) are an important determinant of secondary care utilization. The variation in these rates across GPs is considerable, and cannot be explained by patient morbidity alone. The main objective of this study was to assess the GPs’ referral rate to secondary care in Norway, any associations between the referral decision and patient, GP, health care characteristics and who initiated the referring issue in the consultation. Methods The probabilities of referral to secondary care and/or radiological examination were examined in 100 consecutive consultations of 44 randomly chosen Norwegian GPs. The GPs recorded whether the issue of referral was introduced, who introduced it and if the patient was referred. Multilevel and naive multivariable logistic regression analyses were performed to explore associations between the probability of referral and patient, GP and health care characteristics. Results Of the 4350 consultations included, 13.7% (GP range 4.0%-28.0%) of patients were referred to secondary somatic and psychiatric care. Female GPs referred significantly more frequently than male GPs (16.0% versus 12.6%, adjusted odds ratio, AOR, 1.25), specialists in family medicine less frequently than their counterparts (12.5% versus 14.9%, AOR 0.76) and salaried GPs more frequently than private practitioners (16.2% versus 12.1%, AOR 1.36). In 4.2% (GP range 0%-12.9%) of the consultations, patients were referred to radiological examination. Specialists in family medicine, salaried GPs and GPs with a Norwegian medical degree referred significantly more frequently to radiological examination than their counterparts (AOR 1.93, 2.00 and 1.73, respectively). The issue of referral was introduced in 23% of the consultations, and in 70.6% of these cases by the GP. The high referrers introduced the referral issue significantly more frequently and also referred a significantly larger proportion when the issue was introduced

  6. Patients' Perspectives on Wait Times and the Referral-Consultation Process While Attending a Tertiary Diabetes and Endocrinology Centre: Is Econsultation an Acceptable Option?

    PubMed

    Keely, Erin; Traczyk, Lara; Liddy, Clare

    2015-08-01

    The goal of this study was to establish patients' perspectives on the acceptability of wait times, the impact of wait times on their health and the possibility of using electronic consultations (eConsultations) to avoid visits to specialists. A 2-stage patient survey (self-administered and with a follow-up telephone call) and a chart audit was conducted on a sequential sample of patients attending their initial consultations in a tertiary diabetes and endocrinology centre. Patients' perspectives on actual and ideal wait times, the impact of waiting for access, the effectiveness of the referral-consultation process and attitudes toward eConsultations as an alternative to traditional referral-consultations were collected. The study involved 101 patients (22% for diabetes, 78% for endocrinologic conditions), whose comments were collated and categorized. Of the 101 patients who completed the survey, 61 also completed telephone interviews. The average wait time was 19 weeks; the median 10 weeks. More than 30% of patients waited longer than 6 months and 6% waited longer than 1 year. Overall, 90% of patients thought that the maximum wait time should be less than 3 months. While waiting, 58% of patients worried about a serious undiagnosed disease, 30% found their symptoms had affected their daily activities and 24% had to miss work or school due to symptoms. Of the patients, 46% considered eConsultation a viable alternative to face-to-face visits. Excessive wait times for specialist care remain barriers and have negative impacts on patients. Wait times significantly exceeded times patients considered acceptable. eConsultations provide acceptable alternatives for many patients, and they reduced the number of patients requiring traditional consultations. PMID:25797111

  7. Interdisciplinary expert consultation via a teleradiology platform--influence on therapeutic decision-making and patient referral rates to an academic tertiary care center.

    PubMed

    Helck, A; Matzko, M; Trumm, C G; Grosse, C; Piltz, S; Reiser, M; Ertl-Wagner, B

    2009-12-01

    In addition to teleradiological reporting as a nighthawking or a regular service, teleradiological communication can be used for interdisciplinary expert consultation. We intended to evaluate an interdisciplinary consultation system based on a teleradiology platform with regard to its impact on therapeutic decision-making, directed patient referrals to an academic tertiary care center and the economic benefit for the hospital providing the service. Therefore, consultations from five secondary care centers and consecutive admissions to an academic tertiary care center were prospectively evaluated over a time period of six months. A total of 69 interdisciplinary expert consultations were performed. In 54 % of the cases the patients were consecutively referred to the university hospital for further treatment. In all acutely life-threatening emergencies (n = 9), fast and focused treatment by referral to the academic tertiary care center was achieved (average time to treat 130 min). The admissions to the academic tertiary care center led to improved utilization of its facilities with additional revenue of more than 1,000000 euro p. a. An interdisciplinary expert consultation via a teleradiology platform enables fast and efficient expert care with improved and accelerated patient management and improved utilization of the service providing hospital. PMID:19859862

  8. Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety Net Health Setting

    PubMed Central

    Scheibe, Meghan M.; Imboden, John B.; Schmajuk, Gabriela; Margaretten, Mary; Graf, Jonathan D.; Chen, Alice H.; Yelin, Edward H.; Yazdany, Jinoos

    2015-01-01

    Objective Health information technology (HIT) holds promise in increasing access to rheumatologists by improving the quality and efficiency of referrals, but few studies have examined its use for this purpose. We evaluated the use and impact of a novel electronic referral (eReferral) system in rheumatology in a safety net health system. Methods We examined eReferrals over four years. Our primary outcome was use of pre-consultation exchange, defined as back-and-forth communication between referring and specialty care providers, facilitating triage of referrals, requests for more information, or resolution of questions without a visit. We calculated the proportion of eReferrals that underwent pre-consultation exchange, time to reviewer response, and number of visits scheduled. To increase generalizability, we selected a random sample of eReferrals to undergo additional blinded, adjudicated review to assess agreement on appropriateness for pre-consultation exchange. Results Between 2008–2012, 2,383 eReferrals were reviewed and 2,105 were eligible for analysis. One-quarter of eReferrals were resolved without a clinic visit. The proportion of eReferrals undergoing pre-consultation exchange increased over time (55% in 2008 vs. 74% in 2011). The volume of referrals steadily increased over time. Reviewer response time averaged between 1–4 days. In the random sample of eReferrals that underwent adjudicated review, agreement between reviewers was high (kappa 0.72). Conclusion HIT-enabled pre-consultation exchange was used for a majority of eReferrals and facilitated communication between referring clinicians and rheumatologists. This redesigned system of care allowed for triage of a high number of referrals, with large numbers of referrals determined to be appropriate for pre-consultation exchange. PMID:25623810

  9. Communication Consultants and Consulting: A Survey of ABC Members.

    ERIC Educational Resources Information Center

    Axley, Stephen R.

    1987-01-01

    Suggests that communication consultants are diverse in degree qualifications, in disciplines, and in kind of consulting services offered. Also suggests that consultants serve large businesses and that they conduct various writing and nonwriting workshops for client organizations. Notes that word-of-mouth and college referrals are important means…

  10. Pre-Referral Consultation: Sucessful Intervention for At-Risk Youth.

    ERIC Educational Resources Information Center

    Armil, Janet L.

    Pre-Referral Consultation (PRC) is a category of student referral separate from the conventional special education referral, through which any person can refer for help--any student who may be in crisis, falling through the cracks, or otherwise at risk. It exemplifies the integration of special education personnel into the general education…

  11. Changes in Referral Interviews with Teachers after Behavioral Consultation Training.

    ERIC Educational Resources Information Center

    McDougall, Linda M.; And Others

    1988-01-01

    Evaluated effectiveness of a one-day in-service workshop on behavioral consultation using 16 school professionals (including 13 psychologists) who submitted audiotapes of prereferral interviews with teachers before and after workshop. Concluded that brief workshops can be effective in developing Problem Identification Interviewing skills and that…

  12. Pre-referral GP consultations in patients subsequently diagnosed with rarer cancers: a study of patient-reported data

    PubMed Central

    Mendonca, Silvia C; Abel, Gary A; Lyratzopoulos, Georgios

    2016-01-01

    Background Some patients with cancer experience multiple pre-diagnostic consultations in primary care, leading to longer time intervals to specialist investigations and diagnosis. Patients with rarer cancers are thought to be at higher risk of such events, but concrete evidence of this is lacking. Aim To examine the frequency and predictors of repeat consultations with GPs in patients with rarer cancers. Design and setting Patient-reported data on pre-referral consultations from three English national surveys of patients with cancer (2010, 2013, and 2014), pooled to maximise the sample size of rarer cancers. Method The authors examined the frequency and crude and adjusted odds ratios for ≥3 (versus 1–2) pre-referral consultations by age, sex, ethnicity, level of deprivation, and cancer diagnosis (38 diagnosis groups, including 12 rarer cancers without prior relevant evidence). Results Among 7838 patients with 12 rarer cancers, crude proportions of patients with ≥3 pre-referral consultations ranged from >30.0% to 60.0% for patients with small intestine, bone sarcoma, liver, gallbladder, cancer of unknown primary, soft-tissue sarcoma, and ureteric cancer. The range was 15.0–30.0% for patients with oropharyngeal, anal, parotid, penile, and oral cancer. The overall proportion of responders with any cancer who had ≥3 consultations was 23.4%. Multivariable logistic regression indicated concordant patterns, with strong evidence for variation between rarer cancers (P <0.001). Conclusion Patients with rarer cancers experience pre-referral consultations at frequencies suggestive of middle-to-high diagnostic difficulty. The findings can guide the development of new diagnostic interventions and ‘safety-netting’ approaches for symptomatic presentations encountered in patients with rarer cancers. PMID:26917657

  13. Contemporary Practices in School Psychology: A National Survey of Roles and Referral Problems.

    ERIC Educational Resources Information Center

    Bramlett, Ronald K.; Murphy, John J.; Johnson, Jenna; Wallingsford, Leah; Hall, John D.

    2002-01-01

    School psychologists (N=370) from a national organization were surveyed about their roles, types of referrals, consultation practices, and crisis team involvement. Assessment was the most common role. Most referrals were for academic problems. Behavioral consultation was the most common model. The majority of respondents had some involvement in…

  14. Psychiatric Consultation and Substance Use Disorders

    PubMed Central

    Specker, Sheila; Meller, William H.; Thurber, Steven

    2009-01-01

    Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although

  15. Referral patterns between primary care and genitourinary medicine.

    PubMed

    Champion, J K; Ross, J D

    1999-02-01

    Many patients attending genitourinary medicine (GUM) clinics are self referred, but some patients initially present to their general practitioner (GP). The aim of this study was to describe the referral pattern of GPs in the Lothian region of Scotland to the local GUM clinic. A questionnaire was completed by all patients referred by their GP and a case note review supplied further diagnostic and demographic information. Of 1140 (23%) patients, 965 were available for study and were referred by their GP. There was a wide variability in referral rates from different practices and from different partners within a practice. The median referral rate per 100,000 practice population was 22.4/year (range 0-586). A referral letter accompanied the patient in 797/965 (83%) cases. The detection of cases of chlamydia and gonorrhoea in patients in primary care subsequently referred to the GUM clinic was low and poor diagnostic acumen for herpes simplex virus (HSV) was notable. No consistent practice for investigation or treatment prior to referral was found and there was marked failure of the investigations initiated in primary care to achieve diagnosis. Despite this, 24% of patients were already on treatment at the time of their GUM consultation. Few STDs were diagnosed in primary care and subsequently referred to the GUM clinic suggesting either failure to diagnose infections or reluctance to refer on for confirmation, treatment, test of cure and health education. PMID:10215118

  16. Behavioral Consultation: Theory and Process

    ERIC Educational Resources Information Center

    Russell, Michael L.

    1978-01-01

    This model examines the theory, clinical process, and intervention techniques of behavioral consultation in educational and medical settings. Behavioral consultation requires empirical validation of intervention. It also holds the counselee accountable for consultations. The consultant has many techniques, but must be sensitive to interaction…

  17. E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

    PubMed Central

    Naseriasl, Mansour; Adham, Davoud; Janati, Ali

    2015-01-01

    Background: around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment’s and services. In order to respond these challenges and reduction of health system’s transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. Methods: relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby’s index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. Results: we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. Conclusion: each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner. PMID:26236167

  18. Resistance, Reactance, and Consultation.

    ERIC Educational Resources Information Center

    Hughes, Jan N.; Falk, Robert S.

    1981-01-01

    Presents a review of techniques for dealing with consultee resistance. Suggests the social psychological theory of reactance is a useful conceptual framework for considering resistance in consultation. Discusses examples of its application, variables that predict the likely effectiveness of a reactance utilization intervention, and ethical issues.…

  19. Consultation psychiatry in an Italian child guidance center: a report on 200 referrals.

    PubMed

    Fava, G A

    1981-01-01

    A consecutive unselected series of 200 children referred for psychiatric consultation to an Italian Child Guidance Center is included in this study. All diagnoses were made in accord with the third edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM III). Functional enuresis was the most common psychiatric disturbance (15 percent), followed by developmental reading disorder (14.5 percent) and mild mental retardation (12.5 percent). There was no case of attention deficit disorder with hyperactivity (hyperkinetic syndrome). All depressions were consequences of another disorder and remitted when the child received attention and care. In 20.5 percent of cases no psychiatric diagnosis was made and the child apparently had been referred because of emotional problems in the parent. PMID:7327018

  20. Consultants, Consultancy and Consultocracy in Education Policymaking in England

    ERIC Educational Resources Information Center

    Gunter, Helen M.; Hall, David; Mills, Colin

    2015-01-01

    The role and contribution of consultants and consultancy in public services has grown rapidly and the power of consultants suggests the emergence of a "consultocracy". We draw on research evidence from the social sciences and critical education policy (CEP) studies to present an examination of the state of the field. We deploy a…

  1. 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....

  2. 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....

  3. 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....

  4. The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults

    PubMed Central

    Podolsky, Anna; Stern, David T.; Peccoralo, Lauren

    2015-01-01

    Background Communication and courtesy are important elements of consultations, but there is limited published data about the quality of trainee consults. Objectives This study assessed residents' views on consult interactions, evaluated the impact of the consult interactions on patient care, and developed and implemented a pocket card and training on trainee consults. Methods We surveyed resident and fellow physicians at Mount Sinai Hospital to assess perceptions, created a CONSULT card that uses a mnemonic for key elements, and developed a training session for how to call consults. We also conducted a consult training session using the CONSULT card as part of orientation in 2011 for all interns. We assessed the acceptability, feasibility, and sustainability of this intervention. Results Of 1001 trainees, 403 (40%) responded. Respondents reported that the most important components of calling consults included giving patient name, medical record number, and location (91%), and giving a clear question/reason (89%). Respondents also reported that these behaviors are done consistently for only 64%, and 10% of consults, respectively. Trainees reported that consult interactions affect the timeliness of treatment (62%), timeliness of tests performed (57%), appropriateness of diagnosis (56%), and discharge planning (49%). Approximately 300 interns attended the consult training session, and their feedback demonstrated acceptability and utility of the session. Conclusions Trainees believe that consult interactions impact patient care, but important components of the consult call are often missing. Our training and CONSULT card is an acceptable, feasible, and novel training intervention. Once developed, the training session and CONSULT card require minimal faculty time to deliver. PMID:26217436

  5. 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

  6. 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

  7. 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

  8. 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…

  9. 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....

  10. 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....

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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

  17. 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

  18. Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

    PubMed Central

    Bossyns, Paul; Abache, Ranaou; Abdoulaye, Mahaman S; Miyé, Hamidou; Depoorter, Anne-Marie; Van Lerberghe, Wim

    2006-01-01

    Background The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. Methods Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. Results The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. Conclusion Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with. PMID:16608534

  19. 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

  20. 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...

  1. Phone Consultation for Behavioral Health-Related Referrals in Integrated Primary Care.

    PubMed

    Valleley, Rachel J; Hine, Jeffrey F; Clare, Ann; Evans, Joseph H

    2015-10-01

    Behavioral health (BH) providers add value to primary care teams. This descriptive study illustrates one such role that the BH provider can serve. The on-site BH provider responded to patient phone inquiries regarding BH topics for pediatricians over the course of 15 months. The majority of these calls were for children 10 years and younger and related to externalizing problems. Phone calls were relatively brief (i.e., 11-15 minutes). More than half of these phone calls resulted in families scheduling an appointment with nearly 75% showing up for the initial session. Providing this type of adjunctive service may result in earlier access to care and efficiently assigning responsibilities to the appropriate team member. PMID:26242397

  2. Communication Consulting as Persuasion: Issues and Implications.

    ERIC Educational Resources Information Center

    Ross, Roseanna G.

    Focusing on the issue of the training and preparation of the communication specialist in communication consulting, an investigation of the persuasive elements in the client-consulting relationship suggests that more direct focus on consulting as persuasion can lead to more responsible and effective enactment of the role of both consultant and…

  3. Generating Clients and Referral Sources.

    ERIC Educational Resources Information Center

    Russell, Martha; Price, Meg; Becht, Monika

    1997-01-01

    Includes three theme articles: "Visibility, Connectedness, and Collaboration: Keys to Marketing a Private Practice" (Martha Russell); "If You Build It (and Publicize It) They Will Come: An Overview of Private Practice Marketing Strategies" (Meg Price); and "The Art of Networking in Private Practice" (Monika Becht). (SK)

  4. 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

  5. Using web technology and Java mobile software agents to manage outside referrals.

    PubMed

    Murphy, S N; Ng, T; Sittig, D F; Barnett, G O

    1998-01-01

    A prototype, web-based referral application was created with the objective of providing outside primary care providers (PCP's) the means to refer patients to the Massachusetts General Hospital and the Brigham and Women's Hospital. The application was designed to achieve the two primary objectives of providing the consultant with enough data to make decisions even at the initial visit, and providing the PCP with a prompt response from the consultant. The system uses a web browser/server to initiate the referral and Java mobile software agents to support the workflow of the referral. This combination provides a light client implementation that can run on a wide variety of hardware and software platforms found in the office of the PCP. The implementation can guarantee a high degree of security for the computer of the PCP. Agents can be adapted to support the wide variety of data types that may be used in referral transactions, including reports with complex presentation needs and scanned (faxed) images Agents can be delivered to the PCP as running applications that can perform ongoing queries and alerts at the office of the PCP. Finally, the agent architecture is designed to scale in a natural and seamless manner for unforeseen future needs. PMID:9929190

  6. Narrative and Structure in Consultation

    ERIC Educational Resources Information Center

    Hadley, David

    2012-01-01

    This article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…

  7. Consultation Stressors and Stress Management.

    ERIC Educational Resources Information Center

    Portman, Sandy Kosub

    A high incidence of occupational stress has been demonstrated in the mental health and social service professions and appears to be a major factor contributing to low worker morale, absenteeism, high job turnover, and other indices of job stress. A study was conducted to examine the issue of occupational stress among psychological consultants.…

  8. 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

  9. Improving efficiency and saving money in an otolaryngology urgent referral clinic.

    PubMed

    Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind

    2015-06-16

    A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost. PMID:26090368

  10. 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…

  11. 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...

  12. 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...

  13. 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)...

  14. Observed Consultation: Confidence and Accuracy of Assessors

    ERIC Educational Resources Information Center

    Tweed, Mike; Ingham, Christopher

    2010-01-01

    Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…

  15. Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation

    ERIC Educational Resources Information Center

    Thornberg, Robert

    2014-01-01

    The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

  16. The 'iceberg' of illness and 'trivial' consultations.

    PubMed

    Hannay, D R

    1980-09-01

    The medical symptom 'iceberg' and 'trivia' were defined in terms of people's own perceptions of their symptoms and their subsequent referral behaviour. The data were collected by household interviews of patients registered at a health centre and included information on personal and environmental characteristics. Bivariate and multivariate analysis was used to explore associations between those who were part of the symptom 'iceberg' or 'trivia', and factors which might have caused such incongruous referral behaviour. PMID:7452594

  17. 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…

  18. Peter Block's Flawless Consulting and the Homunculus Theory: Within Each Person Is a Perfect Consultant.

    ERIC Educational Resources Information Center

    Ross, Gloria J.

    1993-01-01

    Notes that Block (1981) saw consultant authenticity as significant to process of consulting and believed that, as consultant acknowledged feelings and thoughts when they surfaced, client commitment and trust would develop. Adds that Block has defined five phases to consulting and detailed work that must be completed in each phase to provide…

  19. Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals.

    PubMed

    Hong, B; Shaikh, Z; Adcock, S; Aldallal, S N

    2016-05-27

    Objectives i) To prospectively explore patients' experience through the two-week wait (2WW) referral process; ii) To compare the relative true malignancy diagnostic rate between general medical practitioners (GMPs) and general dental practitioners (GDPs) over a six-month period; iii) To compare management of 2WW referral cases between GMPs and GDPs before the referral and during the 2 weeks in regards to symptomatic support, investigations in primary care, and information communicated to patients and secondary care clinicians; iv) To investigate the benign conditions that comprise 2WW referrals by finding out the final diagnoses of all cases included in the study.Method The patient inclusion criteria were all 2WW referral patients who attended consultation clinics during the six-month study period in Royal Cornwall Hospital NHS Trust. We prospectively distributed patient questionnaires and clinician's referral assessment forms. We obtained the final diagnoses of all participants electronically, and also identified all malignancies diagnosed via routine referral route during the study period from the cancer services team.Results Two hundred and twenty patients referred via 2WW pathway participated in the study. Of these, 148 referrals were from GMPs and 72 from GDPs. The overall malignancy diagnostic yield was 6.2%; markedly higher from GMPs (9.5%) than GDPs (1.4%), and higher number than those from routine pathway. The GMPs and GDPs showed similar levels of clinical management and information exchange judging from the participants' responses. We also identified the top nine most commonly urgently referred benign conditions.Conclusion We reiterate the need for improved communication between clinicians and patients and between clinicians. We also suggest more focus on education in commonly encountered conditions as well as malignant lesions. The number of 2WW referrals we received from GMPs was nearly twice as many as those from GDPs, highlighting the importance of

  20. Rheumatic Disease, the Family Physician, and the Consultants: When to Hold Them and When to Fold Them

    PubMed Central

    Koehler, Barry; Warren, Gwen

    1990-01-01

    The principles of when to refer in rheumatologic disorders vary little from the general pattern, but some disease-specific advice is helpful. Follow the age-old tenets of referring if diagnosis is uncertain, if treatment advice is needed, or if you are unable to meet the many needs of patients with chronic illnesses. It is often valuable to ask why the patient wants a referral. Education, referral to allied health professionals, and assessing how well you are supporting the patient are all important. It is also essential to maintain contact with both patient and consultant if referral is necessary. PMID:21234070

  1. 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...

  2. Linking Knowledge and Action: PRI's Community Consultant.

    ERIC Educational Resources Information Center

    Spencer, Gregory P.

    Within the Partnership for Rural Improvement (PRI), community consultants operate within three complex sets of relationships: client groups, the organizational structure of PRI, and the local operational base. Community consultants are responsible for developing and facilitating rural development and for providing assistance in community and…

  3. Consulting and Training--Career Options.

    ERIC Educational Resources Information Center

    Church, Olive D.

    1986-01-01

    Business teachers have additional career options to consider, namely, joining a consulting-training firm as a junior professional employee; entering a firm as an associate; investing personal resources in an already successful firm; starting one's own firm; and/or applying for part- or full-time work as an internal consultant or trainer and…

  4. Developing Knowledge and Value in Management Consulting. Research in Management Consulting.

    ERIC Educational Resources Information Center

    Buono, Anthony F., Ed.

    This document contains 11 papers that explore knowledge and value development in the field of management consulting, with particular emphasis on trends and techniques in the practice of management consulting and the current theory and dynamics of management consulting. The following papers are included: "Introduction" (Anthony F. Buono);…

  5. Fifteen minute consultation: tics and Tourette syndrome.

    PubMed

    Ong, Min Tsui; Mordekar, Santosh R; Seal, Arnab

    2016-04-01

    Tic disorders including Tourette syndrome (TS) are neuropsychiatric disorders that are common referrals to paediatricians, paediatric neurologists and child psychiatrists. Although differentiating tics and TS from other movement disorders is not difficult, it is essential to detect comorbid conditions and their contribution to TS. PMID:26396225

  6. Competency-Based Behavior Consultation Training: An Evaluation of Consultant Outcomes, Treatment Effects, and Consumer Satisfaction

    ERIC Educational Resources Information Center

    Lepage, Kathy; Kratochwill, Thomas R.; Elliott, Stephen N.

    2004-01-01

    Assessments of consultants, clients, and consumer satisfaction were used to examine the effects of a competency-based consultation training program conducted over 4 years. Using a multiple-baseline framework to assess training effects on consultants and single-case study designs to evaluate changes in client behavior, a number of significant…

  7. Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study

    PubMed Central

    Martins, Sonia Maria; Salibe-Filho, William; Tonioli, Luís Paulo; Pfingesten, Luís Eduardo; Braz, Patrícia Dias; McDonnell, Juliet; Williams, Siân; do Carmo, Débora; de Sousa, Jaime Correia; Pinnock, Hilary; Stelmach, Rafael

    2016-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented ‘matrix support’: a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157–87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems. PMID:27536853

  8. Implementation of 'matrix support' (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study.

    PubMed

    Martins, Sonia Maria; Salibe-Filho, William; Tonioli, Luís Paulo; Pfingesten, Luís Eduardo; Braz, Patrícia Dias; McDonnell, Juliet; Williams, Siân; do Carmo, Débora; de Sousa, Jaime Correia; Pinnock, Hilary; Stelmach, Rafael

    2016-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented 'matrix support': a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157-87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems. PMID:27536853

  9. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 5 2014-04-01 2014-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. (a)...

  10. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 5 2013-04-01 2013-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  11. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  12. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 5 2012-04-01 2012-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  13. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  14. Breaking the Cycle of Office Referrals and Suspensions: Defensive Management

    ERIC Educational Resources Information Center

    Fields, Barry

    2004-01-01

    This paper focuses on a strategy--Defensive Management--designed to assist teachers to better manage non-compliance and defiance in the classroom, with the ultimate goal of reducing disciplinary referrals and flow-on suspensions and exclusions from school. Non-compliance and defiance are behaviours that teachers find particularly challenging and,…

  15. Public Library Information and Referral Project, Phase II. Final Report.

    ERIC Educational Resources Information Center

    Childers, Thomas; Krauser, Cheri

    This study is the second of a two-phase survey of public library information and referral (I&R) service. In this phase, seven public libraries offering I&R services were studied in depth to provide descriptions of their operations, organizational factors, and the reactions of their users. Organizational factors and operations were studied through…

  16. Identification, Referral and Assessment of Handicapped Students: A Trainer's Manual.

    ERIC Educational Resources Information Center

    Spearman, Carolyn; Gaddis, Ruth

    The trainer's manual offers a sampling of workshop materials to assist the regular classroom teacher in the process of screening, identification, referral, and assessment of handicapped students. Following an introduction are sections with information, sample handouts, forms, and checklists on the following topics (sample subtopics in…

  17. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    ERIC Educational Resources Information Center

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  18. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral and scheduling for hearing. 1603.201 Section 1603.201 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION PROCEDURES... scheduling for hearing. (a) Upon request by the complainant under paragraph (b) of this section or if...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49...

  20. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49...

  1. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49...

  2. 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

  3. Traveller health and primary care in Ireland: a consultative forum.

    PubMed

    Van Hout, Marie Claire

    2010-05-01

    Travellers in Ireland continue to experience health disparity, cultural fragmentation and a lack of visibility in health service provision. This paper reports on a pilot study exploring factors that affect Traveller health and the experiences of primary care services from the perspectives of key Traveller health stakeholders in Ireland. The study was designed as an initial consultative forum using a single focus group (n = 13) in order to yield specific recommendations for the development of a designated primary care service framework for Travellers. A thematic analysis of the narratives identified key areas of interest--emerging issues in Traveller health, recognition of Traveller culture and ethnic identity,Traveller uptake of primary care services, the role of the primary health care Traveller (PHCT) worker, and recommendations for a primary care service framework for Travellers in Ireland. The findings highlight the importance of consulting Traveller communities in the design of a primary care service framework within each local needs analysis. The promotion of Traveller advocacy, visible access and referral pathways can therefore be achieved, with PHCT workers acting as a 'bridge' between Travellers and the designated area primary care team. PMID:20503791

  4. 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

  5. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Referral of medical care and property claims for... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims for litigation. (a) Criteria for referral. The RJA will forward the claims file and a litigation report...

  6. Resistance: Experienced and Novice Consultants' Interpretations and Strategies for Addressing It in Behavioral Consultation Interviews

    ERIC Educational Resources Information Center

    Gorges, Todd; Elliott, Stephen N.; Kettler, Ryan J.

    2004-01-01

    This study examined whether experienced and novice school psychology consultants differed in identification of consultee resistance, attribution of sources of resistance, and quantity and variety of strategies to handle resistance. The participants were characterized as novice consultants (N = 33) if they had completed fewer than 20 cases or as…

  7. Effective Supervision and Consultation: A Model for the Development of Functional Supervision and Consultation Programs.

    ERIC Educational Resources Information Center

    Harvey, David R.; Schramski, Thomas G.

    1984-01-01

    Proposes the Effective Supervision and Consultation (ESC) model as a guide for counselor educators who are helping agencies build effective supervision programs. The ESC model is presented with an emphasis on the assessment, training, and evaluation components of consultation services in counselor supervision. (JAC)

  8. Substance Use Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    2016-07-01

    The enormous public health impact of adolescent substance use and its preventable morbidity and mortality show the need for the health care sector, including pediatricians and the medical home, to increase its capacity related to substance use prevention, detection, assessment, and intervention. The American Academy of Pediatrics published its policy statement "Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians" in 2011 to introduce the concepts and terminology of screening, brief intervention, and referral to treatment (SBIRT) and to offer clinical guidance about available substance use screening tools and intervention procedures. This policy statement is a revision of the 2011 SBIRT statement. An accompanying clinical report updates clinical guidance for adolescent SBIRT. PMID:27325638

  9. Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology

    ERIC Educational Resources Information Center

    American Psychologist, 2007

    2007-01-01

    The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The…

  10. Service referral for juvenile justice youths: associations with psychiatric disorder and recidivism.

    PubMed

    Hoeve, Machteld; McReynolds, Larkin S; Wasserman, Gail A

    2014-05-01

    Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk. PMID:23397231

  11. Teachers' personalities and students' behavior in referrals for special education.

    PubMed

    Hill, R B; Baldo, A J; D'Amato, R C

    1999-04-01

    84 regular classroom teachers completed four self-report personality scales (self-concept, tolerance, locus of control, and teachers' efficacy) and reviewed hypothetical records of three types of students (withdrawn, acting-out, and neutral) and made decisions for referral for each student to special education. Scores for self-concept, tolerance, locus of control, and teachers' efficacy were not related to their decisions to refer across types of students. PMID:10335062

  12. Referral rates and waiting lists: some empirical evidence.

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

    This paper provides some empirical evidence on topics discussed at greater length in a recent paper in Health Economics (Goddard, J.A., Malek, M. and Tavakoli, M. Health Economics 1995; 4: 41-55), which modelled the relationship between referral rates and waiting lists for hospital treatment for non-urgent conditions within a queuing theory framework. Here, we estimate a version of the demand function used in this model, with panel data for Scottish Health Board Areas during the period 1990-1992. Separate models are estimated for each of six broadly defined 'waiting list' specialisms, for which we have data on referral rates and waiting times. The six specialisms are General Surgery, Ear Nose and Throat Surgery, Gynaecology, Ophthalmology, Orthopaedics and Urology. PMID:9809711

  13. 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

  14. Profiling outpatient workload: practice variations between consultant firms and hospitals in south west England.

    PubMed Central

    Faulkner, A C; Harvey, I M; Peters, T J; Sharp, D J; Frankel, S J

    1997-01-01

    OBJECTIVES: To describe the variation in outpatient new to old ratios between consultants and between providers for seven high volume specialties (four surgical, three medical). DESIGN: This was a descriptive study at consultant and provider unit level based upon patient administration system data from the South and West Regional Health Authority for the financial year 1992-93. Additional components of variance analysis was used to distinguish individual consultant effects from host institution effects. SETTING: The former South Western Regional Health Authority area from Gloucestershire to Cornwall. SUBJECTS: Altogether 345 consultant firms in seven specialties grouped into 13 provider unit groups. MAIN MEASURES: New to old ratio, omitting elective inpatients followed up as outpatients. RESULTS: Variation between consultants is greater in surgical than in medical specialties, while absolute levels of new to old ratios tend to be higher in surgical specialties than in medical. Variation between provider unit groups is also greater in surgical specialties. Analysis of variance shows that more total variance is attributable to provider unit group in gynaecology than in other specialties. CONCLUSIONS: Within individual specialties there is evidence of substantial variation that is not attributable to underlying differences in morbidity patterns. There is evidence of marked variation in terms of both individual consultants and institutions, a finding that provides the springboard for further analytical work. Published routine outpatient activity statistics should distinguish between new referrals, inpatient follow up, and clinic rebookings. PMID:9229062

  15. [Correct and timely referral of patients to centers of reference].

