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Sample records for academic tertiary referral

  1. 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

  2. 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…

  3. Epidemic keratoconjunctivitis outbreak at a tertiary referral eye care clinic.

    PubMed

    Montessori, V; Scharf, S; Holland, S; Werker, D H; Roberts, F J; Bryce, E

    1998-08-01

    An outbreak of epidemic keratoconjunctivitis (EKC) occurred at a tertiary referral eye care clinic between late September and mid-November 1995. Before the outbreak, instruments were cleaned with 70% isopropyl alcohol and handwashing between patients was not routine. Infection control measures were implemented when the outbreak was recognized in mid-October. Control measures included triaging suspected cases to a separate waiting area, cohorting cases to a specific examining room, endorsing the use of gloves and handwashing during examinations of patients, and cleaning instruments with a buffered bleach solution. Thirty-six cases were diagnosed before the infection control measures were taken, and 3 cases were seen after the control measures were taken. Also, numerous secondary cases occurred in the community. No additional cases were diagnosed from DEcember to February 25, 1996. Acquisition of the infection was linked to visits to 4 of 20 physicians in the eye clinic with 61% of cases associated with visits to 1 of those 4 physicians. The use of diagnostic lenses applied directly to the eye was associated with infection (odds ratio = 2.83, 95% confidence interval = 0.79 to 10.4), although this did not reach statistical significance. The use of tonometers, ophthalmic solutions, or laser therapy was not associated with infection, and all environmental cultures were negative. This outbreak emphasizes the need for implementation of routine infection control guidelines to prevent nosocomial transmission of epidemic keratoconjunctivitis and stresses the need for appropriate disinfection of instruments. PMID:9721392

  4. Epidemiology of Pseudomonas aeruginosa in a tertiary referral teaching hospital.

    PubMed

    Bradbury, R S; Champion, A C; Reid, D W

    2009-10-01

    A genotypically indistinguishable strain of Pseudomonas aeruginosa (Australian epidemic strain III: AES III) has previously been found in a proportion of adults with cystic fibrosis (CF) in Tasmania, Australia. The aim of this study was to identify a source of these infections within the major tertiary referral hospital for the State of Tasmania, and to determine if this strain could be isolated from settings other than the CF lung. A total of 120 isolates of P. aeruginosa were collected from clinical and environmental sources within the hospital and from environmental locations in the hospital vicinity. These isolates were genotyped by random amplification of polymorphic DNA (RAPD)-polymerase chain reaction (PCR) and antimicrobial susceptibility testing was performed using the Clinical and Laboratory Standards Institute method. Confirmation of similar genotypes identified by RAPD-PCR was performed using pulsed-field gel electrophoresis with restriction enzyme SpeI. AES III was not recovered from any source other than the respiratory secretions of CF patients. P. aeruginosa in the non-CF settings was found to be panmictic, and no cross-infection or acquisition of hospital environment strains by patients was observed. PMID:19699556

  5. Infantile Marfan syndrome in a Korean tertiary referral center

    PubMed Central

    Seo, Yeon Jeong; Lee, Ko-Eun; Kwon, Bo Sang; Bae, Eun Jung; Noh, Chung Il

    2016-01-01

    Purpose Infantile Marfan syndrome (MFS) is a rare congenital inheritable connective tissue disorder with poor prognosis. This study aimed to evaluate the cardiovascular manifestations and overall prognosis of infantile MFS diagnosed in a tertiary referral center in Korea. Methods Eight patients diagnosed with infantile MFS between 2004 and 2014 were retrospectively evaluated. Results Their median age at the time of diagnosis was 2.5 months (range, 0–20 months). The median follow-up period was 25.5 months (range, 0–94 months). The median length at birth was 50.0 cm (range, 48–53 cm); however, height became more prominent over time, and the patients were taller than the 97th percentile at the time of the study. None of the patients had any relevant family history. Four of the 5 patients who underwent DNA sequencing had a fibrillin 1 gene mutation. All the patients with echocardiographic data of the aortic root had a z score of >2. All had mitral and tricuspid valve prolapse, and various degrees of mitral and tricuspid regurgitation. Five patients underwent open-heart surgery, including mitral valve replacement, of whom two required multiple operations. The median age at mitral valve replacement was 28.5 months (range, 5–69 months). Seven patients showed congestive heart failure before surgery or during follow-up, and required multiple anti-heart failure medications. Four patients died of heart failure at a median age of 12 months. Conclusion The prognosis of infantile MFS is poor; thus, early diagnosis and timely cautious treatment are essential to prevent further morbidity and mortality. PMID:26958064

  6. Improving medical SHO weekend handover at a tertiary referral centre.

    PubMed

    Curtis, Olivia; Fisher, Rachel

    2013-01-01

    The GMC states that, 'You must be satisfied that, when you are off duty, suitable arrangements have been made for your patients' medical care…including effective hand-over procedures' [1]. The medical weekend handover system at this tertiary referral centre involved multiple pieces of paper with no clear list of tasks, and no way to identify critically unwell patients. Patients could be missed from the ward round or could be difficult to identify under pressure. The authors felt this process could pose a threat to patient safety so decided to improve it. A questionnaire was distributed to all 11 medical SHOs with 100% response rate. Results showed that 72% thought the process was unstructured, 81% did not think the process was always safe, and 100% thought it could be improved. After discussions with senior medical management and with the approval of the trust audit committee, a new weekend handover proforma was designed, taking into consideration the results and comments from the questionnaire. The new proforma is accessible through a shared drive, which can be accessed by all medical SHOs in the hospital. Each team is able to copy their patients onto the combined ward-based list. There are columns for specific weekend jobs and registrar/SHO reviews. Any potentially unwell patients are highlighted in bold and discussed with the on-call SHO on Friday. All medical SHOs were given a post-implementation questionnaire after the new handover process had been in place for two months. Results of this showed that 100% of SHOs felt an improvement had been made, with 100% stating that the new system was more structured (64% always, 36% most of the time). The SHO's perception of patient safety increased from 81% generally unsafe, to 100% generally safe. The new handover has been well received and supported by the current SHO cohort. Improvements in the structure of handover have been made with perceived improvements in patient safety. Due to the success of the system, the

  7. 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

  8. An analysis of paramilitary referrals to psychiatric services at a tertiary care center

    PubMed Central

    Verma, Rohit; Mina, Shaily; Deshpande, Smita N.

    2013-01-01

    Background: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. Materials and Methods: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. Results: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. Conclusion: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the

  9. 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

  10. 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

  11. 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

  12. Chest imaging features of patients afflicted with Influenza A (H1N1) in a Malaysian tertiary referral centre

    PubMed Central

    Bux, SI; Mohd. Ramli, N; Ahmad Sarji, S; Kamarulzaman, A

    2010-01-01

    This is a retrospective descriptive study of the chest imaging findings of 118 patients with confirmed A(H1N1) in a tertiary referral centre. About 42% of the patients had positive initial chest radiographic (CXR) findings. The common findings were bi-basal air-space opacities and perihilar reticular and alveolar infiltrates. In select cases, high-resolution computed tomography (CT) imaging showed ground-glass change with some widespread reticular changes and atelectasis. PMID:21611071

  13. Clinical features of infectious keratitis at a tertiary referral center in a rural area of Korea

    PubMed Central

    Lee, Seung-Jun; Lee, Jang Hun; Kim, Moosang; Han, Sang Beom; Hyon, Joon Young

    2015-01-01

    Purpose To evaluate clinical features of infectious keratitis at a tertiary referral center in a rural area of Korea. Results This was a retrospective study. Medical records of 70 patients who were diagnosed with infectious keratitis and underwent corneal culture were reviewed. Data including demographics, predisposing factors, and microbiological profiles were collected and analyzed. Results Age distribution showed one peak at sixth and seventh decade, and 48 patients (68.6%) were ≥50 years old. The male to female ratio was 43 (61.4%):27 (38.6%). Ocular surface disease was the most frequently found (48 cases, 68.6%). Gram-positive bacteria were most common (ten patients, 66.7%), followed by Gram-negative bacteria (three patients, 20%) and fungi (two patients, 13.3%). In this study, 34.3% of patients were treated by at least one topical antimicrobial before culture. Patients who received topical therapy before culture showed positive culture rate of 16.7%, and patients who underwent corneal culture without topical antibiotics showed positive culture rate of 23.9%. However, there was no statistically significant difference between the two groups in positive culture rate (P=0.554). Conclusion The proportions of the elderly and male patients were higher than the young and female patients, respectively. Gram-positive bacteria were the most common pathogens, and ocular surface disease was the most common predisposing factor. PMID:26675320

  14. Is vitamin D testing at a tertiary referral hospital consistent with guideline recommendations?

    PubMed

    Norton, Katherine; Vasikaran, Samuel D; Chew, Gerard T; Glendenning, Paul

    2015-06-01

    To determine if 25 hydroxyvitamin D (25OHD) testing at our tertiary referral hospital is consistent with guideline recommendations concerning the clinical indications for testing, the timing of repeat testing and utilisation of the test result, we conducted a retrospective audit of electronic laboratory and patient case records. We included adult inpatients and outpatients who had serum 25OHD measured during a randomly selected one-week audit period and who had patient case records available for detailed review. The audit sample comprised 184 serum 25OHD measurements (134 initial and 50 repeat tests). There were 81 (60%) initial and 15 (30%) repeat tests [96 (52%) overall] that were consistent with guideline recommendations concerning clinical indication, timing of repeat testing and utilisation of result. Almost half the 25 hydroxyvitamin D tests audited were potentially unnecessary and/or not utilised clinically. Improved adherence to guideline recommendations for 25 hydroxyvitamin D testing, utilisation of test results and enforcement of new indications for testing due to be introduced by Medicare Australia could result in significant cost savings without adversely affecting patient outcomes. PMID:25938355

  15. Impact of Institution of a Stroke Program upon Referral Bias at a Rural Academic Medical Center

    ERIC Educational Resources Information Center

    Riggs, Jack E.; Libell, David P.; Brooks, Claudette E.; Hobbs, Gerald R.

    2005-01-01

    Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a…

  16. 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…

  17. Impact of Institution of a Stroke Program Upon Referral Bias at a Rural Academic Medical Center

    ERIC Educational Resources Information Center

    Riggs, Jack E.; Libell, David P.; Brooks, Claudette E.; Hobbs, Gerald R.

    2005-01-01

    Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a…

  18. Early onset degenerative dementias: demographic characteristics and etiologic classification in a tertiary referral center.

    PubMed

    Maiovis, Pantelis; Ioannidis, Panagiotis; Konstantinopoulou, Elina; Karacostas, Dimitris

    2015-03-01

    Early onset dementia (EOD) is a major diagnostic challenge as it often presents with atypical features and may be attributed to treatable diseases. Primary degenerative dementias (Alzheimer's disease-AD, frontotemporal lobar degeneration-FTLD, Lewy body dementia-LBD), although traditionally considered to affect older people, are still a main cause of EOD. 491 demented patients were assessed from January 1, 2003 to December 31, 2010 in the Neurology Department of a tertiary referral center. Patients were classified as AD, behavioral variant frontotemporal dementia (bvFTD), non-fluent agrammatic variant primary progressive aphasia (naPPA), semantic variant PPA (svPPA), corticobasal degeneration (CBD), or progressive supranuclear palsy (PSP) who also met criteria for naPPA and LBD. Finally, their demographic characteristics were analysed, according to age at onset (EOD <65 years, late onset dementia-LOD ≥65 years). From the 491 patients, 137 (27.9 %) were EOD. In the EOD group, 52 (38 %) were diagnosed with bvFTD, 34 (24.8 %) with AD, 27 (19.7 %) with naPPA, 10 (7.2 %) with svPPA, 12 (8.8 %) with CBD or PSP, and 2 (1.5 %) with LBD. Demographic characteristics did not differ significantly among diagnostic categories in the EOD group, while in the LOD group FTLD patients were younger and more frequently men compared to both AD and LBD patients. EOD patients had more years of education than LOD patients. Degenerative disorders as causes of EOD are not rare. High clinical alertness is warranted to achieve correct and timely diagnosis. PMID:24878660

  19. Indications for Corneal Transplantation at a Tertiary Referral Center in Tehran

    PubMed Central

    Zare, Mohammad; Javadi, Mohammad-Ali; Einollahi, Bahram; Baradaran-Rafii, Alireza; Ghanavati, Siamak Zarei; Farsani, Mohammad-Reza Jamshidi; Mohammadi, Parviz; Feizi, Sepehr

    2010-01-01

    Purpose To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Methods Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. Results During this period, 776 eyes of 756 patients (including 504 male subjects) with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8%) followed by bullous keratopathy (n=90, 11.6%), non-herpetic corneal scars (n=62, 8.0%), infectious corneal ulcers (n=61, 7.9%), previously failed grafts (n=61, 7.9%), endothelial and stromal corneal dystrophies (n=28, 3.6%), and trachoma keratopathy (n=26, 3.3%). Other indications including Terrien’s marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%), deep anterior lamellar keratoplasty (n=108, 13.9%), conventional lamellar keratoplasty (n=44, 5.7%), automated lamellar therapeutic keratoplasty (n=8, 1.0%), and Descemet stripping endothelial keratoplasty (n=6, 0.8%) in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. Conclusion In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium. PMID:22737335

  20. Evaluation of Unpreparedness When Issuing Copies of Medical Records in Tertiary Referral Hospitals

    PubMed Central

    Moon, Myong-Mo; Seo, Sun-Won; Park, Woo-Sung; Kim, Yoon; Kim, Sung-Soo; Choi, Eun-Mi; Park, Jong; Park, Il-Soon

    2010-01-01

    Objectives As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. Methods The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. Results The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. Conclusions The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information. PMID:21818431

  1. Clinicopathological predictive factors in the early remission of corticotroph pituitary macroadenomas in a tertiary referral centre

    PubMed Central

    Witek, Przemysław; Zieliński, Grzegorz; Szamotulska, Katarzyna; Maksymowicz, Maria; Kamiński, Grzegorz

    2016-01-01

    Objective Corticotroph macroadenomas are a rare cause of Cushing's disease (CD), but their properties are not well-recognised. The aim of this study was to evaluate the clinical and pathological aspects of corticotroph macroadenomas with particular emphasis on proliferation markers and their associations with the efficacy of surgical treatment. Design A prospective cohort study was conducted in a tertiary referral centre in Poland. Methods In total, 59 patients with CD (20 macroadenomas and 39 microadenomas) were included in this study. Hormonal and imaging parameters, histopathological and ultrastructural features of the corticotroph tumours and the early surgical outcomes were evaluated. Results ACTH and ACTH/cortisol ratios were higher in macroadenomas (P<0.001 and P=0.002 respectively). Greater tumour volumes were associated with higher Ki-67 and p53 expression (Ptrend=0.009 and Ptrend=0.024 respectively) and the rates of sparsely granulated adenomas (Ptrend=0.036). Immediate postoperative remission and early biochemical remission rates were lower in macroadenomas compared to microadenomas (P<0.001). A logistic regression model showed that the immediate postoperative remission or early biochemical remission depended on tumour volume (P=0.005 and P=0.006 respectively) and invasiveness based on Knosp grades 3 and 4 for macroadenomas and a lack of surgical pseudocapsule for microadenomas (P=0.004 and P=0.007 respectively). Conclusion Corticotroph macroadenomas differ from the more common microadenomas not only in terms of hormonal and imaging characteristics but also in terms of immunohistochemical and ultrastructural features and proliferation markers. The early effectiveness of surgery depends primarily on tumour volume and invasiveness. PMID:26811407

  2. A Comparison of Career Success between Graduates of Vocational and Academic Tertiary Education

    ERIC Educational Resources Information Center

    Backes-Gellner, Uschi; Geel, Regula

    2014-01-01

    This paper analyses whether tertiary education of different types, i.e., academic or vocational tertiary education, leads to more or less favorable labor market outcomes. We study the problem for Switzerland, where more than two thirds of the workforce gain vocational secondary degrees and a substantial number go on to a vocational tertiary degree…

  3. 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…

  4. The quality of life of people with epilepsy at a tertiary referral centre in Malaysia

    PubMed Central

    2013-01-01

    Background Epilepsy, a chronic disorder of brain characterised by a predisposition to generate epileptic seizures, has an effect on the psychosocial well-being of sufferers. Measuring the quality of life (QOL) of people with epilepsy (PWE) is increasingly recognized as an important component of clinical management. QOL measures differ between countries and there is limited information regarding PWE in Malaysia. The aim of this study was to determine the health related QOL and its relationship with the presence of seizures in PWE at a Malaysian tertiary referral center. Methods A total of 106 adults with epilepsy attending the weekly neurology clinic of Universiti Sains Malaysia Hospital were interviewed in this cross-sectional study. The QOL was measured using a validated Malay translated version of the Quality of Life in Epilepsy Scale-31 (QOLIE-31). Analysis of covariance was used for data analysis. Results The mean age was 31.8 years old (standard deviation (SD) 11.0) and 56.6% were females. The mean total score of QOLIE-31was 68.9 (SD 15.9). The highest subscale score was the medication effects with a mean of 79.4 (SD 28.5) and the lowest was seizure worry with 47.5 (SD 25.0). Respondents who had one or more seizures in the past four weeks had significantly lower mean score of QOL [63.4, 95% CI: 59.2, 67.5] than those who had no seizure [mean score 73.5, 95% CI: 69.3, 77.9] after adjusting for age, sex, treatment, duration and age at onset of epilepsy [F test =11.215, p = 0.001, R2 = 0.159]. All the sub-scales of QOL showed significant moderate correlation with the frequency of seizures except for cognitive functioning. Conclusions Worrying about seizure had the major contribution on QOL, while medication effect had the least. This study confirms the importance of seizure control for a better QOL in Malaysian patients with epilepsy. PMID:23972031

  5. Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS): Experience at a Tertiary Referral Center

    PubMed Central

    Helm, Caitlin E.; Blackwood, R. Alexander

    2015-01-01

    Background Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is an autoimmune disorder presenting with obsessive compulsive disorder and/or tics. Like Sydenham’s chorea, its presumed pathogenesis consists of autoantibodies cross-reacting with neurons in response to a group A beta-hemolytic streptococcal infection (GASI). There are currently no diagnostic laboratory findings and management ranges from antibiotic prophylaxis to intravenous immunoglobulin to plasmapheresis. The diagnosis remains controversial, resulting in inconsistent referrals and significant patient anxiety. Methods A retrospective study was performed on all patients referred to the Pediatric Infectious Disease Division with a pre-referral diagnosis of PANDAS. Patients were analyzed by demographics, medical history, co-morbidities, symptoms, prior treatment, laboratory tests, management strategies, and treatment outcomes. Results From 2003 to 2013, there were 21 patients with a pre-referral diagnosis of PANDAS. Only five met the diagnostic criteria. No patient at referral had an objective scale to monitor symptoms. Eight referrals had a major psychiatric disorder, and none fulfilled diagnostic criteria (p<0.01). Discussion The majority of the patients referred with a pre-diagnosis of PANDAS do not fulfill diagnostic criteria nor do they have objective criteria for symptom monitoring. Major psychiatric disorders do not seem to be associated with PANDAS, and better physician education may prevent misdiagnoses. Multidisciplinary management is recommended. PMID:26196024

  6. Peace Management and Enhanced Academic Performance of Tertiary Institutions in South-South Nigeria

    ERIC Educational Resources Information Center

    Ebuara, Victor Obule; Ekpoh, Uduak Imo

    2011-01-01

    This study was embarked upon with a view to examining the need for peace in the management of tertiary institutions towards enhancing academic performance in south-south Nigeria. Three hypotheses and one research question guided the study. One thousand, two hundred and nineteen (1219) academic and non-academic staff were selected for the study. A…

  7. Reoperations for Persistent or Recurrent Primary Hyperparathyroidism: Results of a Retrospective Cohort Study at a Tertiary Referral Center

    PubMed Central

    Nawrot, Ireneusz; Chudziński, Witold; Ciąćka, Tomasz; Barczyński, Marcin; Szmidt, Jacek

    2014-01-01

    Background Parathyroid reoperations are challenging and achieving a cure requires multidisciplinary treatment team cooperation. The aims of this study were to summarize our experience in revision surgery for persistent (pHPT) or recurrent primary hyperparathyroidism (rHPT) and to explore factors underlying failure to cure at initial surgery. Material/Methods This was a retrospective cohort study of patients who underwent reoperations for pHPT or rHPT at a tertiary referral center. The database of parathyroid surgery was searched for eligible patients (treated in the years 2000–2012). The primary outcome was the cure rate. All the patients were followed-up for at least 12 months postoperatively. Factors underlying failure to cure at initial surgery were reviewed based on hospital records. Results The study group comprised 88 patients (69 women, 19 men) operated on for persistent (n=57) or recurrent disease (n=31), who underwent 98 reoperations, including 26 (2.4%) patients first operated on at our institution, and 72 (81.8%) patients operated on elsewhere, but referred for revision surgery. A long-term cure was achieved in 83/88 patients (94.3%). The mean post-reoperation follow-up was 91.7 (12–176) months. Missed hyperfunctioning parathyroid gland was found on reoperation in eutopic position in 49 (55.5%) patients, and in ectopic position in 39 (44.3%) patients, including 20 (22.7%) cases of cervical ectopy and 19 (21.6%) cases of mediastinal ectopy. Conclusions Multidisciplinary treatment team cooperation at a tertiary referral center, consisting of an accurate preoperative localization, expertise in parathyroid re-explorations, and correct use of intraoperative adjuncts, contribute to the high success rate of parathyroid reoperations. PMID:25201515

  8. Morbidity and mortality of endoscopist-directed nurse-administered propofol sedation (EDNAPS) in a tertiary referral center

    PubMed Central

    Ooi, Marie; Thomson, Andrew

    2015-01-01

    Background and study aims: Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) has been evaluated in community settings rather than tertiary referral centers. Patients and methods: A hospital-wide prospectively collected database of Medical Emergency Team Calls (METCALL), emergency responses triggered by medically unstable patients, was reviewed. Responses that followed EDNAPS were extracted and compared with a prospectively entered database of all endoscopies performed using EDNAPS over the same period. Results: A total of 33,539 endoscopic procedures (16,393 gastroscopies, 17,146 colonoscopies) were performed on 27,989 patients using EDNAPS. Intravenous drugs included midazolam (0 – 5 mg), fentanyl (0 – 100 mcg), and propofol (10 – 420 mg). Of 23 METCALLs (18 gastroscopies and 5 colonoscopies), there were 16 with ASA scores of III or higher. Indications for gastroscopy were gastrointestinal (GI) hemorrhage (n = 11; 8 variceal, 3 nonvariceal), dysphagia (n = 5), PEG removal (n = 1), and dyspepsia (n = 1). Fifteen of 22 patients, including all of those who had a colonoscopy, made a full recovery and returned to the ward or were discharged home. In the gastroscopy group, seven were intubated and admitted to Intensive Care, of whom six were emergency cases for gastrointestinal bleeding (n = 4 variceal, n = 2 non variceal) and one in which the indication was PEG removal. Two deaths occurred in the intubated group. Conclusions: In a tertiary referral center, EDNAPS for low-to-moderate risk (ASA ≤ 2) patients undergoing gastroscopy and colonoscopy is very safe. Gastroscopy is associated with greater anesthetic risk than colonoscopy and those with high ASA scores needing urgent endoscopy for upper gastrointestinal hemorrhage are at particular risk of cardiorespiratory decompensation. PMID:26528490

  9. The Impact of HECS Debt on Australian Students' Tertiary Academic Performance

    ERIC Educational Resources Information Center

    Birch, Elisa R.; Miller, Paul W.

    2006-01-01

    The Australian literature suggests that students' academic success in tertiary education is principally influenced by their university entrance score. Personal, secondary school and university characteristics have more minor impacts on tertiary outcomes. Little research has been undertaken into the relationship between students' marks and the…

  10. Tracking emergency department overcrowding in a tertiary care academic institution.

    PubMed

    Bullard, Michael J; Villa-Roel, Cristina; Bond, Kenneth; Vester, Michael; Holroyd, Brian R; Rowe, Brian H

    2009-01-01

    Despite the release of a national report describing key markers of emergency department (ED) overcrowding, limited linear data using these markers have been published. We sought to report the degree and trends of ED overcrowding in a typical academic hospital and to highlight some of the key markers of ED patient flow and care. We conducted a prospective study in a large Canadian urban tertiary care teaching hospital that receives approximately 55,000 annual adult ED visits. A database captured demographic and real-time process of care data for each patient from 2000 to 2007. Descriptive data are reported using Canadian Triage and Acuity Scale (CTAS) scores. Over the study period, the ED patient visit volume and presentation times remained predictable. Emergent cases (CTAS levels 1-2) doubled from 8 to 16.6%, and urgent cases (CTAS level 3) increased from 40.2 to 50.3%. Moreover, semi-urgent presentations (CTAS level 4) decreased from 42.4 to 28.8%, and non-urgent cases (CTAS level 5) dropped from 9.4 to 4.3%. The median wait time from triage to bed location increased from two minutes (inter-quartile range [IQR] 1, 46) in 2000 to 27 minutes (IQR 2, 110) in 2007, while the median time from bed location to physician remained constant (29 minutes in 2001 versus 28 minutes in 2007). Overall, admissions increased from 20.4 to 23%. Semi-urgent and non-urgent admissions dropped from 11.5 to 7.4% and 3.2 to 1.8%, respectively. Admitted patients "boarding" in the ED increased from 70,955 hours in 2002 to 118,741 hours in 2007, while the number of emergent and urgent patients leaving without being seen increased by more than 400%. ED overcrowding in a tertiary care hospital is primarily a result of access block due to boarding admitted patients, a situation that poses serious risks to the majority of patients who have emergent or urgent conditions that cannot be managed appropriately in the waiting room. PMID:19553772

  11. Iatrogenic Biliary Injuries: Multidisciplinary Management in a Major Tertiary Referral Center

    PubMed Central

    Salama, Ibrahim Abdelkader; Shoreem, Hany Abdelmeged; Saleh, Sherif Mohamed; Hegazy, Osama; Housseni, Mohamed; Abbasy, Mohamed; Badra, Gamal; Ibrahim, Tarek

    2014-01-01

    Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center. PMID:25435672

  12. Chalkface Challenges: A Study of Academic Dishonesty amongst Students in New Zealand Tertiary Institutions

    ERIC Educational Resources Information Center

    de Lambert, Kelly; Ellen, Nicky; Taylor, Louise

    2006-01-01

    This paper presents the findings of two investigations into the prevalence and profile of academic dishonesty amongst students in New Zealand's tertiary institutions and compares this with findings from other studies. Staff and students report on their personal experiences of academic dishonesty and these are compared with official information…

  13. Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

    PubMed Central

    Swan, Michael P; Bourke, Michael J; Williams, Stephen J; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

  14. The effects of booking body mass index on obstetric and neonatal outcomes in an inner city UK tertiary referral centre

    PubMed Central

    Chereshneva, Maria; Hinkson, Larry; Oteng-Ntim, Eugene

    2008-01-01

    The aim of the study was to investigate the effects of booking body mass index (BMI) on obstetric and neonatal outcomes in an inner city UK tertiary referral maternity centre. The Guy's and St Thomas' Maternity and Gynaecology (Terranova Healthware) Database was studied. All women that delivered at St Thomas' during 2005 with normal and high BMI were included in the study. Subjects were divided into three groups: BMI 19–24.9 (normal); 25–29.9 (overweight) and 30 or greater (obese). Groups were compared using Stata Statistical software. The study included 3642 patients: 2169 normal, 945 overweight and 528 obese. Both overweight and obese groups had a statistically significant association with gestational diabetes (odds ratio [OR] 5.7 and 11.6), hypertension in pregnancy (including preeclampsia [ORs 1.5 and 2.4], preterm rupture of membranes (ORs 3.7 and 5.0) and preterm delivery (ORs 1.4 and 1.6). The rate for caesarean delivery was increased in both overweight and obese women (ORs 1.4 and 1.7). Obesity is an independent risk factor for adverse obstetric outcomes and is significantly associated with caesarean section delivery.

  15. Pulmonary Sclerosing Pneumocytoma of the Lung: CT Characteristics in a Large Series of a Tertiary Referral Center

    PubMed Central

    Shin, So Youn; Kim, Mi Young; Oh, Sang Young; Lee, Hyun Joo; Hong, Soon Auck; Jang, Se Jin; Kim, Sung-Soo

    2015-01-01

    Abstract The purpose of this study is to describe the detailed clinical, chest computed tomography (CT), and 18F-fluorodeoxyglucose positron emission tomography (FDG PET) characteristics of the tumor boundary for the diagnosis and investigate the outcome of pulmonary sclerosing pneumocytoma (PSP) using confirmed large data of a tertiary referral center. Confirmed 76 patients were included. We evaluated the findings of CT including 4 CT signs, FDG PET, and histopathology. Most patients had a single lesion (92.1%), smooth boundary (65.8%), and oval shape (65.8%) and the mean diameter was 22.7 mm. The CT signs included marginal pseudocapsule (50%), overlying vessel (26.3%), air gap (2.6%), and halo sign (17.1%). A predominantly solid was the most common histopathologic type. The mean maximum standardized uptake value on FDG PET of 17 patients was 1.8 (range, near 0 or normal tissue metabolism ∼2.9). PSP should be considered in middle-aged women whose CT features show incidental nodule(s), commonly with surrounding ground-glass opacity and characteristic CT signs of the tumor boundary, and hypometabolic uptake on FDG PET. Outcome of patients is excellent. PMID:25634202

  16. Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014

    PubMed Central

    Altay, Yesim; Burcu, Ayse; Aksoy, Gozde; Ozdemir, Evin Singar; Ornek, Firdevs

    2016-01-01

    Background Indications for corneal transplantation in developed and developing nations differ according to the different spectrum of corneal disease in each country. Objective The purpose of this study is to analyze the changing indications and surgical techniques for corneal transplantation over the past 20 years at a tertiary referral center in Turkey. Methods We retrospectively reviewed the records of patients who underwent keratoplasty from January 1995 to December 2014 (between 1995 and 2004, period 1, and between 2005 and 2014, period 2). Patients’ demographic data, indications for corneal transplantation, and the type of surgery were recorded. Results The number of keratoplasties performed ranged from 548 in period 1 to 782 in period 2. Between 1995 and 2004, the leading indications were keratoconus (34.1%), bullous keratopathy (17%), and non-herpetic corneal scar (13.3%), and between 2005 and 2014, they were keratoconus (33.8%), corneal stromal dystrophy (14.2%), and bullous keratopathy (12.7%). All the keratoplasties performed in the 1995–2004 period were penetrating keratoplasty (PKP). During the period 2005–2014, PKP accounted for 93%, automated lamellar keratoplasty 5.8%, and deep anterior lamellar keratoplasty 1.2% of all corneal transplantations. Conclusion Keratoconus was the leading indication for keratoplasty in both periods. In the 2005–2014 period, corneal stromal dystrophy increased significantly. All the keratoplasties performed in period 1 and 93% of all keratoplasties performed in period 2 were PKP. PMID:27330270

  17. Demographic and Clinical Features of Pediatric Uveitis at a Tertiary Referral Center in Iran

    PubMed Central

    Rahimi, Mansour; Oustad, Marjan; Ashrafi, Afsaneh

    2016-01-01

    Purpose: To determine the clinical features and distribution of uveitis in the pediatric age group at a referral eye care center in Shiraz, South Iran. Materials and Methods: All new cases of uveitis in patients 18-year-old or younger referred from January 2007 to December 2013 were enrolled in this study. The patient underwent a complete history of systemic and ocular diseases, comprehensive ophthalmic examination. Patients were classified according to the International Uveitis Study Group definitions. The definitive diagnosis was based on clinical manifestations and laboratory investigations. Results: Seventy-seven eyes (54 patients) comprised the study sample. The mean age at the onset of uveitis was 12.5 years. The female-to-male ratio was 1.25. Anterior uveitis was the most frequent anatomical location (40.7%), followed by intermediate uveitis (33.3%), posterior uveitis (18.5%), and panuveitis (7.5%). Seventy-four percent of patients presented with chronic uveitis. Noninfectious uveitis (81.5%) was the most frequent etiology. Thirty-seven percent of patients had a specific diagnosis for uveitis, and 63% were classified as idiopathic cases. Toxocariasis was the most common infectious cause. Associated systemic diseases were present in 14.8% of patients. The most frequent systemic disease was juvenile idiopathic arthritis in 9.2% of patients. Complications occurred in 66 (85.5%) of affected eyes. The most common complications were posterior synechia (20.7%), cataract (18.8%), and cystoid macular edema (12.9%). Conclusions: Uveitis in the majority of children had an insidious onset and was chronic. Over half the patients had a specific diagnosis. Idiopathic cases were more common in the intermediate uveitis group. PMID:27555706

  18. Pattern of traumatic brain injury treated by general surgeons in a tertiary referral hospital.

    PubMed

    Chattopadhyay, Shankar Das; Karmakar, Nisith Chandra; Sengupta, Ritankar; SenGupta, Tamal Kanti; Ray, Debasis; Basus, Shibaji

    2013-09-01

    The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observational study was conducted in patients of head injury admitted through emergency in the department of general surgery in NRS Medical College, Kolkata during the year 2011 to determine the pattern of head injury patients admitted and nature of intervention. A total number of 3861 patients were admitted in a single year. Obviously this represents the tip of the iceburg. Traumatic brain injury was the highest in the age group of 31-40 years (33.5%) followed by 21-30 years (29.1%) in the most fruitful phase of life. The traumatic brain injury death was more common in males. The maximum number of cases was from rural areas ie, farmers and labours. To minimise the morbidity and mortality resulting from head injury there is need for better maintenance of roads, improvement of road visibility and lighting, rigid enforcement of traffic rules and imparting road safety education to school children. Despite valiant efforts and advancement in medical sciences and infrastructure in the form of neurosurgery departments and trauma care units to cope with the changing world of trauma, there still remains a huge responsibility and a definite part to be played by the general surgeons to manage head injury patient even in tertiary hospitals. PMID:24968524

  19. An Autopsy Study of Liver Injuries in a Tertiary Referral Centre of Eastern Nepal

    PubMed Central

    Subedi, Nuwadatta; Yadav, B.N.; Jha, Shivendra; Gurung, Sharmila; Pradhan, Amshu

    2013-01-01

    Background: Liver is the largest gland in the body and it frequently gets wounded. The objective of this study was to determine the patterns, types and severities of liver injuries which were caused by mechanical trauma and to study the organs associated with liver injuries. Material and Methods: This was a hospital based, cross sectional study which was conducted on the autopsies showing the evidence of liver injuries in the mortuary of a tertiary hospital in eastern Nepal. All consecutive autopsy cases which were handled within one year’s time (n=46) were included in our study. The cases were studied in detail for liver injuries, which included age, sex, severity, associated injuries, site of the injury, description of the injury, etc. Results: The mean age of the victims was 33.87 years and there was a male: female ratio of 3.6:1. The injuries had resulted from blunt trauma in 41 (89.1%) cases, the most common of which was road traffic accidents, constituting 37(80.4%) cases. Grade III injuries were seen in 14 (30.4%) cases. Laceration of the liver was the most frequent finding that was evident in 34 (73.9%) cases. Right lobe of the liver was injured in 30 (74%) cases. The sole presence of liver injuries among abdomino-pelvic organs was seen in 14 (30.4%) cases. In 40 (87%) cases, liver injuries were associated with other regional injuries. Conclusion: Laceration is the most common liver injury among autopsy cases. Right lobe is mostly affected and grade III injuries are the most common ones. Liver injuries are frequently associated with other abdomino-pelvic organs and multiple regional injuries. PMID:24086875

  20. Influence of Autoimmune Biomarkers on Interstitial Lung Diseases: a Tertiary Referral Center Based Case-Control Study

    PubMed Central

    Bauer, Philippe R.; Kalra, Sanjay; Osborn, Thomas G.; St. Sauver, Jennifer; Hanson, Andrew C.; Schroeder, Darrell R.; Ryu, Jay H.

    2015-01-01

    Background The benefit of routinely measuring autoimmune biomarkers to evaluate patients with interstitial lung disease (ILD) remains debated outside specific contexts such as connective tissue disease (CTD). This study aimed at evaluating the influence of biomarkers on outcome on patients with ILD in a case-control study at a tertiary referral center. We hypothesized that patients with positive autoimmune biomarkers have increased odds of developing ILD even in the absence of CTD. Methods We reviewed the medical records of 3573 patients seen at the ILD clinic in Mayo Clinic Rochester between September 2001 and September 2006. We assessed their clinical course through June 25, 2013. We included patients with patterns of ILD most often associated with CTD (n=1256) while excluding patients with other known causes of ILD. Controls (n=2317) included cases seen at the ILD clinic without evidence of ILD. Results We identified 930 (26%) cases of ILD alone, 124 (3%) CTD alone, 326 (9%) ILD combined with CTD, and 2193 (61%) with no ILD or CTD. Positive antinuclear antibodies (ANA), rheumatoid factor and aldolase were associated with ILD. After adjustment for age, gender, race, smoking history and CTD, ANA remained an independent risk factor for ILD (OR 1.70, 95% CI 1.33–2.17). Among patients with ILD, the presence of CTD but not biomarker alone was associated with a better survival. Conclusion In this study, the presence of positive biomarkers was associated with increased odds of ILD, even in the absence of overt CTD, but was not associated with a better outcome. PMID:25670028

  1. Adapting the Academic Motivation Scale for Use in Pre-Tertiary Mathematics Classrooms

    ERIC Educational Resources Information Center

    Lim, Siew Yee; Chapman, Elaine

    2015-01-01

    The Academic Motivation Scale (AMS) is a comprehensive and widely used instrument for assessing motivation based on the self-determination theory. Currently, no such comprehensive instrument exists to assess the different domains of motivation (stipulated by the self-determination theory) in mathematics education at the pre-tertiary level (grades…

  2. Academic Experiences in a Cross-National Tertiary Program: Language Immersion Amid the Sciences

    ERIC Educational Resources Information Center

    Sakurai, Yusuke

    2009-01-01

    This paper explores Malaysian students' problems within their science and engineering tertiary courses in Japanese through their diary entries and semi-structured interviews. The study analyses how students implement management strategies to overcome their problems. Although many studies are available regarding students' academic activities in a…

  3. The detection and upgrade rates of prostate adenocarcinoma following transperineal template-guided prostate biopsy – a tertiary referral centre experience

    PubMed Central

    Telford, Robert; Viney, Richard; Patel, Prashant

    2016-01-01

    Introduction We aim to present transperineal template-guided prostate biopsy (template biopsy) outcomes at a tertiary referral centre. Furthermore, to identify the detection rate of prostate cancer in those with a previous negative transrectal ultrasound guided prostate biopsy and the upgrade rate of those on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma. Material and methods We conducted a prospective study of 200 consecutive men who underwent template biopsy over a 22-month period in a tertiary referral centre, using a standard 24 region template prostate biopsy technique. Indications and histology results, as well as complications, were recorded. Results Median age was 67 years and median PSA was 10 ng/mL. Overall detection rate was 47%. 39.5% of cases with previous negative transrectal biopsies were found to have prostate adenocarcinoma. 47.5% of cases on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma were upgraded. The most frequent complication was acute urinary retention at a rate of 12.5%, however, the use of a single prophylactic dose of tamsulosin was found to be beneficial, with 13 cases needed to treat to prevent one episode. Conclusions Template biopsies are safe and efficacious with an overall detection rate of 47% in the present series. Due to the high detection rate, one must consider template biopsy following one negative transrectal biopsy where there is persistent clinical suspicion. Furthermore, those considering active surveillance for Gleason 3 + 3 = 6 disease should be offered template biopsy to confirm the grade of their disease. PMID:27123325

  4. The Influence of Insurance Status on Access to and Utilization of a Tertiary Hand Surgery Referral Center

    PubMed Central

    Calfee, Ryan P.; Shah, Chirag M.; Canham, Colin D.; Wong, Ambrose H.W.; Gelberman, Richard H.; Goldfarb, Charles A.

    2012-01-01

    Background: The purpose of this study was to systematically examine the impact of insurance status on access to and utilization of elective specialty hand surgical care. We hypothesized that patients with Medicaid insurance or those without insurance would have greater difficulty accessing care both in obtaining local surgical care and in reaching a tertiary center for appointments. Methods: This retrospective cohort study included all new patients with orthopaedic hand problems (n = 3988) at a tertiary center in a twelve-month period. Patient insurance status was categorized and clinical complexity was quantified on an ordinal scale. The relationships of insurance status, clinical complexity, and distance traveled to appointments were quantified by means of statistical analysis. An assessment of barriers to accessing care stratified with regard to insurance status was completed through a survey of primary care physicians and an analysis of both patient arrival rates and operative rates at our tertiary center. Results: Increasing clinical complexity significantly correlated (p < 0.001) with increasing driving distance to the appointment. Patients with Medicaid insurance were significantly less likely (p < 0.001) to present with problems of simple clinical complexity than patients with Medicare and those with private insurance. Primary care physicians reported that 62% of local surgeons accepted patients with Medicaid insurance and 100% of local surgeons accepted patients with private insurance. Forty-four percent of these primary care physicians reported that, if patients who were underinsured (i.e., patients with Medicaid insurance or no insurance) had been refused by community surgeons, they were unable to drive to our tertiary center because of limited personal resources. Patients with Medicaid insurance (26%) were significantly more likely (p < 0.001) to fail to arrive for appointments than patients with private insurance (11%), with no-show rates increasing

  5. 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

  6. Strategic planning and designing of a hospital disaster manual in a tertiary care, teaching, research and referral institute in India

    PubMed Central

    Talati, Shweta; Bhatia, Prateek; Kumar, Ashok; Gupta, A. K.; Ojha, Col. D

    2014-01-01

    BACKGROUND: As per the “Disaster Management Act, 2005” of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned stakeholders. METHODS: A committee of members from hospital administration, clinical, diagnostic and supportive departments worked on an initial document prepared according to the Act and gave their inputs to frame a final disaster manual. RESULTS: The prepared departmental standard operating procedures involved 116 people (doctors and paramedical staff), and were then synchronized, in 12 committee meetings, to produce the final hospital disaster manual. CONCLUSIONS: The present disaster manual is one of the few comprehensive plans prepared by the stakeholders of a government hospital in India, who themselves form a part of the disaster response team. It also helped in co-ordinated conduction of mock drills. PMID:25215145

  7. Adapting the academic motivation scale for use in pre-tertiary mathematics classrooms

    NASA Astrophysics Data System (ADS)

    Lim, Siew Yee; Chapman, Elaine

    2015-09-01

    The Academic Motivation Scale ( ams) is a comprehensive and widely used instrument for assessing motivation based on the self-determination theory. Currently, no such comprehensive instrument exists to assess the different domains of motivation (stipulated by the self-determination theory) in mathematics education at the pre-tertiary level (grades 11 and 12) in Asia. This study adapted the ams for this use and assessed the properties of the adapted instrument with 1610 students from Singapore. Exploratory and confirmatory factor analyses indicated a five-factor structure for the modified instrument (the three original ams intrinsic subscales collapsed into a single factor). Additionally, the modified instrument exhibited good internal consistency (mean α = .88), and satisfactory test-retest reliability over a 1-month interval (mean r xx = .73). The validity of the modified ams was further demonstrated through correlational analyses among scores on its subscales, and with scores on other instruments measuring mathematics attitudes, anxiety and achievement.

  8. Liver surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.

    PubMed

    Torzilli, Guido; Viganò, Luca; Giuliante, Felice; Pinna, Antonio Daniele

    2016-06-01

    During the last decades, liver surgery had an extraordinary evolution and diffusion thanks to a drastic reduction of operative mortality and morbidity rates. A debate is ongoing about the need for centralization of liver resections in tertiary referral centers. Robust evidences showed that complex surgical procedures have lower mortality rates when performed in high-volume centers. The present expert group reviewed the literature data and proposed guidelines to identify surgical units that should be entitled to perform liver surgery in Italy. Three separate types of requirements were identified. First, the hospital requirements that include the following criteria: (1) a hospital of 1st level according to the Italian law; (2) the presence of a dedicated hepatobiliary or hepatobiliopancreatic unit or a team dedicated to liver surgery into a general surgery unit; (3) the mandatory presence of oncology, hepatology, radiology, interventional radiology, digestive endoscopy, intensive care, and pathology units; (4) the availability of a liver transplant team into the hospital or into another hospital within an established partnership; (5) a periodic multidisciplinary meeting. Second, the volume requirements: the unit has to perform more than 20 liver resections per year for malignant liver diseases with a 90-day mortality rate < 3 %. Finally, the organization requirements: the presence of specific diagnostic-therapeutic flowcharts for liver diseases. PMID:27294278

  9. An outcome of Surgically Treated Head and Neck Cancer in one of the tertiary Referral Center in the East Coast of Malaysia: A 6-year Retrospective Analysis

    PubMed Central

    ABDULLAH, Kahairi; RAJA LOPE AHMAD, Raja Ahmad; ASHA’ARI, Zamzil Amin; RAZALI, Mohd Sayuti; LEMAN, Wan Islah

    2014-01-01

    Background: Surgical management of head and neck cancer is undoubtedly challenging, and we would like to see the outcome of managing such cases at one of the tertiary referral center in the East Coast of Malaysia. Methods: A 6-year retrospective analysis of surgically treated head and neck cancer cases in Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang was conducted. Results: The total number of patients reviewed was 55 and mean age of the patients was 59 years (SD 12). The larynx was the most common surgically treated site (29.1%), followed by the oral cavity (16.4%) and the paranasal sinuses (14.5%). Majority of the patients presented with stage III (32.8%) and stage IV (41.8%) cancer. Post-operative local complications (23.6%) and wound breakdown was identified as the most common cause (20%). Low hemoglobin level prior to surgery was associated with anemia after surgery (P = 0.007) and prolonged hospital stay (P = 0.030). Tumor recurrence was observed in 21.8% of the cases. Advanced stage tumor had more percentage of positive margin than early stage tumor i.e., 23% in early stage versus 58% in advanced stage (P = 0.050). Conclusion: Surgical management of head and neck cancer in this center has an acceptable outcome. PMID:25977619

  10. Characteristics of Travel-Related Severe Plasmodium vivax and Plasmodium falciparum Malaria in Individuals Hospitalized at a Tertiary Referral Center in Lima, Peru.