    PubMed

    Costa, Joana; Valença-Filipe, Rita; Rodrigues, Jorge

    2013-01-01

    The correct and timely referral of patients, from peripheral hospitals, without specialized surgical care, namely in hand surgery, like Plastic Surgery or Orthopedics is of crucial importance. The authors report the case of a patient that presents in the Plastic Surgery Department with a chronic infection of the hypothenar eminence of the right hand. The clinical history suggests the persistence of a foreign body, despite two previous surgical procedures for removal, performed in the residence hospital. Surgical exploration was performed and the foreign body was removed without complications. The intent of this presentation is to alert for the importance of the timely referral of patients that can benefit of specialized care, namely of plastic surgery, when this is no possible in the residence hospital, in view of better health care and better patient treatment. PMID:23809751

  16. Model Information and Referral Systems: A Bridge to the Future.

    ERIC Educational Resources Information Center

    Shanahan, James L.; And Others

    This pamphlet focuses on the concept of information and referral (I&R) as a system and describes seven highly effective I&R systems that bring together people in need with the human service agencies that can help them. It is noted that when thinking in terms of I&R systems, attention must be directed to the overall quality of the structures and…

  17. Assessment and Policy for Commercial Driver License Referrals

    PubMed Central

    Miller, Christopher M.; Khanna, Amit; Strohl, Kingman P.

    2007-01-01

    This report describes experiences, subsequent action, and policy recommendations regarding sleep disorders assessment of veterans in relation to a commercial driver medical examiner referral. A series of 6 veterans were seen in our sleep clinic, presenting with an order from a commercial driver medical examiner (CDME) for polysomnography and/or Multiple Sleep Latency Testing (PSG/MSLT). We searched the literature for an evidence-based justification for handling this referral, and we concluded that there is neither federal policy nor current evidence to suggest that any current diagnostic test, including PSG/MSLT and/or MWT, is capable of predicting which individual drivers are at risk for fall-asleep crashes. The best indicator of risk is self-reported sleepiness, regardless of cause. Thus, we concluded that an administrative request for a “PSG/MSLT” is not a rational use of VA resources. Procedures and a policy for the Cleveland VA system were developed to respond to the request for evaluation, recognizing that sleep problems and disorders other than sleep apnea may be present in this population. An educational component was an important feature of this response. We suspect that this approach may be appropriate for managed care systems in general. Citation: Miller CM; Khanna A; Strohl KP. Assessment and policy for commercial driver license referrals. J Clin Sleep Med 2007;3(4):417-423. PMID:17694732

  18. Assessment of Consultation and Intervention Implementation: A Review of Conjoint Behavioral Consultation Studies

    ERIC Educational Resources Information Center

    Collier-Meek, Melissa A.; Sanetti, Lisa M. H.

    2014-01-01

    Reviews of treatment outcome literature indicate treatment integrity is not regularly assessed. In consultation, two levels of treatment integrity (i.e., consultant procedural integrity [CPI] and intervention treatment integrity [ITI]) provide relevant implementation data. Specifically, assessment of CPI and ITI are necessary to conclude (a)…

  19. Trends in pediatric cardiology referrals, testing, and satisfaction at a Canadian tertiary centre.

    PubMed

    Caddell, Andrew J; Wong, Kenny K; Barker, Andrew P; Warren, Andrew E

    2015-01-01

    Anecdotal and European evidence suggests that outpatient pediatric referrals and their diagnostic testing burden are increasing. We sought to characterize new pediatric cardiology referrals, testing performed, outcomes, and patient satisfaction in a Canadian academic hospital and how these had changed over time. Clinical data were extracted from new outpatient consultations to the IWK Children's Heart Centre between August 1, 2011 and August 17, 2012 and compared with similar local data collected in July-February 2002 using χ(2) testing. Predictors of significant differences were sought using regression analysis. Satisfaction data were collected from a validated patient questionnaire, and 620 new outpatients were evaluated. Organic disease was more likely in younger patients (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.8-4.0) or in patients referred by pediatricians (OR, 2.3; 95% CI, 1.6-3.3). Odds of echocardiography being performed were significantly increased if patients were younger than 1 year (OR, 2.0; 95% CI, 1.3-3.0), were seen at outreach clinics (OR, 1.7; 95% CI, 1.2-2.3), or were referred by pediatricians (OR, 3.7; 95% CI, 2.6-5.3). Cardiologists differed significantly in ordering echocardiograms for referred patients (P = 0.002). The patients referred in the current era have significantly less organic disease than did those in 2002 (27% vs 37%; P = 0.007), but they underwent significantly more echocardiography (58% vs 38%; P < 0.001) and Holter monitoring (12% vs 4%; P = 0.001). Satisfaction results were high and unrelated to diagnostic testing. Pediatric cardiology referrals in Maritime Canada have increased in volume, consistent with changes seen at other centres. This, coupled with changing cardiac investigations, has increased testing burden. Individual cardiologists affected the odds of echocardiography being ordered. Satisfaction with services was high, with no predictors identified. PMID:25547558

  20. The Relationship between Gender of Consultant and Social Power Perceptions within School Consultation. Research Brief

    ERIC Educational Resources Information Center

    Erchul, William P.; Raven, Bertram H.; Wilson, Kristen E.

    2004-01-01

    This study's focus was on school psychologists' perceived effectiveness of 11 social power bases (Raven, 1993) that may be drawn upon when consulting with initially resistant teachers. Specifically, the relationship between consultant gender and perceptions of power base effectiveness was examined. The Interpersonal Power Inventory-Form CT…

  1. A model for assessment and referral of clients with bowel symptoms in community pharmacies.

    PubMed

    Sriram, Deepa; McManus, Alexandra; Emmerton, Lynne M; Parsons, Richard W; Jiwa, Moyez

    2016-04-01

    Background To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies. Method 'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff. Results Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future. Conclusion A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer. PMID:26700973

  2. Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

    PubMed Central

    Marques, André C; Calderaro, Daniela; Yu, Pai C; Gualandro, Danielle M; Carmo, Gabriel A L; Azevedo, Fernanda R; Pastana, Adriana F; Lima, Eneas M O; Monachini, Maristela; Caramelli, Bruno

    2014-01-01

    OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations. PMID:25518017

  3. Executive Searches and the Use of Consultants

    ERIC Educational Resources Information Center

    Atwell, Robert H.

    2009-01-01

    Formerly, search consultants were used in higher education at only a small number of institutions--and even there, only when recruiting presidents. But over the years, the industry has grown to the point that many large and small firms now compete for higher education searches, including ones for administrators and even some for endowed faculty,…

  4. Occupational illness and poison control centers. Referral patterns and service needs.

    PubMed Central

    Blanc, P. D.; Maizlish, N.; Hiatt, P.; Olson, K. R.; Rempel, D.

    1990-01-01

    In a study of occupational illness reported to a regional poison control center and to gauge the center's outreach and services, we did follow-up interviews of 301 case contacts over a 6-month period. We ascertained referral routes, reasons for contacting the poison control center, and awareness of the center's function. For 122 cases a nonphysician was the initial poison control center contact. Of the nonphysician contacts, 41 had already consulted a health care provider and been referred to the poison control center for assistance. Of the 70 persons with exposure, only 21 had been aware before their exposures that poison control center services might include occupational chemical illness consultation. Physicians and nonphysicians expressed similar reasons for contacting the poison control center, with 118 of 301 identifying the need for an exposure hazard risk assessment. These data suggest that although those contacting a poison control center because of occupational illness include a variety of cases, they have many similar service needs. PMID:2305574

  5. Consultation and Decision Processes in a Research and Development Laboratory

    ERIC Educational Resources Information Center

    Smith, Clagett G.

    1970-01-01

    Study of relationship between consultation and decision processes in an industrial research laboratory showed the efficacy of multidirectional consultation coupled with a pattern of shared, decentralized decision making. (Author/KJ)

  6. Toward a Feminist and Multicultural Model of Consultation and Advocacy

    ERIC Educational Resources Information Center

    Hoffman, Mary Ann; Phillips, Elaine L.; Noumair, Debra A.; Shullman, Sandra; Geisler, Carol; Gray, Jacque; Homer, Judith; Horne, Sharon; Paulk, Diana L.; Remer, Randa; Robinson, Shelagh; Rocha-Singh, Indra; Tinsley, Diane J.; Toporek, Rebecca; Ziegler, Donna

    2006-01-01

    The authors present core ideas or constructs that might be integral to a feminist and multicultural model of consultation. According to the model, the structure of consultation is (a) nonhierarchical and (b) an open triad (incorporating extrapersonal and outside factors). The process of consultation is (c) culturally responsive and (d) empowering.…

  7. Consultation-liaison psychiatry and clinical ethics: a model for consultation and teaching.

    PubMed

    Hayes, J R

    1986-11-01

    The consultation-liaison psychiatrist is often expected to perform the role of clinical ethicist or moral arbiter in the course of responding to psychiatric consultations. This article develops the idea that certain aspects of good consultation-liaison skills make this appropriate and consultation-liaison psychiatrists ought not to shy away from helping with difficult ethical problems. However, a systematic approach to clinical ethics is usually not part of consultation-liaison training. Two simple conceptual models can provide such a systematic approach and can be used in any clinical setting. The two models can also be easily taught and lend themselves to use in structuring teaching or case conferences about clinical ethics. The first model comes from formal philosophy (summarized by Veatch) and is a four-step hierarchy of levels of moral discourse. The other model comes from clinical medicine, based on work by Siegler, and provides another four-point checklist, this time of areas that must be considered in each decision. This article presents each of these four-point frameworks, alludes to the large amount of work that underpins these ostensibly simple models, and offers a case for demonstration/discussion of how the consultation-liaison psychiatrist use the models for structuring clinical ethical decision making and teaching. PMID:3792831

  8. TCARE: Tailored Caregiver Assessment and Referral

    ERIC Educational Resources Information Center

    Montgomery, Rhonda; Kwak, Jung

    2008-01-01

    Care managers, including nurses and social workers, often lack information that would help them more effectively target services to caregivers' needs. Useful information includes the type of services that will be most helpful for caregivers and the best time to start using these services. Generally, caregivers are simply told what services they…

  9. Free Universities and Learning Referral Centers, 1978.

    ERIC Educational Resources Information Center

    Calvert, Robert, Jr.; Draves, William A.

    Data on free universities and learning centers (including the addresses of the institutions) are presented. In a survey developed by the Free University Network for the National Center for Education Statistics, statistics on the free universities and learning centers are provided in the following areas: numbers of institutions, enrollment data,…

  10. [Teacher Referral Information and Statistical Information Forms.

    ERIC Educational Resources Information Center

    Short, N. J.

    This rating information form used to refer children to the PIC program, elicits information concerning the child's emotional, cognitive, and personality development. See TM 001 111 for details of the program in which it is used. (DLG)

  11. Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

    PubMed Central

    Craven, M. A.; Allen, C. J.; Kates, N.

    1995-01-01

    OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent

  12. Population-Based Analysis of Hematologic Malignancy Referrals to a Comprehensive Cancer Center, Referrals for Blood and Marrow Transplantation, and Participation in Clinical Trial, Survey, and Biospecimen Research by Race.

    PubMed

    Clay, Alyssa; Peoples, Brittany; Zhang, Yali; Moysich, Kirsten; Ross, Levi; McCarthy, Philip; Hahn, Theresa

    2015-08-01

    Racial and ethnic disparities have been reported in clinical trial/research participation, utilization of autologous and allogeneic blood and marrow transplantation (BMT), and availability of allogeneic donors. We performed a population-based cohort study to investigate adult hematologic malignancy referrals to a US tertiary cancer center, utilization of BMT, and participation in clinical trial, survey, and biospecimen research by race. US Census Data and the New York State Public Access Cancer Epidemiology Database identified the racial distribution of the general population and new hematologic malignancy cases in the primary catchment area. From 2005 to 2011, 1106 patients aged 18 to 75 years were referred for BMT consultation; although the rate of BMT among hematologic malignancy referrals did not differ by race, the reasons for not receiving a BMT did. Participation in biospecimen research did not vary by race; however, African Americans and other minorities were significantly less likely to participate in survey research than European Americans. Although rates of hematologic malignancy referrals and use of BMT for minorities appear to be low (<10%), they closely reflect the race distribution of all hematologic malignancy cases and the western New York population. African Americans are equally likely as other races to participate in biospecimen banking, but further study is needed to understand reasons for lower participation in survey research. PMID:25899454

  13. [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

  14. Developing satisfied and talented consultants

    SciTech Connect

    Greenwood, Sarah; Higgs, Helen

    2007-07-01

    It has been well documented that the ageing, male dominated profile of the workforce in the UK nuclear industry will not support the forecasted nuclear renaissance. Based upon the aspects of age, gender and level of education, there is an existing shortfall in available knowledgeable resource to undertake and manage the extensive new build, operational and decommissioning programmes. The 2005 Nuclear Employers Survey advised the industry to recruit and train more: - young and qualified people. - experienced and qualified people from outside the industry. The future for the UK nuclear industry lies with people in their 20's and 30's. It is essential that not just technical talent but also managerial talent be identified early and that they are nourished and allowed to flourish. (authors)

  15. NICU consultants and support staff

    MedlinePlus

    ... x-rays and other imaging tests, such as barium enemas and ultrasounds. Pediatric radiologists have extra training ... make body parts easier to see, as with barium enemas. X-rays of bones are also commonly ...

  16. Capacity and Charter Project Consultation.

    ERIC Educational Resources Information Center

    Association of Colleges of Applied Arts and Technology of Ontario, North York.

    The 25 colleges of Ontario's Colleges of Applied Arts and Technology have strategic directions built upon new programs services, accessible diverse learning options, state-of-the-art learning technology, innovative alliances with business and education, and inter-institutional resource sharing. Yet the implementation of these strategic directions…

  17. 43 CFR 10005.7 - Agency consultation and public involvement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Agency consultation and public involvement... COMMISSION'S MITIGATION AND CONSERVATION PLAN § 10005.7 Agency consultation and public involvement. The Commission considers agency consultation and public involvement to be central components of the...

  18. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 2 2012-10-01 2012-10-01 false Planning and consultation process. 400.57 Section... Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish a public/private RCA program must engage in a planning and consultation process with the local...

  19. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 2 2011-10-01 2011-10-01 false Planning and consultation process. 400.57 Section... Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish a public/private RCA program must engage in a planning and consultation process with the local...

  20. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 2 2013-10-01 2012-10-01 true Planning and consultation process. 400.57 Section... Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish a public/private RCA program must engage in a planning and consultation process with the local...

  1. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 2 2014-10-01 2012-10-01 true Planning and consultation process. 400.57 Section... Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish a public/private RCA program must engage in a planning and consultation process with the local...

  2. State of the Science in the Assessment and Management of Severe Behavior Problems in School Settings: Behavior Analytic Consultation to Schools

    ERIC Educational Resources Information Center

    Mueller, Michael M.; Nkosi, Ajamu

    2007-01-01

    In school settings, behavior analysts are often called in to consult on severe behavioral issues that surpass the knowledge, experience, and training of local school personnel. Severe behavior such as aggression to staff, SIB, and property destruction are common severe behavior referrals. The benefits of functional assessments, functional…

  3. Patterns in Office Referral Data by Grade, Race/Ethnicity and Gender

    PubMed Central

    Kaufman, Joy S.; Jaser, Sarah S.; Vaughan, Ellen L.; Reynolds, Jesse S.; Di Donato, John; Bernard, Stanley N.; Hernandez-Brereton, Maria

    2014-01-01

    Research supports that office referral data is useful in informing programmatic decisions and in planning interventions such as Positive Behavior Interventions and Supports (PBIS). Knowledge of the different patterns of office referrals may facilitate the development of interventions that are targeted to specific groups of students. This study examines patterns in office referrals within an urban district by gender, race/ethnicity and grade. Findings reveal that there are clear differences by grade that appear to be related to developmental level, with greater numbers of referrals for aggression in younger students (grades K-8), greater numbers of referrals for disrespectful behavior in middle school students (grades 7–8), and greater numbers of referrals for attendance problems in high school students. There were also gender differences in the rate and type of referrals, with significantly more referrals for boys’ delinquent and aggressive behavior than girls, which may relate to how schools define unacceptable behavior and the method used to collect this data. Finally, there were differences by race/ethnicity, in that there were significantly more referrals for African American/black students than Hispanic students, which suggest that schools need to consider students’ racial/ethnic background in the development of behavioral expectations. PMID:25580076

  4. Health service delivery and research outcomes of a common departmental structure for psychiatric consultation-liaison and social work services at a university hospital.

    PubMed

    Hammer, J S; Strain, J J; Lyons, J S

    1991-03-01

    Convincing evidence exists that psychosocial factors have a major impact on both outcome and costs in the medical/surgical services in general hospitals. This paper describes the Human Services Department's impact on social work and consultation-liaison psychiatry, using a data-based management system across five specialties: 1) social work; 2) consultation-liaison psychiatry; 3) supportive care (hospice); 4) home care (home health discharge planning); and 5) pastoral care, which offers opportunities for research and quality assurance monitoring. Time spent in service delivery was used to estimate the cost per hour: 1) pastoral care $96; 2) social work $36; 3) consultation-liaison psychiatry $59; 4) home care $49. Referral to social work was preferred for a range of family and discharge planning services. Consultation-liaison services were preferred for depression, paranoid behavior, and management problems. Referral overlap was noted for "coping with diagnosis" for social work and consultation-liaison psychiatry. Using a computerized data base format for documenting the referral process, work accomplished, and time spent among those services providing mental health care in the general hospital permits the observation of redundancy of services delivered and their costs. PMID:1903755

  5. Referral Pattern and Special Interests in Children and Adolescents with Asperger Syndrome: A Turkish Referred Sample

    ERIC Educational Resources Information Center

    Tanidir, Canan; Mukaddes, Nahit M.

    2014-01-01

    Objectives: To investigate the most frequent reasons for referral, the most common special interests, age at first referral to a mental health service, and the age of diagnosis in children and adolescents with Asperger syndrome living in Turkey. Methods: This study includes 61 children and adolescents diagnosed with Asperger syndrome using…

  6. Mental Health and Substance Use: A Qualitative Study of Resident Assistants' Attitudes and Referral Practices

    ERIC Educational Resources Information Center

    Reingle, Jennifer; Thombs, Dennis; Osborn, Cynthia; Saffian, Steven; Oltersdorf, Dan

    2010-01-01

    This study described mental health and substance use referral practices of resident assistants (RAs). Interviews were conducted with 48 RAs at three campuses. RAs generally had positive attitudes toward helping residents, and believed that existing norms supported their referral actions. However, many perceived referring residents to be…

  7. Red eyes and red-flags: improving ophthalmic assessment and referral in primary care

    PubMed Central

    Kilduff, Caroline; Lois, Charis

    2016-01-01

    Up to five percent of primary care consultations are eye-related, yet 96% of General Practitioners (GPs) do not undergo postgraduate ophthalmology training. Most do not feel assured performing eye assessments. Some red eye conditions can become sight threatening, and often exhibit red-flag features. These features include moderate pain, photophobia, reduced visual acuity (VA), eye-trauma, or unilateral marked redness. The aim of this project was to improve primary care assessment and referral of patients presenting with red-flag features based on the NICE ‘Red Eye’ Clinical Knowledge Summary recommendations. Data was collected retrospectively from 139 red eye consultations. A practice meeting highlighted poor awareness of red-flag features, low confidence levels in eye assessments, and time-constraints during appointments. Interventions were based on feedback from staff. These included a primary care teaching session on red-flag features, a VA measurement tutorial, and provision of a red eye toolkit, including VA equipment, to each consultation room. At baseline, each patient had on average 0.9 red-flag features assessed. Only 36.0% (9/25) of patients with red-flag features were appropriately referred to same-day ophthalmology services. Following two improvement cycles, a significant improvement was seen in almost every parameter. On average, each patient had 2.7 red-flag features assessed (vs 0.9, p<0.001). VA was assessed in 55.6% of consultations (vs 7.9%, p<0.001), pain was quantified in 81.5% (vs 20.9%, p=0.005), eye-trauma or foreign-body (51.8% vs 8.6%, p<0.001), extent of redness was documented in 66.7% (vs 14.4%, p<0.001). Only photophobia remained poorly assessed (18.5% vs 14.4%, p=0.75). Following this, 75.0% (6/8) of patients were appropriately referred. This project reflected the literature regarding low confidence and inexperience amongst GPs when faced with ophthalmic conditions. Improvements in education are required to ensure accurate

  8. Dutch general practitioners' referral of children to specialists: a comparison between 1987 and 2001

    PubMed Central

    Otters, Hanneke; van der Wouden, Johannes C; Schellevis, François G; van Suijlekom-Smit, Lisette W A; Koes, Bart W

    2004-01-01

    Background: Although children are frequently referred to specialists, detailed information on referral patterns of them is scarce. Even less information is available on how referral patterns evolve over time. Aims: To examine current referral patterns for children aged 0–17 years and compare these with referral patterns reported for 1987. Design of study: Data were analysed from two national cross-sectional surveys, performed in 2001 (91 general practices) and in 1987 (103 general practices). Setting: Dutch general practice. Method: All new referrals to specialists were assessed by age, sex, International Classification of Primary Care (ICPC) category, specialty referred to, and specific episodes of disease. Referral measures were quantified as new referrals per 1000 person–years and per 100 new episodes, a measure of likelihood of a young person with a specific diagnosis to be referred. Rates in 2001 were compared with those from 1987. Results: Referral rates decreased from 138 per 1000 person–years in 1987, to 84 per 1000 person–years in 2001. Age differences in referral rates were similar in both surveys. Compared with 1987, more boys than girls were referred to specialists. The overall likelihood of a condition being referred decreased from 8.0 per 100 episodes in 1987 to 6.5 per 100 episodes in 2001. Reasons for referral had also changed by 2001, particularly for the ear, nose, and throat (ENT) specialist and ophthalmologist. Moreover, referral rates for acute otitis media, refractive disorders, and vision problems decreased two- to fourfold in 2001. Conclusion: Presently, Dutch general practitioners tend to manage more health problems themselves and refer less young people to specialists. PMID:15527611

  9. Parents with Learning Disabilities and Speech and Language Therapy. A Service Evaluation of Referrals and Episodes of Care

    ERIC Educational Resources Information Center

    Stansfield, Jois

    2012-01-01

    The speech and language therapy (SLT) service in an area of northern England receives referrals of parents who have learning disabilities. The aim of this study was to identify current referral patterns and quantify the level of demand upon the SLT service from this relatively new referral population to enable to service to meet the needs of these…

  10. Service Coordinators' Perceptions of Autism-Specific Screening and Referral Practices in Early Intervention

    ERIC Educational Resources Information Center

    Pizur-Barnekow, Kris; Muusz, Marta; McKenna, Catherine; O'Connor, Emily; Cutler, Ann

    2013-01-01

    Service coordinators in a statewide early intervention program were surveyed to develop an understanding of screening and referral practices to identify children on the autism spectrum. Quantitative and qualitative data summarizing autism-specific screening and referral practices are reported. More than 50% of the respondents reported that they…

  11. 24 CFR 103.100 - Notification and referral to substantially equivalent State or local agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Notification and referral to substantially equivalent State or local agencies. 103.100 Section 103.100 Housing and Urban Development... may accept interim referrals under 24 CFR part 115 with regard to the alleged discriminatory...

  12. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  13. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  14. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  15. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  16. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  17. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare Department of Health and Human Services... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  18. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  19. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for self-referral and point of... Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option...) Point of service option. As a general rule, a POS benefit is an option that an MA organization may...

  20. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for self-referral and point of... Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option...) Point of service option. As a general rule, a POS benefit is an option that an MA organization may...

  1. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for self-referral and point of... Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option...) Point of service option. As a general rule, a POS benefit is an option that an MA organization may...

  2. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  3. An Information and Referral Model for Improving Self-Help Group Utilization.

    ERIC Educational Resources Information Center

    Wollert, Richard

    This paper describes the Self-Help Information Service (SIS), and summarizes data evaluating the program. Associated with a generally focused information and referral service (I&R), SIS was designed to facilitate research on self-help groups. Its specific goals were to develop and maintain a telephone referral service disseminating self-help group…

  4. Substance Use Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    Levy, Sharon J L; Williams, Janet F

    2016-07-01

    The enormous public health impact of adolescent substance use and its preventable morbidity and mortality highlight the need for the health care sector, including pediatricians and the medical home, to increase its capacity regarding adolescent substance use screening, brief intervention, and referral to treatment (SBIRT). The American Academy of Pediatrics first published a policy statement on SBIRT and adolescents in 2011 to introduce SBIRT concepts and terminology and to offer clinical guidance about available substance use screening tools and intervention procedures. This clinical report provides a simplified adolescent SBIRT clinical approach that, in combination with the accompanying updated policy statement, guides pediatricians in implementing substance use prevention, detection, assessment, and intervention practices across the varied clinical settings in which adolescents receive health care. PMID:27325634

  5. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 13.11 Section 13.11 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall file the complaint...

  6. 20 CFR 355.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Referral of complaint and answer to the ALJ. 355.11 Section 355.11 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 355.11 Referral of complaint and answer to the ALJ....

  7. Neighborhood Communications Centers: Planning Information and Referral Services in The Urban Library.

    ERIC Educational Resources Information Center

    Yin, Robert K.; And Others

    The potential development of information and referral (I&R) services in branch libraries was explored by examining five cases where such services have been initiated. The extent to which the public library system is appropriate for information and referral services was carefully examined in the light of its ability to carry on seven functions: (1)…

  8. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for self-referral and point of... Beneficiary Protections § 422.105 Special rules for self-referral and point of service option. (a) Self... item or service is covered only if further action is taken by the enrollee. (b) Point of service...

  9. 5 CFR 185.111 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 185.111 Section 185.111 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.111 Referral of complaint and answer to the ALJ. Upon...

  10. An Employer's Guide to Child Care Consultants.

    ERIC Educational Resources Information Center

    Eichman, Caroline

    This guide is designed to help employers hire a qualified child care consultant who will evaluate child care options in light of employees' needs and help develop and implement appropriate child care options. These options include: (1) establishment of a child care facility; (2) financial assistance; (3) a resource and referral service; (4)…

  11. Barriers to Home and Community-Based Service Referrals: The Physician's Role

    ERIC Educational Resources Information Center

    Reder, Sheri; Hedrick, Susan; Guihan, Marylou; Miller, Sara

    2009-01-01

    The purpose of this study was to obtain information about Department of Veteran Affairs (VA) long-term care (LTC) referrals that could be used to develop interventions that increase the likelihood of referrals to home and community-based services (HCBS) instead of institutional care. This primarily qualitative study was conducted at five VA…

  12. Early Referral and Other Factors Affecting Vocational Rehabilitation Outcome for the Workers' Compensation Client.

    ERIC Educational Resources Information Center

    Gardner, John A.

    1991-01-01

    Estimated benefits from systematic early referral of injured workers for vocational rehabilitation services. Used data from Florida workers' compensation cases closed in 1985 to estimate gains from referral for evaluation not later than six months from injury date. Concludes that social benefits could be nearly $10 million annually and that…

  13. Consultative Services in the Schools: A Model.

    ERIC Educational Resources Information Center

    Chandler, Louis A.

    1980-01-01

    A model child evaluation center was established in a public school to demonstrate alternative methods for providing psychoeducational services, and function as a field training clinic for school psychologists. The center was successful in encouraging teachers to utilize consultative services, and in reducing referrals for psychological evaluation.…

  14. Psychiatric referrals during peace and wartimes: a Nigerian experience.

    PubMed

    Okulate, Gbenga T

    2005-07-01

    Using a questionnaire administered by us, we sought to investigate the differences between patients referred to the psychiatric department of a Nigerian military general hospital during peacetime and those referred during the civil war in Liberia in which Nigerian soldiers were involved as peacekeepers. Referrals to psychiatry in peacetime were quite few but increased considerably during the period of combat in direct relation to the increase in the number of surgical wounded in action cases. Organic mental disorders and anxiety disorders were more frequently referred in peacetime than in war, whereas substance abuse disorders were more frequent during the combat period. Non-psychotic psychiatric conditions were less referred in the wartime group, partly because of nonrecognition at the mission areas and also because of recovery in front-line areas or consideration of their evacuation as a nonpriority. Mental health workers engaged at the mission areas require more training in the identification of such cases. PMID:16130633

  15. 20 CFR 416.919s - Authorizing and monitoring the consultative examination.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... comprehensive oversight management of its consultative examination program, with special emphasis on key... providers, with respect to SSA's program requirements involving consultative examination report content and... management of their consultative examination programs. Procedures To Monitor the Consultative Examination...

  16. Pediatric Chiropractic Care: The Subluxation Question And Referral Risk.

    PubMed

    Homola, Samuel

    2016-02-01

    Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a 'vertebral subluxation' or a 'vertebral subluxation complex' alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations - the International Chiropractic Association and the American Chiropractic Association - support chiropractic care for children, which includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice. PMID:26806448

  17. SBIRT as a Vital Sign for Behavioral Health Identification, Diagnosis, and Referral in Community Health Care

    PubMed Central

    Dwinnells, Ronald

    2015-01-01

    The purpose of this quasi-experimental design study was to examine the effectiveness of the behavioral health Screening, Brief Intervention, and Referral to Treatment (SBIRT) program at a community health center. The study group was twice as likely (25.3%) to have depression and substance abuse diagnosed compared with the control group (11.4%) (P <.001). Referral rates for the study group were more likely to occur (12.4%) compared with referral rates for the control group (1.0%) (P <.001); however, the kept appointment rates by patients for behavioral health problems referrals remained low for both groups. SBIRT was effectively utilized in a community health center, resulting in increased rates for diagnosis of behavioral health problems and referrals of patients. PMID:25964405

  18. Relationship between the Social and Demographic Characteristics of Post-Sentence Offenders and the Outcomes of Forensic Psychiatric Referrals.

    ERIC Educational Resources Information Center

    Prandoni, Jogues R.

    1984-01-01

    Examined differences between offenders (N=240) by referral source, completion of referral, and recommendation for further services. The most substantial relationship was between source and outcome of referral, with probationers referred by probation officers more likely to be recommended for mental health services. (JAC)

  19. Using Consultation to Support English Learners: The Experiences of Bilingual School Psychologists

    ERIC Educational Resources Information Center

    O'Bryon, Elisabeth C.; Rogers, Margaret R.