    PubMed

    Llanos-Chea, Fiorella; Martínez, Dalila; Rosas, Angel; Samalvides, Frine; Vinetz, Joseph M; Llanos-Cuentas, Alejandro

    2015-12-01

    Severe Plasmodium falciparum malaria is uncommon in South America. Lima, Peru, while not endemic for malaria, is home to specialized centers for infectious diseases that admit and manage patients with severe malaria (SM), all of whom contracted infection during travel. This retrospective study describes severe travel-related malaria in individuals admitted to one tertiary care referral hospital in Lima, Peru; severity was classified based on criteria published by the World Health Organization in 2000. Data were abstracted from medical records of patients with SM admitted to Hospital Nacional Cayetano Heredia from 2006 to 2011. Of 33 SM cases with complete clinical data, the mean age was 39 years and the male/female ratio was 2.8. Most cases were contracted in known endemic regions within Peru: Amazonia (47%), the central jungle (18%), and the northern coast (12%); cases were also found in five (15%) travelers returning from Africa. Plasmodium vivax was most commonly identified (71%) among the severe infections, followed by P. falciparum (18%); mixed infections composed 11% of the group. Among the criteria of severity, jaundice was most common (58%), followed by severe thrombocytopenia (47%), hyperpyrexia (32%), and shock (15%). Plasmodium vivax mono-infection predominated as the etiology of SM in cases acquired in Peru. PMID:26483126

  11. Trends in Maternal Mortality Ratio in a Tertiary Referral Hospital and the Effects of Various Maternity Schemes on It

    PubMed Central

    Kaur, Harpreet; Kaur, Sharanjit; Singh, Sukhwinderjit

    2015-01-01

    Objective: To analyze the trend in maternal mortality ratio in a tertiary care centre and the effect of various maternity schemes on it. Materials and methods: Retrospective analysis of all maternal deaths occurring in the Guru Gobind Singh Medical College & Hospital, Faridkot, Punjab, India was done from Jan 2010 to Dec 2012. Every maternal death was scrutinized from various aspects like direct cause of death, age, locality, antenatal care and gestational age. Results: The total number of deliveries has risen from 957 in 2010 to 1063 in 2012 at the same time the maternal mortality ratio has increased from 835.94 in 2010 to 2054.55 per one live birth in 2012. Haemorrhage (24.12%) and sepsis (18.9%) were the most common causes of death followed closely by pregnancy induced hypertension including eclampsia (15.5%). Anemia (12.06%) contributed to the most common indirect cause of death. Conclusion: Implementation of the various maternity schemes has had no significant impact on the profile of dying mothers. There is a need to stress the importance of good antenatal care in reducing Maternal Mortality Ratio. PMID:26175763

  12. The use of autologous serum for the treatment of ocular surface disease at a Swedish tertiary referral center

    PubMed Central

    von Hofsten, Joanna; Egardt, Maria; Zetterberg, Madeleine

    2016-01-01

    Purpose The study aims to describe an intact cohort with mixed ocular surface disease (OSD) treated with autologous serum (AS) eye drops in a tertiary eye center. Patients and methods All cases (n=32 eyes, 24 patients) treated with AS for OSD at the Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, between 2002 and 2013 were included and medical records were reviewed retrospectively. Results Mean duration of treatment with 20% AS was 28.3±56.1 (median: 12, range: 3–217) days. The most common indication for AS treatment was a persistent epithelial defect (PED), which was seen in 16 eyes of 14 patients. Mean duration of PED prior to treatment was 19.3±18.9 (median: 10, range: 5–68) days. Complete or partial epithelial healing occurred in nine eyes (56.2%). The remaining seven eyes (44%) did not respond to treatment or data were missing. The second group consisted of nine eyes of five patients with superficial punctate keratitis (SPK) secondary to dry eye syndrome. Complete or partial healing of the epithelium occurred in five eyes (56%), and the remaining four eyes (44%) were lost to follow-up. A third group included five eyes with AS as an adjuvant treatment after corneal perforation, whereas a fourth group consisted of one patient with dry eye after laser-assisted in situ keratomileusis (LASIK). Conclusion In this cohort, patients with PED or SPK responded well to treatment with AS. Standardized preparation protocols, defined optimal serum concentrations for various indications, and large randomized clinical trials are needed to fully comprehend the role of AS in the treatment of OSD. PMID:27042143

  13. Premature Termination of MexR Leads to Overexpression of MexAB-OprM Efflux Pump in Pseudomonas aeruginosa in a Tertiary Referral Hospital in India

    PubMed Central

    2016-01-01

    Objectives The present study was undertaken to investigate the mutations that are present in mexR gene of multidrug resistant (MDR) isolates of Pseudomonas aeruginosa collected from a tertiary referral hospital of north east India. Methods 76 MDR clinical isolates of P. aeruginosa were obtained from the patients who were admitted to or attended the clinics of Silchar medical college and hospital. They were screened phenotypically for the presence of efflux pump activity by an inhibitor based method. Acquired resistance mechanisms were detected by multiplex PCR. Real time PCR was performed to study the expression of mexA gene of MexAB-OprM efflux pump in isolates with increase efflux pump activity. mexR gene of the isolates with overexpressed MexAB-OprM efflux pump was amplified, sequenced and analysed. Results Out of 76 MDR isolates, 24 were found to exhibit efflux pump activity phenotypically against ciprofloxacin and meropenem. Acquired resistance mechanisms were absent in 11 of them and among those isolates, 8 of them overexpressed MexAB-OprM. All the 8 isolates possessed mutation in mexR gene. 11 transversions, 4 transitions, 2 deletion mutations and 2 insertion mutations were found in all the isolates. However, the most significant observation was the formation of a termination codon at 35th position which resulted in the termination of the polypeptide and leads to overexpression of the MexAB-OprM efflux pump. Conclusions This study highlighted emergence of a novel mutation which is probably associated with multi drug resistance. Therefore, further investigations and actions are needed to prevent or at least hold back the expansion and emergence of newer mutations in nosocomial pathogens which may compromise future treatment options. PMID:26866484

  14. Prevalence of H. Pylori in Tonsillar Tissue of Patients with Chronic Recurrent Tonsillitis Using Rapid Urease Test in a Tertiary Referral Hospital in Sub Saharan Africa.

    PubMed

    Ochung'o, O Peter; Mugwe, P; Masinde, P; Waweru, W

    2015-09-01

    There has been conflicting results regarding the presence of H. pylori in tonsillar tissue. Our objective was to analyze for the presence of H. pylori in tonsillar tissue in patients undergoing tonsillectomy for chronic recurrent tonsillitis using rapid urease test in a Tertiary care academic medical center in a sub Saharan hospital. A prospective cross-sectional analysis of 39 consecutive cases of patients undergoing tonsillectomy secondary to chronic recurrent tonsilitis was done. Rapid urease test was conducted on each tonsillectomy tissue and results were determined using color change at specific time intervals within 24 h. Average age of the patients was 4.3 years. Among the 39 tonsillar tissues analysed using rapid urease test, H. pylori was present in 30.5 % of the samples. Colonisation by H. pylori of the palatine tonsils is a new frontier with conflicting results depending on the accuracy of the test method used and population studied. More studies need to be performed to ascertain the different rates of colonisation based on geographical regions. PMID:26405654

  15. Viral Aetiology of Central Nervous System Infections in Adults Admitted to a Tertiary Referral Hospital in Southern Vietnam over 12 Years

    PubMed Central

    Tan, Le Van; Thai, Le Hong; Phu, Nguyen Hoan; Nghia, Ho Dang Trung; Chuong, Ly Van; Sinh, Dinh Xuan; Phong, Nguyen Duy; Mai, Nguyen Thi Hoang; Man, Dinh Nguyen Huy; Hien, Vo Minh; Vinh, Nguyen Thanh; Day, Jeremy; Chau, Nguyen Van Vinh; Hien, Tran Tinh; Farrar, Jeremy; de Jong, Menno D.; Thwaites, Guy; van Doorn, H. Rogier; Chau, Tran Thi Hong

    2014-01-01

    Background Central nervous system (CNS) infections are important diseases in both children and adults worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the viral causes of the diseases is of public health importance, in order to better inform immunization policy, and may influence clinical management. Methodology/Principal Findings Study was conducted at the Hospital for Tropical Diseases in Ho Chi Minh City, a primary, secondary, and tertiary referral hospital for all southern provinces of Vietnam. Between December 1996 and May 2008, patients with CNS infections of presumed viral origin were enrolled. Laboratory diagnostics consisted of molecular and serological tests targeted at 14 meningitis/encephalitis-associated viruses. Of 291 enrolled patients, fatal outcome and neurological sequelae were recorded in 10% (28/291) and 27% (78/291), respectively. Mortality was especially high (9/19, 47%) amongst those with confirmed herpes simplex encephalitis which is attributed to the limited availability of intravenous acyclovir/valacyclovir. Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses were the most common viruses detected, responsible for 36 (12%), 19 (6.5%), 19 (6.5%) and 8 (2.7%) respectively, followed by rubella virus (6, 2%), varicella zoster virus (5, 1.7%), mumps virus (2, 0.7%), cytomegalovirus (1, 0.3%), and rabies virus (1, 0.3%). Conclusions/Significance Viral infections of the CNS in adults in Vietnam are associated with high morbidity and mortality. Despite extensive laboratory testing, 68% of the patients remain undiagnosed. Together with our previous reports, the data confirm that Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses are the leading identified causes of CNS viral infections in Vietnam, suggest that the

  16. Transcriptional Analysis of MexAB-OprM Efflux Pumps System of Pseudomonas aeruginosa and Its Role in Carbapenem Resistance in a Tertiary Referral Hospital in India

    PubMed Central

    2015-01-01

    Carbapenem resistance presents severe threat to the treatment of multidrug resistant Pseudomonas aeruginosa infections. The study was undertaken to investigate the role of efflux pumps in conferring meropenem resistance and effect of single dose exposure of meropenem on transcription level of mexA gene in clinical isolates of P. aeruginosa from a tertiary referral hospital of India. Further, in this investigation an effort was made to assess whether different components of MexAB-OprM operon expresses in the same manner and the extent of contributions of those components in meropenem resistance in its natural host (P. aeruginosa) and in a heterologous host (E. coli). Out of 83 meropenem nonsusceptible isolates, 22 isolates were found to possess efflux pump activity phenotypically. Modified hodge test and multiplex PCR confirmed the absence of carbapenemase genes in those isolates. All of them were of multidrug resistant phenotype and were resistant to all the carbepenem drug tested. MexAB-OprM efflux pump was found to be overexpressed in all the study isolates. It could be observed that single dose exposure meropenem could give rise to trivial increase in transcription of mexA gene. Different constructs of MexAB-OprM (mexR-mexA-mexB-OprM; mexA-mexB-OprM; mexA-mexB) could be expressed in both its natural (P. aeruginosa PAO1) and heterologous host (E. coli JM107) but transcription level of mexA gene varied in both the hosts before and after single dose exposure of meropenem. Different components of the operon failed to enhance meropenem resistance in E. coli JM107 and P. aeruginosa PAO1. This study could prove that MexAB-OprM efflux pump can significantly contribute to meropenem resistance in hospital isolates of P. aeruginosa where an acquired resistant mechanism is absent. Thus, equal importance should be given for diagnosis of intrinsic resistance mechanism so as to minimize treatment failure. As meropenem could not enhance mexA transcriptions significantly, there

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

    PubMed Central

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

    2016-01-01

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

  18. The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital

    PubMed Central

    Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock

    2016-01-01

    Background For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. Methods From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Results Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7–207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Conclusion Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department. PMID:27136299

  19. Attitude of Academic Staff in Nigerian Tertiary Educational Institutions to Student Evaluation of Instruction (SEI): A Case Study of Cross River State University

    ERIC Educational Resources Information Center

    Idaka, Idaka I.; Joshua, Monday T.

    2009-01-01

    This study was designed to assess the attitude of academic staff in Nigerian tertiary educational institutions to student evaluation of instruction (SEI) and to find out the variable factors that influenced the expressed attitude of members of the academic staff, using Cross River State University as a case study. The study was a survey and so a…

  20. Willing and Enabled: The Academic Outcomes of a Tertiary Enabling Program in Regional Australia

    ERIC Educational Resources Information Center

    Andrewartha, Lisa; Harvey, Andrew

    2014-01-01

    This paper examines the achievement levels of students undertaking the Tertiary Enabling Program (TEP) at La Trobe University. The TEP is an alternative pathway program that traverses multiple institutions, campuses, and disciplinary areas, and is designed to prepare a diverse student cohort for tertiary study. The Program integrates several…

  1. Disruptive innovation in academic medical centers: balancing accountable and academic care.

    PubMed

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay

    2015-05-01

    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care. PMID:25517702

  2. Preparedness for Tertiary Chemistry: Issues of Placement and Performance of Academic Development Programmes

    ERIC Educational Resources Information Center

    Potgieter, M.; Davidowitz, B.; Mathabatha, S. S.

    2008-01-01

    The introduction of an outcomes-based curriculum in South Africa together with a new syllabus for physical sciences for grades 10-12, prompted the development of an instrument to monitor conceptual understanding in chemistry at the secondary-tertiary interface. This instrument was used to evaluate placement within different programmes at tertiary…

  3. Hong Kong Tertiary Students' Conceptions of Assessment of Academic Ability

    ERIC Educational Resources Information Center

    Wang, Zhenlin; Brown, Gavin T. L.

    2014-01-01

    Students' beliefs, attitudes, experiences and responses towards assessment reflect the ecology of their specific context. The study examines Hong Kong tertiary students' conceptions of assessment using focus group interviews and the content analysis technique. Using six focus groups, 26 Hong Kong university students were interviewed.…

  4. The Usage and Impact of Internet Enabled Phones on Academic Concentration among Students of Tertiary Institutions: A Study at the University of Ibadan, Nigeria

    ERIC Educational Resources Information Center

    Ezemenaka, Emeka

    2013-01-01

    The usage of Internet enabled phones has been a 21st century phenomenon that spreads for different purposes and functions. This study looks into the usage and perceived effect implications internet enabled phones have on the academic performance of the tertiary students using University of Ibadan students in Nigeria as a case study. The study was…

  5. Use of Social Media and Its Impact on Academic Performance of Tertiary Institution Students: A Study of Students of Koforidua Polytechnic, Ghana

    ERIC Educational Resources Information Center

    Owusu-Acheaw, M.; Larson, Agatha Gifty

    2015-01-01

    The study sought to assess students' use of social media and its effect on academic performance of tertiary institutions students in Ghana with a focus on Koforidua Polytechnic students. Questionnaire was used for collecting data. Out of one thousand five hundred and seventy-eight copies of the questionnaire distributed, one thousand five hundred…

  6. Influence of Marital Stressors on Role Performance of Married Academic Women in Tertiary Institutions in Cross River State and Need for Counselling Therein

    ERIC Educational Resources Information Center

    Okpechi, Philip A.; Usani, Michael Okoi

    2015-01-01

    This study investigated the influence of marital stressors on role performance of married academic women of tertiary institutions in Cross River State. In order to accomplish the purpose of the study, two objectives and corresponding two hypotheses were postulated to guide the study. The survey research design was adopted in the study. A total of…

  7. Student Experience and Tertiary Expectations: Factors Predicting Academic Literacy amongst First-Year Pharmacy Students

    ERIC Educational Resources Information Center

    Scouller, Karen; Bonanno, Helen; Smith, Lorraine; Krass, Ines

    2008-01-01

    Enhancing student performance in the first year and increasing retention rates have become important priorities for universities, resulting in a focus on support, especially for students deemed "at risk". Research suggests the importance of entry pathways into university and academic literacy for successful progression. However, there is little…

  8. Case Meetings for Teaching English for Specific Academic Purposes in a Tertiary Aeronautical Engineering Programme

    ERIC Educational Resources Information Center

    Tatzl, Dietmar

    2015-01-01

    This article presents an innovative adaptation of the case method to teaching English for specific academic purposes. Widespread in its traditional form in various content disciplines, the case method bears the potential for truly student-centred language instruction. The current application transforms learners from case analysts to case authors…

  9. The Effect on Academic Health Centers of Tertiary Care in Community Hospitals.

    ERIC Educational Resources Information Center

    Gee, David A.; Rosenfeld, Lisa A.

    1984-01-01

    The growing cost of medical education and the provision of care to the indigent can be endangered by the dilution of revenue sources traditionally available to the academic health centers but which are being taken over by suburban hospitals. (Author/MLW)

  10. Academic mobility as a key factor of quality assurance in tertiary education

    NASA Astrophysics Data System (ADS)

    Voroshilova, Anna A.

    2015-01-01

    Academic mobility of both faculty and students forms a critical element of the international dimension of higher education and is one of the most important factors of quality assurance of higher education institutions worldwide. Internationalization and globalization of Russian higher education system is having one of the major impacts on the quality management and assurance. Faculty and student mobility figures are now one of the core factors for obtaining state accreditation for Russian universities as well as an important indicator showing the university success and prestige. The aim of the paper is a closer look at the perspectives and results of the academic mobility, the factors stimulating and discouraging mobility, and the outcomes of the mobility influencing the education in Russian universities. Siberian State Aerospace University has had more than 10 years experience in organizing student mobility. Most of the problems in carrying out international activities are common for the whole Russia but still there are some peculiarities featuring technical universities situated in the centre of Russia.

  11. Utilization of a Pharmacy Clinical Surveillance System for Pharmacist Alerting and Communication at a Tertiary Academic Medical Center.

    PubMed

    Hohlfelder, Benjamin; Stashek, Chad; Anger, Kevin E; Szumita, Paul M

    2016-01-01

    The objective of this analysis is to describe the utilization metrics of a pharmacy clinical surveillance system (PCSS) at a tertiary, academic medical center.We performed a retrospective database analysis assessing rule-based alerts (RBA), interventions and pharmacist communication notes documented in the PCSS from January 1, 2014 to December 31, 2014. Reports were generated on 92 unique RBAs sent to clinicians for evaluation. Metrics assessed included the number of RBAs that were triggered, clinically evaluated, intervened on by pharmacists, and therapeutic category of interventions. Pharmacy communication notes were also evaluated.A total of 399,979 RBAs were triggered through the PCSS. During that time, pharmacists documented a total of 17,733 interventions. The most common RBAs were related to lab abnormalities (132,487; 33 %) and anticoagulation/antiplatelet therapy (126,425; 32.1 %). Interventions were most frequently related to RBAs regarding anticoagulation/antiplatelet therapy (6412; 36 %) and antimicrobial therapy (3320; 19 %). Pharmacist communication was most commonly related to clarification of medication and lab orders, and therapeutic drug monitoring.Based on utilization metrics presented, the implementation of a PCSS has successfully generated RBAs to aid pharmacists in clinical practice and improved departmental documentation and communication. Further analysis is warranted to assess the impact of the RBAs, interventions, and communication notes on outcomes such as hospital cost and adverse drug events. PMID:26547844

  12. Ticking the right boxes: classification of patients suspected of Lyme borreliosis at an academic referral center in the Netherlands.

    PubMed

    Coumou, J; Herkes, E A; Brouwer, M C; van de Beek, D; Tas, S W; Casteelen, G; van Vugt, M; Starink, M V; de Vries, H J C; de Wever, B; Spanjaard, L; Hovius, J W R

    2015-04-01

    To provide better care for patients suspected of having Lyme borreliosis (LB) we founded the Amsterdam Multidisciplinary Lyme borreliosis Center (AMLC). The AMLC reflects a collaborative effort of the departments of internal medicine/infectious diseases, rheumatology, neurology, dermatology, medical microbiology and psychiatry. In a retrospective case series, characteristics of 200 adult patients referred to the AMLC were recorded, and patients were classified as having LB, post-treatment LB syndrome (PTLBS), persistent Borrelia burgdorferi sensu lato (s.l.) infection despite antibiotic treatment or no LB. In addition, LB, PTLBS and persistent B. burgdorferi s.l. infection cases were classified as 'definite,' 'probable' or 'questionable.' Of the 200 patients, 120 (60%) did not have LB and 31 (16%) had a form of localized or disseminated LB, of which 12 were classified as definite, six as probable and 13 as questionable. In addition, 34 patients (17%) were diagnosed with PTLBS, of which 22 (11%) were probable and 12 (6%) questionable. A total of 15 patients (8%) were diagnosed with persistent B. burgdorferi s.l. infection, of which none was classified as definite, three as probable and 12 as questionable. In conclusion, in line with previous studies, the number of definite and probable (persisting) LB cases was low. The overall high number of questionable cases illustrates the fact that it can sometimes be challenging to either rule out or demonstrate an association with a B. burgdorferi s.l. infection, even in an academic setting. Finally, we were able to establish alternative diagnoses in a large proportion of patients. PMID:25658524

  13. Evaluation of interventional endoscopy unit efficiency metrics at a tertiary academic medical center

    PubMed Central

    Yang, Dennis; Summerlee, Robert; Suarez, Alejandro L.; Perbtani, Yaseen; Williamson, J. Blair; Shrode, Charles W.; Gupte, Anand R.; Chauhan, Shailendra S.; Draganov, Peter V.; Forsmark, Chris E.; Wagh, Mihir S.

    2016-01-01

    Background and study aims: There is an increasing demand for interventional endoscopic services and the need to develop efficient endoscopic units. The aim of this study was to analyze performance data and define metrics to improve efficiency in a single academic interventional endoscopy center. ]Patients and methods: The prospective operations performance data (6-month period) of our interventional endoscopy unit (EU) was analyzed. First-case start time (FIRST) delay was defined as any time the first patient of the day entered the endoscopy room after the scheduled time. Non-endoscopy time (NET) and total time (TT) were defined as non-procedural and total time elapsed in the EU, respectively. Time-interval between successive patients (TISP) was defined as the time from one patient departure from the room until the time of arrival of the next patient in the room. Results: A total of 1421 patients underwent 1635 endoscopic procedures. FIRST was delayed (54.2 % cases) by 13.6 min (range 1 – 53), but started within 15 min of the scheduled time in 85 % of the cases. NET accounted for 9.1 hours (67.2 %) of 13.5 hours TT/day. TISP (37.1 min, range 5 – 125) comprised 54.2 % of the NET, and was delayed (> 30 min) in 49.8 % of cases. “Patient flow” processes (registration, admission, transportation, scheduling) accounted for 50.1 % of TISP delays. Conclusions: Delays in NET, specifically TISP, rather than FIRST, were identified as a cause for decreased efficiency. “Patient flow” processes were the main reasons for delays in TISP. This study identifies potential process measures that can be used as benchmarks to improve efficiency in the EU. PMID:26878040

  14. Prevalence and factors predictive of intraocular fungal infection in patients with fungemia at an academic urban tertiary care center

    PubMed Central

    Geraymovych, Elena; Conduff, Joseph H; Braich, Puneet S; Leffler, Christopher T; Brar, Vikram S

    2015-01-01

    Objective To report the prevalence and to identify factors predictive of intraocular infection in patients with fungemia receiving prophylactic antifungal therapy. Methods A retrospective review of patients who received prophylactic antifungal therapy and a dilated fundus examination at an academic urban tertiary care center from 2000 to 2007. Basic demographic information, fungal species grown, antifungal agent(s) used, number of positive blood culture specimens, visual acuity, visual symptoms, and known risks of disseminated candidiasis were noted. Logistic regression analysis was used to determine the factors significantly associated with intraocular fungal infection. Results A total of 132 patients with positive fungemia culture were requested to have ophthalmology consults. The prevalence of ocular infection was 6.9% (N=9). All nine patients were infected with Candida species. Undergoing gastrointestinal (GI) surgery within the prior 6 months was significantly related to developing intraocular infection, with an odds ratio of 18.5 (95% confidence interval, 15.1–24.3; P=0.002). Having ≥3 positive fungal blood cultures was also a significant risk factor, with an odds ratio of 2.6 (95% confidence interval, 1.8–3.7; P=0.03). Among 40 patients having GI surgery, eight (20.0%) had intraocular fungal disease, compared with one of 92 patients (1.1%) not having GI surgery. Among 125 patients with a negative baseline examination result, two of 32 patients (6.3%), who had recent GI surgery, subsequently developed fungal ocular disease, compared with 0 of 93 patients (0%), who did not have recent GI surgery. Conclusion Recent GI surgery and higher numbers of positive fungal blood culture specimens may be predictive of candida ocular infections. Normal baseline fundoscopy examination results in patients with such risks may require repeat evaluations to detect delayed manifestations. PMID:26491246

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

    PubMed

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

    2016-04-01

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

  16. Using needs assessment to develop curricula for screening, brief intervention, and referral to treatment (SBIRT) in academic and community health settings.

    PubMed

    Satre, Derek D; McCance-Katz, Elinore F; Moreno-John, Gina; Julian, Katherine A; O'Sullivan, Patricia S; Satterfield, Jason M

    2012-01-01

    This article describes the use of a brief needs assessment survey in the development of alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) curricula in 2 health care settings in the San Francisco Bay Area. The samples included university medical center faculty (n = 27) and nonphysician community health and social service providers in a nearby suburban county (n = 21). Informed by curriculum development theory and motivational interviewing strategies, questions regarding clinical and educational priorities, perceived importance and confidence with screening and intervention techniques, and referral resource availability were included. Medical center faculty expressed greater concern about limited appointment time (P = .003), adequacy of training (P = .025), and provider confidence (P = .038) as implementation obstacles and had lower confidence in delivering SBIRT (P = .046) and providing treatment referrals (P = .054) than community providers. The authors describe their approach to integrating needs assessment results into subsequent curriculum development. Findings highlight potential differences between physician and nonphysician training needs. PMID:22738009

  17. UCLA rewrites the script for academic networks.

    PubMed

    1998-08-01

    Known worldwide for its high-tech tertiary and quaternary specialties, UCLA Medical Center developed a two-pronged strategy for maintaining referral volume in the face of intensifying managed care cost/referral control. Its 1. Recruited primary care clinician educators, and built a network of affiliated PC physicians and small PC offices in its historical service area. Now it draws 36% of outpatient visits, 40% of fee-for-service Medicare discharges, and 20% of total discharges from its network, providing "role models for academic-affiliated primary care medicine." 2. Began to bolster its draw further afield, developing long-distance consultation relationships/shared protocols with specialists in the rest of the L.A. Basin (home to another 45% of UCLA's business), and as far away as Las Vegas. PMID:10182868

  18. 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

  19. A Comparison of Single-Gender Classes and Traditional, Coeducational Classes on Student Academic Achievement, Discipline Referrals, and Attitudes toward Subjects

    ERIC Educational Resources Information Center

    Smith, Debra Messenger

    2010-01-01

    In recent years, there has been a resurgence of interest in single gender education. Emerging science has proven that boys and girls learn differently. This study compared fifth grade single-gender classes to fifth grade traditional, coeducational classes in the same urban middle school. The following were compared: students' academic achievement;…

  20. Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center.

    PubMed

    Franco, Diana L; Disbrow, Molly B; Kahn, Allon; Koepke, Laura M; Harris, Lucinda A; Harrison, M Edwyn; Crowell, Michael D; Ramirez, Francisco C

    2015-01-01

    Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO). Proton pump inhibitor (PPI) use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder. PMID:25694782

  1. 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…

  2. 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…

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

    PubMed Central

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

    2016-01-01

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

  4. A 10 years audit of cardiothoracic referrals from a pulmonology service in a developing country: impact of patient human immunodeficiency virus status

    PubMed Central

    Nyale, George Mwamnemo; Anderson, Ronald; Patel, Atulkumar Ramanlal

    2016-01-01

    Background There are few studies that have documented the clinical presentation, complication rate and outcome of cardiothoracic referrals from a Pulmonology Service, particularly in developing countries. Furthermore, the impact of human immunodeficiency virus (HIV) status on such referrals and their outcomes is not well documented. Methods This was a retrospective audit of combined pulmonologist/cardiothoracic consultations, undertaken among the tertiary academic hospitals attached to the University of the Witwatersrand, Johannesburg, South Africa, over a 10 years period (2001–2010) in order to document the clinical features of these referrals and to determine any impact of HIV status on trends in disease presentations, complications and outcome. Results A total of 847 patients were evaluated on whom a variety of surgical procedures was performed, 50.4% being therapeutic, 32.8% diagnostic and 16.9% both therapeutic and diagnostic. HIV status was known in 488 cases. Of these 229 (46.9%) were HIV-seropositive and 259 (53.1%) -seronegative. The main reasons for referral were for infective conditions, including tuberculosis (TB), pleural disease/effusion/empyema, and other bacterial infections, with significantly more of the TB patients being HIV-seropositive (P<0.0001).There was a trend for increasing presentations for TB and pleural conditions, particularly during the last 4–5 years of the audit, coinciding with an increase in the numbers of HIV-positive referrals. HIV status had no impact on the frequency of surgical complications or mortality. Conclusions The audit indicates an increasing referral rate of HIV-seropositive patients to cardiothoracic services in Johannesburg, particularly in association with TB and pleural diseases. However with careful cardiothoracic/pulmonologist evaluation of the cases the frequency of complications and mortality appear to be no different from that of HIV-seronegative cases. PMID:27162782

  5. Tertiary Education in Australia: A Bibliography.

    ERIC Educational Resources Information Center

    Lundberg, Kristine, Comp.

    A bibliography on tertiary education in Australia is presented. The following topics are included: tertiary education of aborigines; academic salaries; colleges of advanced education; community colleges; the constitutional and legal basis of education; courses and awards; educational policy and the politics of education; entrance requirements;…

  6. 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

  7. Rethinking the Tertiary Mathematics Curriculum

    ERIC Educational Resources Information Center

    Petocz, Peter; Reid, Anna

    2005-01-01

    Mathematics curriculum at the tertiary level is located within a range of social and cultural theories, and is often constructed by academics seeking to promulgate a particular view of mathematics. We argue that such a curriculum should incorporate a real acknowledgement of the different ways in which students understand the nature of mathematics…

  8. 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…

  9. Faculty Referrals - The Kiss of Death or a Powerful Motivator? What Makes the Difference?

    ERIC Educational Resources Information Center

    Maxwell, Martha

    1997-01-01

    States that for faculty to make effective referrals to academic support programs, they should be knowledgeable about services and describe them to students in their classes early in the term, they must endorse the use of the service and repeatedly encourage students to attend, and they must make their referrals personal. (VWC)

  10. A Descriptive Study of Office Disciplinary Referrals in High Schools

    ERIC Educational Resources Information Center

    Flannery, K. Brigid; Fenning, Pamela; McGrath Kato, Mimi; Bohanon, Hank

    2013-01-01

    The purpose of this paper is to share descriptive data about Office Discipline Referrals (ODRs) in a sample of 112 high schools that used the School-wide Information System (SWIS) database to collect discipline data during the 2005-2006 academic year. The findings were that tardies, defiance/disrespect and skip/truancy were the most common types…

  11. Infective endocarditis: a tertiary referral centre experience from Turkey

    PubMed Central

    Agca, Fahriye Vatansever; Demircan, Necmiye; Peker, Tezcan; Ari, Hasan; Karaagac, Kemal; Ozluk, Ozlem Arican; Yilmaz, Mustafa; Tenekecioglu, Erhan

    2015-01-01

    Introduction: We aimed to define the current characteristics of infective endocarditis (IE) in a part of Turkey. Methods: All patients who were hospitalized in our hospital with a diagnosis of IE between 2009 and 2014 were included in the study. Data were collected from archives records of all patients. Modified Duke criteria were used for diagnosis. Results: There were 85 IE cases during the study period. The mean age of patients was 52 years. Fourty eight of patients were males. Native valves involved in 47%, prostetic valves involved in 40% and pacemaker or ICD lead IE in 13% of patients. Mitral valve was the most common site of vegetationb (38%). The most common valvular pathology was mitral regurgitation. The most common predisposing factor was prosthetic valve disease (40%). Positive culture rate was 68%. Staphylococci were the most frequent causative microorganisms isolated (27%) followed by Streptococcus spp. (11%). In-hospital mortality rate was 36%. Conclusion: In Turkey, IE occurs in relatively young patients. In high developed part of Turkey, prosthetic and dejenerative valve disease is taking the place of rheumatic valve disease as a predisposing factor. Surgery is an important factor for preventing mortality. PMID:26550353

  12. Ipilimumab-induced colitis: experience from a tertiary referral center

    PubMed Central

    O’Connor, Anthony; Marples, Maria; Mulatero, Clive; Hamlin, John; Ford, Alexander C.

    2016-01-01

    Background: Ipilimumab is an anticytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody used for the treatment of malignant melanoma. It can cause immune-mediated inflammatory adverse events, including diarrhoea and even intestinal perforation or death in clinical trials but there is a dearth of data on postmarketing outcomes. Methods: A total of 546 patients attending for treatment of metastatic melanoma between 1 January 2009 and 31 August 2015 were identified by interrogation of the oncology database. A total of 83 of these patients received ipilimumab. Clinical information was extracted from chart reviews, endoscopy and radiology reports, and prescription data. Results: A total of 83 patients received ipilimumab. Only 19.3% (n = 16) of patients developed a diarrhoeal illness not attributable to other causes. The median grade of diarrhoea among included patients was 2 (range 1–4). In two cases, diarrhoea settled spontaneously without any specific treatment. A total of 87.5% of patients received antidiarrhoeal agents such as loperamide or codeine. These resolved symptoms in all patients with grade 1 diarrhoea. For other treatment, 50% patients received systemic glucocorticosteroids and 31.3% required infliximab. Infliximab resolved symptoms in 100% of cases compared with 50% for systemic glucocorticosteroids. Conclusions: The rate of diarrhoea related to ipilimumab in real-world practice is substantial, but below the range observed in data from RCTs. Grade 1 colitis can usually be managed symptomatically, without recourse to stopping ipilimumab. When diarrhoea was grade 2 or above, results from glucocorticosteroids use proved disappointing; but infliximab has been shown to work well. Further research is required into the earlier use of infliximab as an effective treatment for ipilimumab-induced diarrhoea. PMID:27366214

  13. Relationship between Web-Based Learning Time outside the Classroom and Academic Achievement in German as a Tertiary Language by the Students on Vocational High Schools

    ERIC Educational Resources Information Center

    Hanbay, Orhan

    2013-01-01

    The purpose of this empirical research is to investigate the relationship between web-based learning time and academic achievement in German. 36 learners of L3 German with L1 Turkish and L2 English from Vocational High School of Kahta at Adiyaman University were the participants of this study. The empirical process of the study continued 6 weeks…

  14. Academic Practice in Transition: Hidden Stories of Academic Identities

    ERIC Educational Resources Information Center

    Churchman, Deborah; King, Sharron

    2009-01-01

    Academic work is becoming increasingly restrictive and controlled as tertiary institutions move towards a more corporate managerialistic mode of operating. This paper uses a narrative lens to explore the ways in which academic staff make sense of this new environment. In particular, it compares academic staff's stories of their worklife with the…

  15. Tertiary Hyperparathyroidism

    PubMed Central

    Davies, D. R.; Dent, C. E.; Watson, Lyal

    1968-01-01

    In our first 200 cases of primary hyperparathyroidism confirmed by operation 12 were also shown to have a long history either of a malabsorption syndrome or of chronic renal-glomerular failure. We consider that they first went through a phase of secondary hyperparathyroidism, during which one or more of the glands became autonomous adenamata. This then produced the biochemical changes of “primary” hyperparathyroidism, necessitating excision of the adenoma. This condition is best described as “tertiary” hyperparathyroidism. The transition from secondary to tertiary hyperparathyroidism occurred in four of the 12 patients while under our observation. We think the same process can be traced retrospectively in the other eight cases. The concept of tertiary hyperparathyroidism may help to explain the high incidence of other diseases in association with primary hyperparathyroidism. The behaviour of the parathyroid glands provides a valuable model for the investigation of tumour formation in man. All states occurred in our patients with primary hyperparathyroidism, from normal through hyperplasia to adenoma formation and finally to parathyroid carcinoma. PMID:5691200

  16. Collaborating in the Transition to Tertiary Writing.

    ERIC Educational Resources Information Center

    Clerehan, Rosemary; Moore, Tim; Vance, Sheila

    The Monash University (Australia) Transition to Tertiary Writing Project seeks to produce a World Wide Web-based resource for first-year students to facilitate their transition to the kinds of thinking and writing valued at the university. The background research on which this language and academic skills (LAS) project is based centers on three…

  17. Gynaecological referrals to Baragwanath Hospital.

    PubMed

    Buchmann, E; Ephraim, G; Kathawaroo, S

    1994-04-01

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

  18. West Hackberry Tertiary Project

    SciTech Connect

    Gillham, Travis H.

    1999-01-14

    The West Hackberry Tertiary Project is a field test of the concept that air injection can be combined with the Double Displacement Process to produce a tertiary recovery process that is both low cost and economic at current oil prices.

  19. Referral Handbook of Community Services.

    ERIC Educational Resources Information Center

    Myers, Renny J.; And Others

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

  20. 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...

  1. 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...

  2. 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...

  3. 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

  4. The Australian Academic Profession in Transition: Addressing the Challenge of Reconceptualising Academic Work and Regenerating the Academic Workforce

    ERIC Educational Resources Information Center

    Bexley, Emmaline; James, Richard; Arkoudis, Sophie

    2011-01-01

    Australia has an ageing academic workforce and the nation's capacity to refresh, build and maintain this workforce during a period of expansion in tertiary education participation needs urgent consideration. To inform possible strategies to recruit and retain academic staff, this study investigates the current attitudes of the academic profession…

  5. Predicting Academic Success of Health Science Students for First Year Anatomy and Physiology

    ERIC Educational Resources Information Center

    Anderton, Ryan S.; Evans, Tess; Chivers, Paola T.

    2016-01-01

    Students commencing tertiary education enter through a number of traditional and alternative academic pathways. As a result, tertiary institutions encounter a broad range of students, varying in demographic, previous education, characteristics and academic achievement. In recent years, the relatively constant increase in tertiary applications in…

  6. Academic Dystopia: Knowledge, Performativity, and Tertiary Education

    ERIC Educational Resources Information Center

    Roberts, Peter

    2013-01-01

    Jean-Francois Lyotard's classic work, "The Postmodern Condition," was first published in 1979 and has been available in English translation since 1984 (Lyotard 1984). Intended as a "report on knowledge," "The Postmodern Condition" has gained a wide readership among critical policy analysts with an interest in universities and research. Lyotard…

  7. 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…

  8. 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…

  9. 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

  10. 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

  11. 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

  12. Neonatal Hearing Screening Programme (NHSP): At A Rural Based Tertiary Care Centre.

    PubMed

    Sharma, Yojana; Mishra, Girish; Bhatt, Sushen H; Nimbalkar, Somashekhar

    2015-12-01

    Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3 years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94 %) neonates passed in the 1st DPOAE test with 2.05 % refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10 % neonates had one or other high risk factor. Out of high risk neonates, 1.8 % were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7 %. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis. PMID:26693457

  13. Collaborative case conferences in rectal cancer: case series in a tertiary care centre

    PubMed Central

    Eskicioglu, C.; Forbes, S.; Tsai, S.; Francescutti, V.; Coates, A.; Grubac, V.; Sonnadara, R.; Simunovic, M.

    2016-01-01

    Background In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (mccs) for consecutive patients with cancer. Collaborative cancer conferences (cccs) are modified mccs that might overcome such barriers. Methods We established a ccc at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on ccc-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as “major” (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as “minor” (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information. Results Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a ccc. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation. Conclusions Preoperative cccs at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review. PMID:27122982

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. Academic Communication across Disciplines and Cultures. Selected Proceedings of the National Conference on Tertiary Literacy: Research and Practice, Volume 2 (1st, Melbourne, Australia, March 14-16, 1996).

    ERIC Educational Resources Information Center

    Golebiowski, Zofia, Ed.; Borland, Helen, Ed.

    These selected papers from the First Conference on Tertiary Literacy focus on communication across differences of culture and discipline in Australian universities. Many of the papers have resulted from cooperation between applied linguists and specialist lecturers and describe cooperative models of literacy education based on interdisciplinary…

  19. 49 CFR 1018.70 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 49 CFR 1018.70 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  1. A Conceptualization of the Referral Process

    ERIC Educational Resources Information Center

    Corazzini, John G.; Shelton, John

    1974-01-01

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

  2. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  3. Using Discipline Referrals To Make Decisions.

    ERIC Educational Resources Information Center

    Tobin, Tary; Sugai, George; Colvin, Geoff

    2000-01-01

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

  4. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  5. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  6. 48 CFR 919.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. 48 CFR 619.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  8. Conjoined twins: experience in an Irish tertiary centre.

    PubMed

    McCarthy, C M; O'Donoghue, K

    2014-04-01

    Conjoined twins are rare, with a reported incidence of 0.19 per 10,000 pregnancies in Europe. We discuss four spontaneous conjoined twin pregnancies presenting to a tertiary referral centre from 2005 to 2011, diagnosed on antenatal dating ultrasound. The cases were monitored closely throughout pregnancy by a multidisciplinary team, with serial surveillance, including ultrasound, fetal echocardiography, magnetic resonance imaging, amniocentesis and further referral to cardiology and paediatric surgery specialists, where indicated. Three female sets were determined antenatally to be not surgically separable; these infants were managed palliatively following a live birth. The male set of conjoined twins was accepted for surgical separation at Great Ormond Street Hospital, London, which was successfully performed electively at 4 months. Of interest, all four parents reside within 20 km of each other, representing a possible cluster of cases. The incidence of conjoined twins in our local population is approximately 0.63 per 10,000 over an 8-year period from 2005 to 2012. This case series highlights a cluster of conjoined twins, managed to viability and delivered in a tertiary referral centre. PMID:24484468

  9. West Hackberry Tertiary Project

    SciTech Connect

    Gillham, Travis; Yannimaras, Demetrios

    1999-11-03

    The West Hackberry Tertiary Project is a field test of the concept that air injection can generate tertiary oil recovery through the Double Displacement Process. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil through gravity drainage. The novel aspect of this project is the use of air as the injection fluid. In Gulf Coast oil reservoirs with pronounced bed dip, reservoir performance has shown that gravity drainage recoveries average 80% to 90% of the original oil in place while water drive recoveries average 50% to 60% of the original oil in place. The target for tertiary oil recovery with the Double Displacement Process is the incremental oil between the 50% to 60% water drive recoveries and the 80% to 90% gravity drainage recoveries. The use of air injection in this process combines the benefits of air's low cost and universal accessibility with the potential for improved oil recovery resulting from spontaneous in situ combustion. If successful, this project will demonstrate that utilizing air injection in the Double Displacement Process will result in an economically viable tertiary process in many Gulf Coast oil reservoirs where other tertiary processes are presently uneconomic. The West Hackberry Tertiary Project receives matching funds from the United States Department of Energy (DOE) as part of the DOE's Class 1 Program for the development of advance recovery technologies in fluvial dominated deltaic reservoirs. In addition, the Petroleum Engineering Department at Louisiana State University (LSU) provides independent study and technology transfer.

  10. Inappropriate circumcision referrals by GPs.

    PubMed Central

    Griffiths, D; Frank, J D

    1992-01-01

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

  11. Entrepreneurship Education in Delta State Tertiary Institution as a Means of Achieving National Growth and Development

    ERIC Educational Resources Information Center

    Osakwe, Regina N.

    2015-01-01

    This study examined entrepreneurship education in Delta Sate tertiary institutions as a means of national growth and development. Two research questions were asked to guide the study. The population comprised all the 1,898 academic staff in eight tertiary institutions in the state. A sample of 800 lecturers was drawn through the multi stage and…

  12. Correlation between the radiological observation of isolated tertiary waves on an esophagram and findings on high-resolution esophageal manometry.

    PubMed

    Halland, M; Ravi, K; Barlow, J; Arora, A

    2016-01-01

    Barium esophagrams are a frequently performed test, and radiological observations about potential abnormal esophageal motility, such as tertiary contractions, are commonly reported. We sought to assess the correlation between tertiary waves, and in particular isolated tertiary waves, on esophagrams and findings on non-synchronous high-resolution esophageal manometry. We retrospectively reviewed reports of esophagrams performed at a tertiary referral center and identified patients in whom tertiary waves were observed and a high-resolution esophageal manometry had been performed. We defined two groups; group 1 was defined as patients with isolated tertiary waves, whereas group 2 had tertiary waves and evidence of achalasia or an obstructing structural abnormality on the esophagram. We collected data on demographics, dysphagia score, associated findings on esophagram, and need for intervention. We reviewed the reports of 2100 esophagrams of which tertiary waves were noted as an isolated abnormality in 92, and in association with achalasia or a structural obstruction in 61. High-resolution manometry was performed in 17 patients in group 1, and five had evidence of a significant esophageal motility disorder and 4 required any intervention. Twenty-one patients in group 2 underwent manometry, and 18 had a significant esophageal motility disorder. An isolated finding of tertiary waves on an esophagram is rarely associated with a significant esophageal motility disorder that requires intervention. All patients with isolated tertiary waves who required intervention had a dysphagia to liquids. Tertiary contractions, in the absence of dysphagia to liquids, indicate no significant esophageal motility disorder. PMID:25327483

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

    PubMed

    Jung, Minsoo; Choi, Mankyu

    2010-01-01

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

  14. 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

  15. 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

  16. Enthusiasm and the Effective Modern Academic

    ERIC Educational Resources Information Center

    Freudenberg, Brett; Samarkovski, Lisa

    2014-01-01

    Academics today face an array of challenges to their enthusiasm, including teaching students from diverse backgrounds with wavering levels of engagement with their studies. Furthermore, reform to the tertiary education sector has seen the corporatisation of universities with management increasingly measuring academic outcomes in respect of both…

  17. Unpredictable Feelings: Academic Women under Research Audit

    ERIC Educational Resources Information Center

    Grant, Barbara M.; Elizabeth, Vivienne

    2015-01-01

    Academic research is subject to audit in many national settings. In Aotearoa/New Zealand, the government regulates the flow of publicly funded research income into tertiary institutions through the Performance-Based Research Fund (PBRF). This article enquires into the effects of the PBRF by exploring data collected from 16 academic women of…

  18. Developing New Academic Developers: Doing before Being?

    ERIC Educational Resources Information Center

    Kensington-Miller, Barbara; Brailsford, Ian; Gossman, Peter

    2012-01-01

    A small group of new academic developers reflected on their induction into the profession and wondered if things could have been done differently. The researchers decided to question the directors of three tertiary academic development units about how they recruited new developers, what skills and competences they looked for and how they inducted…

  19. Tertiary Education And Education for All: Establishing Policy Linkages

    ERIC Educational Resources Information Center

    Ordonez, Victor

    2005-01-01

    There are several areas of intersection between tertiary education and basic education. This article examines four such areas--teacher education, academic research, policy analysis and research, and university outreach--and explores possible policy alternatives by which collaboration in these can be strengthened and optimized. The author submits…

  20. 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....