    2016-01-01

    Through semi-structured interviews, this study explored 11 bilingual school psychologists' (BSPs) consultation experiences with teachers of English learners (EL) to determine referral concerns, recommendations made, challenges encountered, preparation experiences, and skills most needed. The most common referral issue concerned students' academic…

  20. A nationwide telepathology consultation and quality control program in China: implementation and result analysis

    PubMed Central

    2014-01-01

    Background Telepathology may play an important role in pathology consultation and quality control for cancer diagnosis in China, as the country has the largest population of cancer patients worldwide. In 2011, the Pathology Quality Control Center of China and Ministry of Health developed and implemented a nationwide telepathology consultation and quality control program for cancer diagnosis in China. We here report the results of the two-year implementation and experiences. Methods the program built an Internet based telepathology platform to connect participating hospitals and expert consultants. The hardware and software used for the platform were validated in previous validation studies in China. The program had three regional centers consisting of Peking Union Medical College, Huasi Medical College of Sichuan and 2nd affiliated hospital of Zhejiang University. It also had 20 provincial consultation centers based in the provincial referral hospitals. 80 provincial or national pathologists served as expert consultants for the program, providing telepathology consultation for cancer diagnosis for more than 60 participating hospitals. Results from 2011 to July 2013, 16,247 pathology cases were submitted to the platform for consultation. Among them, 84% were due to diagnostic difficulty and 16% were due to request by patients. The preliminary diagnosis provided by submitting pathologists were in agreement with expert opinion in 59.8% of cases but was in disagreement with expert opinion in 24.2% of cases. 16.0% of cases were not provided with preliminary diagnosis. The distribution of pathology cases by system or organ were: digestive system, 17.3%; gynecologic system, 16.7%; head and neck, 15.7%; bone and soft tissue, 10.4%; lung and mediastinum, 8.6%; breast, 7.6%; urinary system, 7.5%; hematopathology, 6.4%; skin, 5.2%; neuropathology, 2.5% and cytopathology, 1.3%. Expert consultants also provided assessment of quality of slide preparation and staining, online

  1. Blurred lines: Performance Enhancement, Common Mental Disorders and Referral in the U.K. Athletic Population.

    PubMed

    Roberts, Claire-Marie; Faull, Andrea L; Tod, David

    2016-01-01

    Through the awareness-raising efforts of several high-profile current and former athletes, the issue of common mental disorders (CMD) in this population is gaining increasing attention from researchers and practitioners alike. Yet the prevalence is unclear and most likely, under-reported. Whilst the characteristics of the sporting environment may generate CMD within the athletic population, it also may exacerbate pre-existing conditions, and hence it is not surprising that sport psychology and sport science practitioners are anecdotally reporting increased incidences of athletes seeking support for CMD. In a population where there are many barriers to reporting and seeking help for CMD, due in part to the culture of the high performance sporting environment, anecdotal reports suggest that those athletes asking for help are approaching personnel who they are most comfortable talking to. In some cases, this may be a sport scientist, the sport psychologist or sport psychology consultant. Among personnel in the sporting domain, there is a perception that the sport psychologist or sport psychology consultant is best placed to assist athletes seeking assistance for CMD. However, sport psychology as a profession is split by two competing philosophical perspectives; one of which suggests that sport psychologists should work exclusively with athletes on performance enhancement, and the other views the athlete more holistically and accepts that their welfare may directly impact on their performance. To add further complication, the development of the profession of sport psychology varies widely between countries, meaning that practice in this field is not always clearly defined. This article examines case studies that illustrate the blurred lines in applied sport psychology practice, highlighting challenges with the process of referral in the U.K. athletic population. The article concludes with suggestions for ensuring the field of applied sport psychology is continually

  2. Blurred lines: Performance Enhancement, Common Mental Disorders and Referral in the U.K. Athletic Population

    PubMed Central

    Roberts, Claire-Marie; Faull, Andrea L.; Tod, David

    2016-01-01

    Through the awareness-raising efforts of several high-profile current and former athletes, the issue of common mental disorders (CMD) in this population is gaining increasing attention from researchers and practitioners alike. Yet the prevalence is unclear and most likely, under-reported. Whilst the characteristics of the sporting environment may generate CMD within the athletic population, it also may exacerbate pre-existing conditions, and hence it is not surprising that sport psychology and sport science practitioners are anecdotally reporting increased incidences of athletes seeking support for CMD. In a population where there are many barriers to reporting and seeking help for CMD, due in part to the culture of the high performance sporting environment, anecdotal reports suggest that those athletes asking for help are approaching personnel who they are most comfortable talking to. In some cases, this may be a sport scientist, the sport psychologist or sport psychology consultant. Among personnel in the sporting domain, there is a perception that the sport psychologist or sport psychology consultant is best placed to assist athletes seeking assistance for CMD. However, sport psychology as a profession is split by two competing philosophical perspectives; one of which suggests that sport psychologists should work exclusively with athletes on performance enhancement, and the other views the athlete more holistically and accepts that their welfare may directly impact on their performance. To add further complication, the development of the profession of sport psychology varies widely between countries, meaning that practice in this field is not always clearly defined. This article examines case studies that illustrate the blurred lines in applied sport psychology practice, highlighting challenges with the process of referral in the U.K. athletic population. The article concludes with suggestions for ensuring the field of applied sport psychology is continually

  3. The Westgate Service and Related Referral, Assessment, and Treatment Processes.

    PubMed

    Bennett, Alice L

    2015-12-01

    The formerly named "Dangerous and Severe Personality Disorder" (DSPD) units are no longer standalone services within the criminal justice system in England and Wales. These sites now provide personality disorder treatment services in the high-security prison estate as part of the new national Offender Personality Disorder (OPD) Pathway Strategy. The OPD Pathway intends to take responsibility for the assessment, treatment, and management of offenders who are likely to have a personality disorder and who present a high risk of re-offending (men and women) and serious harm to others (men). Further PD treatment and progression services are being commissioned in lower security prisons and in the community as part of the new PD Strategy. While the suitability criteria for the two male high-security PD treatment sites are the same, the individual units have their own assessment and treatment methods. This article aims to communicate the referral, assessment, and treatment methods employed within the prison-based Westgate Personality Disorder Treatment Service, HMP Frankland. PMID:24927739

  4. Critical consulting

    SciTech Connect

    Hocker, C.

    1993-02-01

    With increasing complexity in the power industry, consultants have become an indispensible element of any project development team. Top engineers and consultants today bring added value to their clients' projects.

  5. Delay to orthopedic consultation for isolated limb injury

    PubMed Central

    Rouleau, Dominique M.; Feldman, Debbie Ehrmann; Parent, Stefan

    2009-01-01

    ABSTRACT OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation. PMID:19826162

  6. Neglected ends: clinical ethics consultation and the prospects for closure.

    PubMed

    Fiester, Autumn

    2015-01-01

    Clinical ethics consultations (CECs) are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient "closure" for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as "bioethics mediation." PMID:25562222

  7. Communication Training and Consulting in Business, Industry, and Government.

    ERIC Educational Resources Information Center

    Buchholz, William J., Ed.

    Intended as a reference for training and consulting in the field of business communication, this book presents research, implements theory, and explores communication practices vital to all organizations. The titles of the essays and their authors are as follows: (1) "Communication Consulting--The State of the Art" (William J. Buchholz); (2) "The…

  8. Consultants' Handbook.

    ERIC Educational Resources Information Center

    Tuttle, Lester E., Jr., Ed.; Hooker, Dennis A., Ed.

    Two conferences held in Florida in 1968 to prepare consultants to work with in-service professional and para-professional personnel serving migrant children in Florida, led to this analysis of consultant, consultee, and professional staff reactions. Characteristics of a consultant and when and how to use his services are outlined. It is shown how…

  9. Consultation on Higher Education and Social Justice: Statement and Conclusions

    ERIC Educational Resources Information Center

    New Frontiers in Education, 1974

    1974-01-01

    A group of 35 educators, mostly principals and teachers of colleges, met at Bangalore, India in May 1974 for a 5-day consultation on higher education's role in the promotion of social justice. The final statement and other conclusions of the Consultation are presented. (Author/PG)

  10. Starting a nursing consultation practice.

    PubMed

    Schulmeister, L

    1999-03-01

    Because the clinical nurse specialist (CNS) role has been changed or eliminated in many hospital organizations, many CNSs in career transition are considering establishing collaborative or independent nursing consultation practices. Opportunities for consultants exist in diverse practice settings and specialties. Before starting a consultation practice, the CNS should carefully examine goals, identify resources, and begin contacting potential referral sources. He or she must also decide what form of business organization to establish and write a business plan to solidify ideas and prepare for the unexpected. Most CNS consultants rely on personal savings to cover initial business and personal expenses, and many continue working as a CNS until the consultation practice is established. Fees can be set based on community standards, what the market will bear, desired projected income, or a third-party payor's fee schedule. The consultation practice can be marketed by word of mouth, inexpensive advertising techniques such as distributing flyers and business cards, direct mall, and media advertising. In today's healthcare marketplace, opportunities abound for the CNS risk-taker interested in starting a nursing consultation practice. PMID:10382408

  11. 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

  12. The Theory and Application of Information and Referral Systems in the University of Maryland Residence Halls

    ERIC Educational Resources Information Center

    Thoman, Cherie; Moore, Jerry E.

    1977-01-01

    This resource system consists of eight information and referral centers each housing a resource instrument (binders and flip chart), an operator, outreach staff, one mobile instrument, a systematic updating system and an evaluation system. (Author/DOW)

  13. Referral decisions of teachers and school psychologists for twice-exceptional students

    NASA Astrophysics Data System (ADS)

    Hoffman, Jennifer Marie

    The accurate and timely referral and identification of twice-exceptional students remains a challenge. In a statewide study, the referral decisions for both special education and gifted programming evaluations made by four participant groups (i.e., general education teachers, special education teachers, gifted education teachers, and school psychologists) were compared. Participants were randomly assigned to read one of three identically described students in a vignette that differed only in the presence of a diagnostic label--- autism spectrum disorder (ASD), specific learning disability (SLD), or no diagnostic label. In all, special education teachers made the most special education referrals, while gifted education teachers made the most gifted programming referrals, both regardless of the diagnostic label present. The students with diagnostic labels were recommended for special education referrals significantly more than for gifted programming, while this difference was not evident in the no diagnostic label condition. Moreover, the student with the ASD label was the most likely to be referred for evaluations for both special education and gifted programming out of all three vignette conditions. Overall findings indicated the importance of considering the referral source as well as how the presence of a diagnostic label might influence educational referral decisions, particularly in how this might influence overall multidisciplinary team decisions for these unique learners.

  14. Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

    PubMed Central

    Ali-Faisal, Sobia F; Benz Scott, Lisa; Johnston, Lauren; Grace, Sherry L

    2016-01-01

    Objectives To describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment. Setting 3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre. Participants CR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants. Intervention The PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers. Outcome measures The primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction. Results Those who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24). Conclusions There is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest

  15. Remote consulting based on ultrasonic digital immages and dynamic ultrasonic sequences

    NASA Astrophysics Data System (ADS)

    Margan, Anamarija; Rustemović, Nadan

    2006-03-01

    Telematic ultrasonic diagnostics is a relatively new tool in providing health care to patients in remote, islolated communities. Our project facility, "The Virtual Polyclinic - A Specialists' Consulting Network for the Islands", is located on the island of Cres in the Adriatic Sea in Croatia and has been extending telemedical services to the archipelago population since 2000. Telemedicine applications include consulting services by specialists at the University Clinical Hospital Center Rebro in Zagreb and at "Magdalena", a leading cardiology clinic in Croatia. After several years of experience with static high resolution ultrasonic digital immages for referral consulting diagnostics purposes, we now also use dynamic ultrasonic sequences in a project with the Department of Emmergency Gastroenterology at Rebro in Zagreb. The aim of the ongoing project is to compare the advantages and shortcomings in transmitting static ultrasonic digital immages and live sequences of ultrasonic examination in telematic diagnostics. Ultrasonic examination is a dynamic process in which the diagnostic accuracy is highly dependent on the dynamic moment of an ultrasound probe and signal. Our first results indicate that in diffuse parenchymal organ pathology the progression and the follow up of a disease is better presented to a remote consulting specialist by dynamic ultrasound sequences. However, the changes that involve only one part of a parenchymal organ can be suitably presented by static ultrasonic digital images alone. Furthermore, we need less time for digital imaging and such tele-consultations overall are more economical. Our previous telemedicine research and practice proved that we can greatly improve the level of medical care in remote healthcare facilities and cut healthcare costs considerably. The experience in the ongoing project points to a conclusion that we can further optimize remote diagnostics benefits by a right choice of telematic application thus reaching a

  16. Preparing Consultants for Multinational Consulting.

    ERIC Educational Resources Information Center

    Tubbs, Stewart L.; And Others

    The three sections of this paper, written by General Motors Corporation employees from three different countries, discuss different aspects of communication consulting and factors involved in becoming a successful international organizational consultant. The first section, written by an American, outlines the need for communication consulting,…

  17. Evaluation and Referral of Children With Signs of Early Puberty.

    PubMed

    Kaplowitz, Paul; Bloch, Clifford

    2016-01-01

    Concerns about possible early pubertal development are a common cause for referral to pediatric medical subspecialists. Several recent studies have suggested that onset of breast and/or pubic hair development may be occurring earlier than in the past. Although there is a chance of finding pathology in girls with signs of puberty before 8 years of age and in boys before 9 years of age, the vast majority of these children with signs of apparent puberty have variations of normal growth and physical development and do not require laboratory testing, bone age radiographs, or intervention. The most common of these signs of early puberty are premature adrenarche (early onset of pubic hair and/or body odor), premature thelarche (nonprogressive breast development, usually occurring before 2 years of age), and lipomastia, in which girls have apparent breast development which, on careful palpation, is determined to be adipose tissue. Indicators that the signs of sexual maturation may represent true, central precocious puberty include progressive breast development over a 4- to 6-month period of observation or progressive penis and testicular enlargement, especially if accompanied by rapid linear growth. Children exhibiting these true indicators of early puberty need prompt evaluation by the appropriate pediatric medical subspecialist. Therapy with a gonadotropin-releasing hormone agonist may be indicated, as discussed in this report. PMID:26668298

  18. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Environmental review and consultation requirements. 230.25 Section 230.25 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE PROCEDURES FOR IMPLEMENTING NEPA § 230.25 Environmental review and consultation requirements. See 40...

  19. Canine behaviour problems: discussions between veterinarians and dog owners during annual booster consultations.

    PubMed

    Roshier, A L; McBride, E A

    2013-03-01

    The veterinary profession recently acknowledged its responsibility to provide behaviour support, following criticism for focussing on the physiological aspects of welfare and overlooking the psychological. To further understand the practising of behavioural medicine, a 'fly-on-the-wall' approach was used to investigate welfare discussions during dog booster vaccinations. Seventeen consultations involving six veterinarians in two UK small-animal practices were videoed. Qualitative methods were used to analyse themes discussed and questionnaires completed to obtain participant information and perceptions. Five main topics of discussion were identified: navigation, medical, husbandry, behaviour and cost. Veterinarians led the discussion of all topics except behaviour which was instigated approximately equally by veterinarian and client. All clients reported one or more behaviours that were a concern to them, totalling 58 across the sample. Disconcertingly, only 10 were discussed during consultations and none fully explored nor managed beyond the consultation. Behaviour discussion varies between veterinarians; this may reflect their experience, confidence or clients' requests. Owners access welfare information from a variety of sources, not always from veterinarians. Where sources are not knowledgeable, both human and animal welfare can be seriously compromised. Veterinarians need to ensure that clients are enabled to discuss behaviour issues and are provided with appropriate support, be that in-house or via referral. PMID:23457279

  20. 45 CFR 73.735-704 - Professional and consultative services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Professional and consultative services. 73.735-704 Section 73.735-704 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION STANDARDS OF CONDUCT Outside Activities § 73.735-704 Professional and consultative services. (a) Employees may engage in outside professional...

  1. International Consultation and Training on Group Work in South Asia

    ERIC Educational Resources Information Center

    Ibrahim, Farah A.

    2015-01-01

    This article presents a consultation and training for faculty and graduate students in South Asia under the auspices of the United Nations' Transfer of Knowledge Through Expatriate Nationals (TOKTEN) Program. It describes the development of a consultation relationship and training on group work. Needs assessments focusing on both cultural…

  2. Surgical Pathology and Intraoperative Consultation: An Audit

    PubMed Central

    GOLAM, Mostafa; QUEEN, Zarat

    2015-01-01

    Background: While intraoperative consultation has been used in Bangladesh for a long period of time, to date, there has been no published reporting on the performance of frozen sections. The current audit evaluates the performance of frozen sections in a well reputed medical center in Bangladesh, Anowara Medical Services. Objective: This retrospective study has been designed to measure the accuracy of frozen section diagnosis in a medical center in a third-world country, where many surgical procedures rely on intraoperative consultation. Methods: A series of 1379 intra- and peri-operative frozen section cases, from 2007 to 2014, was reviewed. Intraoperative tissue specimens received at Anowara Medical Services were processed for frozen sections. After examination of the frozen section that yielded the initial frozen section diagnoses, the frozen tissues were reprocessed for regular paraffin sectioning. These paraffin sections were examined by a second pathologist, and a final diagnosis was issued. The frozen section diagnosis and final diagnoses of all cases were retrospectively analysed to determine the accuracy of frozen section examination. Results: Overall, accurate diagnosis was made on frozen sections in 98.2% of the cases. The discrepant diagnoses were all clinically significant, i.e., there were discrepancies between benign and malignant diagnoses on frozen and paraffin sections. In 1% of the cases, diagnosis was deferred. Fifty percent of the deferred cases were benign. Two cases, received in formalin, were excluded. In both cases, the diagnosis was positive for malignancy. The number of false negative results (4 false negatives) was slightly lower than that of false positives (5 false positives). Specificity and sensitivity of 99.3% and 99.4% were achieved, respectively. In this study, the positive predictive value was 99.2% and the negative predictive value was 99.5%. Over the years, the number of discrepant diagnoses remained fairly constant. Conclusion

  3. Malpractice and the Communication Consultant: A Proactive Approach.

    ERIC Educational Resources Information Center

    Montgomery, Daniel J.; And Others

    1995-01-01

    Provides communication practitioners with an overview of legal and ethical issues facing individuals who market themselves as professional communication consultants. Discusses the tort of negligence. Outlines court-supported practices that professional consultants might use to help protect clients and themselves. Argues that an understanding of…

  4. 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

  5. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... period from October 16, 2003 through March 16, 2009: (1) Retail pharmacy drug referral certification and... standards identified in paragraph (a) of this section; and (2)(i) Retail pharmacy drugs....

  6. The Feasibility and Acceptability of Google Glass for Teletoxicology Consults.

    PubMed

    Chai, Peter R; Babu, Kavita M; Boyer, Edward W

    2015-09-01

    Teletoxicology offers the potential for toxicologists to assist in providing medical care at remote locations, via remote, interactive augmented audiovisual technology. This study examined the feasibility of using Google Glass, a head-mounted device that incorporates a webcam, viewing prism, and wireless connectivity, to assess the poisoned patient by a medical toxicology consult staff. Emergency medicine residents (resident toxicology consultants) rotating on the toxicology service wore Glass during bedside evaluation of poisoned patients; Glass transmitted real-time video of patients' physical examination findings to toxicology fellows and attendings (supervisory consultants), who reviewed these findings. We evaluated the usability (e.g., quality of connectivity and video feeds) of Glass by supervisory consultants, as well as attitudes towards use of Glass. Resident toxicology consultants and supervisory consultants completed 18 consults through Glass. Toxicologists viewing the video stream found the quality of audio and visual transmission usable in 89 % of cases. Toxicologists reported their management of the patient changed after viewing the patient through Glass in 56 % of cases. Based on findings obtained through Glass, toxicologists recommended specific antidotes in six cases. Head-mounted devices like Google Glass may be effective tools for real-time teletoxicology consultation. PMID:26245879

  7. How head and neck consultants manage patients' emotional distress during cancer follow-up consultations: a multilevel study.

    PubMed

    Zhou, Yuefang; Humphris, Gerry; Ghazali, Naseem; Friderichs, Simon; Grosset, David; Rogers, Simon N

    2015-09-01

    Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant-reduced space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation. PMID:25078155

  8. Determinants of referrals from paraprofessionals to veterinarians in Uganda and Kenya.

    PubMed

    Ilukor, John; Nielsen, Thea; Birner, Regina

    2014-06-01

    Referrals between paraprofessionals and veterinarians are seen as a solution for improving disease surveillance, detection, and reporting as well as ensuring prudent use of antimicrobial agents in animals. This paper used data collected from paraprofessionals in Kenya and Uganda to identify factors influencing referrals to veterinarians by paraprofessionals using a probit regression model. The results show that the determinants of paraprofessional referrals to veterinarians include the following: paraprofessional's mobile phone ownership, gender, and training, as well as attendance of short term trainings, annual assessments, and membership in paraprofessional associations. The paper argues that legislation or supervision of paraprofessionals as well as expansion of mobile phone ownership by paraprofessionals, supporting the formation of paraprofessional associations, and investing in short term training are important factors for strengthening referrals from paraprofessionals to veterinarians. PMID:24646788

  9. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... 1504.3 Section 1504.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PREDECISION REFERRALS TO THE COUNCIL OF PROPOSED FEDERAL ACTIONS DETERMINED TO BE ENVIRONMENTALLY UNSATISFACTORY § 1504.3... information to permit an assessment of the matter's environmental acceptability. (3) Identify any...

  10. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    .... 1504.3 Section 1504.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PREDECISION REFERRALS TO THE COUNCIL OF PROPOSED FEDERAL ACTIONS DETERMINED TO BE ENVIRONMENTALLY UNSATISFACTORY § 1504.3... information to permit an assessment of the matter's environmental acceptability. (3) Identify any...

  11. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... consistent with the equal opportunity provisions of 29 CFR part 34. ... applicant to another human service, training or education program deemed more suitable for the individual... incomplete ISS. Further tracking or follow-up of referrals out of title II is not required. (e)...

  12. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... consistent with the equal opportunity provisions of 29 CFR part 34. ... applicant to another human service, training or education program deemed more suitable for the individual... incomplete ISS. Further tracking or follow-up of referrals out of title II is not required. (e)...

  13. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... consistent with the equal opportunity provisions of 29 CFR part 34. ... applicant to another human service, training or education program deemed more suitable for the individual... incomplete ISS. Further tracking or follow-up of referrals out of title II is not required. (e)...

  14. Identification and Referral for Mental Health Services in Juvenile Detention.

    ERIC Educational Resources Information Center

    Rogers, Kenneth M.; Pumariega, Andres J.; Cuffe, Steven P.

    This report discusses the outcomes of a study that examined the mental health referral patterns of youth referred to a public sector mental health system as the result of a judicial consent decree. The study included two samples of youth ages 13-17 from the entire state of South Carolina. The first group included incarcerated youth recruited from…

  15. Structural Damage Prediction and Analysis for Hypervelocity Impact: Consulting

    NASA Technical Reports Server (NTRS)

    1995-01-01

    A portion of the contract NAS8-38856, 'Structural Damage Prediction and Analysis for Hypervelocity Impacts,' from NASA Marshall Space Flight Center (MSFC), included consulting which was to be documented in the final report. This attachment to the final report contains memos produced as part of that consulting.

  16. Fidelity Measurement in Consultation: Psychometric Issues and Preliminary Examination

    ERIC Educational Resources Information Center

    Sheridan, Susan M.; Swanger-Gagne, Michelle; Welch, Greg W.; Kwon, Kyongboon; Garbacz, S. Andrew

    2009-01-01

    Consultation researchers have long recognized the importance of assessing fidelity of intervention implementation, including the fidelity with which both consultation procedures and behavioral intervention plans are delivered. However, despite decades of discussion about the importance of assessing for fidelity of implementation in intervention…

  17. Factors that Affect Consultation and Screening for Fecal Incontinence

    PubMed Central

    Kunduru, Lalitha; Kim, Sung Min; Heymen, Steve; Whitehead, William E.

    2016-01-01

    Background & Aims Fecal incontinence (FI) affects 15% of people age 70 years and older, but only 10%–30% discuss FI with their physicians. We aimed to identify barriers that prevent people from consulting with their physicians, and physicians from screening for FI. Methods We performed structured interviews of 124 individuals with FI (mean 56 years old, 87.9% women) recruited from 6 medical offices at the University of North Carolina Hospitals from June 2012 through March 2013. The subjects completed the Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale questionnaires. Interview questions aimed to determine which patients had consulted physicians for FI. Eleven of the 56 physicians with patients included in the study responded to the survey. Results Eighty-eight of the 124 participants consulted with their physicians about FI (consulters). These individuals had a higher incidence of depression than the 36 subjects who did not consult with their physicians about FI (non-consulters; P=.04), but similar Fecal Incontinence Severity Index scores. A smaller proportion of non-consulters were aware of available treatments than consulters (P<.01). Fifty-six percent of non-consulters said their FI was not serious enough to consult a physician. There was no difference between consulters and non-consulters in embarrassment in talking about FI. Among consulters, 88% initiated the conversation about FI with their physician. Seven of the 11 responding physicians screened for FI, and only screened high-risk patients. The 4 physicians who did not screen for FI were unaware of its prevalence, viewed FI as a low priority, or stated that patients were responsible for reporting their own symptoms. Conclusions Based on surveys of physicians and patients, many patients have insufficient knowledge about the availability and effectiveness of treatments for FI. Some people with FI do not discuss it with their physician because their symptoms are mild, and most

  18. 20 CFR 416.919p - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... perform ongoing special management studies on the quality of consultative examinations purchased from... equipment required to provide an adequate assessment and record of the existence and level of severity of... Type of Referral and for Report Content § 416.919p Reviewing reports of consultative examinations....

  19. 20 CFR 416.919p - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... perform ongoing special management studies on the quality of consultative examinations purchased from... equipment required to provide an adequate assessment and record of the existence and level of severity of... Type of Referral and for Report Content § 416.919p Reviewing reports of consultative examinations....

  20. Effect of Self-Referral on Bone Mineral Density Testing and Osteoporosis Treatment

    PubMed Central

    Warriner, Amy H.; Outman, Ryan C.; Feldstein, Adrianne C.; Roblin, Douglas W.; Allison, Jeroan J.; Curtis, Jeffrey R.; Redden, David T.; Rix, Mary M.; Robinson, Brandi E.; Rosales, A. Gabriela; Safford, Monika M.; Saag, Kenneth G.

    2014-01-01

    Background Despite national guidelines recommending bone mineral density screening with dual-energy xray absorptiometry (DXA) in women ≥65 years old, many women do not receive initial screening. Objective To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral), (2) self-referral plus patient educational materials, and (3) usual care (UC, physician referral). Research Design Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG). Subjects Women ≥ 65 years old without a DXA in past 5 years. Measures DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing. Results From >12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0 – 24.1% self-referral vs. 4.9 – 5.9% UC, p < 0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared to UC (p < 0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8 – 3.4%) but significantly greater among self-referral versus UC in KPNW. Conclusions DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening. PMID:24984211

  1. Skin Disease in the Uninsured: Diagnoses, Management Decisions, and Referral Outcomes of an Urban Free Clinic.

    PubMed

    Rosenbaum, Brooke E; Freitas, Derek; Nosal, Sarah C; Meydani, Ahou

    2016-01-01

    An understanding of the burden of skin disease in the uninsured population is needed to address the unique barriers they face to access dermatologic care. We conducted a retrospective chart review of patients seen for skin conditions over three years at the New York City (NYC) Free Clinic, a weekly primary care clinic operated by the NYU School of Medicine and the Institute for Family Health. Main outcomes of this study were descriptive analyses of demographic characteristics, diagnoses, management strategies, and referral outcomes, as well as key factors influencing referral to a dermatologist and referral attendance. Diagnosis was a significant predictor of referral (p<.000). The referral attendance rate was 52.5%. Patients older than 50 years were more likely to attend their appointments than younger patients (p=.025). Gender, wait time, and travel distance had no significant association with non-attendance. While demand for dermatologic care by uninsured patients in NYC is high, referral non-attendance remains a substantial barrier to care. PMID:27180711

  2. Relationship between the social and demographic characteristics of post-sentence offenders and the outcomes of forensic psychiatric referrals.

    PubMed

    Prandoni, J R

    1984-01-01

    Examined the relationship between the social and demographic characteristics of post-sentence offenders (N = 240) and outcome of outpatient forensic psychiatric referrals using multiple regression analysis. The referral process was divided into three stages: Decision to refer, compliance with referral, and outcome of referral, and the following research questions were explored: (1) whether there were differences between the social and demographic characteristics of offenders who were referred by court order of the sentencing judge and those referred by their probation officer; (2) the the relationship between socioeconomic status and completion of referral; (3) the relationship between socioeconomic status and recommendation for further mental health services; and (4) the relationship between source of referral and recommendation for mental health services. Results suggest that the relationship between social and demographic variables and the offender's interaction with a forensic mental health system is markedly different from the voluntary clients and mental health resources studied in earlier research. PMID:6086720

  3. The Counseling Referral Process and Degree of Understanding of Helping Services at the University of Kansas. Research Report No. 77-2.

    ERIC Educational Resources Information Center

    O'Neil, James M.; And Others

    The counseling referral process of academic advisors, resident assistants, and student personnel workers referring students to the University Counseling Center was assessed. The Referral Process Inventory (RPI) was developed to assess four areas related to the referral process. The results indicate differential knowledge of referral between groups…

  4. 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...

  5. Nurses' and Patients' Experiences of Tele-Consultations.

    PubMed

    Dichmann Sorknaes, Anne

    2016-01-01

    The study focused on real-time video consultations (tele-consultations) as experienced by Danish hospital-based, respiratory nurses (tele-nurses) and patients with chronic obstructive pulmonary disease, COPD, discharged after hospitalization with acute exacerbation (tele-patients). Tele-patients and tele-nurses consider tele-consultations as distinct, but qualified care, enabling close relationships between patient and nurse. The nurses' performance and their professional identity changed. The patients become active, participants in their treatment and care. PMID:27332392

  6. A Guiding Framework for Integrating the Consultation Process and Behavior Analytic Practice in Schools: The Treatment Validation Consultation Model

    ERIC Educational Resources Information Center

    Andersen, Melissa N.; Hofstadter, Kristi L.; Kupzyk, Sara; Daly, Edward J., III; Bleck, Amanda A.; Collaro, Alyssa L.; Jones, Kristin E.; Clure, Lynne F.; Blevins, Carrie A.

    2010-01-01

    Since behavioral consultation (BC) was introduced over 30 years ago, the core procedures and assumptions of the model have remained largely unchanged in spite of its widespread popularity in practice. This article presents the Treatment Validation Consultation (TVC) model, which addresses limitations of BC and integrates recent technological…

  7. Specialization and referral among the n'anga (traditional healers) of Zimbabwe.

    PubMed

    Arkovitz, M S; Manley, M

    1990-07-01

    Traditional medicine is the source of primary care for most Zimbabweans. N'angas (traditional healers) are consulted for their political and religious powers along with their healing powers. The Zimbabwe National Traditional Healers Association was formed and is officially recognized by the government and has a constitution along with departments of education and research. Each member pays annual dues. Herbal remedies are used. Most n'angas say they are possessed by a healing spirit which they invoke while treating the patient. These n'angas practice specialization--the extent to which the n'angas claim expertise, outside of which they will refer a patient to others. The referral and specialization practices of a select group of n'angas in and around the capital, Harare are studied. 30 n'angas from 7 suburbs of harare were interviewed personally at their place of practice in 1987. All 30 claimed to specialize in the treatment of certain illnesses. They specialized in spiritual, not just medical, problems. The n'angus referred to other n'angas for either or both of 2 reasons: 1) most referred patients for whom their treatment had failed; and 2) patients were referred for suffering an illness which that certain n'anga could not cure, usually because their healing spirit did not give them the cure. There were some things that the n'angas would only send to western medical practitioners and hospitals. These were mostly accidents or emergencies. "Abnormal illnesses" were never referred to Western practitioners and hospitals. "Abnormal illnesses" were caused by evil spirits such as "ngozi." The n'angas were divided over what to do about the acquired immunodeficiency syndrome (AIDS). 1 n'anga sand that he was so good at curing AIDS that he was flown to America to treat a patient. Others would send AIDS patients to hospitals. Most all Zimbabwe natives are descended from Shona and Ndebele cultures. PMID:2219419

  8. Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

    PubMed Central

    Gupte, Gouri; Seraj, Siamak M; Orlander, Jay; Berlowitz, Dan; Fincke, Benjamin G; Simon, Steven R

    2015-01-01

    Background We define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults. Methods We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based. Results Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers. Discussion E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes. PMID:25995331

  9. Continuing medical education: experience and opinions of consultants.

    PubMed Central

    Kerr, D N; Jones, S A; Easmon, C S

    1993-01-01

    The right of consultants to study leave and expenses is not binding on trusts and has been eroded in directly managed units. Complaints led to a survey of consultants in North West Thames region. This showed that most consultants use their own time and money to maintain their knowledge by buying and consulting journals and textbooks, attending local meetings, and using their annual leave for study, but they feel the need for study leave to attend meetings of specialist societies and courses. Leave is usually granted readily but without cover provided by a locum and with a very limited contribution to expenses. To maintain quality of medical care both the right and obligation to take study leave should be contractual. PMID:8518610

  10. Linkages Between Utilization of Prostate Surgical Pathology Services and Physician Self-Referral

    PubMed Central

    Mitchell, Jean M.