  1. 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....

  2. 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....

  3. 32 CFR 701.9 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  4. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  5. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  6. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  7. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  8. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  9. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  10. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  11. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  12. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

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

    PubMed

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

    2002-01-01

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

  14. Academic Dissatisfaction, Managerial Change and Neo-Liberalism

    ERIC Educational Resources Information Center

    Fredman, Nick; Doughney, James

    2012-01-01

    This paper examines perceptions by academics of their work in the Australian state of Victoria, and places such perceptions within the context of international and Australian debates on the academic profession. A 2010 survey conducted by the National Tertiary Education Union in Victoria was analysed in light of the literature on academic work…

  15. Striped tertiary storage arrays

    NASA Technical Reports Server (NTRS)

    Drapeau, Ann L.

    1993-01-01

    Data stripping is a technique for increasing the throughput and reducing the response time of large access to a storage system. In striped magnetic or optical disk arrays, a single file is striped or interleaved across several disks; in a striped tape system, files are interleaved across tape cartridges. Because a striped file can be accessed by several disk drives or tape recorders in parallel, the sustained bandwidth to the file is greater than in non-striped systems, where access to the file are restricted to a single device. It is argued that applying striping to tertiary storage systems will provide needed performance and reliability benefits. The performance benefits of striping for applications using large tertiary storage systems is discussed. It will introduce commonly available tape drives and libraries, and discuss their performance limitations, especially focusing on the long latency of tape accesses. This section will also describe an event-driven tertiary storage array simulator that is being used to understand the best ways of configuring these storage arrays. The reliability problems of magnetic tape devices are discussed, and plans for modeling the overall reliability of striped tertiary storage arrays to identify the amount of error correction required are described. Finally, work being done by other members of the Sequoia group to address latency of accesses, optimizing tertiary storage arrays that perform mostly writes, and compression is discussed.

  16. 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…

  17. Tertiary oil recovery

    SciTech Connect

    Byham, D. E.

    1985-03-05

    An improved method for the recovery of tertiary oil from oil formations containing connate waters having a high brine concentration. A stable alcohol external microemulsion is formed from specific brine-soluble surfactants and alcohols for employment as a chemical slug. Such a microemulsion may be used to efficiently and effectively recover tertiary oil from formations in high brine concentrations. Specific examples of surfactants which may be employed to form the microemulsions of the present invention include amphoteric surfactants such as bis-2-hydroxyethylcocoamine propane sulfonate and bis-2-hydroxyethyloctadecyl amine propane sulfonate.

  18. 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

  19. Promoting a smokers' quitline in Ontario, Canada: an evaluation of an academic detailing approach.

    PubMed

    Kirst, Maritt; Schwartz, Robert

    2015-06-01

    This study assesses the impact of an academic detailing quitline promotional outreach program on integration of patient referrals to the quitline by fax in healthcare settings and quitline utilization in Ontario, Canada. The study employed a mixed methods approach for evaluation, with trend analysis of quitline administrative data from the year before program inception (2005) to 2011 and qualitative interviews with quitline stakeholders. Participants in the qualitative interviews included academic detailing program staff, regional tobacco control stakeholders and quitline promotion experts. Quantitative outcomes included the number of fax referral partners and fax referrals received, and quitline reach. Trends in proximal and distal outreach program outcomes were assessed. The qualitative data were analysed through a process of data coding involving the constant comparative technique derived from grounded theory methods. The study identified that the outreach program has had some success in integrating the fax referral program in healthcare settings through evidence of increased fax referrals since program inception. However, organizational barriers to program partner engagement have been encountered. While referral from health professionals through the fax referral programs has increased since the inception of the outreach program, the overall reach of the quitline has not increased. The study findings highlight that an academic detailing approach to quitline promotion can have some success in achieving increased fax referral program integration in healthcare settings. However, findings suggest that investment in a comprehensive promotional strategy, incorporating academic detailing, media and the provision of free cessation medications may be a more effective approach to quitline promotion. PMID:23766445

  20. A Date With Academic Literacies: Using Brief Conversation to Facilitate Student Engagement With Academic Literacies

    ERIC Educational Resources Information Center

    Dunham, Nicola

    2012-01-01

    The argument that de-contextualized deficit approaches to academic literacies were ineffective (Lea, 2004; Northedge, 2003), has led to expectations that New Zealand Higher Education institutions embed academic literacies within programmes and courses (Tertiary Education Commission, 2010). This paper reports on the use of a teaching and learning…

  1. What do clinicians want? Interest in integrative health services at a North Carolina academic medical center

    PubMed Central

    Kemper, Kathi J; Dirkse, Deborah; Eadie, Dee; Pennington, Melissa

    2007-01-01

    Background Use of complementary medicine is common, consumer driven and usually outpatient focused. We wished to determine interest among the medical staff at a North Carolina academic medical center in integrating diverse therapies and services into comprehensive care. Methods We conducted a cross sectional on-line survey of physicians, nurse practitioners and physician assistants at a tertiary care medical center in 2006. The survey contained questions on referrals and recommendations in the past year and interest in therapies or services if they were to be provided at the medical center in the future. Results Responses were received from 173 clinicians in 26 different departments, programs and centers. There was strong interest in offering several specific therapies: therapeutic exercise (77%), expert consultation about herbs and dietary supplements (69%), and massage (66%); there was even stronger interest in offering comprehensive treatment programs such as multidisciplinary pain management (84%), comprehensive nutritional assessment and advice (84%), obesity/healthy lifestyle promotion (80%), fit for life (exercise and lifestyle program, 76%), diabetes healthy lifestyle promotion (73%); and comprehensive psychological services for stress management, including hypnosis and biofeedback (73%). Conclusion There is strong interest among medical staff at an academic health center in comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness, nutrition and stress management. Future studies will need to assess the cost-effectiveness of such services, as well as their financial sustainability and impact on patient satisfaction, health and quality of life. PMID:17291340

  2. Variations in Decision-Making Approach to Tertiary Teaching: A Case Study in Vietnam

    ERIC Educational Resources Information Center

    Nguyen, Thanh Tien

    2016-01-01

    Although the question of what to teach and how to teach has received much attention from the literature, little was known about the way in which academics in teaching groups make decision on what and how to teach. This paper reports an analysis of variations in the decision-making approach to tertiary teaching through academics' practices of…

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

    PubMed

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

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

  4. 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

  5. Tertiary Education in Portugal

    ERIC Educational Resources Information Center

    OECD Publishing (NJ3), 2008

    2008-01-01

    Portugal's tertiary education sector has expanded significantly over the last 20 years, but participation and overall educational attainment levels remain below European standards and enrolment rates have begun to decline. The OECD review recommends that Portugal's national government should focus on strategic direction and leave higher education…

  6. Mortality in newborns referred to tertiary hospital: An introspection

    PubMed Central

    Aggarwal, Kailash Chandra; Gupta, Ratan; Sharma, Shobha; Sehgal, Rachna; Roy, Manas Pratim

    2015-01-01

    Background: India is one of the largest contributors in the pool of neonatal death in the world. However, there are inadequate data on newborns referred to tertiary care centers. The present study aimed to find out predictors of mortality among newborns delivered elsewhere and admitted in a tertiary hospital in New Delhi between February and September 2014. Materials and Methods: Hospital data for were retrieved and analyzed for determining predictors for mortality of the newborns. Time of admission, referral and presenting clinical features were considered. Results: Out of 1496 newborns included in the study, there were 300 deaths. About 43% deaths took place in first 24 hours of life. Asphyxia and low birth weight were the main causes of death in early neonatal period, whereas sepsis had maximum contribution in deaths during late neonatal period. Severe hypothermia, severe respiratory distress, admission within first 24 hours of life, absence of health personnel during transport and referral from any hospital had significant correlation with mortality. Conclusions: There is need for ensure thermoregulation, respiratory sufficiency and presence of health personnel during transport. PMID:26288788

  7. Visibility of natural tertiary rainbows.

    PubMed

    Lee, Raymond L; Laven, Philip

    2011-10-01

    Naturally occurring tertiary rainbows are extraordinarily rare and only a handful of reliable sightings and photographs have been published. Indeed, tertiaries are sometimes assumed to be inherently invisible because of sun glare and strong forward scattering by raindrops. To analyze the natural tertiary's visibility, we use Lorenz-Mie theory, the Debye series, and a modified geometrical optics model (including both interference and nonspherical drops) to calculate the tertiary's (1) chromaticity gamuts, (2) luminance contrasts, and (3) color contrasts as seen against dark cloud backgrounds. Results from each model show that natural tertiaries are just visible for some unusual combinations of lighting conditions and raindrop size distributions. PMID:22016239

  8. Policy and Practice of Tertiary Literacy. Selected Proceedings of the First National Conference on Tertiary Literacy: Research and Practice, Volume 1 (1st, Melbourne, Australia, March 14-16, 1996).

    ERIC Educational Resources Information Center

    Golebiowski, Zofia, Ed.

    This selection of papers from the First Conference on Tertiary Literacy, which examined the role of literacy as a foundation for knowledge acquisition and dissemination that influences the academic success of tertiary students, presents a number of case studies of policy and practice in Australian universities. Keynote addresses included:…

  9. Improving access in gastroenterology: The single point of entry model for referrals

    PubMed Central

    Novak, Kerri L; Van Zanten, Sander Veldhuyzen; Pendharkar, Sachin R

    2013-01-01

    In 2005, a group of academic gastroenterologists in Calgary (Alberta) adopted a centralized referral intake system known as central triage. This system provided a single point of entry model (SEM) for referrals rather than the traditional system of individual practitioners managing their own referrals and queues. The goal of central triage was to improve wait times and referral management. In 2008, a similar system was developed in Edmonton at the University of Alberta Hospital (Edmonton, Alberta). SEMs have subsequently been adopted by numerous subspecialties throughout Alberta. There are many benefits of SEMs including improved access and reduced wait times. Understanding and measuring complex patient flow systems is key to improving access, and centralized intake systems provide an opportunity to better understand total demand and system bottlenecks. This knowledge is particularly important for specialties such as gastroenterology (GI), in which demand exceeds supply. While it is anticipated that SEMs will reduce wait times for GI care in Canada, the lack of sufficient resources to meet the demand for GI care necessitates additional strategies. PMID:24040629

  10. [Cutaneomucous tertiary syphilis].

    PubMed

    Sekkat, A; Sedrati, O; Derdabi, D

    1994-01-01

    On the basis of two new cases of cutaneous mucosal tertiary syphilis and a personal series of 30 cases observed at the University Hospital of Rabat and Casablanca from 1963 to 1980, we reviewed the clinical presentations of this disease. Late stage syphilis has not disappeared and appears to be increasing over the last decade. Lesions of the nervous system are increasingly reported in atypical often unrecognized forms. Cutaneous mucosal tertiary syphilis is very rare and little known and can take on the form of skin lesions suggesting tuberculosis, deep mycosis, sarcoidosis, leprosy or leishmaniasis. Based on our experience, we recall the variety of clinical presentations including superficial nodules and deep gommas leading to atrophic and rarely hypertrophic scars. The diagnosis relies essentially on the serology results which are always positive at a significant level. The pathology examination adds no essential information. Rapid response to treatment is one of the important criteria of the diagnosis of syphilis. PMID:7979026

  11. 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....

  12. 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....

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

    PubMed

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

    1998-01-01

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

  14. 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

  15. Descriptive Analysis of Selected Data Referral Networks.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

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

  16. 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…

  17. 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

  18. Slowing the Flood of Special Education Referrals.

    ERIC Educational Resources Information Center

    Dauphinais, Paul

    2000-01-01

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

  19. Gifted Girls: Gender Bias in Gifted Referrals

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  20. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  1. 48 CFR 419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  2. 48 CFR 2819.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  3. 48 CFR 1419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  4. 48 CFR 1319.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  5. Alternative Education's Impact on Office Disciplinary Referrals

    ERIC Educational Resources Information Center

    Gut, Eva; McLaughlin, John M.

    2012-01-01

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

  6. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  7. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  8. PLEXUS--The Expert System for Referral.

    ERIC Educational Resources Information Center

    Vickery, A.; Brooks, H. M.

    1987-01-01

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

  9. Changes in Urolithiasis Referral Patterns for Shock Wave Lithotripsy over a Decade: Was There Adherence to AUA/EAU Guidelines?

    PubMed Central

    Noureldin, Yasser A.; Elkoushy, Mohamed A.; Andonian, Sero

    2015-01-01

    Objective The primary objective was to assess changes in referral patterns of urolithiasis for shock wave lithotripsy (SWL) over a decade. The secondary objective was to evaluate the effect of the number of years of practice of referring physicians on these referral patterns. Methods A retrospective review of SWL database was performed for consecutive referrals for SWL at a tertiary stone center between December 1999 and December 2013. Patient demographics and stone characteristics were assessed. The stone location at the time of referral was used as the reference. Retreatments were excluded. In addition, years of practice of the referring physicians were calculated. The 2007 AUA/EAU guidelines on urolithiasis were considered as a reference. Results A total of 8,992 SWL treatments were included. After December 2007, there was a significant increase in the percentage of renal pelvic stones referred for SWL (23.0 vs. 27.1%, p < 0.001). Conversely, proximal ureteral stones significantly decreased after 2007 (24 vs. 18.2%, p < 0.001) including stones > 10 mm (5.1 vs. 2.9%, p < 0.001). Otherwise, there were no changes in the referral patterns for SWL of other stone locations before and after December 2007 (p > 0.05). Furthermore, percentage of stones referred for SWL by urologists practicing for less than 10 years significantly decreased after December 2007 (29.5 vs. 22.8%, p < 0.001). Conclusions The significant reduction in the referral of proximal ureteral stones after December 2007 corresponds to the latest AUA/EAU guidelines on management of ureteral stones. PMID:26889134

  10. The equity imperative in tertiary education: Promoting fairness and efficiency

    NASA Astrophysics Data System (ADS)

    Salmi, Jamil; Bassett, Roberta Malee

    2014-06-01

    While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population membership or disabilities as well as academic and financial barriers are still standing in their way. The authors of this article propose a conceptual framework to analyse equity issues in tertiary education and document the scope, significance and consequences of disparities in tertiary education opportunities. They throw some light on the main determinants of these inequalities and offer suggestions about effective equity promotion policies directed towards widening participation and improving the chances of success of underprivileged youths in order to create societies which uphold humanistic values.

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

    ERIC Educational Resources Information Center

    Altus, Grace T.; Altus, William D.

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

  12. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. 34 CFR 303.206 - Referral policies for specific children.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  14. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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

  3. 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

  4. Rare etiological factor of maxillofacial injury: Case series seen and managed in a tertiary referral centre

    PubMed Central

    Braimah, Ramat Oyebunmi; Ibikunle, Adebayo Aremu; Taiwo, Abdurrazaq Olanrewaju

    2016-01-01

    Entanglement injury from local milling/grinding machine with a conveyor belt is a rare etiology of maxillofacial injuries. While there is abundant literature on industrial cause of trauma, entanglement injury as a mechanism has not been reported in the literature. We present two cases of maxillofacial injury secondary to entanglement of the loose apparel into the conveyor belt of the local grinding machine. The community should be aware of this rare cause of trauma, and adequate protection of children using these facilities should be enforced. One of such measure is to provide physical barriers to guard against these machines. PMID:27162440

  5. Retrospective screening for hepatitis C in a tertiary paediatric referral centre.

    PubMed

    McKeown, C; Thaker, U; Cubitt, W D; Novelli, V

    2003-04-01

    The true prevalence of hepatitis C virus in children in the UK is not known and targeted screening is not standard practice despite an anticipated rise in new cases due to vertical transmission. An extension of the Department of Health's 'look-back' exercise was undertaken in order to determine the prevalence of hepatitis C virus in high-risk patient groups who were transfused with blood and/or blood products before 1991. Five hundred and ninety-five patients transfused between 1971-91 were traced and offered counselling and testing. Blood samples from 405 were analysed for the presence of HCV antibodies and/or HCV RNA by RT-PCR and eight patients were found to be positive. The HCV seroprevalence rate in this cohort was 1.97% and the HCV genome detection rate was 1.72%. In view of the long-term complications from this infection and the availability of potentially effective anti-viral agents, we feel that targeted screening is of value in this setting. PMID:12736971

  6. Minimally invasive endoscopic treatment for lumbar infectious spondylitis: a retrospective study in a tertiary referral center

    PubMed Central

    2014-01-01

    Background Spinal infections remain a challenge for clinicians because of their variable presentation and complicated course. Common management approaches include conservative administration of antibiotics or aggressive surgical debridement. The purpose of this study was to evaluate the efficacy of percutaneous endoscopic debridement with dilute betadine solution irrigation (PEDI) for treating patients with lumbar infectious spondylitis. Methods From January 2005 to July 2010, a total of 32 patients undergoing PEDI were retrospectively enrolled in this study. The surgical indications of the enrolled patients included single-level infectious spondylodiscitis, postoperative infectious spondylodiscitis, advanced infection with epidural abscess, psoas muscle abscess, pre-vertebral or para-vertebral abscess, multilevel infectious spondylitis, and recurrent infection after anterior debridement and fusion. Clinical outcomes were assessed by careful physical examination, Macnab criteria, regular serologic testing, and imaging studies to determine whether continued antibiotics treatment or surgical intervention was required. Results Causative bacteria were identified in 28 (87.5%) of 32 biopsy specimens. Appropriate parenteral antibiotics for the predominant pathogen isolated from infected tissue biopsy cultures were prescribed to patients. Twenty-seven (84.4%) patients reported satisfactory relief of their back pain after PEDI. Twenty-six (81.3%) patients recovered uneventfully after PEDI and sequential antibiotic therapy. No surgery-related major complications were found, except 3 patients with transient paresthesia in the affected lumbar segment. Conclusions PEDI was successful in obtaining a bacteriologic diagnosis, relieving the patient’s symptoms, and assisting in the eradication of lumbar infectious spondylitis. This procedure could be an effective alternative for patients who have a poor response to conservative treatment before a major open surgery. PMID:24669940

  7. Infectious agents in congenital cataract in a tertiary care referral center in North India.

    PubMed

    Singh, Mini P; Ram, Jagat; Kumar, Archit; Khurana, Jasmine; Marbaniang, Merinda; Ratho, Radha Kanta

    2016-08-01

    Congenital cataract has the potential for inhibiting early visual development. Intrauterine infections with Rubella virus, Herpes simplex virus (HSV) and Toxoplasma gondii plays an important role in the development of congenital cataract. The study included 120 children under the age of 6 years presenting with congenital cataract and diagnosed using serology and polymerase chain reaction (PCR). The IgM positivity for rubella, HSV, T. gondii was found to be 5.8%, 1.6% and 8.3% respectively. The overall PCR positivity was found to be 40(33.3%), 25 (20.8%) and 39 (32.5%) for rubella, HSV and T. gondii with mean copy number of 1599 copies/μL; 1716 copies/μL and 1503 copies/μL respectively. Infective etiology significantly contributes to the causation of congenital cataract particularly for rubella virus which is a potentially eradicable disease. This study provides an epidemiological data for rubella, HSV and T. gondii in children with congenital cataract and highlights the need to introduce rubella vaccine in the National Immunization Programme of India. PMID:27236713

  8. Evaluation of the Hemostatic Disorders in Adolescent Girls with Menorrhagia: Experiences from a Tertiary Referral Hospital.