    2012-01-01

    Objective Federal law prohibits a physician from referring Medicare patients for procedures or services to health care entities in which the physician has a financial relationship. This law has exceptions which enable physicians to self-refer under certain conditions. This study evaluates the effects of self-referral on use rates of surgical pathology services performed in conjunction with prostate biopsies and whether such changes are linked to urologist self-referral arrangements. Data and Sample A targeted market area case study design was employed to identify the sample from Medicare claims data. The sample included male beneficiaries who resided in geographically dispersed counties; were continuously enrolled in Medicare fee-for-service (FFS) during 2005-2007; and who met the criteria to be a potential candidate to undergo a prostate biopsy. Outcomes Prostate biopsy procedures per 1000 male Medicare beneficiaries in each county; counts of surgical pathology specimens (jars) associated with prostate biopsy procedures per 1000 male Medicare beneficiaries in each county. Findings Regression analysis shows the self-referral share (percentage) of total utilization was associated with significant increases in the use rate of prostate surgical pathology specimens (p<.01). The use rate of prostate surgical pathology specimens (jars) would be 41.5 units higher in a county where the self-referral share of total utilization was 50% compared to a county with no self-referral (share equals 0%). Conclusions The findings show that urologist self-referral of prostate surgical pathology services results in increased utilization and higher Medicare spending. The results suggest that exceptions in federal and state self-referral prohibitions need to be reevaluated. PMID:24800147

  11. Health Professionals' Perspectives on Exercise Referral and Physical Activity Promotion in Primary Care: Findings from a Process Evaluation of the National Exercise Referral Scheme in Wales

    ERIC Educational Resources Information Center

    Din, Nafees U.; Moore, Graham F.; Murphy, Simon; Wilkinson, Clare; Williams, Nefyn H.

    2015-01-01

    Background and objectives: Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise…

  12. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... consult with and obtain information from the PMA, to examine backup data, and to make suggestions for... during this period, interested persons may submit written comments to the PMA regarding the...

  13. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE MEASUREMENT SERVICES POLICIES... and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended effort... & Technology, Washington, DC 20234....

  14. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE MEASUREMENT SERVICES POLICIES... and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended effort... & Technology, Washington, DC 20234....

  15. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE MEASUREMENT SERVICES POLICIES... and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended effort... & Technology, Washington, DC 20234....

  16. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE MEASUREMENT SERVICES POLICIES... and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended effort... & Technology, Washington, DC 20234....

  17. Electrical innovations, authority and consulting expertise in late Victorian Britain

    PubMed Central

    Arapostathis, Stathis

    2013-01-01

    In this article I examine the practices of electrical engineering experts, with special reference to their role in the implementation of innovations in late Victorian electrical networks. I focus on the consulting work of two leading figures in the scientific and engineering world of the period, Alexander Kennedy and William Preece. Both were Fellows of the Royal Society and both developed large-scale consulting activities in the emerging electrical industry of light and power. At the core of the study I place the issues of trust and authority, and the bearing of these on the engineering expertise of consultants in late Victorian Britain. I argue that the ascription of expertise to these engineers and the trust placed in their advice were products of power relations on the local scale. The study seeks to unravel both the technical and the social reasons for authoritative patterns of consulting expertise. PMID:24686584

  18. US-USSR telemedicine consultation spacebridge to Armenia and Ufa

    NASA Technical Reports Server (NTRS)

    1991-01-01

    The Final Report on the U.S.-U.S.S.R. Telemedicine Consultation Spacebride to Armenia and Ufa is presented. The goal of this activity was to provide expert medical consultation to the Armenian medical personnel in the areas of plastic and reconstructive surgery, physical and psychological rehabilitation, public health, and epidemiology following the devastating earthquake in Dec. 1988. The U.S. and U.S.S.R. implementation teams developed new standards for medical information transmittal as well as protocols and schedules on how to conduct medical consultations. The consultations were provided to the Republic Diagnostic Center in Yerevan, U.S.S.R. by four U.S. medical centers: University of Utah/LDS Hospital, University of Texas, Maryland Institute for Emergency Medical Service Systems, and Uniformed Services University of the Health Sciences.

  19. A Collaborative Approach to Implement Positive Behavior Support Plans for Children with Problem Behaviors: A Comparison of Consultation versus Consultation and Feedback Approach

    ERIC Educational Resources Information Center

    Erbas, Dilek

    2010-01-01

    The purpose of this study is to compare the effectiveness of consultation alone and consultation plus feedback on the proper use of positive behavior support strategies (PBS) on behaviors of three mothers with children with developmental disabilities. Results indicated that consultation plus feedback was more effective than consultation alone…

  20. Over- and Undercontrolled Clinic Referral Problems of Jamaican and American Children and Adolescents: The Culture General and the Culture Specific.

    ERIC Educational Resources Information Center

    Lambert, Michael C.; And Others

    1989-01-01

    Studied clinical referrals of two different societies (Jamaica, where Afro-British culture discourages child aggression, and United States, where uncontrolled child behavior appears more accepted) to determine influence of cultural factors in clinical referral patterns. Found significant difference in clinic-referred problems of American and…

  1. Improving service delivery by evaluation of the referral pattern and capacity in a clinical genetics setting.

    PubMed

    McCann, Emma; Baines, Elizabeth A; Gray, Jonathon R; Procter, Annie M

    2009-08-15

    Quality improvement in specialist services such as clinical genetics is challenging largely due to the complexity of the service and the difficulty in obtaining accurate, reproducible, and measurable data. The objectives were to evaluate the pattern of referrals to the All Wales Medical Genetics Service (AWMGS) North Wales Genetics team based in three separate hospitals, define the capacity of the team and implement change to improve equity, timeliness and efficiency of care delivery to patients. The methodology required collating the monthly referral rates retrospectively for each center over a 2.5-year period and plotting on statistical process control charts. Process mapping of the referral process in each center was undertaken, differences documented and a common pathway implemented. "Did not attend" and "time to first appointment" rates were also measured in one center. PDSA methodology was used to implement "patient focused booking." The results show that the range for referral rates in any given month for each center was 3-33 referrals. The range for referral rate for the whole team was 18-64 per month. Since January 2004 the average number of monthly referrals to the North Wales service has increased by 50%. The potential range in monthly referrals varies between centers and the range of the variability has also increased also in two out of the three centers. Introduction of Patient Focused Booking reduced the "Failed to Attend" rate and 100% of patients were offered a choice of appointments. In addition 100% had a first face-to-face contact within 6 weeks if they chose. The measurement of improvement involved firstly introducing a series of continuous measures to provide a baseline for the process prior to the implementation of any changes and secondly to indicate the impact of the changes following implementation. The measures implemented included process (referrals numbers, percentage of patients offered a choice of appointments), outcome (percentage of

  2. Prenatal diagnosis and telemedicine consultation of fetal urologic disorders.

    PubMed

    Rabie, Nader Z; Canon, Stephen; Patel, Ashay; Zamilpa, Ismael; Magann, Everett F; Higley, Jared

    2016-06-01

    In Arkansas, telemedicine is used commonly in obstetrics through Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the existing statewide telemedicine network. This network is used primarily for tele-ultrasound and maternal-fetal medicine consultation. This study is a retrospective case series, describing all the patients who had a prenatally diagnosed urologic anomaly that required prenatal urologic consultation. From 2009-2013, approximately 1300 anomalies were recorded in the Arkansas Fetal Diagnosis and Management (AFDM) database, 14% of which were urologic anomalies. Twenty-six cases required prenatal urologic consultation, 25 of which were conducted via telemedicine. Teleconsultation allowed patients to combine maternal-fetal medicine and urologic consultations in one visit, saving time and effort and ultimately, for most patients, providing reassurance that delivery could be accomplished locally with postnatal follow-up already arranged. While there are several studies reporting the use of telemedicine for various subspecialty consultations, to our knowledge, this is the first to describe the use of telemedicine for prenatal urology consultation. Future research could randomize patients prospectively to allow comparison of both the outcomes as well as the patient experience. PMID:26199277

  3. The effectiveness of post-detoxication referrals: effects on later detoxication admissions, drunkenness and criminality.

    PubMed

    Smart, R G; Finley, J; Funston, R

    1977-05-01

    This study concerned the effectiveness of post-detoxication referrals to a variety of treatment facilities. The purpose was to discover (i) the proportion of men accepting referrals who actually arrived, (ii) the differences in outcome for patients attending an out-patient clinic, a halfway house, and a long-stay farm, (iii) the differences in outcomes for patients treated in one of the above facilities compared with those for similar patients not receiving treatment. In all, 114 male detoxication admissions were included. However, only 60% arrived, even when firm referrals were made. Those arriving and not arriving did not differ in social or demographic characteristics, nor did those who were referred to the various treatment facilities. However, the referral group had more detoxication admissions in the post-detoxication period. There were no post-treatment overall differences between all treated and untreated patients in detoxication admissions, arrests for drunkenness or criminal convictions. Refusals were more often successes than the treated or untreated groups but this was due to their better prognosis at intake. In general, the data provide little cause for optimism about the value of post-detoxication referrals. PMID:69522

  4. Prevalence and Determinants of True Thyroid Dysfunction Among Pediatric Referrals for Abnormal Thyroid Function Tests

    PubMed Central

    Lahoti, Amit; Klein, Jason; Schumaker, Tiffany; Vuguin, Patricia; Frank, Graeme

    2016-01-01

    Background/Aims. Abnormalities in thyroid function tests (TFTs) are a common referral reason for pediatric endocrine evaluation. However, a sizable proportion of these laboratory abnormalities do not warrant therapy or endocrine follow-up. The objectives of this study were (a) to evaluate the prevalence of true thyroid dysfunction among pediatric endocrinology referrals for abnormal TFTs; (b) to identify the historical, clinical, and laboratory characteristics that predict decision to treat. Methods. This was a retrospective chart review of patients evaluated in pediatric endocrinology office during a weekly clinic designated for new referrals for abnormal TFTs in 2010. Results. A total of 230 patients were included in the study. Median age at referral was 12 years (range = 2-18); 56% were females. Routine screening was cited as the reason for performing TFTs by 33% patients. Majority was evaluated for hypothyroidism (n = 206). Elevated thyroid-stimulating hormone was the most common referral reason (n = 140). A total of 41 out of 206 patients were treated for hypothyroidism. Conclusions. Prevalence of hypothyroidism was 20%. Thyroid follow-up was not recommended for nearly one third of the patients. Among all the factors analyzed, an elevated thyroid-stimulating hormone level and antithyroglobulin antibodies strongly correlated with the decision to treat (P < .005). PMID:27336020

  5. Why general practitioners and consultants change their clinical practice: a critical incident study.

    PubMed Central

    Allery, L. A.; Owen, P. A.; Robling, M. R.

    1997-01-01

    OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. CONCLUSIONS: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered. PMID:9093100

  6. Facilitating physician referrals on the World Wide Web: representation and appropriate utilization of clinical expertise.

    PubMed

    McHolm, G; Obeid, J; Karson, T H; Sato, L; Schaffer, J L; Greenes, R A

    1996-01-01

    In highly integrated and increasingly complex health care systems, the identification and proper utilization of clinical staff expertise are key factors for efficiently delivering high quality patient care. To achieve these capabilities on an enterprise-wide scale, we have embarked on a multi-phased project to develop World Wide Web (WWW)-based physician referral capabilities for two large teaching hospitals. Currently, users may search for information concerning the education, training, board certifications, and self-designated clinical interests of staff members. Address, phone number, email address, and a photo are also presented. Our experience indicates that institutional changes are required to successfully deploy and maintain online physician referral services and that accurate and equitable representation of clinical expertise and the incorporation of referral guidelines require an incremental introduction of a carefully planned program that addresses the needs of clinicians, administrators, and health care policy-makers. PMID:8947760

  7. Situational Consultation

    ERIC Educational Resources Information Center

    Rimehaug, Tormod; Helmersberg, Ingunn

    2010-01-01

    Situational Consultation (SC) is presented as a framework for flexible integration of several models and methodologies in consultation practice by choosing an approach adapted to the specific situation. In SC, models and their characteristic role positions are considered interchangeable tools with qualitative differences in strengths and…

  8. 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

  9. 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

  10. Heightened motor and sensory (mirror-touch) referral induced by nerve block or topical anesthetic.

    PubMed

    Case, Laura K; Gosavi, Radhika; Ramachandran, Vilayanur S

    2013-08-01

    Mirror neurons allow us to covertly simulate the sensation and movement of others. If mirror neurons are sensory and motor neurons, why do we not actually feel this simulation- like "mirror-touch synesthetes"? Might afferent sensation normally inhibit mirror representations from reaching consciousness? We and others have reported heightened sensory referral to phantom limbs and temporarily anesthetized arms. These patients, however, had experienced illness or injury of the deafferented limb. In the current study we observe heightened sensory and motor referral to the face after unilateral nerve block for routine dental procedures. We also obtain double-blind, quantitative evidence of heightened sensory referral in healthy participants completing a mirror-touch confusion task after topical anesthetic cream is applied. We suggest that sensory and motor feedback exist in dynamic equilibrium with mirror representations; as feedback is reduced, the brain draws more upon visual information to determine- perhaps in a Bayesian manner- what to feel. PMID:23791606

  11. Psychiatric consultation in the eastern Canadian Arctic: I. Development and evolution of the Baffin Psychiatric Consultation Service.

    PubMed

    Hood, E; Malcolmson, S A; Young, L T; Abbey, S E

    1993-02-01

    The Baffin Consultation Service of the Clarke Institute of Psychiatry has been providing psychiatric consultation services to the Baffin Island region of the Eastern Canadian Arctic since 1971. This report describes the background history, development and evolution of the service. Attention is focused on aspects of the consultation visits, educational activities of the project and the development of a mental health network. It is suggested that this is a useful model for the provision of psychiatric services to remote areas with limited resources. PMID:8448715

  12. Virtual online consultations: advantages and limitations (VOCAL) study

    PubMed Central

    Greenhalgh, Trisha; Vijayaraghavan, Shanti; Wherton, Joe; Shaw, Sara; Byrne, Emma; Campbell-Richards, Desirée; Bhattacharya, Satya; Hanson, Philippa; Ramoutar, Seendy; Gutteridge, Charles; Hodkinson, Isabel; Collard, Anna; Morris, Joanne

    2016-01-01

    Introduction Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. Methods To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel—audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel—interviews, ethnographic observations and analysis of documents within the trust; macrolevel—key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. Ethics approval City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. Planned outputs We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: ‘what to expect in your virtual consultation’. Discussion The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they

  13. Referrals to neurologists for headaches not due to structural disease.

    PubMed Central

    Fitzpatrick, R; Hopkins, A

    1981-01-01

    Patients attending neurological clinics with headaches that proved not to be due to clearly defined structural disease were interviewed before and after the consultation and approximately one year later. Their expectations of the consultation were ill-formed. About two-thirds of the patients had fears about organic disease although few had psychiatric morbidity. These fears were generally dispelled by the consultation. About one-third of the patients were dissatisfied by the consultation, nearly all by what the neurologist said rather than by what technical procedures he did or did not undertake. Women with a long history of migraine, with significant psychiatric morbidity, and who had initiated the referral themselves were particularly likely to be dissatisfied. Although most patients were still having headaches one year later, visits to the general practitioner for this symptom had greatly declined. PMID:7334400

  14. How we do it: analysing GP referral priorities: the unforeseen effect of 'Choose and Book'.

    PubMed

    Pothier, D D; Repanos, C; Awad, Z

    2006-08-01

    The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category. PMID:16911656

  15. 34 CFR 300.535 - Referral to and action by law enforcement and judicial authorities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Parents and Children Discipline Procedures § 300.535 Referral to and action by law enforcement and... crime committed by a child with a disability to appropriate authorities or prevents State law... Federal and State law to crimes committed by a child with a disability. (b) Transmittal of records. (1)...

  16. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Establishment and use of referral and monitoring agencies. 404.1541 Section 404.1541 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness...

  17. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Establishment and use of referral and monitoring agencies. 404.1541 Section 404.1541 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness...

  18. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Establishment and use of referral and monitoring agencies. 404.1541 Section 404.1541 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness...

  19. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Establishment and use of referral and monitoring agencies. 404.1541 Section 404.1541 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness...

  20. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Establishment and use of referral and monitoring agencies. 404.1541 Section 404.1541 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness...

  1. A Simple and Effective Program to Increase Faculty Knowledge of and Referrals to Counseling Centers

    ERIC Educational Resources Information Center

    Nolan, Susan A.; Pace, Kristi A.; Iannelli, Richard J.; Palma, Thomas V.; Pakalns, Gail P.

    2006-01-01

    The authors describe a simple, cost-effective, and empirically supported program to increase faculty referrals of students to counseling centers (CCs). Incoming faculty members at 3 universities received a mailing and personal telephone call from a CC staff member. Faculty assigned to the outreach program had greater knowledge of and rates of…

  2. Planning and Implementing a Community Based Child Care Information and Referral Clearinghouse.

    ERIC Educational Resources Information Center

    MacWright, Alicia Cox

    To provide for the planning and implementation of a community based, university sponsored, child care information and referral clearinghouse, a doctoral practicum project was undertaken. The primary goal of the project was to provide parents with up-to-date information about the full range of child care and children's services available in…

  3. Teen Court Referral, Sentencing, and Subsequent Recidivism: Two Proportional Hazards Models and a Little Speculation

    ERIC Educational Resources Information Center

    Rasmussen, Andrew

    2004-01-01

    This study extends literature on recidivism after teen court to add system-level variables to demographic and sentence content as relevant covariates. Interviews with referral agents and survival analysis with proportional hazards regression supplement quantitative models that include demographic, sentencing, and case-processing variables in a…

  4. Athletic Training Educators' Instructional Methods and Confidence in Graduating Students' Abilities regarding Psychosocial Intervention and Referral

    ERIC Educational Resources Information Center

    Hamson-Utley, Jennifer Jordan; Stiller-Ostrowski, Jennifer L.

    2011-01-01

    Context: Graduating athletic training students must consider both physical and mental aspects of injury to fully rehabilitate the injured athlete; however, programs may not be preparing students to apply psychosocial strategies that can improve the recovery process. Objective: To examine Psychosocial Intervention and Referral (PIR) content area…

  5. The role of oak pollen in hay fever consultations in general practice and the factors influencing patients' decisions to consult.

    PubMed Central

    Ross, A M; Corden, J M; Fleming, D M

    1996-01-01

    BACKGROUND: Patients often consult for hay fever before significant counts of grass pollen are recorded, and this has prompted the question, 'Are symptoms already present or are patients consulting to obtain medication in anticipation?' AIM: The study is concerned with the relationship between hay fever symptoms and pollens, and also with the impact of the media on patient consulting behaviour. METHOD: Symptom questionnaires were presented to patients consulting with hay fever for the first time that year in 1994 in four Birmingham practices. The questionnaire concerned the nature and duration of symptoms and the influence of the media on their decision to consult. Incidence data collected over the spring and summer periods (1989-1995) in the Weekly Returns Service (WRS) were examined in relation to pollen counts reported by the Midlands Asthma and Allergy Research Association at Derby. Data are presented for oak, birch and grass pollen, but other pollen data including rape, nettle and other trees were also examined. RESULTS: Questionnaire data from 1994 were analysed in two periods starting from 4 April: early (day 1-60) and late (day 61-124). Out of the 364 subjects, 38% consulted in the early period and 62% in the late period. Altogether, 41% developed symptoms before the start of the grass pollen season. Overall, 91% of patients first consulting in the early period had already experienced symptoms compared with 99% late period and were not simply collecting prescriptions in anticipation. The influence of the media on consultation behaviour was very small, except in children, 23% of whom (or their parents) were reported to be influenced. The new episode data from the WRS examined over 7 years showed an early peak that was coterminous with oak pollen, and a later and higher peak with grass pollen. CONCLUSION: The consistency of the relationship between oak pollen and the early peak of hay fever over the years examined suggests that oak pollen is a major cause of

  6. Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

    PubMed Central

    Kheirbek, Raya E.; Fletcher, Ross D.; Bakitas, Marie A.; Fonarow, Gregg C.; Parvataneni, Sridivya; Bearden, Donna; Bailey, F. Amos; Morgan, Charity J.; Singh, Steven; Blackman, Marc R.; Zile, Michael R.; Patel, Kanan; Ahmed, Momanna B.; Tucker, Rodney O.; Brown, Cynthia J.; Love, Thomas E.; Aronow, Wilbert S.; Roseman, Jeffrey M.; Rich, Michael W.; Allman, Richard M.; Ahmed, Ali

    2015-01-01

    Background Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. Methods and Results Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998–2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post-discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years, 58% women, 18% African American). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio {HR} associated with hospice referral, 0.12; 95% confidence interval {CI}, 0.06–0.24). HRs (95% CIs) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post-discharge were 0.03 (0.04–0.21) and 0.17 (0.08–0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% vs. 27%), it was similar at 90 days (64% vs. 67% among hospice-eligible patients). Conclusions A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized HF patients. However, most HF patients who died within 6 months of hospital discharge did not receive a discharge hospice referral. PMID:26019151

  7. [General practice consultation in a hospital emergency department. History, evaluation and prospects].

    PubMed

    Lafay, Vincent; Giraud, Christiane; Bel, Corinne; Giovannetti, Olivier

    2002-10-26

    INSTALLATION OF A GENERAL MEDICINE CONSULTATION: In 1995, in reaction to an increase of more than 35% over three years, related essentially to out-patient consultations, the installation of a general medicine consultation (GMC) near the emergency unit reception area (EUR) was envisaged. The project, developed over 5 years and based on an epidemiological study, was finally set-up in January 2000. The aims of the GMC are to supply information to the patients, help them in their administrative rights, and their subsequent follow-up by an external physician; the benefits expected by the EUR is the re-concentration on heavier and more urgent pathologies. THE FUNCTION OF THE GMC: Exclusively reserved for CCMU 1 patients (level 1 of the clinical classification of emergency unit patients), the GMC relies on general practice, with the presence of general practitioners installed in the SAU (emergency unit) sector, a double admission method (either via the emergency unit, or directly), a means of payment for the consultation and the absence of priority access to the technical network of the hospital. A social services worker is present. RECRUITMENT: After 18 months of activity, the GMC had managed more than 4500 patients and the method of referral via the SAU, almost exclusive at the beginning, has been reduced to a minority. The patients are generally young; socially close to the underprivileged population surrounding the SAU, but not in a situation of precariousness. The four principle motives for consultation are benign traumas, ENT infections, dermatological affections and pain. A DYNAMIC STRUCTURE: The rapid progress in the context of general medicine, and the observations of the physicians and non-physicians participating in this experience, has progressively modified the aim and mission of this GMC, which is gradually becoming a real structure of permanent care. Its originality is its close link between the town and the hospital, whilst permitting the various actors to

  8. Teachers, Teaching and Educational Exclusion: Pupil Referral Units and Pedagogic Practice

    ERIC Educational Resources Information Center

    Meo, Analia; Parker, Andrew

    2004-01-01

    This paper presents the findings of a qualitative research project carried out in a UK Pupil Referral Unit during the 2000/01 academic year. It describes and analyses the strategies adopted by a small group of Behaviour Support Service teachers in order to achieve their everyday occupational goals. It is argued that despite their commitment to the…

  9. The patient and the computer in the primary care consultation

    PubMed Central

    Arnold, Michael; Phillips, Christine; Trumble, Stephen; Dwan, Kathryn

    2011-01-01

    Objective Studies of the doctor–patient relationship have focused on the elaboration of power and/or authority using a range of techniques to study the encounter between doctor and patient. The widespread adoption of computers by doctors brings a third party into the consultation. While there has been some research into the way doctors view and manage this new relationship, the behavior of patients in response to the computer is rarely studied. In this paper, the authors use Goffman's dramaturgy to explore patients' approaches to the doctor's computer in the consultation, and its influence on the patient–doctor relationship. Design Observational study of Australian general practice. 141 consultations from 20 general practitioners were videotaped and analyzed using a hermeneutic framework. Results Patients negotiated the relationship between themselves, the doctor, and the computer demonstrating two themes: dyadic (dealing primarily with the doctor) or triadic (dealing with both computer and doctor). Patients used three signaling behaviors in relation to the computer on the doctor's desk (screen watching, screen ignoring, and screen excluding) to influence the behavior of the doctor. Patients were able to draw the doctor to the computer, and used the computer to challenge doctor's statements. Conclusion This study demonstrates that in consultations where doctors use computers, the computer can legitimately be regarded as part of a triadic relationship. Routine use of computers in the consultation changes the doctor–patient relationship, and is altering the distribution of power and authority between doctor and patient. PMID:21262923

  10. Survey of perceived stress and work demands of consultant doctors.

    PubMed Central

    Agius, R M; Blenkin, H; Deary, I J; Zealley, H E; Wood, R A

    1996-01-01

    OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers. PMID:8664957

  11. Patient referral from nurses to doctors in a nurse-led HIV primary care clinic in South Africa: implications for training and support.

    PubMed

    Venkatesh, Kartik K; de Bruyn, Guy; Lurie, Mark N; Lentle, Kgotso; Tshabangu, Nkeko; Moshabela, Mosa; Martinson, Neil A

    2010-11-01

    Health services in sub-Saharan Africa are under great pressure to provide adequate clinical care due to the continued HIV epidemic, and nurse-driven models of care are one means to address physician shortages. This case-control study examines the reasons for and correlates of patient referral from nurses to physicians at HIV primary care clinics in South Africa prior to initiating antiretroviral treatment. Ninety-seven HIV-infected cases who required physician consolation and 160 controls who did not require physician consultation (matched on gender, age, and date of clinic visit) were consecutively enrolled at both an urban and rural HIV primary care clinic during a 12-month period beginning in March 2006. Univariate and multivariate logistic regression models were used to assess correlates of patient referral to a physician. Cases were more likely to have lower CD4 cell counts and have WHO Stages III and IV disease compared to controls (p<0.05). Predictors of patient referral were a CD4 cell count between 50 and 200 cells/µl (adj OR: 5.27, 95% CI: 2.16-12.88, p<0.0001), a CD4 cell count below 50 cells/µl (adj OR: 3.47, 95% CI: 1.12-10.78, p=0.032), and Stage IV disease (adj OR: 4.58, 95% CI: 1.35-15.60, p=0.015). Additionally, the following ICD-10 clinical diagnoses were associated with patient referral: tuberculosis, aplastic and other anemias, and lower respiratory tract infection (p<0.05). Nurses can provide adequate clinical and diagnostic management for certain clinical conditions to HIV-infected patients. Further studies are needed to examine specifically how HIV healthcare delivery can be scaled-up in resource-limited settings with a high burden of HIV, but with a minimal healthcare infrastructure. PMID:20711891

  12. Adherence patterns to National Comprehensive Cancer Network (NCCN) guidelines for referral to cancer genetic professionals

    PubMed Central

    Febbraro, Terri; Robison, Katina; Wilbur, Jennifer Scalia; Laprise, Jessica; Bregar, Amy; Lopes, Vrishali; Legare, Robert; Stuckey, Ashley

    2016-01-01

    Objective Genetic predisposition is responsible for 5–10% of breast cancer, 10% of ovarian cancer and 2–5% of uterine cancer. The study objective was to compare genetic counseling and testing referral rates among women with breast cancer that met NCCN referral guidelines to the referral rates among women with gynecologic cancers and determine predictors of referral. Methods Utilizing an institutional tumor registry database, patients from an academic women's oncology program were identified who met a subset of NCCN guidelines for genetic referral between 2004 and 2010. Patients diagnosed with ovarian cancer, breast cancer ≤50 years of age, or uterine cancer <50 years of age were included. A retrospective electronic chart review was conducted to evaluate for a genetic referral and uptake of genetic testing. Results 820 women were included (216 uterine, 314 breast, and 290 ovarian cancer). The overall genetic referral rate was 21.7%. 34% of eligible breast cancer patients were referred compared to 13.4% of uterine cancer and 14.5% ofovarian cancer patients (p < 0.0001). Younger age, breast cancer diagnosis, family history and earlier stage were all significant referral predictors. The odds of being referred increased with the number of affected family members. 70.8% of referred patients, consulted with genetics. Among those who consulted with genetics, 95.2% underwent testing. Conclusions Although increasing, genetic counseling remains underutilized across cancer diagnosis. Women with breast cancer are more likely to be referred than women with gynecologic cancers. Younger age, earlier stage and positive family history appear to be predictive of referral for genetic evaluation. PMID:25933682

  13. 25 CFR 170.105 - Are funds available for consultation, collaboration, and coordination activities?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Are funds available for consultation, collaboration, and... Consultation, Collaboration, Coordination § 170.105 Are funds available for consultation, collaboration, and coordination activities? To fund consultation, collaboration, and coordination of IRR Program...

  14. Comparison of rates of referral and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign.

    PubMed

    Harrison, Andrew A; Badenhorst, Christoffel; Kirby, Sandra; White, Douglas; Athens, Josie; Stebbings, Simon

    2014-07-01

    The objective of this research is to measure the effect of a national ankylosing spondylitis (AS) public awareness campaign on numbers of referrals for suspected AS and numbers of cases diagnosed with axial spondyloarthritis (SpA). A television advertising campaign was conducted by Arthritis New Zealand in 2011 to raise public awareness of AS. A retrospective analysis was made of referrals received by the three rheumatology services 3 months before the campaign started and 3 months after the campaign ended. The age, gender, number of referrals for suspected AS and number of referrals resulting in a diagnosis of axial SpA were recorded. Independent analysis showed that the awareness campaign reached 82 % of the primary target audience. In the 3 months after the awareness campaign, there was a significant increase in referrals for suspected AS compared with the 3 months before the campaign (54 vs. 88, 63 %, p = 0.0056). Referrals for other conditions did not change. The number of referrals resulting in a diagnosis of axial SpA also increased (27 vs. 44, 63 %, p = 0.0576). The mean ages of the patients referred and of those diagnosed with axial SpA did not change. The male/female ratio was 1:1 among the referrals for suspected AS and 2:1 in referrals diagnosed with axial SpA, before and after the campaign. The Arthritis New Zealand AS public awareness campaign was associated with a significant increase in referrals to rheumatology services for suspected AS and an increase in the diagnosis of axial SpA in clinics. PMID:24609715

  15. Transaction Cost Analysis of In-Clinic Versus Telehealth Consultations for Chronic Pain: Preliminary Evidence for Rapid and Affordable Access to Interdisciplinary Collaborative Consultation

    PubMed Central

    Theodore, Brian R.; Whittington, Jan; Towle, Cara; Tauben, David J.; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z.

    2015-01-01

    Objectives With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Methods Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient’s case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Results Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. Conclusions U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. PMID:25616057

  16. Teachers and Consultation: Applying Research and Development in Organisations (RADIO)

    ERIC Educational Resources Information Center

    Timmins, Paul; Bham, Mohammed; McFadyen, Jane; Ward, Joanna

    2006-01-01

    In this article we describe how the RADIO process enabled EPiTs to negotiate research with an EPS around its desire to evaluate and develop its consultation work with schools. Findings of the evaluation and their implications for the Service are described and the potential of RADIO as a tool for providing external research support from HEIs for…

  17. 42 CFR 457.232 - Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General. 457.232... to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General... during any quarter to be an overpayment. (c) Allegations or indications of waste fraud and abuse...

  18. A qualitative assessment of the referral system at district level in Zimbabwe: implications on efficiency and effective delivery of health services.

    PubMed

    Hongoro, C; Musonza, T G; Macq, J; Anozie, A

    1998-04-01

    This exploratory study describes the nature and magnitude of the problem of health referrals, health-seeking behavior, perceptions, and knowledge at the district level in Zimbabwe. Data were obtained from focus groups with 159 persons in Tsholotsho and 132 persons in Murewa; from discussions with health personnel from the 6 health centers in Murewa and the 2 rural hospitals in Tsholotsho; and from records among a systematic sample of 400 new outpatients during October 1993 and March 1994 in Murewa district. Findings indicate that 71.8% in outpatient departments at Murewa Hospital had no access to a health center. 24.3% by-passed the health center for treatment at the hospital. 3.8% were referred by health centers. The absolute number of referrals did not change during 1991-93. However, the number directly accessing services from outside the district rose. Focus group participants reported their intention to use the nearest clinic for an illness. In Tsholotsho, people initially used the village community worker/headman. If illness was perceived as serious, patients would go to a hospital. For minor illness, people used traditional herbal remedies. If illness did not change after remedies, the clinic was consulted. Some illnesses were perceived as outside the realm of medicine. Most distinguished between a health center and a hospital, but were unaware of the important, superior functions of the health center. Most did not understand the logic behind the referral system, but appreciated referrals and not the cost of hospital treatment or transportation. The community was unaware of Ward Health Teams. Many did not understand the new fee policy introduced in 1994. PMID:9810401

  19. Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales

    PubMed Central

    Din, Nafees U; Moore, Graham F; Murphy, Simon; Wilkinson, Clare; Williams, Nefyn H

    2015-01-01

    Background and objectives: Referring clinicians’ experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals’ perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. Design: Qualitative semi-structured group interviews. Setting: General practice premises. Methods: Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. Results: Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smoking cessation. Professionals linked decisions on whether to advise physical activity to patients to their own physical activity levels and to subjective judgements of patient motivation. While some described ERS as a holistic alternative to medication, with potential social benefits, others expressed concerns regarding their limited reach and potential to exacerbate inequalities. Barriers to referral included geographic isolation and uncertainties about patient selection criteria, medico-legal responsibilities and a lack of feedback about patient progress. Conclusion: Clinicians’ concerns about expertise, priority setting and time constraints should be addressed to enhance physical activity promotion in primary care. Further research is needed to fully understand decision making relating to provision of physical activity advice and use of ERS. PMID:26527835

  20. Effect of a Counseling Intervention Program on Tenth Grade Students' Attendance, Discipline Referrals, and Academic Achievement

    ERIC Educational Resources Information Center

    Austin, Dorothy Deona Martin

    2013-01-01

    Poor student achievement, high discipline referrals, and student absenteeism were issues in a rural school with a population of approximately 400 students. The purpose of this study was to examine the influence of Effective Teens training on the attendance, discipline referrals, and academic achievement of 10th grade students. The theoretical…

  1. Serving Children with SED in Urban Systems of Care: Referral Agency Differences in Child Characteristics in Baltimore and the Bronx.

    ERIC Educational Resources Information Center

    Walrath, Christine M.; Sharp, Mark J.; Zuber, Michael; Leaf, Philip J.

    2001-01-01

    A study explored the characteristic similarities and differences of 696 children with serious emotional disturbances being served in community-similar urban systems of care as a function of their referral source. Results found the children did not share uniform sociodemographic and psychosocial profiles as a function of the referral agency.…

  2. Re-Referral to Child Protective Services: The Influence of Child, Family, and Case Characteristics on Risk Status

    ERIC Educational Resources Information Center

    Connell, Christian M.; Bergeron, Natasha; Katz, Karol H.; Saunders, Leon; Tebes, Jacob Kraemer

    2007-01-01

    Introduction: This study examines child, family, and case characteristics that impact rates of re-referral to Child Protective Services (CPS) using data on all closed CPS investigations for the state of Rhode Island between 2001 and 2004. Method: A longitudinal dataset of all referrals to CPS was created using state submissions to the National…

  3. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Referral to the Office of Government Ethics... Postemployment Conflict of Interest § 5.54 Referral to the Office of Government Ethics and to the Department of... of Government Ethics and to the Criminal Division, Department of Justice. (b) Unless the...

  4. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Referral to the Office of Government Ethics... Postemployment Conflict of Interest § 5.54 Referral to the Office of Government Ethics and to the Department of... of Government Ethics and to the Criminal Division, Department of Justice. (b) Unless the...

  5. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Referral to the Office of Government Ethics... Postemployment Conflict of Interest § 5.54 Referral to the Office of Government Ethics and to the Department of... of Government Ethics and to the Criminal Division, Department of Justice. (b) Unless the...

  6. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Referral to the Office of Government Ethics... Postemployment Conflict of Interest § 5.54 Referral to the Office of Government Ethics and to the Department of... of Government Ethics and to the Criminal Division, Department of Justice. (b) Unless the...

  7. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Referral to the Office of Government Ethics... Postemployment Conflict of Interest § 5.54 Referral to the Office of Government Ethics and to the Department of... of Government Ethics and to the Criminal Division, Department of Justice. (b) Unless the...

  8. Reflecting on the Role of Competence and Culture in Consultation at the International Level

    ERIC Educational Resources Information Center

    Rosenfield, Sylvia

    2014-01-01

    International educational consultation is challenging work that requires not only attention to best practices in consultation but also additional focus on cultural norms and regularities. In the three articles of this special issue, the consultation competencies of consultants play a critical role, as exemplified by entry issues, problem-solving…

  9. Effects of School Counselors' Cognitive Behavioral Consultation on Irrational and Efficacy Beliefs of Elementary School Teachers

    ERIC Educational Resources Information Center

    Warren, Jeffrey M.; Gerler, Edwin R., Jr.

    2013-01-01

    Consultation is an indirect service frequently offered as part of comprehensive school counseling programs. This study explored the efficacy of a specific model of consultation, rational emotive-social behavior consultation (RE-SBC). Elementary school teachers participated in face-to-face and online consultation groups aimed at influencing…

  10. Stereotyping in a Traditional Society and Its Implications for School Psychologist Referral Patterns: The Case of the Negev Bedouin

    ERIC Educational Resources Information Center

    Thein, Ram

    2007-01-01

    The present report describes the psycho-educational services referral pattern in the school system serving both a permanent Bedouin town A and its vicinity in Israel's Negev desert. The subjects of the study were students in the school system in A between the years 1997 to 2002 (with additional data from 2004). The total number of referrals to…

  11. Teachers' Recognition and Referral of Anxiety Disorders in Primary School Children

    ERIC Educational Resources Information Center

    Headley, Clea J.; Campbell, Marilyn A.

    2011-01-01

    This study investigated the ability of primary school teachers to recognise and refer children with anxiety symptoms. Two hundred and ninety-nine primary school teachers completed a questionnaire exploring their recognition and referral responses to five hypothetical vignettes that described boys and girls with varying severity of anxiety…

  12. The Trauma Syndrome: Identification, Treatment, and Referral of Commonly Seen Problems.

    ERIC Educational Resources Information Center

    Cohon, Donald J., Jr.

    This paper provides counselors and social service case workers serving Indochinese refugees in northern California with guidelines for identifying, treating and making referrals of clients with emotional problems. Freud's theory of trauma neurosis and its effect on refugees' language acquisition, learning ability and job readiness are described.…

  13. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... public and private agencies. 702.505 Section 702.505 Employees' Benefits EMPLOYMENT STANDARDS... public and private agencies. Referrals to such other public and private agencies providing assistance to... of the Veterans Administration, the Social Security Administration, and other such agencies, shall...

  14. Pupil and Staff Perceptions of Rewards at a Pupil Referral Unit

    ERIC Educational Resources Information Center

    Capstick, Joanna

    2005-01-01

    The present study investigated the perceptions of both pupils and staff at a pupil referral unit (PRU) towards the reward system currently in use. The main aims were to establish whether teachers and pupils perceived the same rewards as effective, to determine whether staff and pupils perceived that rewards changed behaviour, and finally whether…

  15. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Vocational rehabilitation; referrals to other public and private agencies. 702.505 Section 702.505 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE...

  16. External reviews, internal influences: consultations and the undergraduate neuroscience curriculum.

    PubMed

    Wiertelak, Eric P

    2012-01-01

    In 2007 FUN established the FUN Program and Department Consultations Service, or FUN-PDCS. Since that founding, the service has provided numerous consultation recommendations to undergraduate programs seeking assistance with external program reviews, designing and improving courses and many other programmatic needs. FUN-PDCS, like FUN, is primarily a grassroots organization and draws on the expertise of the FUN membership to aid programs in their more personalized pursuit of the FUN mission: to promote and improve undergraduate neuroscience education and research. PMID:23493648

  17. A National Survey of Alcohol Screening and Referral in College Health Centers

    ERIC Educational Resources Information Center

    Foote, Jeffrey; Wilkens, Carrie; Vavagiakis, Peter

    2004-01-01

    To determine the extent and nature of alcohol screening and referral services provided by college health centers, the authors conducted a state-stratified, random sampling of 25% of 327 4-year accredited US colleges and universities with health centers. Of the 249 survey respondents, 32% routinely screened students for alcohol use. Urban, public,…

  18. 42 CFR 493.1242 - Standard: Specimen submission, handling, and referral.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Standard: Specimen submission, handling, and referral. 493.1242 Section 493.1242 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Quality...

  19. Guide for Referral and Case Coordination for Young Children in Hospital Settings.

    ERIC Educational Resources Information Center

    Robinson, Cordelia C.; And Others

    The Early Referral and Follow-up Project of the University of Nebraska Medical Center was designed to facilitate developmental assessment and intervention with long-term or repeatedly hospitalized children from birth to 3 years of age. Developmentally delayed children, handicapped children, and children at risk for delays were eligible for…

  20. Similarities between Students Receiving Dress Code Violations and Discipline Referrals at Newport Junior High School

    ERIC Educational Resources Information Center

    Nicholson, Nikki

    2007-01-01

    Background: Looking at dress code violations and demographics surrounding kids breaking the rules. Purpose: To see if there is a connection between dress code violations and discipline referrals. Setting: Jr. High School; Study Sample: Students with dress code violations for one week; Intervention: N/A; Research Design: Correlational; and Control…

  1. Exploring the Gender Gap in Referrals for Children with ADHD and Other Disruptive Behavior Disorders

    ERIC Educational Resources Information Center

    Coles, Erika K.; Slavec, Janine; Bernstein, Melissa; Baroni, Elizabeth

    2012-01-01

    Objective: The current study examined the impact of the gender of children with ADHD on teachers' perceptions toward inattentive, hyperactive, or oppositional behaviors, and how these perceptions relate to teachers' ratings of children's impairment and referral recommendations. Method: Teachers read eight vignettes depicting boys and girls with…

  2. Helping physicians in distress. Developing a physician assessment and referral service.

    PubMed Central

    Fish, J. S.; Steinert, Y.

    1995-01-01

    In 1987, a Physician Assessment and Referral Service was created in the Department of Family Medicine of a large urban hospital to help physicians and their families. This article describes the rationale, development, accomplishments, and limitations of the service in light of 5 years' experience. Although this program was developed for family physicians in particular, it has value for all medical specialties. PMID:7734998

  3. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Vocational rehabilitation; referrals to other public and private agencies. 702.505 Section 702.505 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED...

  4. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Vocational rehabilitation; referrals to other public and private agencies. 702.505 Section 702.505 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED...

  5. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Vocational rehabilitation; referrals to other public and private agencies. 702.505 Section 702.505 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED...

  6. DOCLINE: A National Automated Interlibrary Loan Request Routing and Referral System.

    ERIC Educational Resources Information Center

    Dutcher, Gale A.

    1989-01-01

    Describes an automated interlibrary loan request routing and referral system made available to U.S. biomedical libraries by the National Library of Medicine. The description covers the databases used and the systems modules that support various functions. The current status of the system and possible future developments are discussed. (six…

  7. Referral criteria for assessment and treatment in an ambulatory dysphagia clinic.

    PubMed

    Lorinczi, Klara; Denheyer, Vanessa; Pickard, Amanda; Lee, Alice; Mager, Diana R

    2012-01-01

    Dysphagia is highly prevalent in patients with chronic neurological disorders and can increase the risk for comorbidities such as aspiration pneumonia and malnutrition. Treatment includes timely access to interdisciplinary health care teams with specialized skills in dysphagia management. A retrospective chart review (n=99 of 125 charts screened) was conducted to evaluate the effectiveness of referral criteria to identify and triage patients with suspected dysphagia to an ambulatory dysphagia clinic. Variables collected included demographic information (age), anthropometric information (body mass index [BMI], each patient's sex), reason for referral, primary medical diagnosis, symptomatology (e.g., pneumonia, chest congestion), nutrition and swallowing interventions, clinic wait times, missed/cancelled appointments, and referring health care professional. The mean age and mean BMI ± standard deviation of patients reviewed were 68.7 years ± 18.4 years and 25.2 kg/m² ± 6.7 kg/m², respectively. Average clinic wait times were 158 days (13 to 368 days) for routine and 52 days (0 to 344 days) for urgent assessments (p<0.001). The most common reason(s) for referral was/were related to dysphagia (n=83), surgery (n=50), and/or gastrointestinal symptomatology (n=28); 80% to 90% of patients received varying diagnostic and treatment services for dysphagia. Development of effective referral criteria is critical to ensure that clients with dysphagia receive timely diagnostic, treatment, and nutrition interventions by interdisciplinary health care teams specializing in dysphagia. PMID:23217446

  8. Referral Trends in Mental Health Services for Adults with Intellectual Disability and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Tsakanikos, Elias; Sturmey, Peter; Costello, Helen; Holt, Geraldine; Bouras, Nick

    2007-01-01

    Researchers have paid increasing attention to mental health issues in adults with autism spectrum disorders (ASDs) over the last decades. However, little is known about how rates of clinical referrals, types of mental health diagnoses and treatment in adults with ASDs and intellectual disability have changed. We examined patterns of change in…

  9. Lay Referral Patterns Involved in Cardiac Treatment Decision Making among Middle-Aged and Older Adults

    ERIC Educational Resources Information Center

    Schoenberg, Nancy E.; Amey, Cheryl H.; Stoller, Eleanor Palo; Muldoon, Susan B.

    2003-01-01

    Purpose: This study examined age and contextually related factors that are influential in lay referral patterns during cardiac treatment decision making. Design and Methods: A complementary design was used. The Myocardial Infarction (MI) Onset Study identified demographic correlates of who sought medical care for 1,388 MI (heart attack) survivors.…

  10. Personalized Learning for the At-Risk through Intervention and Referral Services

    ERIC Educational Resources Information Center

    DePass Pipkin, Tamika S.

    2012-01-01

    The purpose of this mixed-methodology study was to examine whether Personalized Student Learning Plans (PSLPs) could reduce at-risk students' academic and social dysfunction. At-risk students were referred to Intervention & Referral Services (I&RS) and PSLPs were used to develop a personal plan for progress. Data sources included…

  11. [Habermas and Paulo Freire: theoretical referrals for the study on communication in nursing].

    PubMed

    Larocca, Liliana Muller; Mazza, Verônica de Azevedo

    2003-08-01

    The present work has the objective of introducing the ideas of Jürgen Habermas and Paulo Freire about the dialogue as a fundamental human phenomenon, data on their trajectories of life, ideological approaches when locating the human being through history and their relevance as theoretical referrals for the study on communication in the process of the nurse's work. PMID:15058821

  12. Teachers' Academic Appraisals and Referral Decisions: The Effect of Sharing Health Information when Diabetes Is Present

    ERIC Educational Resources Information Center

    Cunningham, Melissa M.; Wodrich, David L.

    2012-01-01

    Two prior studies showed that giving teachers more information about a student's illness led them to make better attributions about that student's classroom problems and better classroom accommodations. In this study, 235 teachers appraised academic competence and judged whether to seek help or make a referral for a hypothetical student with type…

  13. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for self-referral and point of service option. 422.105 Section 422.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits...

  14. Comparing Adolescents' Considerations for Self-Referral and Counsellors' Perceptions of These Considerations: An Exploratory Study.

    ERIC Educational Resources Information Center

    Tatar, Moshe

    2001-01-01

    Investigated considerations of adolescents for self-referral to counselors as reported by high school students and school counselors. Counselor trustworthiness was cited as the most important factor by both groups; but counselors attributed more importance to gender and age, while adolescents emphasized counselor expertness. Discusses strategies…

  15. A Financial Ratio Analysis of For-Profit and Non-Profit Rural Referral Centers

    ERIC Educational Resources Information Center

    McCue, Michael J.; Nayar, Preethy

    2009-01-01

    Context: National financial data show that rural referral center (RRC) hospitals have performed well financially. RRC hospitals' median cash flow margin ratio was 10.04% in 2002 and grew to 11.04% in 2004. Purpose: The aim of this study is to compare the ratio analysis of key operational and financial performance measures of for-profit RRCs to…

  16. Referrals to integrative medicine in a tertiary hospital: findings from electronic health record data and qualitative interviews

    PubMed Central

    Griffin, Kristen H; Rivard, Rachael L; Christianson, Jon B; Dusek, Jeffery A

    2016-01-01

    Objective To examine patterns of, and decision-making processes, informing referrals for inpatient access to integrative medicine (IM) services at a large, acute care hospital. Design Retrospective electronic health record review and structured qualitative interviews. Setting A 630-bed tertiary care hospital with an IM service available to inpatients. Participants IM referrals of all inpatients aged ≥18 years between July 2012 and December 2014 were identified using the hospital's electronic health record. Fifteen physicians, 15 nurses and 7 administrators were interviewed to better understand roles and perspectives in referring patients for IM services. Results In the study hospital, primary sources of referrals for IM services were the orthopaedic and neuroscience/spine service lines. While the largest absolute number of IM referrals was made for patients with lengths of stay of 3 days or fewer, a disproportionate number of total IM referrals was made for patients with long lengths of stay (≥10 days), compared with a smaller percentage of patients in the hospital with lengths of stay ≥10 days. Physicians and nurses were more likely to refer patients who displayed strong symptoms (eg, pain and anxiety) and/or did not respond to conventional therapies. IM referrals were predominantly nurse-initiated. A built-in delay in the time from referral initiation to service delivery discouraged referrals of some patients. Conclusions Conventional providers refer patients for IM services when these services are available in a tertiary hospital. Referral patterns are influenced by patient characteristics, operational features and provider perspectives. Nurses play a key role in the referral process. Overcoming cultural and knowledge differences between conventional and IM providers is likely to be a continuing challenge to providing IM in inpatient settings. PMID:27456330

  17. An Examination of Referrals to the School Counselor by Race, Gender, and Family Structure

    ERIC Educational Resources Information Center

    Adams, Jennifer R.; Benshoff, James M.; Harrington, Sonja Y.

    2007-01-01

    This article reports on a study addressing student referral differences based on family structure, gender, and race in teacher-initiated contact to school counselors. Researchers used secondary data from the National Education Longitudinal Study. They used logit log linear analyses in this data analysis. Significant differences existed for all…

  18. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services.... Portable X-ray examinations are performed only on the order of a physician licensed to practice in...

  19. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services.... Portable X-ray examinations are performed only on the order of a physician licensed to practice in...

  20. Development and Validation of a Process for Screening Referrals to Special Education

    ERIC Educational Resources Information Center

    VanDerHeyden, Amanda M.; Witt, Joseph C.; Naquin, Gale

    2003-01-01

    This article describes efforts to examine the validity of a screening process that provides objective data for multidisciplinary team meetings where consideration is being given to teacher referral of a student for assessment and possible placement in special education. In this study, the accuracy with which this process, called Problem Validation…

  1. Early Identification of Behavioral and Emotional Problems in Youth: Universal Screening versus Teacher-Referral Identification

    ERIC Educational Resources Information Center

    Eklund, Katie; Renshaw, Tyler L.; Dowdy, Erin; Jimerson, Shane R.; Hart, Shelley R.; Jones, Camille N.; Earhart, James

    2009-01-01

    Universal screening is one strategy to enhance the early identification of behavioral and emotional problems among youth. Although it appears to be effective, it is unclear if universal screening is more or less effective than current teacher referral practices. Thus, the purpose of this study was to compare the effectiveness of a teacher-rated,…

  2. Patterns of Child Maltreatment Referrals among Asian and Pacific Islander Families

    ERIC Educational Resources Information Center

    Pelczarski, Yoshimi; Kemp, Susan P.

    2006-01-01

    Much of the available data on Asian American families who become involved with the child welfare system relies on global ethnic categories, such as the category Asian/Pacific Islander. To explore the diversity of experience that is hidden by such categories, this article analyzes two years of child maltreatment referrals for Asian and Pacific…

  3. Refer2Quit: Impact of Web-Based Skills Training on Tobacco Interventions and Quitline Referrals

    ERIC Educational Resources Information Center

    Carpenter, Kelly M.; Carlini, Beatriz H.; Painter, Ian; Mikko, A. Tasha; Stoner, Susan A.

    2012-01-01

    Introduction: Tobacco quitlines (QLs) provide effective evidence-based tobacco cessation counseling, yet they remain underutilized. Barriers to utilization include the lack of referrals by health care providers who typically have little knowledge about QLs and low self-efficacy for providing tobacco interventions. In order to educate providers…

  4. Small-Group Standardized Patient Encounter Improves Athletic Training Students' Psychosocial Intervention and Referral Skills

    ERIC Educational Resources Information Center

    Walker, Stacy E.; Weidner, Thomas G.; Thrasher, Ashley B.

    2016-01-01

    Context: Athletic trainers provide psychological support, counseling, intervention, and referral to patients during clinical practice. However, students are rarely exposed to real-life opportunities to develop these skills. Objective: To determine if a small-group standardized patient (SP) encounter improved athletic training students'…

  5. Referral Patterns, Diagnosis, and Disease Management of Patients With Axial Spondyloarthritis

    PubMed Central

    van der Heijde, Désirée; Sieper, Joachim; Elewaut, Dirk; Deodhar, Atul; Pangan, Aileen L.; Dorr, Alexander P.

    2014-01-01

    Background Recognition, diagnosis, and management of axial spondyloarthritis (axial SpA) continue to advance. Objectives The objectives of this study were to compare referrals, diagnosis, and management of axial SpA in Western Europe (WE), North America (US and Canada), and the rest of world (RoW) in academic and community rheumatology practices and to identify areas for further education. Methods Rheumatologists responded online to the MAXIMA (Management of Axial SpA International and Multicentric Approaches) survey. Questions pertained to referral, diagnosis, and management of axial SpA. Results Rheumatologists (N = 809) from 56 countries completed the survey about patients with chronic back pain (≥3 months) starting before age 45 years. Responses from academic and community practice rheumatologists were generally similar. Most referrals were from primary care providers. Symptom duration of 3 years or more at referral was reported more frequently by WE and RoW than US respondents. More WE and RoW than US rheumatologists referred to the Assessment of SpondyloArthritis International Society criteria for axial SpA in clinical practice. Rheumatologists reported prescribing disease-modifying antirheumatic drugs for the management of axial SpA. Sulfasalazine was frequently prescribed across regions; methotrexate was more commonly prescribed by US rheumatologists compared with other regions. Conclusions Referral patterns, diagnosis, and disease management for axial SpA were similar among WE, North America, and RoW rheumatologists and in academic/community practices, although more WE and RoW rheumatologists referred to Assessment of SpondyloArthritis International Society criteria in clinical practice. Disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients, although it was unclear whether these were prescribed for axial or peripheral symptoms. PMID:25417676

  6. 1998 Buyer's Guide and Consultants Directory. A Decade of Changes.

    ERIC Educational Resources Information Center

    Brandt, D. Scott, Comp.

    1998-01-01

    This annual compilation is designed as a resource for access to products (hardware and software) and services related to library automation and information storage. Sections include products and services by category, vendor, and brand name, as well as addresses (including phone/fax, e-mail, and URL for web pages) of companies and consultants. (AEF)

  7. Failure of dietetic referral in patients with gastrointestinal cancer and weight loss.

    PubMed

    Baldwin, C; McGough, C; Norman, A R; Frost, G S; Cunningham, D C; Andreyev, H J N

    2006-10-01

    This study examined whether staff working within a cancer centre treating patients with gastrointestinal malignancy routinely identified individuals from outpatients for referral to a dietitian. A nutrition screening tool is employed only for in-patient admissions. Height, current and usual weight were recorded prospectively in all patients referred for consideration of treatment. First appointment with the dietitian, first hospital admission, demographic and clinical details were obtained from hospital records. Time from first appointment to referral to a dietitian was examined. Between September 2002 and March 2004, 920 patients were included. Five hundred and seventeen patients had lost weight, of whom 223 patients had lost between 5% and 10% and 294 patients had lost more than 10% of their pre-morbid weight. Three hundred and twenty-seven patients (36%) were referred to dietitians. Twenty eight (9%) of referrals were made by staff in outpatients. Two hundred and ninety-nine were referred during or after an inpatient admission but only 39% of these occurred within the first seven days following admission. One third of patients with more than 10% weight loss were not referred for dietary assessment, even following admission. The likelihood of referral was significantly associated with the degree of weight loss (univariate analysis hazard ratio (HR) 1.75, 95% Confidence Interval (CI) 1.4-2.19, multivariate HR 1.65, 95% CI 1.22-2.23) and was independent of factors such as performance status and clinical setting. Few patients were identified early in their treatment for referral to a dietitian. Since most chemotherapy is now given on an outpatient basis, patients are unlikely to be referred if they do not require admission. This study suggests that an out-patient dietetic screening tool is urgently required. Such screening is likely to result in considerable improvements to the clinical care of cancer patients with weight loss. PMID:16930990

  8. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Consultation and comment period. 903.14 Section 903.14 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and Western Area...

  9. 24 CFR 971.9 - Tenant and local government consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Tenant and local government consultation. 971.9 Section 971.9 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING...

  10. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Consulting and advisory services. 200.103 Section 200.103 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE MEASUREMENT SERVICES...

  11. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Environmental Policy Act (NEPA) (40 CFR 1501.8), including but not limited to, the nature and size of the...-Federal sponsors shall consult with and seek advice from the Miccosukee Tribe of Indians of Florida and the Seminole Tribe of Florida throughout the implementation process to ensure meaningful and...

  12. Interactive Teaming: Consultation and Collaboration in Special Programs. Second Edition.

    ERIC Educational Resources Information Center

    Thomas, Carol Chase; And Others

    This book on the educaiton of students with disabilities is organized around an interactive teaming model based on the concepts of consultation and collaboration, and includes key elements of total quality efforts, child and adult learning theories, and recognition of the importance of sensitivity to cultural differences. Part 1 provides a…

  13. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... proposed metropolitan transportation plan and the TIP; (ii) Providing timely notice and reasonable access... metropolitan transportation plan and the TIP; (vii) Seeking out and considering the needs of...

  14. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... proposed metropolitan transportation plan and the TIP; (ii) Providing timely notice and reasonable access... metropolitan transportation plan and the TIP; (vii) Seeking out and considering the needs of...

  15. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... proposed metropolitan transportation plan and the TIP; (ii) Providing timely notice and reasonable access... metropolitan transportation plan and the TIP; (vii) Seeking out and considering the needs of...

  16. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Coordination and consultation. 98.12 Section 98.12 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  17. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.12 Coordination and consultation. The Lead Agency shall: (a... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  18. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.12 Coordination and consultation. The Lead Agency shall: (a... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  19. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.12 Coordination and consultation. The Lead Agency shall: (a... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  20. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.12 Coordination and consultation. The Lead Agency shall: (a... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  1. Business analysis in occupational health and safety consultations.

    PubMed

    Snyder, T B; Himmelstein, J; Pransky, G; Beavers, J D

    1991-10-01

    We present a method for incorporating business analysis into comprehensive health and safety consultations using as an example a plant with an elevated incidence of cumulative trauma disorders. Business information, including product and management history, short- and long-term corporate goals, functional analysis, profit history, organizational structure with respect to health and safety, and personnel and labor-management relationships are evaluated simultaneously with traditional ergonomic factors. The additional business data allow consultants to identify the full scope of etiologies and make practical, credible recommendations that are more likely to be adopted by management and labor. We propose that techniques of "business analysis" be routinely incorporated into occupational health and safety consultations. However, because collection and interpretation of these data require business skills outside the occupational safety and health expert's usual repertoire, the consulting team must include participants with business expertise. We have found that occupational health medical personnel with an understanding of business analysis concepts can be very effective advocates for changes in health and safety practices. We strongly recommend incorporating methods of business analysis into the occupational health and safety curriculum. PMID:1753300

  2. 40 CFR 25.4 - Information, notification, and consultation responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Information, notification, and consultation responsibilities. 25.4 Section 25.4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PUBLIC PARTICIPATION IN PROGRAMS UNDER THE RESOURCE CONSERVATION AND RECOVERY ACT, THE SAFE DRINKING WATER ACT, AND THE CLEAN WATER ACT §...

  3. Public consultation. Up and ATAM (aims, timing, audience, method).

    PubMed

    Khan, U

    1998-04-30

    Although the NHS has some shining examples of public and user involvement, many still view it as an optional extra. Policy makers need to adopt a broader strategy for involving users, carers, staff and the wider public. Badly done public consultation will cause problems for policy makers, alienate participants and fuel public cynicism. PMID:10180417

  4. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... RESTORATION PLAN Program Goals and Responsibilities § 385.10 Implementation responsibilities, consultation... Environmental Policy Act (NEPA) (40 CFR 1501.8), including but not limited to, the nature and size of the... implementation of the Plan, to the restoration of the natural system, to the other goals and purposes of the...

  5. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... RESTORATION PLAN Program Goals and Responsibilities § 385.10 Implementation responsibilities, consultation... Environmental Policy Act (NEPA) (40 CFR 1501.8), including but not limited to, the nature and size of the... implementation of the Plan, to the restoration of the natural system, to the other goals and purposes of the...

  6. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... RESTORATION PLAN Program Goals and Responsibilities § 385.10 Implementation responsibilities, consultation... Environmental Policy Act (NEPA) (40 CFR 1501.8), including but not limited to, the nature and size of the... implementation of the Plan, to the restoration of the natural system, to the other goals and purposes of the...

  7. Early Childhood Mental Health Consultation: Common Questions and Answers

    ERIC Educational Resources Information Center

    Hughes, Mary-alayne; Spence, Christine M.; Ostrosky, Michaelene M.

    2015-01-01

    As the field of early childhood mental health continues to expand and evolve, the evidence base is growing, and early childhood mental health consultation is viewed as a promising practice. However, there continues to be a need for further research, with particular attention given to the utility and effectiveness of this approach with infants and…

  8. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 400.57 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish...

  9. 40 CFR 25.4 - Information, notification, and consultation responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Information, notification, and consultation responsibilities. 25.4 Section 25.4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PUBLIC PARTICIPATION IN PROGRAMS UNDER THE RESOURCE CONSERVATION AND RECOVERY ACT, THE SAFE DRINKING WATER ACT, AND THE CLEAN WATER ACT §...

  10. 40 CFR 25.4 - Information, notification, and consultation responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Information, notification, and consultation responsibilities. 25.4 Section 25.4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PUBLIC PARTICIPATION IN PROGRAMS UNDER THE RESOURCE CONSERVATION AND RECOVERY ACT, THE SAFE DRINKING WATER ACT, AND THE CLEAN WATER ACT §...