    PubMed

    Karaman, Kamuran; Ceylan, Nesrin; Karaman, Erbil; Akbayram, Sinan; Akbayram, Hatice Tuba; Kaba, Sultan; Garipardıç, Mesut; Öner, Ahmet Fayik

    2016-09-01

    Bleeding disorders are a common cause of menorrhagia in the adolescent age group. We aimed to evaluate the incidence of hemostatic disorders, using clinical and laboratory findings of bleeding disorders in adolescent girls with menorrhagia. A retrospective chart review used to evaluate adolescent girls with menorrhagia who were referred to Yuzuncu Yil University Pediatric Hematology clinic between January 2010 and December 2014. Out of 52 patients referred for investigation, 50 patients were included in the study. The mean age and mean menarche age were 14.8 ± 1.42 (range: 12-17) and 12.47 ± 0.55, respectively. In 42 % (n = 21) of patients, anemia was detected. In 22 % (n = 11) of patients, a bleeding disorder was detected: five cases with von Willebrand disease, two cases with acute immune thrombocytopenic purpura, one case with Bernard-Soulier syndrome, one case with Glanzmann thrombasthenia, one case with aplastic anemia and one case with factor X deficiency. The remaining 39 out of the 50 patients were finally diagnosed with dysfunctional uterine bleeding. When compared the patients with bleeding disorders and without bleeding disorders, bleeding from other sites, including gingival bleeding or epistaxis, low platelet counts and prolonged activated partial thromboplastin time were found statistically more frequent in patients with bleeding disorders (p < 0.05). Menorrhagia in adolescents is frequently associated with underlying bleeding disorders. Adolescents with heavy menstrual bleeding and a history of nose or gingival bleeding should be evaluated for congenital bleeding disorders. PMID:27429530

  9. Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre

    PubMed Central

    Navarro, A; Beckingham, IJ; Cameron, IC; Brooks, AJ

    2014-01-01

    Introduction Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM. Methods A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013. Results Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the non-operated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05). Conclusions SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group. PMID:25198972

  10. Radiation-Induced Sarcoma: A 15-Year Experience in a Single Large Tertiary Referral Center

    PubMed Central

    Kim, Kyung Su; Chang, Ji Hyun; Choi, Noorie; Kim, Han-Soo; Han, Ilkyu; Moon, Kyung Chul; Kim, Il Han; Kim, Hak Jae

    2016-01-01

    Purpose The purpose of this study is to report on the incidence and the experience in management of radiation-induced sarcoma (RIS) at a large single center in Korea for 15 years. Materials and Methods We retrospectively reviewed the sarcoma registry of a large institution from January 2000 to April 2014. Results Out of the 3,674 patients listed in the registry, 33 patients (0.9%) diagnosed with RIS were identified. The median latency of RIS was 12.1 years. The number of cases of RIS increased from four cases in the years 2000-2003 to 14 cases in the years 2012-2014. The most common histology was osteosarcoma (36.4%). The median follow-up period was 23.1 months, the median overall survival (OS) of all patients was 2.9 years, and their 5-year survival rate was 44.7%. Univariate and multivariate analyses showed association of the age at diagnosis (p=0.01) and the treatment aim (p=0.001) with the OS. The median OS and the 5-year survival rate of patients treated with curative surgery (n=19) were 9.6 years and 65%, respectively, and of the conservatively treated patients, 0.7 years and 0% (n=14). Re-irradiation was delivered to nine patients, and radiation toxicity was observed in five patients. Conclusion In this study, RIS accounted for 0.9% of the cases of sarcoma, with increasing incidence. Despite the association of curative resection with increased survival, it could be applied to only 58% of the patients. Considering the limited treatment options for RIS, conduct of a genetic study to identify the underlying mechanism of RIS is needed. PMID:27004955

  11. Audit of birth defects in 34,109 deliveries in a tertiary referral center.

    PubMed

    Noraihan, M N; See, M H; Raja, R; Baskaran, T P; Symonds, E M

    2005-10-01

    The objective of the study is to determine the proportion and different types of birth defects among the children born in Hospital Kuala Lumpur. A cross-sectional study was conducted for a period of 18 months where all consecutively born infants, dead or alive were included. There were total of 34,109 births recorded during this period. The proportion of birth defects in Hospital Kuala Lumpur was 3.1% (n = 1056). The commonest involved were the hematology system, (157.7 per 10,000 births), the central nervous system, genitourinary system and chromosomal anomalies. The proportion was significantly higher in males and in the Chinese (p < 0.001). The commonest abnormalities are Glucose 6 Phosphate Deficiency (157.7/10000), Down's syndrome (12.6/10000), thalassaemia (8.8/10000), cleft lip and/or palate (7.6/10000) and anencephaly (7.3/10000). Neural tube defect is common and ranked second after G6PD deficiency. There is a need for a birth defect registry to assess the extent of the problem in Malaysia. PMID:16570708

  12. Mucormycete infection or colonisation: experience of an Australian tertiary referral centre.

    PubMed

    Langford, S; Trubiano, J A; Saxon, S; Spelman, D; Morrissey, C O

    2016-05-01

    Mucormycosis is associated with significant morbidity and mortality. We reviewed patients with mucormycete isolated at Alfred Health, Australia. A retrospective review of 66 patients with mucormycete(s) identified, between 1 April 2008 and 30 June 2014. Baseline demographic, microbiological, radiological, treatment/outcome data were recorded. Site of isolation was sinopulmonary in 77% and skin/soft tissue in 21%. A total of 32% of cases were proven-IFD, 12% probable-IFD and 56% were defined as no-IFD (or colonisation). Rhizopus spp. was identified in 48%. Comparing probable/proven-IFD with no-IFD/colonisation, more patients were postallogeneic stem cell transplantation (28% vs. 0%, P < 0.01) and were receiving immunosuppressive therapy (59% vs. 24%, P < 0.01) including prednisolone >20 mg daily (24% vs. 5%, P = 0.04). A total of 93% of patients with proven/probable IFD received treatment while 30% of no-IFD/colonisation were treated. A total of 72% of patients with proven/probable IFD and 92% of those with colonisation had no further mucormycete isolated. Thirty day mortality was higher in the proven/probable-IFD cohort (24%) compared with no-IFD/colonisation (3%) (P = 0.02). Mucormycosis remains uncommon, with 56% of cases not associated with clinical infection. Immunosuppressive therapy remains strongly associated with mucormycosis. Mortality remains high in those with proven/probable IFD. PMID:26857435

  13. Rare etiological factor of maxillofacial injury: Case series seen and managed in a tertiary referral centre.

    PubMed

    Braimah, Ramat Oyebunmi; Ibikunle, Adebayo Aremu; Taiwo, Abdurrazaq Olanrewaju

    2016-01-01

    Entanglement injury from local milling/grinding machine with a conveyor belt is a rare etiology of maxillofacial injuries. While there is abundant literature on industrial cause of trauma, entanglement injury as a mechanism has not been reported in the literature. We present two cases of maxillofacial injury secondary to entanglement of the loose apparel into the conveyor belt of the local grinding machine. The community should be aware of this rare cause of trauma, and adequate protection of children using these facilities should be enforced. One of such measure is to provide physical barriers to guard against these machines. PMID:27162440

  14. An audit of histopathology reports of carcinoma endometrium: Experience from a tertiary referral center

    PubMed Central

    Deodhar, KK; Rekhi, B; Menon, S; Ganesh, B

    2015-01-01

    Background: The aim was to see, compliance to minimum data information in carcinoma endometrium reports, in a team of 13 pathologists, and also to analyze these parameters e.g. tumor size, type, grade, depth of myometrial invasion, lymph node yield, pTNM stage etc. Materials and Methods: Reports of 114 cases of carcinoma endometrium, that were operated in-house during the years 2008 to 2010 were analyzed from the files of the Pathology department of our hospital. Results: The median age was 58.04 years and median tumor size was 4 cm. Endometrioid adenocarcinoma was the most common type (82.5%), followed by malignant mixed Mullerian tumor (MMMT) (6.1%) and Serous carcinoma (3.5%). Grade 2 was the commonest tumor grade (42.1%). Less than half of myometrial invasion was seen in 50% of the cases and more than half of the myometrial invasion was seen in 46.5% of cases. (Information was not available in four cases). Parametrial involvement was seen in 5.3% cases. The pTNM stage was not mentioned in 71.9% reports. The median lymph node yield was 15. Conclusion: The compliance to adhere to and to provide minimum data information in carcinoma endometrium reports is generally good. Lymph node yield is reasonable. Mentioning of pTNM staging is to be done more meticulously. Use of proformas/checklists is recommended. PMID:25766338

  15. Estimation of thyroglobulin in lymph node aspirates: Pilot experience from a tertiary referral cancer center

    PubMed Central

    Kannan, Subramanian; Chauhan, Subhra; Naveen; Latha, B. S.; Raju, Nalini; Chandrasekhar, Naveen Hedne; Kekatpure, Vikram; Kuriakose, Moni Abraham; Manjunath, P.

    2016-01-01

    Background: Assessment of cervical lymph node involvement in patients with thyroid cancer either during preoperative surgical mapping or detection of recurrences during follow-up is a crucial step in the management of differentiated thyroid cancers (DTCs). In most patients, fine needle aspiration cytology (FNAC) confirms the presence of metastasis in lymph node. However, in cases of paucicellular lymph node aspirate or discordant sonogram and cytology results, thyroglobulin (Tg) measurement in the lymph node aspirate (FNA-Tg) is useful and a value >1 ng/ml is considered consistent with metastatic disease. Context: The addition of FNAC to the US improves the specificity, but 5–10% are nondiagnostic and 6–8% rate of false-negative results. Several studies have reported that the detection of Tg in FNA-needle washes improves the evaluation of suspicious lymph nodes in patients with DTC.Data from Indian centers on FNA-Tg are limited. Aims: We piloted the utility of FNA-Tg in patients with sonographically suspicious cervical lymph node enlargement in the setting of suspicious thyroid nodule or in the follow-up of thyroid cancer. Settings and Design: Prospective data collection. Results: We measured Tg in 13 lymph node aspirates (12 patients, 10 females) among whom 4 patients had a total thyroidectomy and 1 had a hemithyroidectomy. Eight of the 13 lymph node aspirates had FNA-Tg values >150 ng/ml, all of them had unequivocal malignant cytology and four among them had proven metastatic DTC on surgical pathology. The median FNA-Tg of the patients with malignant cytology was 7550 ng/ml with a range of 162–30,000 ng/ml. Among the remaining 5 lymph node aspirate, 2 lymph nodes showed cytological features suggestive of reactive lymphadenitis (FNA-Tg <0.2 ng/ml) and were not operated, 1 had a high-grade malignancy consistent with anaplastic thyroid cancer (FNA-Tg <0.2 ng/ml), and 2 had nondiagnostic cytology (one had non-caseating granuloma on surgical pathology [FNA-Tg 1.3 ng/ml] and in the other patient [FNA-Tg <0.2 ng/ml] surgical intervention was deferred). Conclusions: FNA-Tg was concordant with positive cytology in all patients with DTC and may serve as a useful tool in patients with negative and nondiagnostic cytology to guide surgical management. PMID:27186554

  16. Female Pattern Hair Loss: A Retrospective Study in a Tertiary Referral Center

    PubMed Central

    Siah, Tee Wei; Muir-Green, Llorenia; Shapiro, Jerry

    2016-01-01

    Background: Female pattern hair loss (FPHL) is a very common problem in women. The underlying pathophysiology remains unclear, and there are no universally agreed treatment guidelines. Objective: We explored the clinical features, relevant medical and family history, laboratory evaluation, and treatment and compliance of 210 patients with FPHL. Methods: Data analysis from case notes was performed on 210 patients with a diagnosis of FPHL seen from January 2011 to December 2011. Results: The youngest individual was 8 years old and the oldest was 86 years old. Nearly, 85% of the patients had a family history of androgenetic alopecia. Hypothyroidism and hypertension are the most common medical problems. Telogen effluvium (TE) is the most common concurrent hair loss condition. Only 38% of the patients were found to have normal Vitamin D level, 71% had ferritin level above 30 μg/L, and 85% had normal zinc level at the first consultation. Fifty-nine percent of the patients failed to attend any follow-up appointments. Limitations: One of the limitations of this study is its retrospective nature. Moreover, the severity of FPHL in terms of Ludwig score was not routinely documented in the medical charts. Conclusion: History of TE, hypothyroidism and hypertension, and low serum Vitamin D is common in our patients with FPHL. PMID:27601857

  17. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  18. Acinetobacter Infections and Outcomes at an Academic Medical Center: A Disease of Long-Term Care

    PubMed Central

    Townsend, Jennifer; Park, An Na; Gander, Rita; Orr, Kathleen; Arocha, Doramarie; Zhang, Song; Greenberg, David E.

    2015-01-01

    Background. Our study aims to describe the epidemiology, microbial resistance patterns, and clinical outcomes of Acinetobacter infections at an academic university hospital. This retrospective study analyzed all inpatient clinical isolates of Acinetobacter collected at an academic medical center over 4 years. The data were obtained from an Academic tertiary referral center between January 2008 and December 2011. All consecutive inpatients during the study period who had a clinical culture positive for Acinetobacter were included in the study. Patients without medical records available for review or less than 18 years of age were excluded. Methods. Records were reviewed to determine source of isolation, risk factors for acquisition, drug resistance patterns, and clinical outcomes. Repetitive sequence-based polymerase chain reaction of selected banked isolates was used to determine patterns of clonal spread in and among institutions during periods of higher infection rates. Results. Four hundred eighty-seven clinical isolates of Acinetobacter were found in 212 patients (in 252 admissions). Patients with Acinetobacter infections were frequently admitted from healthcare facilities (HCFs) (59%). One hundred eighty-three of 248 (76%) initial isolates tested were resistant to meropenem. One hundred ninety-eight of 249 (79.5%) initial isolates were multidrug resistant (MDR). Factors associated with mortality included bacteremia (odds ratio [OR] = 1.93, P = .024), concomitant steroid use (OR = 2.87, P < .001), admission from a HCF (OR = 6.34, P = .004), and chronic obstructive pulmonary disease (OR = 3.17, P < .001). Conclusions. Acinetobacter isolates at our institution are frequently MDR and are more common among those who reside in HCFs. Our findings underline the need for new strategies to prevent and treat this pathogen, including stewardship efforts in long-term care settings. PMID:26034772

  19. Ethiopian Tertiary dike swarms

    NASA Technical Reports Server (NTRS)

    Mohr, P. A.

    1971-01-01

    Mapping of the Ethiopian rift and Afar margins revealed the existence of Tertiary dike swarms. The structural relations of these swarms and the fed lava pile to monoclinal warping of the margins partly reflect a style of continental margin tectonics found in other parts of the world. In Ethiopia, however, conjugate dike trends appear to be unusually strongly developed. Relation of dikes to subsequent margin faulting is ambiguous, and there are instances where the two phenomena are spatially separate and of differing trends. There is no evidence for lateral migration with time of dike injection toward the rift zone. No separate impingement of Red Sea, Gulf of Aden, and African rift system stress fields on the Ethiopian region can be demonstrated from the Tertiary dike swarms. Rather, a single, regional paleostress field existed, suggestive of a focus beneath the central Ethiopian plateau. This stress field was dominated by tension: there is no cogent evidence for shearing along the rift margins. A gentle compression along the rift floor is indicated. A peculiar sympathy of dike hade directions at given localities is evident.

  20. The Impact of Multiple Intelligence Theory on Teacher Perception of Giftedness and the Referral of African American Students to Gifted and Talented Education Programs

    ERIC Educational Resources Information Center

    Fisher, Tanya A.

    2013-01-01

    Programs for gifted students have been criticized for narrowly defining giftedness as merely cognitive or academic performance. Teacher referrals are usually an important component of identifying gifted students. Teacher perceptions, low expectations, and lack of cultural competence are perceived as barriers to the access of Gifted and Talented…

  1. Challenges of Student Selection: Predicting Academic Performance

    ERIC Educational Resources Information Center

    van der Merwe, D.; de Beer, M.

    2006-01-01

    Finding accurate predictors of tertiary academic performance, specifically for disadvantaged students, is essential because of budget constraints and the need of the labour market to address employment equity. Increased retention, throughput and decreased dropout rates are vital. When making admission decisions, the under preparedness of students…

  2. Psychotic symptoms in young people warrant urgent referral.

    PubMed

    Deakin, Julia; Lennox, Belinda

    2013-03-01

    There is a worse prognosis for psychosis and schizophrenia when onset is in childhood or adolescence. However, outcomes are improved with early detection and treatment. Psychotic symptoms can be associated with a variety of disorders including schizophrenia, schizoaffective disorder, drug-induced psychosis, personality disorder, epilepsy and autistic spectrum disorder. Positive symptoms include hallucinations and delusions. Negative symptoms include apathy, lack of drive, poverty of speech, social withdrawal and self-neglect. The DSM IV criteria for schizophrenia include two or more of the following: hallucinations, delusions, disorganised speech, grossly disorganised or catatonic behaviour and negative symptoms. Adults may raise concerns about social withdrawal, bizarre ideas, a change in behaviour or a decline in achievement. Most children and young people with psychotic symptoms will not go on to develop psychosis or schizophrenia. Direct enquiry may be needed to elicit suspected unusual beliefs or hallucinations. To distinguish unusual ideas from delusions the ideas should be tested for fixity. For example by asking: 'Are you sure? Could there be another explanation?' Mood and anxiety symptoms should be explored. The assessment should include a developmental history with particular attention to premorbid functioning. Failure to make expected progress whether personal, social or academic is significant. Better outcomes in terms of symptoms and social function are associated with a shorter duration of untreated psychosis. The detection of psychotic symptoms in primary care therefore warrants an urgent referral to secondary care mental health services for assessment and treatment. PMID:23634636

  3. Sociodemographic and Clinical Characteristics of Patients attending Psychotherapy in a Tertiary Care Hospital in Oman

    PubMed Central

    Al-Sharbati, Zena; Hallas, Claire; Al-Zadjali, Hazar; Al-Sharbati, Marwan

    2012-01-01

    Objectives: There is significant evidence that psychotherapy is a pivotal treatment for persons diagnosed with Axis I clinical psychiatric conditions; however, a psychotherapy service has only recently been established in the Omani health care system. This study aimed to investigate the sociodemographic and clinical characteristics of attendees at a psychotherapy clinic at a tertiary care hospital. Methods: An analysis was carried out of 133 new referrals to the Psychotherapy Service at Sultan Qaboos University Hospital, a tertiary care hospital. Results: The majority of referrals were females (59%), aged 18–34 years, employed (38%), had ≤12 years of formal education (51%), and were single (54%). A total of 43% were treated for anxiety disorders (including obsessive compulsive disorder), while 22% were treated for depression. A total of 65% were prescribed psychotropic medications. The utilisation of the Psychotherapy Service and its user characteristics are discussed within the context of a culturally diverse Omani community which has unique personal belief systems such as in supernatural powers (Jinn), contemptuous envy (Hassad), evil eye (Ain) and sorcery (Sihr) which are often used to explain the aetiology of mental illness and influence personal decisions on utilising medical and psychological treatments. Conclusion: Despite the low number of referrals to the Psychotherapy Service, there is reason to believe that psychotherapy would be an essential tool to come to grips with the increasing number of mental disorders in Oman. PMID:22375255

  4. Pattern of Referral of Noncancer Patients to Palliative Care in the Eastern Province of Saudi Arabia

    PubMed Central

    Ghanem, Hafez M; Shaikh, Rawabi M; Alia, Ahmad M Abou; Al-Zayir, Amani S; Alsirafy, Samy A

    2011-01-01

    Aim: The palliative care (PC) needs of patients with noncancer life-threatening illnesses are comparable to that of cancer patients. This report describes the contribution of noncancer patients to the population of PC patients in a tertiary care hospital in the Eastern Province of Saudi Arabia. Materials and Methods: This is a retrospective review of the “palliative care inpatient database” of 21 months. Results: From 474 patients, 20 (4.2%) had a noncancer diagnosis. The main reason for the referral of noncancer patients was pain control. The most prevalent diagnoses were sickle cell disease (SCD) in 6 (30%) patients and peripheral arterial disease (PAD) in 5 (25%). Conclusions: These findings suggest that the PC needs of noncancer patients are largely unmet in our region. Further efforts are necessary to advance noncancer PC in Saudi Arabia. The PC needs of patients with SCD and PAD need to be addressed in future research. PMID:22346049

  5. Neurotology symptoms at referral to vestibular evaluation

    PubMed Central

    2013-01-01

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

  6. Teach Me to Write; but Respec' Meh Right: A Critical Exploration of Vernacular Accommodation in Tertiary Education for All in Trinidad and Tobago

    ERIC Educational Resources Information Center

    Figuera, Renée; Ferreira, Leiba-Ann

    2014-01-01

    Since the introduction of the Education for All policy of the Government Assistance for Tuition Expenses (GATE) in Trinidad and Tobago, more tertiary level classrooms have been furnished with mixed linguistic and academic abilities and have accommodated more non-traditional tertiary-level entrants into the educational system. The expansion of the…

  7. External Quality Assurance of New Zealand Tertiary Education Providers Matters: Life Jacket or Strait-Jacket? AIR 2001 Annual Forum Paper.

    ERIC Educational Resources Information Center

    Weir, Annie

    The reality of external academic/quality audit has arrived for all tertiary education providers in New Zealand under the umbrella of the New Zealand Qualifications Authority. This paper reviews the development over the past decade of external quality assurance of tertiary providers by quality assurance authorities and their associated bodies. The…

  8. 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

  9. Understanding the referral services safe harbor.

    PubMed

    Tomes, J

    1994-02-01

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

  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. 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

  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. Verification in Referral-Based Crowdsourcing

    PubMed Central

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

    2012-01-01

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

  14. Verification in referral-based crowdsourcing.

    PubMed

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

    2012-01-01

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

  15. How Academic Is Academic Development?

    ERIC Educational Resources Information Center

    Fraser, Kym; Ling, Peter

    2014-01-01

    University provision for academic development is well established in the USA, UK and many other countries. However, arrangements for its provision and staffing vary. In Australia, there has been a trend towards professional rather than academic staff appointments. Is this appropriate? In this paper, the domains of academic development work are…

  16. A Meta-Analysis of the Five-Factor Model of Personality and Academic Performance

    ERIC Educational Resources Information Center

    Poropat, Arthur E.

    2009-01-01

    This article reports a meta-analysis of personality-academic performance relationships, based on the 5-factor model, in which cumulative sample sizes ranged to over 70,000. Most analyzed studies came from the tertiary level of education, but there were similar aggregate samples from secondary and tertiary education. There was a comparatively…

  17. Preventing Problem Behaviors: Primary, Secondary, and Tertiary Level Prevention Interventions for Young Children

    ERIC Educational Resources Information Center

    Tobin, Tary J.; Sugai, George

    2005-01-01

    The purpose of this report is to compare changes in social skills, problem behaviors, and academic competence for kindergarten or first grade students identified as being at risk for serious behavior problems who received primary, secondary, or tertiary level preventive interventions. Of the 93 participants in this study, 73% were male; 86% were…

  18. Challenges and Potentials for Writing Centres in South African Tertiary Institutions

    ERIC Educational Resources Information Center

    Archer, A.

    2010-01-01

    There are many challenges involved in developing and running Writing Centres in tertiary contexts in South Africa. These challenges include recognizing the role Writing Centres need to play in the redress of basic academic literacies. They also involve emphasizing writing as a mode of learning where higher cognitive functions such as analysis and…

  19. Using Institutional Research Data on Tertiary Performance to Inform Departmental Advice to Secondary Students

    ERIC Educational Resources Information Center

    Brogt, Erik; Sampson, Kaylene A.; Comer, Keith; Turnbull, Matthew H; McIntosh, Angus R.

    2011-01-01

    This article examines the use of institutional research data on tertiary academic success of students in the first-year Biology program at the University of Canterbury in relation to their secondary school performance in English, Mathematics with Statistics, Biology and Chemistry. This study was commissioned by the School of Biological Sciences to…

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    PubMed Central

    Rowe, F J

    2011-01-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  5. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  6. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  7. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  8. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  9. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  14. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  15. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  16. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  17. 49 CFR 209.133 - Referral for prosecution.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  18. 49 CFR 1503.703 - Civil penalty letter; referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  19. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  20. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  1. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  2. 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...

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

    ERIC Educational Resources Information Center

    Smith, Vernon

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

  4. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  5. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  6. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  8. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  9. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  10. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  11. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  12. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

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

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

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

  14. 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...

  15. 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...

  16. 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...

  17. 49 CFR 1503.703 - Civil penalty letter; referral.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  18. 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)...

  19. 49 CFR 1018.71 - Referral of a compromise offer.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 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…

  1. Tertiary climatic fluctuations and methods of analysis of tertiary floras

    USGS Publications Warehouse

    Wolfe, J.A.

    1971-01-01

    On theoretical grounds, an analysis of the physiognomy of a Tertiary leaf assemblage is more direct and reliable than a circuitous floristic analysis in assigning thermal regimes to fossil assemblages. Using primarily foliar physiognomy and secondarily floristic composition, it can be shown that: (1) some middle latitude Tertiary assemblages probably lived under meteoroligically tropical climates; (2) a major and rapid climatic deterioration occurred in the Oligocene; and (3) a major climatic fluctuation probably occurred in the Late Eocene. These analyses thus substantiate the conclusions of several other paleobotanists regarding climatic fluctuations. Recent criticisms of these analyses are shown to be invalid and to be based largely on misinterpretations. ?? 1971.

  2. Adapting a tertiary-care pediatric weight management clinic to better reach Spanish-speaking families.

    PubMed

    Guzman, Angelica; Irby, Megan B; Pulgar, Camila; Skelton, Joseph A

    2012-06-01

    Pediatric obesity continues to be an epidemic, affecting Hispanic children disproportionately. Recent recommendations outline a step-wise approach to the treatment of overweight and obese children, culminating in tertiary-care, multidisciplinary programs. We detail here how our tertiary-care, family-based, pediatric weight management clinic addressed the problem of few Spanish-speaking families enrolling in treatment after referral by adding a Bilingual Case Manager. Utilizing a family-centered, high-contact, personal approach, our program increased the number of Hispanic families enrolling over ten-fold. Further, outcomes in Hispanic families were equal to or better than other racial/ethnic groups. Lessons learned from this experience may benefit other obesity treatment programs trying to improve care of Spanish-speaking families. PMID:21909984

  3. Unheard voices: outcomes of tertiary care for treatment-refractory psychosis

    PubMed Central

    Sarkar, S. Neil; Tracy, Derek K.; Fernandez, Maria-Jesus Mateos; Nalesnik, Natasza; Dhillon, Gurbinder; Onwumere, Juliana; Prins, Anne-Marye; Schepman, Karen; Collier, Tracy; White, Thomas P.; Patel, Anita; Gaughran, Fiona; Shergill, Sukhwinder S.

    2014-01-01

    Aims and method In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation. Results In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation. Clinical implications Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured. PMID:25237502

  4. Academic Policy.

    ERIC Educational Resources Information Center

    Chicago City Colleges, IL.

    This statement outlines the academic policies of the City Colleges of Chicago. Part I outlines the Institution's academic standards, covering: (1) student class attendance; (2) the grading system; (3) mid-term grades; (4) the use of non-grade designations; i.e., administrative initiated withdrawal, auditor, no-show withdrawal, incomplete, and…

  5. Academic Bullies

    ERIC Educational Resources Information Center

    Fogg, Piper

    2008-01-01

    Many professors have been traumatized by academic bullies. Unlike bullies at school, the academic bully plays a more subtle game. Bullies may spread rumors to undermine a colleague's credibility or shut their target out of social conversations. The more aggressive of the species cuss out co-workers, even threatening to get physical. There is…

  6. Academic Engagement

    ERIC Educational Resources Information Center

    Swift, Christopher

    2010-01-01

    The academy is defined by a fundamentally uncertain pursuit of certainty. The question of whether academic work is a sufficient form of engagement on its own is inseparable from the contradiction inherent to this pursuit. Like any properly academic question, it lends itself to a forum: a response is nearly obligatory for any professor in the…

  7. Academic Duty.

    ERIC Educational Resources Information Center

    Kennedy, Donald

    This book by a former university president examines the state of the research university faculty, focusing on teaching and how success at teaching can be evaluated; ethical problems in reviewing the work of others, research and how it is supported; outside commitments; and research misconduct. Chapters include: "Academic Freedom, Academic Duty,"…

  8. Buckets and Fire: Metaphors in Tertiary Teaching

    ERIC Educational Resources Information Center

    Emerson, Lisa; Mansvelt, Juliana

    2015-01-01

    This paper examines New Zealand tertiary teachers' use of metaphor and their attitudes to the consumer metaphor in relation to teaching. Based on interviews with 16 tertiary teachers, this study shows that although teachers believe the consumer metaphor is accepted by students, tertiary institutions and policy makers, and that it has affected…

  9. Academic Freedom and Academic Tenure.

    ERIC Educational Resources Information Center

    De George, Richard T.

    2001-01-01

    Asserts that Martin Michaelson's proposal in "Should Untenured as Well as Tenured Faculty Be Guaranteed Academic Freedom? A Few Observations," despite its good intentions, is seriously flawed and if adopted in preference to existing standards will weaken rather than strengthen academic freedom. (EV)

  10. Impact of long-stay beds on the performance of a tertiary hospital in emergencies

    PubMed Central

    Pazin, Antonio; de Almeida, Edna; Cirilo, Leni Peres; Lourençato, Frederica Montanari; Baptista, Lisandra Maria; Pintyá, José Paulo; Capeli, Ronaldo Dias; da Silva, Sonia Maria Pirani Felix; Wolf, Claudia Maria; Dinardi, Marcelo Marcos; Scarpelini, Sandro; Damasceno, Maria Cecília

    2015-01-01

    ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. PMID:26603353

  11. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  12. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  13. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  14. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

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

    PubMed

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

    2005-04-01

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

  16. Effect of hospital referral networks on patient readmissions.

    PubMed

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

    2015-05-01

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

  17. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  18. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  19. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  20. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  1. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  2. Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit.

    PubMed

    Shipp, Kimberly D; Chiang, Tracy; Karasick, Stephanie; Quick, Kayla; Nguyen, Sean T; Cantey, Joseph B

    2016-04-01

    Background Antibiotic overuse in neonates is associated with adverse outcomes. Data are limited to guide antibiotic stewardship in the neonatal intensive care unit (NICU). Our objective was to identify areas for antibiotic stewardship improvement in a referral NICU. Methods Retrospective review of antibiotic use administered to infants admitted to a referral NICU compared with an inborn NICU. Antibiotic use was quantified by days of therapy (DOT) per 1,000 patient-days (PD). Results A total of 78% of referral NICU infants received ≥ 1 course of antibiotics. Infants in the referral NICU received more antibiotic DOT/1,000 PD than in the inborn NICU (558.9 vs. 343.2, p < 0.001), with a higher proportion of broad-spectrum therapy. For infants in the referral NICU, 39% of antibiotic courses were started at the transferring hospital; these were broader in spectrum (28 vs. 20%, p < 0.001) and less likely to be de-escalated or discontinued at 48 to 72 hours (58 vs. 87%, p < 0.001) than courses started after transfer. Conclusions Compared with the inborn NICU, suspected sepsis in the referral NICU accounted for more antibiotic utilization, which was broad-spectrum and less likely to be de-escalated. Stewardship interventions should include reserving broad-spectrum therapy for infants with risk factors and de-escalating promptly once culture results become available. PMID:26683603

  3. 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

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

    PubMed Central

    Nunes, Miguel Baptista

    2016-01-01

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

  5. Academic Village.

    ERIC Educational Resources Information Center

    Boles, Rebecca

    2001-01-01

    Presents design features of the Renner Middle School (Plano, Texas) where the sprawling suburbs have been kept at bay while creating the atmosphere of an academic village. Photos and a floor plan are provided. (GR)

  6. Academic Libraries

    ERIC Educational Resources Information Center

    Library Journal, 1970

    1970-01-01

    Building data is given for the following academic libraries: (1) Rosary College, River Forest, Illinois; (2) Abilene Christian College, Abilene, Texas; (3) University of California, San Diego, La Jolla, California. (MF)

  7. Focus on the Top Ten Diagnoses Could Reduce Pediatric Dermatology Referrals.

    PubMed

    Kakande, Betty; Gumedze, Freedom; Hlela, Carol; Khumalo, Nonhlanhla P

    2016-01-01

    There is a sense that many patients seen at referral centers could be managed at a primary health care level. The objective of the current study was to examine the range of diagnoses among consultations at the Red Cross Children's Hospital in Cape Town, South Africa, to help develop a strategy for targeted education of primary health care personnel. This was a retrospective review of data for children seen at a pediatric dermatology clinic from 2005 to 2010, recorded according to International Classification of Diseases coding and compared with published data from similar clinical settings. There were 13,253 clinic visits, with 4,789 patients seen (median age 4.8 yrs, range 2 days to 18.6 yrs). The top 10 diagnoses accounted for 88.5% of consultations (59.5% atopic eczema [AE], 7.1% seborrheic dermatitis [SD], 4.2% superficial mycoses, 3.1% molluscum contagiosum, 2.8% vitiligo, 2.7% viral warts, 2.4% prurigo or scabies, 2.3% psoriasis, 2.3% hemangioma, 2.1% impetigo). Disease prevalence was somewhat different during the first year of life (AE 43.7%, SD 18.6%, hemangiomas 13.4%). Inflammatory dermatoses (76.6%) were more prevalent than infections and infestations (14.5%). The disease spectrum was similar to that in developed countries, although AE prevalence was higher in this study (followed by London 36%, Greece 35%, and Hong Kong 33%) than in 19 published studies. The top 10 diagnoses accounted for more than 70% of diagnoses in 12 studies. The retrospective nature and setting at a specialist clinic increased bias and limited generalizability. Focused education on the optimal care of common diseases, especially AE, could reduce referrals, improve access, and allow specialists at tertiary centers more time to manage complex and uncommon dermatoses. PMID:26572929

  8. Referral patterns to a specialist eating disorder service: the impact of the referrer's gender.

    PubMed

    Feeney, Eileen; Noble, Helen; Waller, Glenn

    2007-01-01

    There is some evidence that the characteristics of general practitioners (GPs) and of the services that they operate influence the likelihood of referring patients to specialist eating disorder services. The aim of this study was to determine whether the gender of the GP is associated with referral rates for different eating disorders. The sample was a retrospective case series of 93 patients, referred to a specialist eating disorder service by local GPs. Associations between GP gender and clinical characteristics of the patients were determined using chi-squared tests and t-tests. Patients with binge eating disorder were substantially more likely to be referred by female GPs, while other atypical cases were more likely to be referred by male GPs. There was no evidence that the patients referred by male GPs differed in clinical presentation from those referred by female GPs. Clinical hypotheses are advanced to explain these biases in the referral practices of male and female clinicians. There is a need for greater education of GPs about the importance of identifying atypical eating disorders and treating them appropriately. PMID:17676672

  9. CHOA concussion consensus: establishing a uniform policy for academic accommodations.

    PubMed

    Popoli, David Michael; Burns, Thomas G; Meehan, William P; Reisner, Andrew

    2014-03-01

    Concussion research generally centers on physical challenges, though aspects such as social functioning and returning to school also warrant attention in pediatric populations. Restoring academic performance postconcussion remains a challenge. Here we provide recommendations addressing a uniform policy for pediatric concussion patients in academic institutions. Tools that may minimize difficulty with academic re-entry include independent educational evaluations, individualized educational programs (IEPs), student support teams (SSTs), letters of academic accommodation, time off, and 504 Plans. Recognition and treatment is crucial for symptom relief and prevention of functional disruption, as is specialist referral during the acute window. We recommend early intervention with a letter of academic accommodation and SST and suggest that 504 Plans and IEPs be reserved for protracted or medically complicated cases. Students with concussion should be observed for anxiety and depression because these symptoms can lead to prolonged recovery, decreased quality of life, and other social challenges. PMID:23960266

  10. English Language and Literature Academic Group at the National Institute of Education, Singapore

    ERIC Educational Resources Information Center

    Lee, Benny P. H.

    2010-01-01

    The National Institute of Education in Singapore (which is part of the Nanyang Technological University) is the leading national pre-service and in-service teacher training tertiary institution. It offers diploma, undergraduate and postgraduate programmes. The academic departments are called Academic Groups (AGs). The English Language and…

  11. Philosophy of Education, Dialogue and Academic Life in Aotearoa-New Zealand

    ERIC Educational Resources Information Center

    Stewart, Georgina; Roberts, Peter

    2016-01-01

    This collaborative paper reflects on academic life in Aotearoa-New Zealand. Drawing on our different personal histories, we examine the dominant influence of neoliberal ideas in shaping tertiary education reform, explore the importance of identity and worldview in structuring academic experience, and discuss the role of philosophy of education in…

  12. Beyond Collusion and Resistance: Academic-Management Relations within the Neoliberal University

    ERIC Educational Resources Information Center

    Shore, Cris; Davidson, Miri

    2014-01-01

    As an early pioneer of market-led institutional reforms and New Public Management policies, New Zealand arguably has one of the most "neoliberalised" tertiary education sectors in the world. This article reports on a recent academic dispute concerning the attempt by management to introduce a new category of casualised academic employee…

  13. Tertiary carbonate reservoirs in Indonesia

    SciTech Connect

    Nayoan, G.A.S.; Arpandi; Siregar, M.

    1981-01-01

    Hydrocarbon production from Tertiary carbonate reservoirs accounted for ca. 10% of daily Indonesian production at the beginning of 1978. Environmentally, the reservoirs appear as parts of reef complexes and high-energy carbonate deposits within basinal areas situated mainly in the back arc of the archipelago. Good porosities of the reservoirs are represented by vugular/moldic and intergranular porosity types. The reservoirs are capable of producing prolific amounts of hydrocarbons: production tests in Salawati-Irian Jaya reaches maximum values of 32,000 bpd, and in Arun-North Sumatra tests recorded 200 MMCF gas/day. Significant hydrocarbon accumulations are related to good reservoir rocks in carbonates deposited as patch reefs, pinnacle reefs, and platform complexes. Exploration efforts expand continuously within carbonate formations which are extensive horizontally as well as vertically in the Tertiary stratigraphic column.

  14. Sustainability Champions? Academic Identities and Sustainability Curricula in Higher Education

    ERIC Educational Resources Information Center

    Wood, Bronwyn E.; Cornforth, Sue; Beals, Fiona; Taylor, Mike; Tallon, Rachel

    2016-01-01

    Purpose: The purpose of this paper is to explore the experiences of academic staff who are committed to embedding sustainability within tertiary curricula and pedagogy. Design/Methodology/Approach: The focus of this paper is on a New Zealand university. A survey of staff was undertaken and in-depth interviews conducted with 11 sustainability…

  15. Psychological Factors Explaining the Referral Behavior of Iranian Family Physicians

    PubMed Central

    Mohaghegh, Bahram; Seyedin, Hesam; Rashidian, Arash; Ravaghi, Hamid; Khalesi, Nader; Kazemeini, Hossein

    2014-01-01

    Background: The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs. Objectives: This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist. Patients and Methods: An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%). Results: The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior. Conclusions: The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by

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

    PubMed Central

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

    2008-01-01

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

  17. 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

  18. Negative Biopsy after Referral for Biopsy-Proven Gastric Cancer

    PubMed Central

    Tae, Chung Hyun; Lee, Jun Haeng; Min, Byung-Hoon; Kim, Kyoung-Mee; Rhee, Poong-Lyul; Kim, Jae J.

    2016-01-01

    Background/Aims Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. Methods A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. Results Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. Conclusions A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral. PMID:25963084

  19. Urgent cancer referral guidelines: a retrospective cohort study of referrals for upper gastrointestinal adenocarcinoma.

    PubMed

    Panter, Simon J; Bramble, Mike G; O'Flanagan, Hilda; Hungin, A Pali S

    2004-08-01

    Dyspepsia in primary care is common and guidelines indicate that patients with alarm symptoms, as defined by the urgent cancer referral guidelines, should be investigated by gastroscopy. The specificity and sensitivity of alarm symptoms is poor and only a small percentage of patients will turn out to have malignant disease. This primary care study shows that employing current guidelines will identify only 72% of patients at their initial visit to a general practitioner, but this figure could be increased to 86% if the guidelines included patients with weight loss or anaemia in the absence of dyspepsia. Past performance indicates that the majority of patients with the commonest symptom complex were not referred quickly and less than half were seen within 4 weeks. PMID:15296562

  20. Neurobehavioral factors associated with referral for learning problems in a community sample: evidence for an adaptational model for learning disorders.

    PubMed

    Waber, Deborah P; Weiler, Michael D; Forbes, Peter W; Bernstein, Jane H; Bellinger, David C; Rappaport, Leonard

    2003-01-01

    We evaluated community general education (CGE; n = 178), community special education (CSE; n = 30) and hospital-referred (HR, n = 145) children (ages 7-6 to 11-11) prospectively over a 2-year period. During this period, 17 CGE children were referred for evaluation (community referred; CR). Prior to referral, CR children performed more poorly than community-nonreferred (CNR) children on cognitive ability, academic achievement, attention problems, and information processing. CR group performance was equivalent to that of CSE and HR groups, but HR children showed poorer academic achievement. Referred children performed more poorly on all measures than nonreferred, whether they met formal diagnostic criteria for a learning disorder or not. Learning disorders may be better conceptualized as a context-dependent problem of functional adaptation than as a disability analogous to physical disabilities, raising questions about the validity of using psychometric test scores as the criterion for identification. PMID:15497490

  1. Younger Children Experience Lower Levels of Language Competence and Academic Progress in the First Year of School: Evidence from a Population Study

    ERIC Educational Resources Information Center

    Norbury, Courtenay Frazier; Gooch, Debbie; Baird, Gillian; Charman, Tony; Simonoff, Emily; Pickles, Andrew

    2016-01-01

    Background: The youngest children in an academic year are reported to be educationally disadvantaged and overrepresented in referrals to clinical services. In this study we investigate for the first time whether these disadvantages are indicative of a mismatch between language competence at school entry and the academic demands of the classroom.…

  2. Academic Politics.

    ERIC Educational Resources Information Center

    Brown, William R.

    The internal politics of colleges and the influence of a current emphasis on efficiency on the traditional independence of the academician are analyzed. It is suggested that the academician does not work in the same differentiated, and therefore interdependent, way as someone in industry or a bureaucracy. Academic activity is segmented, which…

  3. Academic Freedom.

    ERIC Educational Resources Information Center

    Tobin, Brian G.

    The strength of academic freedom has always depended upon historical circumstances. In the United States, higher education began with institutions founded and controlled by religious sects. The notion of who gets educated and to what ends expanded as American democracy expanded. By the 1980's, legitimate calls for equality became a general…

  4. Academic Prophecies.

    ERIC Educational Resources Information Center

    Nielsen, Robert M.; Polishook, Irwin H.

    1985-01-01

    Academic prophecies are characterized by their innocence, detachment from the realities of politics and economics, and deference to a limited cohort of administrative representatives. Careless forecasting of the untested future contributes to public misunderstanding of higher education's role in society. (MLW)

  5. Academic Culture.

    ERIC Educational Resources Information Center

    Clark, Burton R.

    With fragmentation the dominant trend in academic settings around the world, the larger wholes of profession, enterprise, and system are less held together by integrative ideology. Strong ideological bonding is characteristic of the parts, primarily the disciplines. The larger aggregations are made whole mainly by formal superstructure, many…

  6. Academic Cloning.

    ERIC Educational Resources Information Center

    Sikula, John P.; Sikula, Andrew F.

    1980-01-01

    The authors define "cloning" as an integral feature of all educational systems, citing teaching practices which reward students for closely reproducing the teacher's thoughts and/or behaviors and administrative systems which tend to promote like-minded subordinates. They insist, however, that "academic cloning" is not a totally negative practice.…

  7. Academic Aspirations

    ERIC Educational Resources Information Center

    Durant, Linda

    2013-01-01

    As colleges and universities become even more complex organizations, advancement professionals need to have the skills, experience, and academic credentials to succeed in this ever-changing environment. Advancement leaders need competencies that extend beyond fundraising, alumni relations, and communications and marketing. The author encourages…

  8. Referral pattern for epilepsy surgery after evidence-based recommendations

    PubMed Central

    Haneef, Zulfi; Stern, John; Dewar, Sandra; Engel, Jerome

    2010-01-01

    Background: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending “referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs.” We examined whether this led to a change in referral patterns to our epilepsy center. Methods: We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded. Results: We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 ± 10.0 vs 18.6 ± 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 ± 10.3 vs 37.0 ± 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined. Conclusions: Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction. GLOSSARY AAN = American Academy of Neurology; AED = antiepileptic drug; ERSET = Early Randomized Surgical Epilepsy Trial; NES = nonepileptic seizures; RCT = randomized controlled trial; TLE = temporal lobe epilepsy; VNS = vagus nerve stimulator. PMID:20733145

  9. Hospital referrals for low back pain: more coherence needed.

    PubMed Central

    Silman, A J; Jayson, M I; Papageorgiou, A C; Croft, P R

    2000-01-01

    Low back pain is a common reason for hospital referral but little is known of the resulting workload in different specialties. All new outpatient attendances for conditions with low back pain were recorded over one month in a teaching hospital and a district general hospital. The patients were seen in at least ten specialties and two-fifths of them had been seen previously with the same symptom in another department. In the two hospitals, low back pain accounted for 15% and 12% of all new outpatient attendances. A more coherent referral policy is needed. PMID:10741313

  10. Introduction of Electronic Referral from Community Associated with More Timely Review by Secondary Services

    PubMed Central

    Warren, J.; White, S.; Day, K.J.; Gu, Y.; Pollock, M.

    2011-01-01

    Background Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007. Objectives To measure the extent of uptake of eReferral and its association with changes in referral processing. Methods Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders. Results eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (p<0.001), from a paper referral median of 8 days (inter-quartile range, IQR: 4–14) in 2007 to an eReferral median of 5 days (IQR: 2–9) and paper referral median of 6 days (IQR: 2–12) in 2009. Specialists upgrade the referrer-assigned eReferral priority in 19.2% of cases and downgrade it 18.6% of the time. Clinical users appreciate improvement of referral visibility (status and content access); however, both general practitioners and specialists point out system usability issues. Discussion With eReferrals, a referral’s status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems. Conclusions We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and

  11. 25 CFR 217.4 - Referral of questions by the joint managers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... party's proposal, if any, for solution. Such referrals shall be in writing, addressed to the other joint... DISTRIBUTION CORP. § 217.4 Referral of questions by the joint managers. The business committee and the board...

  12. Mixed-Sector Tertiary Education. Research Overview

    ERIC Educational Resources Information Center

    Moodie, Gavin

    2012-01-01

    This research overview provides the key messages arising from two related projects investigating tertiary education institutions that have recently begun to offer tertiary programs outside the sector of their initial establishment and the sector of the majority of their enrolments. These are TAFE institutes offering higher education programs,…

  13. Understanding Secondary-Tertiary Transition in Mathematics

    ERIC Educational Resources Information Center

    Clark, Megan; Lovric, Miroslav

    2009-01-01

    In Clark and Lovric ("Suggestion for a theoretical model for secondary-tertiary transition in mathematics", "Math. Educ. Res. J." 20(2) (2008), pp. 25-37) we began developing a model for the secondary-tertiary transition in mathematics, based on the anthropological notion of a rite of passage. We articulated several reasons why we believe that the…

  14. Tertiary Education and Training in Australia, 2010

    ERIC Educational Resources Information Center

    National Centre for Vocational Education Research (NCVER), 2012

    2012-01-01

    This publication presents information on tertiary education and training during 2010, including statistics on participation and outcomes. The definition of tertiary education and training adopted for this publication is formal study in vocational education and training (VET) and higher education, including enrolments in Australian Qualifications…

  15. Nodular tertiary syphilis in an immunocompetent patient*

    PubMed Central

    Bittencourt, Maraya de Jesus Semblano; de Brito, Arival Cardoso; Nascimento, Bianca Angelina Macêdodo; Carvalho, Alessandra Haber; Drago, Marion Guimarães

    2016-01-01

    Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. About 25% of patients with untreated primary syphilis will develop late signs that generally occur after three to five years, with involvement of several organs. The authors present an immunocompetent female who developed a tertiary stage syphilis presenting with long-standing nodular plaques. PMID:27579755

  16. Nodular tertiary syphilis in an immunocompetent patient.

    PubMed

    Bittencourt, Maraya de Jesus Semblano; Brito, Arival Cardoso de; Nascimento, Bianca Angelina Macêdodo; Carvalho, Alessandra Haber; Drago, Marion Guimarães

    2016-01-01

    Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. About 25% of patients with untreated primary syphilis will develop late signs that generally occur after three to five years, with involvement of several organs. The authors present an immunocompetent female who developed a tertiary stage syphilis presenting with long-standing nodular plaques. PMID:27579755

  17. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... Justice for litigation debts on which aggressive collection activity has been taken in accordance...