  11. Consultation and Collaboration: Novice Educators' Reflections on Their Learning Experiences

    ERIC Educational Resources Information Center

    Robertson, Eleanor T.; Breidenstein, Angela

    2007-01-01

    This article describes a project to teach consultation and collaboration to high school teacher interns and school psychology students at the university level. For 4 years, students participated in a performance-based project as part of a class. Surveys were mailed to graduates to determine the impact of the experience and their current…

  12. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Environmental review and...

  13. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Environmental review and...

  14. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Environmental review and...

  15. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Environmental review and...

  16. The referral practice of general medical practitioners to the surgical specialties: implications for the future.

    PubMed

    McArdle, P J; Whitnall, M

    1996-10-01

    With increasing numbers of general medical practitioners (GMPs) becoming purchasers of health care, providers of surgical services need to understand factors influencing GMP referrals. Using an anonymous postal questionnaire, criteria used by 400 randomly selected general medical practitioners to make referral decisions were assessed. Issues regarding the importance of waiting lists, cost, distance and communication were assessed, along with previous training and fundholding status. The findings of this study reveal that waiting list times for consultation and treatment, along with communication, are the most important criteria influencing referral. Cost, travel and literature from each specialty were the least important factors. General medical practitioners are shown, in the majority, to remain unaware of the range of conditions managed by oral and maxillofacial surgeons. A series of strategies are outlined, which might be used to broaden the referral base for maxillofacial surgery. The need for active education of practitioners is emphasised and the possible effects of regionalisation of the service is discussed. PMID:8909729

  17. Networking: A Key to Career Communication and Management Consulting Success

    ERIC Educational Resources Information Center

    Clark, Thomas

    2009-01-01

    Now that job security with one organization is a relic of the past and companies are outsourcing training and other "nonessential" functions, the author suggests in his career communication classes that students develop the same inventive strategies to plan their employment futures that management consultants use to market themselves in the 21st…

  18. School Evaluation and Consultancy in Italy. Sliding Doors towards Privatisation?

    ERIC Educational Resources Information Center

    Serpieri, Roberto; Grimaldi, Emiliano; Vatrella, Sandra

    2015-01-01

    This article focuses on the increasing centrality assumed by non-educational consultants in the processes of policy design and knowledge production about education in Italy. We identify the recent establishment of the National School Evaluation System as a key policy trajectory and we focus on the case of the last policies to evaluate Italian…

  19. NATIONAL 304(A) AQUATIC LIFE CRITERIA CONSULTATIONS METHODOLOGY AND PROTOTYPE

    EPA Science Inventory

    When consulting with the Services under Section of the Endangered Species Act (ESA), federal agencies are to prepare a biological evaluation which evaluates the potential effects of its action on listed species and critical habitat, and determine whether such species or habitat ...

  20. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... consultation requirements. See 40 CFR 1502.25. (a) For Federal projects, NEPA documents shall be prepared..., 1979, 32 CFR part 197. Procedural requirements for Civil Works studies and projects are discussed below... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Environmental review...

  1. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming § 450.316... services within the area that are provided by: (1) Recipients of assistance under title 49 U.S.C....

  2. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming § 450.316... services within the area that are provided by: (1) Recipients of assistance under title 49 U.S.C....

  3. Internship and Consulting Engagements: Management of the University's Liability.

    ERIC Educational Resources Information Center

    Peak, Daniel A.; O'Hara, Michael J.

    1999-01-01

    Examines liability incurred by university-sponsored information technology internships and consulting relationships with the business community. In these outreach engagements, the university takes the role of primary insurer for the business client and provides an indemnity shield for the university's representatives. As the number of engagements…

  4. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... study potential impacts. Depending on expected extent and severity of impacts, or if entry is deemed... consultation requirements. See 40 CFR 1502.25. (a) For Federal projects, NEPA documents shall be prepared..., 1979, 32 CFR part 197. Procedural requirements for Civil Works studies and projects are discussed...

  5. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... study potential impacts. Depending on expected extent and severity of impacts, or if entry is deemed... consultation requirements. See 40 CFR 1502.25. (a) For Federal projects, NEPA documents shall be prepared..., 1979, 32 CFR part 197. Procedural requirements for Civil Works studies and projects are discussed...

  6. Communication during haematological consultations; patients' preferences and professionals' performances.

    PubMed

    van Bruinessen, Inge R; van der Hout, Lotte E; van Weel-Baumgarten, Evelyn M; Gouw, Hans; Zijlstra, Josée M; van Dulmen, Sandra

    2016-06-01

    Many patients with haematological malignancies experience barriers in clinical communication. Reaching effective communication is of great importance as it has been linked to a range of improved patient outcomes such as satisfaction, compliance to treatment, perceived quality of life and physical and mental health. To get a better understanding how communication in haematological consultations can be improved, the current study focussed on patients' preferences and perceived performances regarding the communicative behaviour of their health care professional. Secondly, the mediation of an online communication tool for patients was analysed. Within a controlled pre- post-test design, 78 datasets of clinical consultations could be analysed. Patients considered both affective and instrumental communication aspects important. The affective communication behaviour of the health care professional met the patients' pre-visit preferences well. In the information exchange, more variability and discrepancies were found. Overall, the online intervention did not seem to influence the patients' perceived communication performance of their health care professional much. To further improve the communication during clinical consultations, health care professionals should inquire about patients' expectations, especially during the exchange of information and advices. At the same time, patients should be supported to express their preferences at the start of the consultation. The study was registered in the Netherlands Trial Register, number 3779. PMID:27091348

  7. Expertise, Ethics Expertise, and Clinical Ethics Consultation: Achieving Terminological Clarity.

    PubMed

    Iltis, Ana S; Sheehan, Mark

    2016-08-01

    The language of ethics expertise has become particularly important in bioethics in light of efforts to establish the value of the clinical ethics consultation (CEC), to specify who is qualified to function as a clinical ethics consultant, and to characterize how one should evaluate whether or not a person is so qualified. Supporters and skeptics about the possibility of ethics expertise use the language of ethics expertise in ways that reflect competing views about what ethics expertise entails. We argue for clarity in understanding the nature of expertise and ethics expertise. To be an ethics expert, we argue, is to be an expert in knowing what ought to be done. Any attempt to articulate expertise with respect to knowing what ought to be done must include an account of ethics that specifies the nature of moral truth and the means by which we access this truth or a theoretical account of ethics such that expertise in another domain is linked to knowing or being better at judging what ought to be done and the standards by which this "knowing" or "being better at judging" is determined. We conclude with a discussion of the implications of our analysis for the literature on ethics expertise in CEC. We do think that there are clear domains in which a clinical ethics consultant might be expert but we are skeptical about the possibility that this includes ethics expertise. Clinical ethics consultants should not be referred to as ethics experts. PMID:27256848

  8. Treatment Integrity in Behavioral Consultation: Measurement, Promotion, and Outcomes

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Kratochwill, Thomas R.

    2008-01-01

    The purpose of this article is to provide an overview of the current state of research in the area of treatment integrity as it relates to behavioral consultation. To this end, four primary topics are discussed. First, a rationale for why treatment integrity is an important professional and methodological concern is presented. Second,…

  9. School Psychologists' Attributions for Success and Failure in Consultation.

    ERIC Educational Resources Information Center

    Smith, Douglas K.; Lyon, Mark A.

    Many surveys of school psychologists have documented their desire to devote more time to consultation--an indirect service delivery system in which the school psychologist interacts with a consultee (teacher, parent, other professional) for purposes of solving a client problem. To expand the work of Martin and Curtis (1981) on school…

  10. Independent Consulting and the American Evaluation Association: Twenty Years Later

    ERIC Educational Resources Information Center

    Bonnet, Deborah G.

    2006-01-01

    This article reviews the evolution of American Evaluation Association's (AEA) Independent Consulting Topical Interest Group (IC TIG). The TIG goes back a joint meeting held in San Francisco in 1984 of the Evaluation Network (ENet) and the Evaluation Research Society (ERS), two years before the organizations merged to become the AEA. On the fringes…

  11. Cops, Consultants, and Goldfish: Variations in Nursing Home Regulation.

    ERIC Educational Resources Information Center

    Gardiner, John A.

    Nursing home regulatory agencies are subjected to a variety of pressures. Nursing home residents' families and friends want the agencies to "get tough" while the nursing home industry wants agencies to act as consultants rather than cops. The task of regulating nursing homes in the United States is primarily carried out by units of state…

  12. Evolving Perspectives: Consultation, School Psychology, and the Clinical Setting.

    ERIC Educational Resources Information Center

    Keane, Barbara R.; And Others

    A training program was implemented to provide consultation services in a residential treatment center for emotionally disturbed individuals. Prior to the program's implementation, clinicians were discouraged and frustrated because staff needs could not adequately be met. Psychological services to 36 severely disturbed females, ages 12 to 22, were…

  13. Corpus Consultation and Advanced Learners' Writing Skills in French

    ERIC Educational Resources Information Center

    Chambers, Angela; O'Sullivan, Ide

    2004-01-01

    In the rapidly changing environment of language learning and teaching, electronic literacies have an increasingly important role to play. While much research on new literacies focuses on the World Wide Web, the aim in this study is to investigate the importance of corpus consultation as a new type of literacy which is of particular relevance in…

  14. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  15. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  16. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  17. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  18. Students' Psychological Web Consulting: Function and Outcome Evaluation

    ERIC Educational Resources Information Center

    Efstathiou, G.

    2009-01-01

    This paper refers to a brief interaction with a mental health professional via written electronic communication. Web consulting services have proved popular, but there is controversy regarding the efficacy of such brief interventions to address problems and enable service users to access other forms of counseling. University students are…

  19. Remote video management for intraoperative consultation and surgical telepresence.

    PubMed

    Boanca, Cosmin; Rafiq, Azhar; Tamariz, Francisco; Lavrentyev, Vladimir; Onisor, Daniel; Flerov, Evgeniy; Popescu, Irinel; Merrell, Ronald C

    2007-10-01

    Telemedicine applications can connect surgeons from one operating room (OR) to a distant consultant. The additional capacity of telepresence provides remote consultants the ability to control their own view of the surgical field using robotic management of a network camera. The goal of this study was to compare access to surgical field by robotic camera versus image controlled by the surgeon using a camera mounted to the table. A Stryker laparoscopic camera was attached to the OR table using a Mediflex arm, and video image was transmitted with a Polycom Transfer Control Protocol (TCP)/Internet Protocol (IP) connection. A network Sony camera was mounted on a tripod, connected over the Internet using a parallel TCP/IP connection. A Web interface allowed control of the camera angle and zoom. In 22 consultations effective bandwidth was 800 Kbps for the network camera and 1024 Kbps for the Stryker camera. The operation was thyroidectomy and the consultant was either in Moscow, Russia, or Bucharest, Romania. The quality of the image in both methods was indiscernible. The ability to identify critical surgical anatomy was also indiscernible. No transmission session failed or had an interruption. The robotic camera can be a powerful tool for surgical collaboration. PMID:17999622

  20. 5 CFR 900.709 - Notice and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Notice and consultation. 900.709 Section 900.709 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) INTERGOVERNMENTAL PERSONNEL ACT PROGRAMS Nondiscrimination on the Basis of Handicap in Federally Assisted Programs of the Office...

  1. CAHRD Consultation 2014: the 10-20 year Horizon Introduction and Overview – as circulated to Consultation participants

    PubMed Central

    2015-01-01

    The overall aim of the 2014 Consultation is to bring together internal and external partners to help shape the strategic direction for CAHRD over the 10 to 20 year horizon. Our strategic thinking will be guided by our vision of a healthy future for low and middle income populations and our mission to transform health systems to improve the health of these populations. Partnership between northern and southern institutions is integral to this work and critical in the consultation process. The Consultation considers four selected areas of the current work of CAHRD: Lung Health, Maternal & Newborn Health, Neglected Tropical Diseases, and Health Systems. We aim to foster dialogue and learning between these and across contexts and disciplines. The major challenges that will need to be addressed over the next 10 to 20 years will be scoped and pathways to possible solutions proposed. The overall vision is a process of co-production of knowledge

  2. Research ethics consultation: ethical and professional practice challenges and recommendations.

    PubMed

    Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

    2015-05-01

    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

  3. Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

    PubMed Central

    Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

    2015-01-01

    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

  4. 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

  5. Prospectively Collected Characteristics of Adult Patients, Their Consultations and Outcomes as They Report Breathlessness When Presenting to General Practice in Australia

    PubMed Central

    Currow, David C.; Clark, Katherine; Mitchell, Geoffrey K.; Johnson, Miriam J.; Abernethy, Amy P.

    2013-01-01

    Introduction Breathlessness is a subjective sensation, so understanding its impacts requires patients’ reports, including prospective patient-defined breathlessness as a reason for presenting to general practitioners (GP).The aim of this study was to define the prevalence of breathlessness as a reason for GP consultations while defining the clinico-demographic factors of these patients and the characteristics and outcomes of those consultations. Methods Using nine years of the Family Medicine Research Centre database of 100 consecutive encounters from 1,000 practices annually, the patient-defined reason for encounter ‘breathlessness’ was explored using prospectively collected data in people ≥18 years with clinical data coded using the International Classification for Primary Care V2. Dichotomous variables were analysed using chi square and 95% confidence intervals calculated using Kish’s formula for a single stage clustered design. Results Of all the 755,729 consultations collected over a nine year period from 1 April, 2000, 7255 included breathlessness as a reason for encounter (0.96%; 95% CI 0.93 to 0.99) most frequently attributed to chronic obstructive pulmonary disease. Only 48.3% of GPs saw someone reporting breathlessness. The proportion of consultations with breathlessness increased with age. Breathlessness trebled the likelihood that the consultation occurred in the community rather than the consulting room (p<0.0001) and increased 2.5 fold the likelihood of urgent referral to hospital (p<0.0001). Of those with breathlessness, 12% had undiagnosed breathlessness at the end of the consultation (873/7255) with higher likelihood of being younger females. Discussion Breathlessness is a prevalent symptom in general practitioner. Such prevalence enables future research focused on understanding the temporal pattern of breathlessness and the longitudinal care offered to, and outcomes for these patients, including those who leave the consultation without a

  6. Developmental Structural Tooth Defects in Dogs - Experience From Veterinary Dental Referral Practice and Review of the Literature.

    PubMed

    Boy, Sonja; Crossley, David; Steenkamp, Gerhard

    2016-01-01

    Developmental tooth abnormalities in dogs are uncommon in general veterinary practice but understanding thereof is important for optimal management in order to maintain masticatory function through preservation of the dentition. The purpose of this review is to discuss clinical abnormalities of the enamel and general anatomy of dog teeth encountered in veterinary dental referral practice and described in the literature. More than 900 referral cases are seen annually between the two referral practices. The basis of the pathogenesis, resultant clinical appearance, and the principles of management for each anomaly will be described. Future research should be aimed toward a more detailed analysis of these conditions so rarely described in the literature. PMID:26904551

  7. Developmental Structural Tooth Defects in Dogs – Experience From Veterinary Dental Referral Practice and Review of the Literature

    PubMed Central

    Boy, Sonja; Crossley, David; Steenkamp, Gerhard

    2016-01-01

    Developmental tooth abnormalities in dogs are uncommon in general veterinary practice but understanding thereof is important for optimal management in order to maintain masticatory function through preservation of the dentition. The purpose of this review is to discuss clinical abnormalities of the enamel and general anatomy of dog teeth encountered in veterinary dental referral practice and described in the literature. More than 900 referral cases are seen annually between the two referral practices. The basis of the pathogenesis, resultant clinical appearance, and the principles of management for each anomaly will be described. Future research should be aimed toward a more detailed analysis of these conditions so rarely described in the literature. PMID:26904551

  8. Building access to specialist care through e-consultation

    PubMed Central

    Liddy, Clare; Rowan, Margo S; Afkham, Amir; Maranger, Julie; Keely, Erin

    2013-01-01

    Background Limited access to specialist care remains a major barrier to health care in Canada, affecting patients and primary care providers alike, in terms of both long wait times and inequitable availability. We developed an electronic consultation system, based on a secure web-based tool, as an alternative to face-to-face consultations, and ran a pilot study to evaluate its effectiveness and acceptability to practitioners. Methods In a pilot program conducted over 15 months starting in January 2010, the e-consultation system was tested with primary care providers and specialists in a large health region in Eastern Ontario, Canada. We collected utilization data from the electronic system itself (including quantitative data from satisfaction surveys) and qualitative information from focus groups and interviews with providers. Results Of 18 primary care providers in the pilot program, 13 participated in focus groups and 9 were interviewed; in addition, 10 of the 11 specialists in the program were interviewed. Results of our evaluation showed good uptake, high levels of satisfaction, improvement in the integration of referrals and consultations, and avoidance of unnecessary specialist visits. A total of 77 e-consultation requests were processed from 1 Jan. 2010 to 1 Apr. 2011. Less than 10% of the referrals required face-to-face follow-up. The most frequently noted benefits for patients (as perceived by providers) included improved access to specialist care and reduced wait times. Primary care providers valued the ability to assist with patient assessment and management by having access to a rapid response to clinical questions, clarifying the need for diagnostic tests or treatments, and confirming the need for a formal consultation. Specialists enjoyed the improved interaction with primary care providers, as well as having some control in the decision on which patients should be referred. Interpretation This low-cost referral system has potential for broader

  9. Faculty Consulting in Natural Sciences and Engineering: Between Formal and Informal Knowledge Transfer

    ERIC Educational Resources Information Center

    Amara, Nabil; Landry, Rejean; Halilem, Norrin

    2013-01-01

    Academic consulting is a form of knowledge and technology transfer largely under-documented and under-studied that raises ethical and resources allocation issues. Based on a survey of 2,590 Canadian researchers in engineering and natural sciences, this paper explores three forms of academic consulting: (1) paid consulting; (2) unpaid consulting…

  10. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... associates and consultants (Architect-engineer services). 52.244-4 Section 52.244-4 Federal Acquisition... consultants (Architect-engineer services). As prescribed in 44.204(b), insert the following clause: Subcontractors and Outside Associates and Consultants (Architect-Engineer Services) (AUG 1998) Any...

  11. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... associates and consultants (Architect-engineer services). 52.244-4 Section 52.244-4 Federal Acquisition... consultants (Architect-engineer services). As prescribed in 44.204(b), insert the following clause: Subcontractors and Outside Associates and Consultants (Architect-Engineer Services) (AUG 1998) Any...

  12. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... associates and consultants (Architect-engineer services). 52.244-4 Section 52.244-4 Federal Acquisition... consultants (Architect-engineer services). As prescribed in 44.204(b), insert the following clause: Subcontractors and Outside Associates and Consultants (Architect-Engineer Services) (AUG 1998) Any...

  13. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... associates and consultants (Architect-engineer services). 52.244-4 Section 52.244-4 Federal Acquisition... consultants (Architect-engineer services). As prescribed in 44.204(b), insert the following clause: Subcontractors and Outside Associates and Consultants (Architect-Engineer Services) (AUG 1998) Any...

  14. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... associates and consultants (Architect-engineer services). 52.244-4 Section 52.244-4 Federal Acquisition... consultants (Architect-engineer services). As prescribed in 44.204(b), insert the following clause: Subcontractors and Outside Associates and Consultants (Architect-Engineer Services) (AUG 1998) Any...

  15. Clinical Document Architecture integration system to support patient referral and reply letters.

    PubMed

    Lee, Sung-Hyun; Song, Joon Hyun; Kim, Il Kon; Kim, Jeong-Whun

    2016-06-01

    Many Clinical Document Architecture (CDA) referrals and reply documents have been accumulated for patients since the deployment of the Health Information Exchange System (HIES) in Korea. Clinical data were scattered in many CDA documents and this took too much time for physicians to read. Physicians in Korea spend only limited time per patient as insurances in Korea follow a fee-for-service model. Therefore, physicians were not allowed sufficient time for making medical decisions, and follow-up care service was hindered. To address this, we developed CDA Integration Template (CIT) and CDA Integration System (CIS) for the HIES. The clinical items included in CIT were defined reflecting the Korean Standard for CDA Referral and Reply Letters and requests by physicians. CIS integrates CDA documents of a specified patient into a single CDA document following the format of CIT. Finally, physicians were surveyed after CIT/CIS adoption, and they indicated overall satisfaction. PMID:24963075

  16. The consultant nurse - expert practitioner and much more.

    PubMed

    Mitchell, Theresa; Butler-Williams, Carole; Easton, Karen; Ingledew, Ian; Parkin, Donna; Wade, Sharon; Warner, Richard

    The consultant nurse (CN) role is usually described in terms of four domains devised by the Department of Health - clinical practice, education and training, leadership, and research and service development. This study set out to explicate the diversity and complexity of CN roles in an NHS trust; to describe aspects of extraordinary practice and to identify perceived differences between this role and other advanced practice roles. Accounts were written by six CNs and subjected to concept mapping to facilitate identification of extraordinary practice. Four themes emerged: entrepreneurial activity and innovation; clinical autonomy and role dynamism; influential national and international research conduct; consultancy and education across discipline boundaries. These included descriptions of higher order skills that surpass usual requirements of 'expert' or 'advanced' practice. Comparisons with other advanced practice roles are drawn from the literature and data collected in this study. Differences between the roles have implications for sustainability. PMID:20505613

  17. The Effectiveness of “Two-Week” Referrals for Suspected Bone and Soft Tissue Sarcoma

    PubMed Central

    Malik, A.; Wigney, L.; Murray, S.; Gerrand, C. H.

    2007-01-01

    The two-week “wait” target introduced in 2000 requires that patients with suspected cancer referred by general practitioners should be seen within two weeks. We reviewed patients who had been referred under this standard to the North of England Bone and Soft Tissue Tumour Service, to determine if the referral guidelines had been followed, and what proportion of patients referred under the guideline had malignant tumours. 40 patients were referred under the guideline between January 2004 and December 2005. Ten of these patients (2548%) had malignant tumours, compared with 243 of 507 (48%) of those referred from other sources. In 9 of the 40 cases, the patient did not meet the criteria for urgent referral. Although this target has focussed attention on shortening the time to diagnosis and treatment, prioritising patients referred from general practitioners has the potential to disadvantage those with malignant tumours referred from other sources. PMID:18288262

  18. Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong.

    PubMed

    Chung, Vincent C H; Hillier, Sheila; Lau, Chun Hong; Wong, Samuel Y S; Yeoh, Eng Kiong; Griffiths, Sian M

    2011-01-01

    Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster

  19. Use of Uncertainty Reduction and Narrative Paradigm Theories in Management Consulting and Teaching: Lessons Learned

    ERIC Educational Resources Information Center

    Barker, Randolph T.; Gower, Kim

    2009-01-01

    Teaching business communication while performing professional business consulting is the perfect learning match. The bizarre but true stories from the consulting world provide excellent analogies for classroom learning, and feedback from students about the consulting experiences reaffirms the power of using stories for teaching. When discussing…

  20. Community Care Workers, Poor Referral Networks and Consumption of Personal Resources in Rural South Africa

    PubMed Central

    Sips, Ilona; Haeri Mazanderani, Ahmad; Schneider, Helen; Greeff, Minrie; Barten, Francoise; Moshabela, Mosa

    2014-01-01

    Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data – CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers. PMID:24781696

  1. Community care workers, poor referral networks and consumption of personal resources in rural South Africa.

    PubMed

    Sips, Ilona; Haeri Mazanderani, Ahmad; Schneider, Helen; Greeff, Minrie; Barten, Francoise; Moshabela, Mosa

    2014-01-01

    Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data - CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers. PMID:24781696

  2. Improving Quality of Care for Hospitalized Smokers with HIV: Tobacco Dependence Treatment Referral and Utilization

    PubMed Central

    Fitzgerald, Sharon A.; Richter, Kimber P.; Mussulman, Laura; Howser, Eric; Nahvi, Shadi; Goggin, Kathy; Cooperman, Nina A.; Faseru, Babalola

    2016-01-01

    Article-at-a-Glance Background Most persons living with HIV smoke cigarettes and tend to be highly dependent, heavy smokers. Few such persons receive tobacco treatment, and many die from tobacco-related illness. Although advancements in antiretroviral therapy (ART) have increased the quality and quantity of life, the health harms from tobacco use diminish these gains. Without cessation assistance, thousands will benefit from costly ART, only to suffer the consequences of tobacco-related disease and death. A study was conducted to examine in detail inpatient tobacco treatment for smokers with HIV. Methods Data collected at hospital admission and data collected by tobacco treatment specialists were examined retrospectively for all inpatients with HIV who were admitted to an academic medical center for a five-year period. Specifically, the prevalence of cigarette smoking, factors predictive of referral to tobacco treatment, referral for tobacco treatment, treatment participation, and abstinence at six months post-treatment were measured. Differences in referral and treatment participation between all smokers and smokers with HIV were also assessed. Results Among the 422 admitted persons with HIV, 54.5% smoked and 21.7% were referred to inpatient tobacco treatment services. Substance abuse and tobacco-related diagnoses were predictive of referral to inpatient tobacco treatment specialists. Among the 14 treatment participants reached for follow-up, 11 (78.6%) made quit attempts and 3 (21.4%) reported abstinence. Smokers with HIV were less likely to be referred to and treated by tobacco treatment services than all smokers admitted during the same time frame. Conclusions Although tobacco is a major cause of mortality, few smokers with HIV are offered treatment during hospitalization. Those who are treated attempt to quit. Hospitalization offers a prime opportunity for initiating smoking cessation among those with HIV. PMID:27066925

  3. 77 FR 31348 - Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section 106 Consultation Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section..., National Park Service, City of Lowell, and Boott Hydropower, Inc. and the Eldred L. Field...

  4. 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

  5. Screening and referral for axial spondyloarthritis--need of the hour.

    PubMed

    Danve, Abhijeet; Deodhar, Atul

    2015-06-01

    Although axial spondyloarthritis (axSpA) is as prevalent as rheumatoid arthritis, it is commonly under recognized due to variety of reasons. AxSpA contributes to significant loss of function and disability among young adults. With the availability of newer assessment methods and effective therapeutic agents, early diagnosis and appropriate treatment are possible. As mechanical back pain is widely prevalent in general population, selection of patients with high likelihood of having axSpA and referral to rheumatologists is very important to allow prompt diagnosis and management of axSpA yet avoid improper utilization of resources. Various referral strategies have been developed for this purpose which have included patients with chronic back pain for >3 months with age of onset <45 years and one or more typical spondyloarthritis features with high sensitivity and specificity. Consistent application of both simple and complex strategies has demonstrated similar results in various clinical studies. About 35-45 % of patients referred to rheumatologists using these strategies were finally diagnosed to have axSpA. Potential referring providers include primary care physicians, physical therapists, orthopedic and spine surgeons, chiropractors, rehabilitation medicine physicians, ophthalmologists, gastroenterologists, and dermatologists. Increasing the awareness and education of the referring providers are two very important steps in the success of the referral strategy. With proper application of any strategy described below, a rheumatologist will need to see two to three patients with chronic back pain to identify one patient with axSpA. PMID:25946983

  6. Organisational culture and consultant nurse outcomes: Part 1--Organisational culture.

    PubMed

    Manley, K

    2000-01-01

    Organisational culture is presented as a complex concept underpinned by specific values, beliefs and assumptions that account for the way things are done. Strong organisational cultures and a number of other attributes are highlighted as having influence on performance. The role of leadership is recognised as key to facilitating cultural change, as is the use of approaches which clarify values and highlight contradictions between espoused culture and culture in practice. A three-year study in which a consultant nurse post in critical care was operationalised demonstrated the achievement of an organisational culture with positive impact on the unit in which it was based, on practitioners and their practice, and also on the trust. Transformational leadership combined with other facilitative processes, expertise in the practice of nursing, and other subroles of the consultant nurse are further highlighted as influential. PMID:11235414

  7. Case Complexity and Quality Attestation for Clinical Ethics Consultants.

    PubMed

    Spielman, Bethany; Craig, Jana; Gorka, Christine; Miller, Keith

    2015-01-01

    A proposal by the American Society for Bioethics and Humanities (ASBH) to identify individuals who are qualified to perform ethics consultations neglects case complexity in candidates' portfolios. To protect patients and healthcare organizations, and to be fair to candidates, a minimum case complexity level must be clearly and publicly articulated. This proof-of-concept study supports the feasibility of assessing case complexity. Using text analytics, we developed a complexity scoring system, and retrospectively analyzed more than 500 ethics summaries of consults performed at an academic medical center during 2013. We demonstrate its use with seven case summaries that range in complexity from uncomplicated to very complicated. We encourage the ASBH to require a minimum level of case complexity, and recommend that attestation portfolios include several cases of moderate complexity and at least one very complex case. PMID:26399673

  8. Trauma care and referral patterns in Rwanda: implications for trauma system development

    PubMed Central

    Ntakiyiruta, Georges; Wong, Evan G.; Rousseau, Mathieu C.; Ruhungande, Landouald; Kushner, Adam L.; Liberman, Alexander S.; Khwaja, Kosar; Dakermandji, Marc; Wilson, Marnie; Razek, Tarek; Kyamanywa, Patrick; Deckelbaum, Dan L.

    2016-01-01

    Background Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. Methods We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ2 and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. Results Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). Conclusion To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions. PMID:26812407

  9. Screening and Referral for Postpartum Depression among Low-Income Women: A Qualitative Perspective from Community Health Workers.

    PubMed

    Boyd, Rhonda C; Mogul, Marjie; Newman, Deena; Coyne, James C

    2011-01-01

    Postpartum depression is a serious and common psychiatric illness. Mothers living in poverty are more likely to be depressed and have greater barriers to accessing treatment than the general population. Mental health utilization is particularly limited for women with postpartum depression and low-income, minority women. As part of an academic-community partnership, focus groups were utilized to examine staff practices, barriers, and facilitators in mental health referrals for women with depression within a community nonprofit agency serving low-income pregnant and postpartum women. The focus groups were analyzed through content analyses and NVIVO-8. Three focus groups with 16 community health workers were conducted. Six themes were identified: (1) screening and referral, (2) facilitators to referral, (3) barriers to referral, (4) culture and language, (5) life events, and (6) support. The study identified several barriers and facilitators for referring postpartum women with depression to mental health services. PMID:21603131

  10. Video consultation for trauma and emergency surgical patients.

    PubMed

    Joseph, Bellal; Hadeed, George; Sadoun, Moutamn; Rhee, Peter M; Weinstein, Ronald S

    2012-01-01

    The saying goes that a picture is worth a thousand words, but what then is the value of video? For the care of trauma and emergency surgical patients, the use of video consultation between medical providers may be worth its weight in gold. Telemedicine has become an important tool in reducing the disparity among the haves and the have not's, in this case facilities with a trauma service and those without. This article presents the use of live video for trauma consultations between the only level 1 trauma center in Southern Arizona and several smaller rural hospitals. We also expand on what we believe the future and direction of telesurgery in the fields of critical care and trauma surgery. PMID:22948367

  11. 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...

  12. 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...

  13. Psychopathology and Related Psychosocial Factors in Children with Office Discipline Referrals at School: Evidence from a Developing Country.

    PubMed

    Esin, İbrahim Selçuk; Dursun, Onur Burak; Acemoğlu, Hamit; Baykara, Burak

    2015-10-01

    Many childhood psychiatric disorders present their first symptoms as challenging behaviors at school. Evidence from cross-national studies enhance the understanding of the biological and cultural variables underlying these behaviours. In this study, we aim to identify the psychopathology among children with office disciplinary referrals and assess psychosocial risk factors related to this situation. Forty-seven students who had received an office discipline referral and eighty-three controls who had never been given an office disciplinary referral participated in this study. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime, socio-demographic data form were administered to children to assess their respective psychopathologies and psychosocial risk factors. Attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and obsessive compulsive disorder were significantly higher in children with Office discipline referrals. Psychiatric assessment should be one of the first steps in the evaluation processes of assessing challenging behaviors at school. PMID:25827302

  14. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    PubMed

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted. PMID:25824071

  15. Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning

    PubMed Central

    Roysden, Nathaniel; Wright, Adam

    2015-01-01

    Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient’s first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis. PMID:26958306

  16. Retrospective study of biopsied head and neck lesions in a cohort of referral Taiwanese patients

    PubMed Central

    2014-01-01

    Introduction A study of the whole spectrum of biopsied head and neck (HN) diseases in Taiwan has not yet been performed. Therefore, the current study aimed to provide updated information about HN lesions in a cohort of referral Taiwanese patients for histopathological examination. Methods HN lesions (2000–2011) in patients with records of age, sex, and histological diagnoses were retrieved from the Oral Pathology Department of the institution. These lesions were classified into four main categories: tumor/tumor-like reactive lesions, cystic/pseudocystic lesions, inflammatory/infective lesions, and others/miscellaneous lesions. Results A total of 37,210 HN lesions were included in the current study. Most of these lesions were distributed in the group of tumor/tumor-like reactive lesions, followed by the groups of inflammatory/infective lesions, cystic/pseudocystic lesions, and others/miscellaneous lesions. Squamous cell carcinoma was the most common HN lesion, and was also the most frequent malignant lesion among the referral patients. Conclusion It was worthy of note that squamous cell carcinoma and oral potentially malignant disorders comprised high percentages of all HN lesions for the present cohort of referral patients. PMID:25047214

  17. GP views of their management and referral of psychological problems: a qualitative study.

    PubMed

    Sigel, Paul; Leiper, Rob

    2004-09-01

    The ways that GPs manage and make referral decisions for psychological problems are crucial for the provision of mental health care, although the ways they undertake these tasks are not well understood. A long tradition of psychiatric research in the UK has identified significant shortcomings in detection rates, raising concerns that a large proportion of mental health problems go unrecognized and untreated. Other research has suggested that GPs have a different approach to psychological problems than their mental health colleagues, accounting for some of the particular conditions of primary care, although this approach may differ from the methods used by mental health specialists. The present study explored the views of 10 GPs in one geographic locality about managing and making referral decisions for psychological problems. Grounded theory analysis of interview data allowed for the development of a model made up of five components. This model described the ways that GPs explored psychological problems in the context of containing patients' health problems. Referral decisions were made when GPs felt they had reached the limits of their capabilities for treating a particular problem, taking account of the patient's suitability for psychological therapy and access to psychology services. These decisions were influenced by GPs' views of psychological problems and therapies as well as by their professional interactions with psychologists. The implications of the findings for understanding how GPs work with mental health problems and the ways that psychological services can help are discussed. PMID:15355581

  18. 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

  19. Genetic referrals of Middle Eastern origin in a western city: inbreeding and disease profile.

    PubMed Central

    Hoodfar, E; Teebi, A S

    1996-01-01

    Inbreeding or consanguineous marriage is a common traditional practice in Middle Eastern cultures. Studies from various countries and communities of this region showed that the frequencies range from 20% to greater than 70%. Inbreeding is known to have adverse effects on morbidity and mortality, in particular with respect to autosomal recessive disorders. This study examined 200 couples representing all referrals of Middle Eastern origin seen at a large Clinical Genetics Unit in Montreal. They were compared with a similar sized group of different cultural backgrounds from among the same referrals. The rate of intercultural marriages and inbreeding was found to be 24% and 23.5% respectively in the Middle Eastern group, while they were 22.5% and 5% in the comparison group. Excluding the referrals for consanguinity only, the rate of inbreeding among the study group was 16.4%. Within the Middle Eastern group, autosomal recessive disorders were more than twice as common in the inbred than in the non-inbred families, the pattern of which is consistent with previous observations. PMID:8728693

  20. \\Defining Patient Advocacy for the Context of Clinical Ethics Consultation: A Review of the Literature and Recommendations for Consultants.

    PubMed

    Brazg, Tracy; Lindhorst, Taryn; Dudzinski, Denise; Wilfond, Benjamin

    2016-01-01

    The idea of patient advocacy as a function of clinical ethics consultation (CEC) has been debated in the bioethics literature. In particular, opinion is divided as to whether patient advocacy inherently is in conflict with the other duties of the ethics consultant, especially that of impartial mediator. The debate is complicated, however, because patient advocacy is not uniformly conceptualized. This article examines two literatures that are crucial to understanding patient advocacy in the context of bioethical deliberations: the CEC literature and the literature on advocacy in the social work profession. A review of this literature identifies four distinct approaches to patient advocacy that are relevant to CEC: (1) the best interest approach, (2) the patient rights approach, (3) the representational approach, and (4) the empowerment approach. After providing a clearer understanding of the varied meanings of patient advocacy in the context of CEC, we assert that patient advocacy is not inherently inconsistent with the function of the ethics consultant and the CEC process. Finally, we provide a framework to help consultants determine if they should adopt an advocacy role. PMID:27333067

  1. Kenyan medical student and consultant experiences in a pilot decentralised training program at the University of Nairobi

    PubMed Central

    Kibore, Minnie W.; Daniels, Joseph A.; Child, Mara J.; Nduati, Ruth; Njiri, Francis J.; Kinuthia, Raphael; O'Malley, Gabrielle; John-Stewart, Grace; Kiarie, James; Farquhar, Carey

    2015-01-01

    Background Over the past decade, the University of Nairobi (UoN) has increased the number of enrolled medical students three-fold in response to the growing need for more doctors. This has resulted in a congested clinical training environment and limited opportunities for students to practice clinical skills at the tertiary teaching facility. To enhance the clinical experience, the UoN Medical Education Partnership Initiative Program undertook to train medical students in non-tertiary hospitals around the country under the mentorship of consultant preceptors at these hospitals. This study focused on the evaluation of the pilot decentralised training rotation. Methods The decentralised training program was piloted in October 2011 with 29 fourth-year medical students at four public hospitals for a seven-week rotation. We evaluated student and consultant experiences using a series of focus group discussions. A three-person team developed the codes for the focus groups and then individually and anonymously coded the transcripts. The teams’ findings were triangulated to confirm major themes. Results Before the rotation, the students expressed the motivation to gain more clinical experience as they felt they lacked adequate opportunity to exercise clinical skills at the tertiary referral hospital. By the end of the rotation, the students felt they had been actively involved in patient care, had gained clinical skills and had learned to navigate socio-cultural challenges in patient care. They further expressed the wish to return to those hospitals for future practice. The consultants expressed their motivation to teach and mentor students and acknowledged that the academic interaction had positively impacted on patient care. Discussion The decentralised training enhanced students’ learning by providing opportunities for clinical and community experiences and has demonstrated how practicing medical consultants can be engaged as preceptors in students learning. This

  2. Health care ethics consultation: nature, goals, and competencies. A position paper from the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation.

    PubMed

    Aulisio, M P; Arnold, R M; Youngner, S J

    2000-07-01

    Patients, families, and health care providers have a right to expect that ethics consultants can deal competently with the complex issues that they are asked to address. The Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation explored core competencies and related issues in ethics consultation. This position paper summarizes the content of the resulting Task Force Report, which included nine general conclusions: 1) U.S. societal context makes "ethics facilitation" an appropriate approach to ethics consultation; 2) ethics facilitation requires certain core competencies; 3) core competencies can be acquired in various ways; 4) individual consultants, teams, or committees should have the core competencies for ethics consultation; 5) consult services should have policies that address access, patient notification, documentation, and case review; 6) abuse of power and conflicts of interest must be avoided; 7) ethics consultation must have institutional support; 8) evaluation of process, outcomes, and competencies is needed; and 9) certification of individuals and accreditation of programs are rejected. PMID:10877742

  3. Interactive software for cooperative medicine and remote consultations

    NASA Astrophysics Data System (ADS)

    Ligier, Yves; Ratib, Osman M.; Rejmer, Marek; Moricz, Robert

    1993-09-01

    A multimodality image manipulation and analysis software called OSIRIS was developed at the University Hospital of Geneva. This software package is currently used on different hardware platforms as part of a hospital-wide PACS project. An extension of this software was recently designed to allow cooperative work on remotely located workstations. This extension was developed to allow remote consultations and communications between physicians over local and wide area networks. For teleradiology and cooperative consultations, images are exchanged between the different workstations in an ACR-NEMA based format called PAPYRUS. The interactive session can then take place where the communication protocol between the two remote stations allows for simultaneous manipulation of the same images and a live conversation through a vocal link. A special communication protocol was developed to transmit the different actions performed on one station to the other. The lower level communication protocol is TCP-IP. In addition to the local usage in Geneva, this platform was also adopted as part of a European teleradiology project called TELEMED, regrouping 17 partners from 9 different countries. It is being tested on international broadband networks for remote consultations between different countries in Europe.

  4. 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...

  5. 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...

  6. Consultation in Special Needs Education in Sweden and Finland: A Comparative Approach

    ERIC Educational Resources Information Center

    Sundqvist, Christel; von Ahlefeld Nisser, Désirée; Ström, Kristina

    2014-01-01

    The article compares the conditions and implementation of special education professionals' consulting task in Sweden and Finland. The article first describes the background of the consulting teacher role and special education in Sweden and in Finland. Two different perspectives in the continuum on consultation are presented, followed by a…

  7. Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study

    PubMed Central

    Gildea, Carolynn; Meechan, David; Rubin, Greg; Round, Thomas; Vedsted, Peter

    2015-01-01

    Objective To assess the overall effect of the English urgent referral pathway on cancer survival. Setting 8049 general practices in England. Design Cohort study. Linked information from the national Cancer Waiting Times database, NHS Exeter database, and National Cancer Register was used to estimate mortality in patients in relation to the propensity of their general practice to use the urgent referral pathway. Participants 215 284 patients with cancer, diagnosed or first treated in England in 2009 and followed up to 2013. Outcome measure Hazard ratios for death from any cause, as estimated from a Cox proportional hazards regression. Results During four years of follow-up, 91 620 deaths occurred, of which 51 606 (56%) occurred within the first year after diagnosis. Two measures of the propensity to use urgent referral, the standardised referral ratio and the detection rate, were associated with reduced mortality. The hazard ratio for the combination of high referral ratio and high detection rate was 0.96 (95% confidence interval 0.94 to 0.99), applying to 16% (n=34 758) of the study population. Patients with cancer who were registered with general practices with the lowest use of urgent referral had an excess mortality (hazard ratio 1.07 (95% confidence interval 1.05 to 1.08); 37% (n=79 416) of the study population). The comparator group for these two hazard ratios was the remaining 47% (n=101 110) of the study population. This result in mortality was consistent for different types of cancer (apart from breast cancer) and with other stratifications of the dataset, and was not sensitive to adjustment for potential confounders and other details of the statistical model. Conclusions Use of the urgent referral pathway could be efficacious. General practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer. PMID:26462713

  8. Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation

    PubMed Central

    Moll van Charante, Eric Peter; ter Riet, Gerben; Drost, Sara; van der Linden, Loes; Klazinga, Niek S; Bindels, Patrick JE

    2006-01-01

    Background Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. Methods For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. Results The mean NTAA rate was 27.5% – ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48–1.76) and lower with increasing age (RR 0.96, CI 0.93–0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51–0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18–1.78) and lowest for chest pain (RR 0.18; CI 0.06–0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04–1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5). Conclusion Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates. PMID:17163984

  9. 25 CFR 170.100 - What do the terms “consultation, collaboration, and coordination” mean?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false What do the terms âconsultation, collaboration, and... Consultation, Collaboration, Coordination § 170.100 What do the terms “consultation, collaboration, and... explanation. (b) Collaboration means that all parties involved in carrying out planning and...

  10. 25 CFR 170.100 - What do the terms “consultation, collaboration, and coordination” mean?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false What do the terms âconsultation, collaboration, and... Consultation, Collaboration, Coordination § 170.100 What do the terms “consultation, collaboration, and... explanation. (b) Collaboration means that all parties involved in carrying out planning and...

  11. 25 CFR 170.100 - What do the terms “consultation, collaboration, and coordination” mean?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false What do the terms âconsultation, collaboration, and... Consultation, Collaboration, Coordination § 170.100 What do the terms “consultation, collaboration, and... explanation. (b) Collaboration means that all parties involved in carrying out planning and...

  12. 25 CFR 170.100 - What do the terms “consultation, collaboration, and coordination” mean?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true What do the terms âconsultation, collaboration, and... Consultation, Collaboration, Coordination § 170.100 What do the terms “consultation, collaboration, and... explanation. (b) Collaboration means that all parties involved in carrying out planning and...

  13. 25 CFR 170.100 - What do the terms “consultation, collaboration, and coordination” mean?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What do the terms âconsultation, collaboration, and... Consultation, Collaboration, Coordination § 170.100 What do the terms “consultation, collaboration, and... explanation. (b) Collaboration means that all parties involved in carrying out planning and...

  14. 29 CFR 1908.5 - Requests and scheduling for onsite consultation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 5 2010-07-01 2010-07-01 false Requests and scheduling for onsite consultation. 1908.5 Section 1908.5 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR CONSULTATION AGREEMENTS § 1908.5 Requests and scheduling for onsite consultation. (a) Encouraging requests—(1)...

  15. An Exploration of Infant and Toddler Child Care Consultation: A Multiple Case Study

    ERIC Educational Resources Information Center

    John, Christine Marie

    2015-01-01

    This qualitative, multiple case study was an exploration of the professional development (PD) experience of consultation as it occurred within infant and toddler child care settings. Consultation is dependent upon the establishment of a relationship between the consultant and the consultee and offers opportunities for professional growth and…

  16. 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...

  17. The Relationship between Reading Fluency Intervention and the Need for Special Education Referrals

    ERIC Educational Resources Information Center

    Polcyn, Dawn M.

    2012-01-01

    Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate…

  18. Cognitive Set and Clinical Inference: Referral Information May Not (Always) Affect Psychosocial Assessment.

    ERIC Educational Resources Information Center

    Abraham, Ivo L.

    1986-01-01

    Studied the effects of general referral information about a client on subsequent clinical inferences. Nursing students (N=54) were randomly assigned to "referral information" or "no referral information" conditions before being presented with additional data. Clinical inferential tasks included the assessment of maladjustment, client stress,…

  19. Relationships among Relational Communication Processes and Consultation Outcomes for Students with Attention Deficit Hyperactivity Disorder

    ERIC Educational Resources Information Center

    Erchul, William P.; DuPaul, George J.; Grissom, Priscilla F.; Junod, Rosemary E. Vile; Jitendra, Asha K.; Mannella, Mark C.; Tresco, Katy E.; Flammer-Rivera, Lizette M.; Volpe, Robert J.

    2007-01-01

    Consultation has been shown to be an effective means to deliver school-based psychological services. The purpose of this study was to link patterns of consultant and teacher verbal interactions to consultation outcomes. Relational communication (Rogers & Escudero, 2004) was the research perspective taken, and the source of the consultation…

  20. Behavior Psychology in the Schools: Innovations in Evaluation, Support, and Consultation.

    ERIC Educational Resources Information Center

    Luiselli, James K., Ed.; Diament, Charles, Ed.

    This volume of "Behavior Psychology in the Schools," discusses key topics in behavioral consultations in public school settings. Following an introduction, articles include: (1) "Focus, Scope, and Practice of Behavioral Consultation to Public Schools" (James K. Luiselli), which describes a four-stage process of consultation and the expanding role…

  1. When Does Consultation Lead to Intervention Implementation?: Critical Issues for Research and Practice.

    ERIC Educational Resources Information Center

    Noell, George H.; Witt, Joseph C.

    1999-01-01

    Suggests that, in applying the consultation model to the special educational needs of students in regular classes, little is known about the extent to which regular teachers actually implement recommended interventions following consultation. Proposes research on the relationship between consultation and intervention implementation and addresses…

  2. Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences

    PubMed Central

    Shabazz, Tariq; Parry-Smith, William; Oates, Sharon; Henderson, Steven; Mountfield, Joanna

    2016-01-01

    Objective To explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine. Design Questionnaire survey. Setting Royal College of Obstetricians and Gynaecologists (RCOG). Participants O&G consultant members/fellows of the RCOG working in the UK. Main outcome measures Measures included a typology of 4 bullying and undermining consequences from major to coping. Results There was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on ‘frequency of occurrence’, 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not. Conclusions Significant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions. PMID:27324715

  3. Bridging Theory and Practice: A Conceptual Framework for Consulting Organisations

    ERIC Educational Resources Information Center

    Mohammed, Meca B.; Welch, Jennie; Hazle Bussey, Leslie

    2015-01-01

    A growing number of organisations are emerging as partners to districts pursuing systemic improvement. Given the critical role a consulting organisation could play in supporting system reform efforts, how does a district leader looking to establish a consulting partnership determine what characteristics in a consulting organisation may be more…

  4. Change and the Consultant. Symposium 43. [Concurrent Symposium Session at AHRD Annual Conference, 2000.

    ERIC Educational Resources Information Center

    2000

    This document contains three papers from a symposium on change and the consultant that was conducted during a conference on human resource development (HRD). "A Theory of Consultancy" (Daniel R. Boroto, Douglas A. Zahn, Darren C. Short) presents an emerging theory of consultancy that is based on an analysis of thousands of videotaped consultations…

  5. Clinical audit of genetic testing and referral patterns for fragile X and associated conditions.

    PubMed

    Cotter, Megan; Archibald, Alison D; McClaren, Belinda J; Burgess, Trent; Francis, David; Hills, Louise; Martyn, Melissa; Oertel, Ralph; Slater, Howard; Cohen, Jonathan; Metcalfe, Sylvia A

    2016-06-01

    An audit was conducted of laboratory/clinical databases of genetic tests performed between January 2003 and December 2009, and for 2014, as well as referrals to the clinical service and a specialist multidisciplinary clinic, to determine genetic testing request patterns for fragile X syndrome and associated conditions and referrals for genetic counseling/multidisciplinary management in Victoria, Australia. An expanded allele (full mutation, premutation or intermediate) was found in 3.7% of tests. Pediatricians requested ∼70% of test samples, although fewer general practitioners and more obstetricians/gynecologists ordered tests in 2014. Median age at testing for individuals with a full mutation seeking a diagnosis without a fragile X family history was 4.3 years (males) and 9.4 years (females); these ages were lower when pediatricians ordered the tests (2.1 years and 6.1 years, respectively). Individuals with a premutation were generally tested at a later age (median age: males, 33.2 years; females, 36.4 years). Logistic regression showed that a family history of ID (OR 3.28 P = 0.005, CI 1.77-5.98) was the only indication to independently increase the likelihood of a test-positive (FM or PM) result. Following testing, ∼25% of full mutation or premutation individuals may not have attended clinical services providing genetic counseling or multidisciplinary management for these families. The apparent delay in fragile X syndrome diagnosis and lack of appropriate referrals for some may result in less than optimal management for these families. These findings suggest continued need for awareness and education of health professionals around diagnosis and familial implications of fragile X syndrome and associated conditions. © 2016 Wiley Periodicals, Inc. PMID:26892444

  6. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  7. A Pharmaceutical Bioethics Consultation Service: Six-Year Descriptive Characteristics and Results of a Feedback Survey

    PubMed Central

    Van Campen, Luann E.; Allen, Albert J.; Watson, Susan B.; Therasse, Donald G.

    2015-01-01

    Background: Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods: Data on the descriptive characteristics of bioethics consultations were collected from 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results: Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions: Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service raises

  8. Effective consultation in nursing.

    PubMed

    McCutcheon, S; Perkin, K

    1996-01-01

    Given the fiscal challenges within health care today, nurse administrators, whether acting in the role of client or consultant, must determine the most effective and efficient way to solve problems and achieve goals. The consultation process can be viewed from both the client's and the consultant's perspective. This article is intended to provide a practical approach to addressing the issues within the consultation process. The steps of the consultation process are reviewed. The evolution from solving problems to achieving goals is described. The importance of the use of a screening tool when interviewing prospective consultants is emphasized and an example of a generic screening tool is provided. During the interview, consultants are advised to clearly determine the problem or goal, the outcomes which the client expects, possible barriers and risks, and the philosophical fit between both parties. Nurses practise consultation skills daily and, therefore, consultation is a viable opportunity for self-employment. PMID:8695611

  9. 20 CFR 416.919p - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Reviewing reports of consultative examinations. 416.919p Section 416.919p Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Standards for the Type of Referral and for Report Content §...

  10. 20 CFR 416.919p - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Reviewing reports of consultative examinations. 416.919p Section 416.919p Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Standards for the Type of Referral and for Report Content §...

  11. Digital Video Capture and Synchronous Consultation in Open Surgery

    PubMed Central

    Rafiq, Azhar; Moore, James A.; Zhao, Xiaoming; Doarn, Charles R.; Merrell, Ronald C.

    2004-01-01

    Objective: To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities. Summary Background Data: Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy. Methods: Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses. Results: Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience. Conclusion: The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of

  12. Family Counseling Interventions: Understanding Family Systems and the Referral Process.

    ERIC Educational Resources Information Center

    McWhirter, Ellen Hawley; And Others

    1993-01-01

    This article describes concepts underlying the idea of the "family as a system"; compares and contrasts four approaches to family therapy (those of Virginia Satir, Jay Haley, Murray Bowen, and Salvador Minuchin); and offers suggestions to teachers referring parents for family counseling. (DB)

  13. Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

    ERIC Educational Resources Information Center

    Becker, Janet E.

    2004-01-01

    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care,…

  14. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... the FDIC refers a past-due, legally enforceable debt to FMS for tax refund offset, it will certify to FMS that: (a) The debt is past due and legally enforceable in the amount submitted to FMS and that the..., in that it has: (1) Submitted the debt to FMS for collection by administrative offset and...

  15. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... the FDIC refers a past-due, legally enforceable debt to FMS for tax refund offset, it will certify to FMS that: (a) The debt is past due and legally enforceable in the amount submitted to FMS and that the..., in that it has: (1) Submitted the debt to FMS for collection by administrative offset and...

  16. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the FDIC refers a past-due, legally enforceable debt to FMS for tax refund offset, it will certify to FMS that: (a) The debt is past due and legally enforceable in the amount submitted to FMS and that the..., in that it has: (1) Submitted the debt to FMS for collection by administrative offset and...

  17. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... the FDIC refers a past-due, legally enforceable debt to FMS for tax refund offset, it will certify to FMS that: (a) The debt is past due and legally enforceable in the amount submitted to FMS and that the..., in that it has: (1) Submitted the debt to FMS for collection by administrative offset and...

  18. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... the FDIC refers a past-due, legally enforceable debt to FMS for tax refund offset, it will certify to FMS that: (a) The debt is past due and legally enforceable in the amount submitted to FMS and that the..., in that it has: (1) Submitted the debt to FMS for collection by administrative offset and...

  19. An Analysis of WhatsApp Usage for Communication Between Consulting and Emergency Physicians.

    PubMed

    Gulacti, Umut; Lok, Ugur; Hatipoglu, Sinan; Polat, Haci

    2016-06-01

    The aim of this study was to evaluate WhatsApp messenger usage for communication between consulting and emergency physicians. A retrospective, observational study was conducted in the emergency department (ED) of a tertiary care university hospital between January 2014 and June 2014. A total of 614 consultations requested by using the WhatsApp application were evaluated, and 519 eligible consultations were included in the study. The WhatsApp messages that were transferred to consultant physicians consisted of 510 (98.3 %) photographic images, 517 (99.6 %) text messages, 59 (11.3 %) videos, and 10 (1.9 %) voice messages. Consultation was most frequently requested from the orthopedics clinic (n = 160, 30.8 %). The majority of requested consultations were terminated only by evaluation via WhatsApp messages. (n = 311, 59.9 %). Most of the consulting physicians were outside of the hospital or were mobile at the time of the consultation (n = 292, 56.3 %). The outside consultation request rate was significantly higher for night shifts than for day shifts (p = .004), and the majority of outside consultation request were concluded by only WhatsApp application (p < .001). WhatsApp is useful a communication tool between physicians, especially for ED consultants who are outside the hospital, because of the ability to transfer large amounts of clinical and radiological data during a short period of time. PMID:27083574

  20. Cognitive Predictors of Reading and Math Achievement among Gifted Referrals

    ERIC Educational Resources Information Center

    Rowe, Ellen W.; Miller, Cristin; Ebenstein, Lauren A.; Thompson, Dawna F.

    2012-01-01

    This study investigated the predictive power of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Full Scale IQ (FSIQ), the General Ability Index (GAI), and the WISC-IV index score composites on subsequent reading and math standardized test scores among high-achieving students. The sample consisted of 84 elementary-age students…

  1. Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs

    PubMed Central

    Bray, Jeremy W; Mallonee, Erin; Dowd, William; Aldridge, Arnie; Cowell, Alexander J; Vendetti, Janice

    2014-01-01

    This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models. PMID:25114610

  2. Interventions to improve screening and appropriate referral of patients with cancer for distress: systematic review protocol

    PubMed Central

    McCarter, Kristen; Britton, Ben; Baker, Amanda; Halpin, Sean; Beck, Alison; Carter, Gregory; Wratten, Chris; Bauer, Judy; Booth, Debbie; Forbes, Erin; Wolfenden, Luke

    2015-01-01

    Introduction It is estimated that 35–40% of patients with cancer experience distress at some stage during their illness. Distress may affect functioning, capacity to cope, treatment compliance, quality of life and survival of patients with cancer. Best practice clinical guidelines recommend routine psychosocial distress screening and referral for further assessment and/or psychosocial support for patients with cancer. However, evidence suggests this care is not provided consistently. Methods and analysis We developed our methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The review is registered with PROSPERO and any amendments to the protocol will be tracked. The primary aim of this systematic review is to examine the impact of interventions delivered in healthcare settings that are aimed at (1) improving routine screening of patients for psychosocial distress and (2) referral of distressed patients with cancer for further assessment and/or psychosocial support. The effectiveness of such interventions in reducing psychosocial distress, and any unintended adverse effect of the intervention will also be assessed in patients with cancer. Data sources will include the bibliographic databases Cochrane Central Register of Controlled trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL. Eligible studies must compare an intervention (or two or more interventions) in a healthcare setting to improve the rate of screening for psychosocial distress and/or referral for further assessment and/or psychosocial support for patients with cancer with no intervention or ‘usual’ practice. Two investigators will independently review titles and abstracts, followed by full article reviews and data extraction. Disagreements will be resolved by consensus and if necessary, a third reviewer. Where studies are sufficiently homogenous, trial data will be pooled and meta-analyses performed. Ethics and

  3. Cognitive predictors of reading and math achievement among gifted referrals.

    PubMed

    Rowe, Ellen W; Miller, Cristin; Ebenstein, Lauren A; Thompson, Dawna F

    2012-09-01

    This study investigated the predictive power of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Full Scale IQ (FSIQ), the General Ability Index (GAI), and the WISC-IV index score composites on subsequent reading and math standardized test scores among high-achieving students. The sample consisted of 84 elementary-age students who received an individual cognitive assessment with the WISC-IV in the previous year as part of the application process for gifted and talented programming through their schools. Although there were no significant differences among the mean WISC-IV index scores, 77% of the individual students evidenced statistically significant WISC-IV index score variability. Thus, intraindividual test score variability appears to be the norm among high-achieving students. In spite of this variability, regression analyses indicated that the FSIQ predicted reading comprehension and mathematics achievement better than, or as well as, the GAI or individual scores for verbal comprehension and perceptual reasoning. None of the cognitive variables correlated significantly with achievement scores for Word Reading or Pseudoword Decoding scores, but the FSIQ, GAI, Verbal Comprehension, and Perceptual Reasoning scores predicted reading comprehension. Limitations and directions for future research are discussed. PMID:22963069

  4. Incidental Findings on Cone Beam Computed Tomography and Reasons for Referral by Dental Practitioners in Indore City (M.P)

    PubMed Central

    Nagarajappa, Sandesh; Dasar, Prahlad L; Warhekar, Ashish M; Parihar, Ajay; Phulambrikar, Tushar; Airen, Bhuvnesh; Jain, Deepika

    2015-01-01

    Introduction: Cone beam computed tomography is a new diagnostic innovation to dental imaging. Despite the use of CBCT in oral and maxillofacial imaging, reports on its use either by individual practitioners or referral patterns to CBCT centers is lacking. Hence, a study was conducted to determine incidental findings on CBCT and reasons for referral by dental practitioners in Indore city. Materials and Methods: A retrospective analysis of 795 records that were referred for CBCT imaging at Institutional and Oracal CBCT Centre, Indore was undertaken. Referrals from both within and outside institution, as well as from private practitioners were considered. The reason for CBCT referral, provision diagnosis, final diagnosis and any incidental diagnosis were recorded. Results: This retrospective chart audit revealed that 56.7 % were male and 43.3% were females. Greatest source of patients was referred by oral surgeons (21.9%) followed by oral and maxillofacial radiologist (14.2%) and prosthodontist (9.3%). The most common reason for referral was for implant analysis (24.2%) and the most common incidental finding diagnosed by CBCT was oral malignancies. Conclusion: In Institutional set-up, CBCT referrals were mostly for the reason of planning implant placement followed by trauma whereas private practitioners used CBCT mostly for implant placement followed by impaction. CBCT was being utilized more by Oral surgeons in private sector whereas it in an Institutional setup majority of referrals from Department of Oral Diagnosis and Radiology. Findings that were most commonly diagnosed incidentally on CBCT were Orofacial malignancies followed maxillary sinus pathologies. PMID:25859519

  5. 34 CFR 361.41 - Processing referrals and applications.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... exploration of the individual's abilities, capabilities, and capacity to perform in work situations is carried out in accordance with § 361.42(e) or, if appropriate, an extended evaluation is carried out...

  6. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT... positive drug test result, or has a confirmed alcohol test of 0.04 or greater, or refuses to submit to a drug or alcohol test required by this part, the employer shall advise the employee of the...

  7. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT... positive drug test result, or has a confirmed alcohol test of 0.04 or greater, or refuses to submit to a drug or alcohol test required by this part, the employer shall advise the employee of the...

  8. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT... positive drug test result, or has a confirmed alcohol test of 0.04 or greater, or refuses to submit to a drug or alcohol test required by this part, the employer shall advise the employee of the...

  9. CAPTA Referrals for Infants and Toddlers: Measuring Early Interventionists' Perceptions

    ERIC Educational Resources Information Center

    Herman-Smith, Robert L.

    2009-01-01

    In 2003, Congress amended the Child Abuse Protection and Treatment Act (CAPTA) to require that all child victims of substantiated abuse or neglect under the age of 3 years be assessed for developmental concerns. To date, there has been little study of CAPTA's implementation in Part C early intervention programs. The "Professional Interventionist…

  10. Comparison of face-to-face and telephone consultations in primary care: qualitative analysis

    PubMed Central

    Hewitt, Heather; Gafaranga, Joseph; McKinstry, Brian

    2010-01-01

    Background There is evidence that telephone consultations in general practice are typically shorter than face-to-face consultations and that fewer problems are presented in them. Aim To compare the communicative practices of doctors and patients in face-to-face and telephone consultations, in order to understand the contrasts between the two consulting modes. Design of study Conversation analysis. Setting Eight NHS GP surgeries in Scotland. Method Transcription and conversation analysis of 32 face-to-face and 33 telephone consultations. Participants Eighteen GPs and 65 patients. Results There are no underlying contrasts between the communicative practices used in face-to-face and telephone consultations. Telephone consultations are typically used by patients to deal with a limited range of single-issue concerns, whereas a wide range of different problem types is dealt with in face-to-face consultations. Most telephone consultations for new problems lead to a face-to-face meeting rather than a diagnosis, making them shorter than equivalent face-to-face consultations. Interaction in telephone consultations is continuous and orderly, but in face-to-face consultations there are periods of silence that facilitate the introduction of additional topics, including social speech and rapport building. Doctors on the telephone are less likely to elicit additional concerns than in face-to-face consultations, and ask fewer questions when patients present self-diagnosed problems or describe problems with treatment. Conclusion Doctors in general practice do not substantially change their communicative behaviour on the telephone. Telephone consultations are shorter and include less problem disclosure than face-to-face meetings, partly because they are typically mono-topical and partly because of intrinsic differences between the two channels. PMID:20423575

  11. An evaluation of Polaroid photographic imaging for cutaneous-lesion referrals to an outpatient clinic: a pilot study.

    PubMed

    Singh, S; Stevenson, J H; McGurty, D

    2001-03-01

    A pilot study consisted of 65 patient referrals to a Regional Plastic Surgery Department in which the referral letter, accompanied by a high-quality Polaroid photograph, was assessed by four consultants. The diagnosis, degree of urgency of treatment, grade of surgeon (to undertake the operation) and anticipated time for the procedure were recorded. The results were statistically analysed. Our aim was to evaluate the diagnostic accuracy and consistency of the four observers. The majority of malignant skin lesions were detected accurately; those that were missed received urgent attention due to a high degree of suspicion. This study supports the view that 'triage' of referrals using high-quality photographic images in association with an accurate referral letter can offer a significant reduction in pressure on waiting time and inconvenience for patients by avoiding an additional outpatient visit. Advantages to purchasers in terms of cost savings on outpatient visits and travelling reimbursement can result from this initiative. PMID:11207125

  12. Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

    PubMed Central

    Guy, David; Ghanem, Gabriella; Loblaw, Andrew; Buckley, Roger; Persaud, Beverly; Cheung, Patrick; Chung, Hans; Danjoux, Cyril; Morton, Gerard; Noakes, Jeff; Spevack, Les; Hajek, David; Flax, Stanley

    2016-01-01

    Introduction: We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends. Methods: From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records. Results: 1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed (p<0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management; 57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions were made in those who attended the MDC compared to those who only saw a urologist (p<0.0001). Conclusions: In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low- to intermediate-risk disease over time. Timely multidisciplinary consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multi-disciplinary DAP. PMID:27217859

  13. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia

    PubMed Central

    2014-01-01

    Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). Results Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. Conclusions Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended. PMID:24826198

  14. Discrepancy in Diagnosis of Primary Myelofibrosis between Referral and Tertiary Care Centers

    PubMed Central

    Yi, Cecilia Arana; Jeyakumar, Ghayathri; Medina, Pedro; Cortes, Jorge; Pierce, Sherry; Bueso-Ramos, Carlos; Kantarjian, Hagop; Verstovsek, Srdan

    2015-01-01

    Primary myelofibrosis (PMF) is myeloproliferative neoplasm whose diagnosis is based on a combination of clinical and pathology criteria. We evaluated 560 consecutive patients who were diagnosed with PMF upon a referral to our center and evaluated the frequency of and reasons for diagnostic discordance. Discordance in the diagnosis was found in 70 (12.5%) patients. Discordant cases had a significantly lower grade of bone marrow fibrosis (grade 0–1), more likely to be JAK2V617F-mutation negative, and have no peripheral blood blasts, possibly explaining the difficulty in making a proper diagnosis and underscoring the need for a complete evaluation at a tertiary center. PMID:24284333

  15. 13 CFR 302.10 - Attorneys' and consultants' fees; employment of expediters and administrative employees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL TERMS AND CONDITIONS FOR INVESTMENT... attorneys' or consultants' fees incurred in connection with obtaining Investment Assistance and...

  16. 13 CFR 302.10 - Attorneys' and consultants' fees; employment of expediters and administrative employees.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL TERMS AND CONDITIONS FOR INVESTMENT... attorneys' or consultants' fees incurred in connection with obtaining Investment Assistance and...

  17. 13 CFR 302.10 - Attorneys' and consultants' fees; employment of expediters and administrative employees.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL TERMS AND CONDITIONS FOR INVESTMENT... attorneys' or consultants' fees incurred in connection with obtaining Investment Assistance and...

  18. 13 CFR 302.10 - Attorneys' and consultants' fees; employment of expediters and administrative employees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL TERMS AND CONDITIONS FOR INVESTMENT... attorneys' or consultants' fees incurred in connection with obtaining Investment Assistance and...

  19. 13 CFR 302.10 - Attorneys' and consultants' fees; employment of expediters and administrative employees.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL TERMS AND CONDITIONS FOR INVESTMENT... attorneys' or consultants' fees incurred in connection with obtaining Investment Assistance and...

  20. Relation between a career and family life for English hospital consultants: qualitative, semistructured interview study

    PubMed Central

    Dumelow, Carol; Littlejohns, Peter; Griffiths, Sîan

    2000-01-01

    Objective To explore the relation between work and family life among hospital consultants and their attitude towards the choices and constraints that influence this relation. Design Qualitative study of consultants' experiences and views based on tape recorded semistructured interviews. Setting Former South Thames health region in southeast England. Participants 202 male and female NHS hospital consultants aged between 40 to 50 years representing all hospital medical specialties. Results Three types of relation between work and family life (career dominant, segregated, and accommodating) were identified among hospital consultants. Most consultants had a segregated relation, although female consultants were more likely than male consultants to have a career dominant or an accommodating relation. Many male consultants and some female consultants expressed considerable dissatisfaction with the balance between their career and family life. A factor influencing this dissatisfaction was the perceived lack of choice to spend time on their personal or family life, because of the working practices and attitudes within hospital culture, if they wanted a successful career. Conclusions Consultants are currently fitting in with the profession rather than the profession adapting to enable doctors to have fulfilling professional and personal lives. Current government policies to increase the medical workforce and promote family friendly policies in the NHS ought to take account of the need for a fundamental change in hospital culture to enable doctors to be more involved in their personal or family life without detriment to their career progress. PMID:10827044

  1. Specialist Pediatric Palliative Care Referral Practices in Pediatric Oncology: A Large 5-year Retrospective Audit

    PubMed Central

    Ghoshal, Arunangshu; Salins, Naveen; Damani, Anuja; Deodhar, Jayita; Muckaden, MaryAnn

    2016-01-01

    Purpose: To audit referral practices of pediatric oncologists referred to specialist pediatric palliative care services. Patients and Methods: Retrospective review of medical case records of pediatric palliative care patients over a period of 5 years from January 1, 2010 to December 31, 2014. Descriptive summaries of demographic, clinical variables, and patient circumstances at the time of referral and during end-of-life care were examined. Results: A total of 1135 patients were referred from pediatric oncology with a gradual increasing trend over 5 years. About 84.6% consultations took place in the outpatient setting. In 97.9% of the cases, parents were the primary caregivers. Availability of specialist pediatric health-care services at local places was available in 21.2% cases and 48% families earned <5000 INR (approximately 73 USD) in a month. Around 28.3% of the referrals were from leukemia clinic and maximum references were late with 72.4% patients having advanced disease at presentation. 30.3% of the referrals were made for counseling and communication and 54.2% had high symptom burden during referral. After referral, 21.2% patients continued with oral metronomic chemotherapy and 10.5% were referred back to oncology services for palliative radiotherapy. Only 4.9% patients had more than 2 follow-ups. 90.8% of the patients were cared for at home in the last days of illness by local general practitioners. 70.6% of the deaths were anticipated. Conclusions: Oncologists referred patients late in the course of disease trajectory. Most of the referrals were made for counseling and communication, but many patients had high symptom burden during referral. PMID:27559254

  2. Assessment of providers' referral decisions in Rural Burkina Faso: a retrospective analysis of medical records

    PubMed Central

    2012-01-01

    Background A well-functioning referral system is fundamental to primary health care delivery. Understanding the providers' referral decision-making process becomes critical. This study's aim was to assess the correctness of diagnoses and appropriateness of the providers' referral decisions from health centers (HCs) to district hospitals (DHs) among patients with severe malaria and pneumonia. Methods A record review of twelve months of consultations was conducted covering eight randomly selected HCs to identify severe malaria (SM) cases among children under five and pneumonia cases among adults. The correctness of the diagnosis and appropriateness of providers' referral decisions were determined using the National Clinical Guidebook as a 'gold standard'. Results Among the 457 SM cases affecting children under five, only 66 cases (14.4%) were correctly diagnosed and of those 66 correctly diagnosed cases, 40 cases (60.6%) received an appropriate referral decision from their providers. Within these 66 correctly diagnosed SM cases, only 60.6% were appropriately referred. Among the adult pneumonia cases, 5.9% (79/1331) of the diagnoses were correctly diagnosed; however, the appropriateness rate of the provider's referral decision was 98.7% (78/79). There was only one case that should not have been referred but was referred. Conclusions The adherence to the National Guidelines among the health center providers when making a diagnosis was low for both severe malaria cases and pneumonia cases. The appropriateness of the referral decisions was particularly poor for children with severe malaria. Health center providers need to be better trained in the diagnostic process and in disease management in order to improve the performance of the referral system in rural Burkina Faso. PMID:22397326

  3. 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…

  4. Diabetes mellitus in Addis Ababa, Ethiopia: admissions, complications and outcomes in a large referral hospital

    PubMed Central

    Harries, A. D.; Ade, S.; Tayler-Smith, K.; Ali, E.; Firdu, N.; Yifter, H.

    2015-01-01

    Setting: The Black Lion Referral Hospital, Addis Ababa, Ethiopia. Objective: To document indications for admission, complications and outcomes of patients with diabetes mellitus (DM) admitted between 2010 and 2013. Design: A descriptive retrospective study using medical files. Results: Of 8048 admissions, 523 (6.5%) had DM; of these, 418 medical records were retrieved: 301 (72%) patients had type 2 and 104 (28%) type 1 disease, with male sex (62%) and older age (median age 60 years) being features of type 2 disease. Main admission diagnoses for type 2 disease were diabetic foot ulcer (39%) and cardiovascular disease (21%); for type 1 disease, it was diabetic ketoacidosis (62%). Hypertension, neuropathy, nephropathy, retinopathy and diabetic foot accounted for 85% of the 756 existing complications. Overall in-patient mortality was 21%. Of the 89 deaths, 77 occurred among patients with type 2 disease; the main indications for admission were diabetic foot ulcer/gangrene and cardiovascular disease. Conclusion: DM, especially type 2 DM, is an important cause of admission to Ethiopia’s largest referral hospital. Many patients had already developed disease-related complications at admission, and mortality was high. There is a need to improve awareness about and care for DM in Ethiopia. PMID:26400605

  5. The Effect of Training and Consultation Condition on Teachers' Self-Reported Likelihood of Adoption of a Daily Report Card

    ERIC Educational Resources Information Center

    Holdaway, Alex S.; Owens, Julie Sarno

    2015-01-01

    Using a within-subjects design and validated vignettes, this study examined the relative effects of four training and consultation conditions (i.e., consultation with key opinion leaders, consultation with observation and performance feedback, consultation with motivational interviewing, and professional development-as-usual) on teachers' (N =…

  6. 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

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. Early Detection, Referral, Investigation, and Diagnosis of Children with Growth Disorders.

    PubMed

    Savage, Martin O; Backeljauw, Philippe F; Calzada, Raúl; Cianfarani, Stefano; Dunkel, Leo; Koledova, Ekaterina; Wit, Jan M; Yoo, Han-Wook

    2016-01-01

    Early diagnosis is a key objective in clinical medicine, and early detection of pathological short stature has tangible benefits for growth prognosis and the well-being of the child. Despite late diagnosis being common in growth disorders, programmes of height screening in primary care are not universal in developed countries and may be random or non-existent. A notable exception is automated growth monitoring in Finland, where an algorithm to detect abnormal growth is integrated into children's electronic health records, resulting in increased diagnoses of pathological short stature. Evidence-based anthropometric criteria for referral of short stature to secondary or tertiary care are now published, due largely to excellent studies in the Netherlands. Following referral of the short child, the protocol for laboratory investigations remains somewhat controversial because in healthy children their diagnostic yield can be too low for cost-effectiveness. However, outside of tertiary academic paediatric endocrinology centres, baseline screening tests are considered worthwhile and may speed up diagnosis and treatment. Finally, auxological cut-offs cannot replace good clinical practice, and the understanding that early and effective management depends on commitment to a diagnosis and individualisation of therapy in the short child cannot be overemphasised. PMID:27055026

  12. Impact of a brief telephone referral on quitline use, quit attempts and abstinence

    PubMed Central

    Mathew, Amanda R.; Burris, Jessica L.; Alberg, Anthony J.; Cummings, K. Michael; Carpenter, Matthew J.

    2015-01-01

    Quitline use can prompt quit attempts and promote abstinence among smokers, but rates of use are low and outcomes of brief quitline referrals unclear. In this study, a brief intervention was delivered to smokers who expressed motivation to quit in the next 30 days (N = 221) to encourage use of their state quitline. Correlates of quitline use were examined, and quitline callers versus non-callers were compared on the following outcomes at 2-month follow-up: cessation medication use, quit attempts and abstinence. Of the 221 smokers given a quitline referral, 34% called the quitline. Baseline motivation alone distinguished quitline callers from non-callers. Quitline use was positively associated with use of cessation medication, an association that remained robust even after adjusting for baseline motivation to quit. A trend was observed in which callers were marginally more likely than non-callers to report both a 24-h quit attempt and 7-day point prevalence abstinence. Relative to non-callers, callers also endorsed greater confidence to quit and increased self-efficacy to resist smoking temptations at follow-up. This study demonstrates a minimal intervention can promote acceptance of quitlines and favorable cessation outcomes among smokers motivated to quit. PMID:25092882

  13. Advanced nurse practitioner-led referral for specialist care and rehabilitation.

    PubMed

    Mashlan, Wendy; Hayes, Julie; Thomas, Ceri

    2016-02-01

    In response to the need for appropriate and timely care of frail older patients admitted to hospital, a dedicated advanced nurse practitioner (ANP)-led referral service was developed. The service has continued to evolve over the 13 years since its implementation in accordance with changing service demands. This article describes the role of the ANP in care of the elderly/rehabilitation medicine and focuses on one area of clinical practice developed by the team: an ANP-led referral service. The aim of developing the service was to ensure that patients who required specialist care and rehabilitation could be identified and assessed as soon as possible after admission, with the premise that they could be transferred to a bed in care of the elderly medical wards. This was perceived by the ANPs to be advantageous for patients, who would receive care from a specialist team, and for care of the elderly staff who could use their knowledge and skills appropriately and safely. PMID:26938608

  14. Haematological malignancies and acute kidney injury requiring nephrology consultation: challenging the worst of the worst

    PubMed Central

    Chuva, Teresa; Maximino, José; Barbosa, Joselina; Silva, Sandra; Paiva, Ana; Baldaia, Jorge; Loureiro, Alfredo

    2016-01-01

    Background Acute kidney injury (AKI) often complicates the course of haematological malignancies (HMs) and confers a worse prognosis. The majority of these patients are managed by the attending physician, yet, a small group, mostly coincident with the worst presentation and outcomes, requires nephrology consultation, challenging the clinician with ethical issues regarding the decision to initiate or forgo renal support therapy. The purpose of this work is to identify the prognostic determinants for in-hospital mortality in this population. Methods A retrospective, observational chart review was undertaken at a single tertiary referral oncological centre. We reviewed the medical records of in-hospital patients with AKI and HM between 1 January 1995 and 31 December 2014 who met the criteria for RIFLE (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) classification of I or higher and were followed by a nephrologist. Results Three hundred and forty-five patients were included in the study. Predictors of in-hospital death in patients with HM and AKI were septic shock [odds ratio (OR) 4.290 (95% CI 2.058–8.943)], invasive mechanical ventilation (IMV) [OR 4.305 (95% CI 2.075–8.928)] and allogeneic stem cell transplantation (SCT) [OR 2.232 (95% CI 1.260–3.953)]. The combination of each risk factor was used to estimate the probability of dying. Patients with all three risk factors had a risk of death of 86%. Conclusions Septic shock, IMV and allogeneic SCT were identified as independent predictors of death in patients with HM and AKI, with only a small chance of survival if all three were present. Depending on the combination of risk factors, the indication for aggressive life support therapies, such as RST, might be questionable. PMID:27274827

  15. Toward Effective Quality Assurance in Evidence-Based Practice: Links between Expert Consultation, Therapist Fidelity, and Child Outcomes

    ERIC Educational Resources Information Center

    Schoenwald, Sonja K.; Sheidow, Ashli J.; Letourneau, Elizabeth J.

    2004-01-01

    This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was…

  16. Committees and Controversy: Consultants in the Construction of Education Policy

    ERIC Educational Resources Information Center

    Gabriel, Rachael; Paulus, Trena

    2015-01-01

    The increasingly common practice of engaging consulting firms to assist states with educational policy agendas requires an analysis of the role these consultants play in what is positioned as a democratic decision-making process. In this study, we examine the discourse of a state-level advisory committee formed to develop a new teacher evaluation…

  17. [Suicidality at the general hospital – perspective of consultation and liaison psychiatry].

    PubMed

    Imboden, Christian; Hatzinger, Martin

    2015-10-01

    Suicidality is a common problem in the general hospital. Patients with comorbid psychiatric disorders or during a psychosocial crisis can develop suicidal ideation during their stay at the general hospital, especially if they suffer from chronic disease. Some somatic disorders, such as cancer, epilepsy, chronic obstructive pulmonary disease, asthma, stroke and chronic pain conditions are associated with an increased risk of suicide. The fact that (1) a major part of patients are treated in the emergency room (ER) after a suicide attempt and (2) a suicide attempt is the strongest predictor for later completed suicide emphasizes the importance of expertise in dealing with suicidal patients in the ER. In order to improve prevention of suicides and suicide attempts within the general hospital and after discharge it is important to educate staff concerning suicidality and enhance detection of suicidal patients. A consultation and liaison psychiatrist should always be involved when there are suicidal patients on wards and in the ER. Assessment of suicidal patients has always to include clear recommendations concerning patient safety and treatment of the underlying condition as well as specific approaches in dealing with suicidal thoughts. Safety measures can include close monitoring, constant observation, restriction to means of suicide, referral to a psychiatric clinic and treatment with sedatives, generally benzodiazepines. Psychiatric disorders are ideally treated according to guidelines and clear recommendations should be given concerning treatment after discharge. Specific psychotherapy for suicidal behaviour possibly reduces the risk of future suicides. A special situation is created by assisted suicides which attribute to suicides in the elderly with a recent increase in the Swiss population. In some cases, undiagnosed depression may contribute to the decision making process, hence, underlining the importance of improved detection and treatment of depression in

  18. Sexual and Nonsexual Offenders With Intellectual and Learning Disabilities: A Comparison of Characteristics, Referral Patterns, and Outcome

    ERIC Educational Resources Information Center

    Lindsay, William R.; Smith, Anne H. W.; Law, Jacqueline; Quinn, Kathleen; Anderson, Andrew; Smith, Astrid; Allan, Ronald

    2004-01-01

    This article reports an evaluation of a community intellectual disability offender service over the period from 1990 to 2001. Men who committed sex offenses or sexually abusive incidents (n = 106) and men who committed other types of offenses and serious incidents (n = 78) are compared on personal characteristics, referral sources, forensic…

  19. 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

  20. "Speeding up the road to recovery": The Complex Recovery Assessment and Consultation (CRAC) service.

    PubMed

    Davis Le Brun, Stephanie

    2015-01-01

    The number of bed closures in mental health is on the rise, creating additional pressure on services, including acute mental health services. An efficient way of working is required in order to streamline the acute care pathway and decrease unnecessary delays to length of stay, ensuring all individuals can be offered an inpatient bed when in crisis. The Complex Recovery Assessment and Consultation (CRAC) service was created in order to support acute mental health inpatient clinicians in streamlining hospital stays for service users who present with complex presentations that require lengthier admissions (over 40 days) by offering assessment, advice, and intervention from a rehabilitation perspective. The team was also created to understand why individuals may require a lengthy hospital stay. Preliminary data showed that requiring a placement on discharge proved to be the most significant factor in increased length of stay and so the team took on a new role of discharge coordinator after around a year of operating. This involved assisting in decreasing any delays out of hospital through improved communication and dedicated time to complete tasks, such as completing paperwork for placement referrals and funding panels. Since taking on this role it was found that the time taken for individuals to be discharged to a rehabilitation or specialist placement decreased; a rehabilitation placement by 13.12 days and a specialist placement by 9.22 days. Discharge to a family address also decreased by 2.9 days and a home address by 2.47 days. Those patients with complex presentations benefit from having one dedicated team to coordinate the discharge process. Their lengthier acute inpatient stay is improved through streamlining care pathways, ultimately decreasing delays in discharge. PMID:26734397

  1. “Speeding up the road to recovery”: The Complex Recovery Assessment and Consultation (CRAC) service

    PubMed Central

    Davis Le Brun, Stephanie

    2015-01-01

    The number of bed closures in mental health is on the rise, creating additional pressure on services, including acute mental health services. An efficient way of working is required in order to streamline the acute care pathway and decrease unnecessary delays to length of stay, ensuring all individuals can be offered an inpatient bed when in crisis. The Complex Recovery Assessment and Consultation (CRAC) service was created in order to support acute mental health inpatient clinicians in streamlining hospital stays for service users who present with complex presentations that require lengthier admissions (over 40 days) by offering assessment, advice, and intervention from a rehabilitation perspective. The team was also created to understand why individuals may require a lengthy hospital stay. Preliminary data showed that requiring a placement on discharge proved to be the most significant factor in increased length of stay and so the team took on a new role of discharge coordinator after around a year of operating. This involved assisting in decreasing any delays out of hospital through improved communication and dedicated time to complete tasks, such as completing paperwork for placement referrals and funding panels. Since taking on this role it was found that the time taken for individuals to be discharged to a rehabilitation or specialist placement decreased; a rehabilitation placement by 13.12 days and a specialist placement by 9.22 days. Discharge to a family address also decreased by 2.9 days and a home address by 2.47 days. Those patients with complex presentations benefit from having one dedicated team to coordinate the discharge process. Their lengthier acute inpatient stay is improved through streamlining care pathways, ultimately decreasing delays in discharge. PMID:26734397

  2. 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

  3. Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting

    PubMed Central

    Marrón, Belén; Ostrowski, Janusz; Török, Marietta; Timofte, Delia; Orosz, Attila; Kosicki, Andrzej; Całka, Alicja; Moro, Daniela; Kosa, Dezider; Redl, Jenö; Qureshi, Abdul Rashid; Divino-Filho, Jose Carolino

    2016-01-01

    Introduction Integrated Care Settings (ICS) provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT), offering at least both types of dialysis. Objectives To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics. Methods Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start. Results Modality information (80% of patients) and renal education (87%) were more frequent (p<0.001) in Planned (P) than in Non-Planned (NP) start. Median time from information to dialysis start was 2 months. 89% of patients started on hemodialysis, 49% were referred late to ICS (<3 months from referral to RRT) and 58% were NP start. Late referral, non-vascular renal etiology, worse clinical status, shorter time from information to RRT and less peritoneal dialysis (PD) were associated with NP start (p<0.05). In multivariate logistic regression analysis, P start (p≤0.05) was associated with early referral, eGFR >8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. “Optimal care,” defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%. Conclusions Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD. PMID:27228101

  4. Residence, delivery and referral patterns of infants and fetuses with birth defects delivered in Hawaii, 1986-1999.

    PubMed

    Forrester, M B; Merz, R D

    2003-03-01

    Information on residence, delivery and referral patterns is useful to a birth defects program for allocation of resources, predicting where deliveries may have occurred, and estimating the impact of altering geographic inclusion criteria. The purpose of this study was to describe the residence, delivery and referral patterns for infants and fetuses with birth defects delivered in Hawaii. Data were obtained from the Hawaii Birth Defects Program and included birth defects cases delivered between 1986 and 1999 with known delivery residence and place of delivery. Of 12,873 total cases, 171 (1%) were delivered to out-of-state residents. Of the remaining 12,702 cases delivered to residents in the four Counties of Hawaii, 9905 (78%) were to City and County of Honolulu residents and 2797 (22%) were to residents of Hawaii, Kauai and Maui Counties. Of the cases delivered to City and County of Honolulu residents, 9903 were delivered in that County. Of the cases delivered to residents of the other three Counties, 591 (21%) were referred to the City and County of Honolulu for delivery, and 1602 (57%) were referred to the City and County of Honolulu for any reason. Honolulu delivery referral rates and total referral rates for cases delivered to Hawaii, Kauai and Maui County residents were higher with prenatal diagnosis of a birth defect (59 and 87%, respectively) and elective termination (70 and 85%, respectively), and varied among 53 different types of birth defect (0-83% and 23-100%, respectively). PMID:12802980

  5. 12 CFR 308.136 - Notice to and consultation with the Securities and Exchange Commission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... proceedings are to be initiated, and the nature of and basis for the proposed action; and (b) Consult with the... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Notice to and consultation with the Securities and Exchange Commission. 308.136 Section 308.136 Banks and Banking FEDERAL DEPOSIT...

  6. Patterns of Risk in Adult Protection Referrals for Sexual Abuse and People with Intellectual Disability

    ERIC Educational Resources Information Center

    Cambridge, Paul; Beadle-Brown, Julie; Milne, Alisoun; Mansell, Jim; Whelton, Beckie

    2011-01-01

    Background: Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods: Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual…

  7. Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

    ERIC Educational Resources Information Center

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

    The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

  8. A National Survey of U.S. Internists’ Experiences with Ethical Dilemmas and Ethics Consultation

    PubMed Central

    DuVal, Gordon; Clarridge, Brian; Gensler, Gary; Danis, Marion

    2004-01-01

    OBJECTIVE To identify the ethical dilemmas that internists encounter, the strategies they use to address them, and the usefulness of ethics consultation. DESIGN National telephone survey. SETTING Doctors’ offices. PARTICIPANTS General internists, oncologists, and critical care/pulmonologists (N = 344, 64% response rate). MEASUREMENTS Types of ethical dilemmas recently encountered and likelihood of requesting ethics consultation; satisfaction with resolution of ethical dilemmas with and without ethics consultation. RESULTS Internists most commonly reported dilemmas regarding end-of-life decision making, patient autonomy, justice, and conflict resolution. General internists, oncologists, and critical care specialists reported participating in an average of 1.4, 1.3, and 4.1 consultations in the preceding 2 years, respectively (P < .0001). Physicians with the least ethics training had the least access to and participated in the fewest ethics consultations; 19% reported consultation was unavailable at their predominant practice site. Dilemmas about end-of-life decisions and patient autonomy were often referred for consultation, while dilemmas about justice, such as lack of insurance or limited resources, were rarely referred. While most physicians thought consultations yielded information that would be useful in dealing with future ethical dilemmas (72%), some hesitated to seek ethics consultation because they believed it was too time consuming (29%), might make the situation worse (15%), or that consultants were unqualified (11%). CONCLUSIONS While most internists recall recent ethical dilemmas in their practices, those with the least preparation and experience have the least access to ethics consultation. Health care organizations should emphasize ethics educational activities to prepare physicians for handling ethical dilemmas on their own and should improve the accessibility and responsiveness of ethics consultation when needed. PMID:15009780

  9. Final Report to the National Commission on Libraries and Information Science from the Community Information and Referral Services Task Force.

    ERIC Educational Resources Information Center

    National Commission on Libraries and Information Science, Washington, DC.

    This report describes the work of the Community Information and Referral (CI&R) Services Task Force, which was appointed by the National Commission on Libraries and Information Science (NCLIS) to investigate the status of CI&R in libraries and social service agencies and to make recommendations regarding the appropriate role for libraries in the…

  10. Integrating screening, brief intervention and referral to treatment (SBIRT) into an abortion clinic: an exploratory study of acceptability.

    PubMed

    Appel, Lindsay; Ramanadhan, Shaalini; Hladky, Katherine; Welsh, Chris; Terplan, Mishka

    2015-04-01

    Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6, respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use. PMID:25596511

  11. Developing and Implementing a Multispecialty Graduate Medical Education Curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT)

    ERIC Educational Resources Information Center

    Tetrault, Jeanette M.; Green, Michael L.; Martino, Steve; Thung, Stephen F.; Degutis, Linda C.; Ryan, Sheryl A.; Martel, Shara; Pantalon, Michael V.; Bernstein, Steven L.; O'Connor, Patrick G.; Fiellin, David A.; D'Onofrio, Gail

    2012-01-01

    The authors sought to evaluate the feasibility and acceptability of initiating a Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol and other drug use curriculum across multiple residency programs. SBIRT project faculty in the internal medicine (traditional, primary care internal medicine, medicine/pediatrics),…

  12. 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

  13. Teaching the Teachers: Faculty Preparedness and Evaluation of a Retreat in Screening, Brief Intervention, and Referral to Treatment

    ERIC Educational Resources Information Center

    Childers, Julie W.; Broyles, Lauren M.; Hanusa, Barbara H.; Kraemer, Kevin L.; Conigliaro, Joseph; Spagnoletti, Carla; McNeil, Melissa; Gordon, Adam J.

    2012-01-01

    Effective clinical faculty are essential for disseminating substance abuse screening, brief intervention, and referral to treatment (SBIRT). The authors developed an 8-hour SBIRT training for internal medicine faculty preceptors. Trainers conducted SBIRT lectures and small-group communication practice sessions. The authors assessed participants'…

  14. Patterns in Referral and Admission to Vocational Rehabilitation Associated with Coexisting Psychiatric and Substance-Use Disorders.

    ERIC Educational Resources Information Center

    Drebing, Charles E.; Rosenheck, Robert; Schutt, Russell; Kasprow, Wesley J.; Penk, Walter

    2003-01-01

    Studies homeless adults entering the Healthcare for Homeless Veterans program to identify whether the rate of referral and admission to vocational rehabilitation differed between adults with psychiatric disorders and those with a coexisting substance-use disorder (SUD). Participants with an SUD had an 11% greater chance of being referred to…

  15. Increasing Teacher Delivery of Contingent Praise and Contingent Materials using Consultant Feedback and Praise.

    ERIC Educational Resources Information Center

    Mace, F. Charles; And Others

    1983-01-01

    The purpose of the present study was to (1) broaden the range of teacher behaviors to include both the use of contingent praise and contingent educational materials; (2) present a procedure efficent in terms of demands on teacher and consultant time; and (3) illustrate the delivery of services using a behavioral consultation model. (BW)

  16. 22 CFR 161.11 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... may have effects in the United States on listed species or their habitat. As appropriate, written request for consultation, along with the draft environmental document, shall be conveyed by the Office...

  17. Improving Teaching and Learning in Higher Education: Metaphors and Models for Partnership Consultancy

    ERIC Educational Resources Information Center

    Morrison, Keith

    2003-01-01

    The management of partnerships with external consultants is discussed with reference to seven metaphors of partnership, illuminated by an external consultancy review of teaching and learning in a University Language Centre. Shortcomings are shown in each of the seven metaphors. A model of partnership is advocated, based on Habermas' principles of…

  18. Teacher Characteristics Associated with Responsiveness and Exposure to Consultation and Online Professional Development Resources

    ERIC Educational Resources Information Center

    Downer, Jason T.; Locasale-Crouch, Jennifer; Hamre, Bridget; Pianta, Robert

    2009-01-01

    Research Findings: This article is a natural follow-up to intent-to-treat findings indicating that the MyTeachingPartner Consultancy, inclusive of online video resources and Web-mediated consultation, improved the quality of pre-K teachers' interactions with children. This study takes a close look at implementation fidelity within the effective…

  19. Fetal alcohol spectrum disorders: guidance for recognition, diagnosis, differential diagnosis and referral.

    PubMed

    Senturias, Yasmin; Asamoah, Alexander

    2014-04-01

    FASDs are the most common preventable cause of developmental and intellectual disabilities in the United States and yet can easily be overlooked in pediatric and adolescent practices. Early diagnosis, presence of developmental and educational services, and a nurturing home environment have been associated with decreased occurrence of secondary disabilities such as substance use and criminal involvement.23 Therefore, it is important for providers to know how to go about the identification, diagnostic, and evaluation process. Pediatric care clinicians should be knowledgeable about the diagnostic criteria for fetal alcohol syndrome and know common differentiating conditions. Furthermore, they should be able to recognize other disorders on the spectrum, and in doing so, they should facilitate appropriate referral, initial management, and coordination of care. PMID:24810411

  20. 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