  18. Discipline Referral Outcomes: Meeting the Needs of Students

    ERIC Educational Resources Information Center

    Bergh, Bethney; Cowell, Joan

    2013-01-01

    In this study, school disciplinary procedures/programs used in response to disciplinary referrals and programs that schools have in place to prevent, intervene, and respond to behaviors that result in suspensions or expulsions from the classroom or school were investigated. The focus of this study was school leaders' concerns regarding the…

  19. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Referral of claims. 304.21 Section 304... for arbitration may also be modified to add one or more additional parties, if such intervention is... description of the facility, the EPA response action taken at the facility, the EPA claim, and the...

  20. "An Evaluation of the Special Needs Referral Process." Practitioner Perspectives.

    ERIC Educational Resources Information Center

    Bryans, Amanda B.

    1999-01-01

    Notes that articulating existence and cause of referral biases is critical to more effective preschool services. Maintains that until high child poverty, exposure to violence, and shortage of safe and stimulating environments are addressed, escalating rates of serious child emotional/behavioral problems will continue. Asserts that we must question…

  1. 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…

  2. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Voluntary referral policy. 219.403 Section 219.403 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees §...

  3. Referral tracking system shows accurate bottom-line assessment.

    PubMed

    Henkel, J

    1990-12-01

    Rose Medical Center in Denver, Colo., needed a way to track referrals from its many offsite care centers to determine their impact on revenue. Programmers at Rose developed a microbased system, eventually bought by SMS, that measures profitability against investment to become a true decision support tool for hospital executives. PMID:10108212

  4. Early Childhood Developmental Screenings: Predictors of Screening Referral Completion

    ERIC Educational Resources Information Center

    Jennings, Danielle J.

    2012-01-01

    Developmental screening programs identify young children with delayed skill growth or challenging behaviors and refer them to community agencies for evaluation or other services. This research studied the predictive impact of developmental screening results and child and family characteristics on the completion of these referrals for evaluation. A…

  5. Prereferral Intervention Strategies to Reduce Referrals to Special Education

    ERIC Educational Resources Information Center

    Ajayi, Eniola D.

    2010-01-01

    The purpose of this quasi-experimental study was to determine the impact of specific prereferral intervention strategies on the reduction of referrals to special education among identified 39 second-grade students from an elementary school in one public school district in New Jersey. A mixed research methodology incorporating quantitative and…

  6. 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…

  7. 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)...

  8. 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...

  9. 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...

  10. 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...

  11. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  12. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  13. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  14. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  15. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  16. Midwifery workforce profile in Limpopo Province referral hospitals

    PubMed Central

    Ogunbanjo, Gboyega A.

    2014-01-01

    Background In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas. Objective To determine the profile of registered nurses (RNs) involved in maternity care in public referral hospitals of the Limpopo Province, South Africa. Method A cross-sectional descriptive study was conducted in all maternity units of Limpopo's public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0. Results The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62). The majority (152/210; 70%) were 40 years and older, 56% (117/210) had been working for more than 10 years, and 63/210 (30%) were due to retire within 10 years. Only 22% (46/210) had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9%) of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study. Conclusion This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province. PMID:26245396

  17. Patient Referrals: A Behavioral Outcome of Continuing Medical Education

    ERIC Educational Resources Information Center

    Mahan, J. Maurice; And Others

    1978-01-01

    One method for evaluating an aspect of physician practice behavior, patient referrals, resulting from continuing medical education programs on cancer at the University of Texas Medical Branch is described. Data presented provide strong support for the effectiveness of continuing education in modifying physician practice behavior. (LBH)

  18. 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,…

  19. Diagnostic Classification Decisions As a Function of Referral Information.

    ERIC Educational Resources Information Center

    Ysseldyke, James E.; Algozzine, Bob

    Educational decision makers (N=224) participated in a computer simulated decision making experience to ascertain the extent to which referral information on a child with a suspected handicapping condition biased classification decisions. Ss were randomly assigned to 16 conditions varying on the basis of the child's sex, socioeconomic status,…

  20. 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...

  1. 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...

  2. 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...

  3. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Department of Justice. 15.8 Section 15.8 Labor Office of the Secretary of Labor ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND RELATED... Justice. An award, compromise or settlement of a claim under § 2672 title 28, United States Code, and...

  4. 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…

  5. 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...

  6. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2011-10-01 2011-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  7. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2014-10-01 2014-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  8. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2013-10-01 2013-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  9. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2012-10-01 2012-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  10. 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)...

  11. 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)...

  12. 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)...

  13. 29 CFR 1425.5 - Referral to FSIP.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE MEDIATION ASSISTANCE IN THE FEDERAL SERVICE § 1425.5 Referral to FSIP. If the mediation process has been completed and the parties are... Federal Services Impasses Panel. The Service shall not refer a case to FSIP until the mediation...

  14. 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...

  15. 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...

  16. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees § 219.403... voluntary referral policy that affords more favorable conditions to employees troubled by alcohol or drug...: (1) A covered employee who is affected by an alcohol or drug use problem may maintain an...

  17. 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...

  18. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees § 219.403... voluntary referral policy that affords more favorable conditions to employees troubled by alcohol or drug...: (1) A covered employee who is affected by an alcohol or drug use problem may maintain an...

  19. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees § 219.403... voluntary referral policy that affords more favorable conditions to employees troubled by alcohol or drug...: (1) A covered employee who is affected by an alcohol or drug use problem may maintain an...

  20. Reducing Unnecessary Referrals: Guidelines for Teachers of Diverse Learners

    ERIC Educational Resources Information Center

    Hoover, John J.

    2012-01-01

    The need to reduce unnecessary referrals of culturally and linguistically diverse learners continues to challenge practitioners in today's schools and classrooms. Discerning learning difference from disability is fundamental to reversing the trend of misidentification and misplacement of diverse students in special education. One effective way for…

  1. 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…

  2. 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...

  3. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Post-referral timeline (45 days). 303.310 Section 303... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline (45...) The lead agency must develop procedures to ensure that in the event the circumstances described in...

  4. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Post-referral timeline (45 days). 303.310 Section 303... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline (45...) The lead agency must develop procedures to ensure that in the event the circumstances described in...

  5. 24 CFR 902.77 - Referral to the Departmental Enforcement Center (DEC).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Referral to the Departmental Enforcement Center (DEC). 902.77 Section 902.77 Housing and Urban Development Regulations Relating to Housing... § 902.77 Referral to the Departmental Enforcement Center (DEC). (a) Referral of Troubled PHA to the...

  6. 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…

  7. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive...

  8. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection...

  9. 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...

  10. 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,…

  11. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Post-referral timeline (45 days). 303.310 Section 303.310 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline...

  12. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Referrals to the Department of Justice. 213.37 Section 213.37 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Referrals to the Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS...

  13. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37 Section 213.37 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Referrals to the Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS...

  14. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Referrals to the Department of Justice. 213.37 Section 213.37 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Referrals to the Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS...

  15. "Fit for Change": A Preliminary Exploration of the Relationship between Academic Literacy Practitioners and Disciplinary Specialists as a Complex System

    ERIC Educational Resources Information Center

    Cattell, Karin

    2013-01-01

    At tertiary institutions in South Africa and internationally, academic literacy practitioners and disciplinary specialists have traditionally functioned as separate communities of practice. However, research indicates that academic literacy is most successfully acquired when it is integrated into and taught within the contexts of specific academic…

  16. ABC and VED Analysis of the Pharmacy Store of a Tertiary Care Teaching, Research and Referral Healthcare Institute of India.

    PubMed

    Devnani, M; Gupta, Ak; Nigah, R

    2010-04-01

    The ABC and VED (vital, essential, desirable) analysis of the pharmacy store of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, was conducted to identify the categories of items needing stringent management control. The annual consumption and expenditure incurred on each item of pharmacy for the year 2007-08 was analyzed and inventory control techniques, i.e. ABC, VED and ABC-VED matrix analysis, were applied. The drug formulary of the pharmacy consisted of 421 items. The total annual drug expenditure (ADE) on items issued in 2007-08 was Rs. 40,012,612. ABC analysis revealed 13.78%, 21.85% and 64.37% items as A, B and C category items, respectively, accounting for 69.97%, 19.95% and 10.08% of ADE of the pharmacy. VED analysis showed 12.11%, 59.38% and 28.51% items as V, E, and D category items, respectively, accounting for 17.14%, 72.38% and 10.48% of ADE of the pharmacy. On ABC-VED matrix analysis, 22.09%, 54.63% and 23.28% items were found to be category I, II and III items, respectively, accounting for 74.21%, 22.23% and 3.56% of ADE of the pharmacy. The ABC and VED techniques need to be adopted as a routine practice for optimal use of resources and elimination of out-of-stock situations in the hospital pharmacy. PMID:21264126

  17. Objective and perceptual analysis of outcome of voice rehabilitation after laryngectomy in an Indian tertiary referral cancer centre.

    PubMed

    Varghese, B T; Mathew, A; Sebastian, S; Iype, E M; Sebastian, P; Rajan, B

    2013-07-01

    Post laryngectomy voice rehabilitation is very challenging in centres with limited resources because of cost concerns and morbidity. A study of laryngectomised voice rehabilitated patients on follow up was performed to look into overall quality of life (QOL), morbidity and voice quality. Those patients who had visited head and neck surgical outpatient department during the period of January 2008 to October 2009 were evaluated for their QOL, morbidity and voice quality, objectively and subjectively. Voice rating and QOL rating showed a distinct discrepancy which could be explained by the morbidity recorded for surgical voice restoration in the present study. Voice rehabilitation strategy after laryngectomy in a low resource setting has to take in account financial social educational background of the patient besides technical issues. PMID:24427633

  18. Extended spectrum beta lactamase producing gram negative bacilli in a tertiary referral hospital of Assam--experience with two methods.

    PubMed

    Nath, Reema; Saikia, Lahari; Mahanta, J

    2006-10-01

    Extended Spectrum Beta Lactamases (ESBL) are enzymes produced in some gram negative bacilli that mediate resistance to extended spectrum cephalosporins. 683 clinical isolates of Escherisia coli and Klebsiella pneumoniae were studied for their capacity to produce ESBL. Isolates showing resistance to at least two of the third generation cephalosporins were studied for ESBL production by Jarlier technique and combination disc methods. Out of the 457 E. Coli and 226 Klebsiella pneumoniae isolated in Assam Medical College, 29.76% and 53.1% were resistant to two cephalosporins of which 29.41% and 29.16% strains showed production of ESBL. However, 6 (4.41%) and 16 (13.34%) strains additionally showed production of ESBL when tested with combination disc method. Though the Jarlier technique is popular, for detection of ESBL, yet false negative results warrants for alternative method. In the absence of molecular detection methods in routine clinical microbiology laboratory, combination disc method appears to be a better option. PMID:17183880

  19. Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center.

    PubMed

    Lu, Yu-Chuan; Hong, Jian-Hua; Chiang, Bing-Juin; Pong, Yuan-Hung; Hsueh, Po-Ren; Huang, Chao-Yuan; Pu, Yeong-Shiau

    2016-05-01

    The aim of this study was to investigate the profiles of pathogens and patterns of antibiotic resistance of emphysematous pyelonephritis (EPN), offering recommendations for initial antibiotic treatment.Between January, 2001, and November, 2014, demographic data, presenting clinical features, management strategies, and treatment outcomes of 51 patients with EPN were retrospectively reviewed, analyzing microbiological characteristics of causative pathogens and patterns of antibiotic resistance.Overall survival rate was 90.2% (46/51). Pathogens isolated most frequently were Escherichia coli (49.0%), Klebsiella pneumoniae (19.6%), and Proteus mirabilis (17.7%). Approximately 24% of E coli isolates and 22% K pneumoniae isolates were resistant to fluoroquinolones. Improper empiric antibiotic use (P = 0.02) and third-generation cephalosporin-resistant pathogens (G3CRP) (P = 0.01) were significantly more common in cases of patient fatality. Prior hospitalization and antibiotic use within past year (P = 0.03), need for emergency hemodialysis (P = 0.03), and development of disseminated intravascular coagulation (DIC) (P = 0.03) were factors correlating significantly with microbial resistance to third-generation cephalosporins. The area under the receiver operating characteristic curve was 0.91. The cut-off point determined by the maximum Youden index for 2 of these 3 factors yielded a sensitivity of 0.8 and specificity of 0.93.Third-generation cephalosporins are recommended as initial treatment of EPN. In patients with histories of prior hospitalization and antibiotic use and in those needing emergency hemodialysis or developing DIC, carbapenem is the empiric antibiotic of choice. Patients presenting with 2 or more factors carry the highest risk of G3CRP involvement. Fluoroquinolone and gentamicin should be avoided. PMID:27227920

  20. Posttransplant Lymphoproliferative Disorder of the Thorax: CT and FDG-PET Features in a Single Tertiary Referral Center.

    PubMed

    Yoon, Ga Young; Kim, Mi Young; Huh, Joo Rryung; Jo, Kyung-Wook; Shim, Tae Sun

    2015-08-01

    To investigate the chest computed tomography (CT) and F-18 fluoro-2-deoxy-D-glucose positron emission tomographic (FDG-PET) findings of posttransplant lymphoproliferative disorder (PTLD) in the thorax.From November 2004 to February 2013, the cases of 12 adult patients (3 female and 9 male, age range 34-68, and median age 46 years) with proven PTLD were retrospectively reviewed. The transplanted organs included the kidney (5/12), liver (4/12), heart (1/12), combined kidney and pancreas (1/12), and hematopoietic stem cell (1/12). We investigated the relationship of the Epstein-Barr virus (EBV) to the patients' long-term follow-up, and evaluated the characteristics of the lesions on the chest CT and FDG-PET. The lesions were classified into 2 patterns: that of lymph node and lung involvement.The interval between the transplantation and the onset of PTLD was 2 to 128 months (median, 49). Positive EBV-encoded RNA in the pathologic specimens was found in 10 patients (83.3%). Eight patients were positive for EBV PCR in their blood, and 3 patients showed seroconversion without antiviral therapy. The responses to treatment were complete in 7 cases (58.3%), partial remission in 4 cases (33.3%), and undetermined in 1 case (8.3%). The more common chest CT patterns showed lymph node involvement (10/12) rather than lung involvement (3/12). The median maximum-standardized uptake value on the FDG-PET scans was 7.7 (range, 2.7-25.5).In patients with PTLD involving the thorax, lymphadenopathy was the more common manifestation on the chest CT rather than lung involvement. The lesions showed hypermetabolism on FDG-PET. PMID:26252295

  1. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan.

    PubMed

    Miyata, Kei; Ochi, Satoko; Enatsu, Rei; Wanibuchi, Masahiko; Mikuni, Nobuhiro; Inoue, Hiroyuki; Uemura, Shuji; Tanno, Katsuhiko; Narimatsu, Eichi; Maekawa, Kunihiko; Usui, Keiko; Mizobuchi, Masahiro

    2016-05-15

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9-52 years; interquartile range (IQR), 24-45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5-30; IQR, 3-21), and the median disease duration was 25 years (4-38; IQR, 6-32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  2. Colorectal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.

    PubMed

    Ruffo, Giacomo; Barugola, Giuliano; Rossini, Roberto; Sartori, Carlo Augusto

    2016-06-01

    Improving the quality and effectiveness of care is a key priority of any health policy. The outcomes of health care can be considered as indicators of effectiveness or quality. The scientific literature that evaluates the association between the volume of activity and the outcome of health interventions has greatly developed over the past decade, but, for practical reasons, ethical and social issues, a few randomized controlled studies were made to evaluate this association, although there are numerous observational studies of outcome and systematic reviews of the studies themselves. The colorectal surgery is the most studied area and it represents the ideal testing ground to determine the effectiveness of the quality indicators because of the high incidence of the disease and the wide spread in the territory of the structures that aim to tackle these issues. Numerous studies have documented an association between the large number of colo-rectal surgical procedures and the quality of results. In particular, the volume of activity is one of the characteristics of measurable process that can have a significant impact on the outcome of health care. In conclusion, the ability to use volume thresholds as a proxy for quality is very tempting but it is only part of reality. Infact, the volume-outcome relationship strictly depends on the type of cancer (colon vs rectum) and it appears somehow stronger for the individual surgeon than for the hospital; especially for the 5-year overall survival, operative mortality and number of permanent stoma. PMID:27278551

  3. Different measures, different outcomes? Survey into the effectiveness of chronic pain clinics in a London tertiary referral center

    PubMed Central

    Shah, Savan; Ho, Alexandra C; Kuehler, Bianca M; Childs, Susan R; Towlerton, Glyn; Goodall, Ian D; Bantel, Carsten

    2015-01-01

    Background Chronic pain clinics aim to improve challenging conditions, and although numerous studies have evaluated specific aspects of therapies and outcomes in this context, data concerning service impact on outcome measures in a general pain population are sparse. In addition, current trends in commissioning increasingly warrant services to provide evidence for their effectiveness. While a plethora of outcome measures, such as pain-intensity or improvement scores, exist for this purpose, it remains surprisingly unclear which one to use. It also remains uncertain what variables predict treatment success. Objectives This cross-sectional study was conducted to evaluate clinic performance employing different tools (pain scores, pain categories, responder analysis, subjective improvement, satisfaction), and to determine predictors of outcome measures. Patients and methods Patients attending scheduled clinic follow-up appointments were approached. They were asked to complete the modified short-form Brief Pain Inventory (BPI-SF) that also included assessments for satisfaction and subjective improvement. Comparisons were made with BPI-SF responses that were completed by each patient on admission. Nonparametric tests were employed to evaluate service impact and to determine predictors for outcome. Results Data of 118 patients were analyzed. There was considerable variation in impact of pain clinics depending on the outcome measure employed. While median pain scores did not differ between admission and follow-up, scores improved individually in 30% of cases, such that more patients had mild pain on follow-up than on admission (relative risk 2.7). Furthermore, while only 41% reported at least moderate subjective improvement after admission to the service, the majority (83%) were satisfied with the service. Positive treatment responses were predicted by “number of painful regions” and “changes in mood”, whereas subjective improvement was predicted by “helpfulness of treatments”. Conclusion Depending on the outcome measure employed, pain clinics showed varying degrees of impact on patients’ pain experiences. This calls into question the current practice of using nonstandardized outcome reporting for evaluation of service performances. PMID:26346112

  4. Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre

    PubMed Central

    Çorbacıoğlu, Aytül; Aslan, Halil; Aydın, Serdar; Akbayır, Özgür; Ersan, Fırat; Alpay, Verda; Dağdeviren, Hediye; Kısacık, Songül

    2012-01-01

    Objective We reviewed the data of the termination of pregnancy (TOP) cases between 2002 and 2010 to evaluate the changes in fetal indications for both early and late TOPs in this period. Material and Methods The data of 962 TOP cases were analysed in two groups according to the periods as in 2002–2006 and 2007–2010. The women were also subdivided into two categories according to their gestational age; <23 weeks’ gestation (early termination) and ≥23 weeks’ gestation (late termination). Results Four hundred and fifty-eight (47.6%) of TOPs were performed between 2002 and 2006 (Group 1) and 504 (52.3%) were performed between 2007 and 2010 (Group 2). The number of early (<23 weeks) and late (≥23 weeks) terminations were 583 (60.6%) and 379 (39.3%), respectively. The vast majority of anomalies were central nervous sytem malformations (51.8%). They were followed by multiple anomalies (10.2%) and chromosomal anomalies (9.4%). Chromosomal and cardiovascular system anomalies were significantly higher in 2007–2010 in comparison to 2002–2006 (p<0.0001 and p=0.002, respectively). There was no statistically significant difference between the fetal indications that led to early termination compared to those that led to late termination. Conclusion The distribution of indications for TOP was influenced by the development in prenatal screening policy, resulting in a significant increase in terminations due to chromosomal and cardiovascular system anomalies. Cultural, educational, religious and legal factors cause differences in the indications for TOP as well as the gestational age that TOPS are performed. PMID:24592014

  5. Comparison of Diagnostic Algorithms for Detecting Toxigenic Clostridium difficile in Routine Practice at a Tertiary Referral Hospital in Korea

    PubMed Central

    Moon, Hee-Won; Kim, Hyeong Nyeon; Hur, Mina; Shim, Hee Sook; Kim, Heejung; Yun, Yeo-Min

    2016-01-01

    Since every single test has some limitations for detecting toxigenic Clostridium difficile, multistep algorithms are recommended. This study aimed to compare the current, representative diagnostic algorithms for detecting toxigenic C. difficile, using VIDAS C. difficile toxin A&B (toxin ELFA), VIDAS C. difficile GDH (GDH ELFA, bioMérieux, Marcy-l’Etoile, France), and Xpert C. difficile (Cepheid, Sunnyvale, California, USA). In 271 consecutive stool samples, toxigenic culture, toxin ELFA, GDH ELFA, and Xpert C. difficile were performed. We simulated two algorithms: screening by GDH ELFA and confirmation by Xpert C. difficile (GDH + Xpert) and combined algorithm of GDH ELFA, toxin ELFA, and Xpert C. difficile (GDH + Toxin + Xpert). The performance of each assay and algorithm was assessed. The agreement of Xpert C. difficile and two algorithms (GDH + Xpert and GDH+ Toxin + Xpert) with toxigenic culture were strong (Kappa, 0.848, 0.857, and 0.868, respectively). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of algorithms (GDH + Xpert and GDH + Toxin + Xpert) were 96.7%, 95.8%, 85.0%, 98.1%, and 94.5%, 95.8%, 82.3%, 98.5%, respectively. There were no significant differences between Xpert C. difficile and two algorithms in sensitivity, specificity, PPV and NPV. The performances of both algorithms for detecting toxigenic C. difficile were comparable to that of Xpert C. difficile. Either algorithm would be useful in clinical laboratories and can be optimized in the diagnostic workflow of C. difficile depending on costs, test volume, and clinical needs. PMID:27532104

  6. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan

    PubMed Central

    MIYATA, Kei; OCHI, Satoko; ENATSU, Rei; WANIBUCHI, Masahiko; MIKUNI, Nobuhiro; INOUE, Hiroyuki; UEMURA, Shuji; TANNO, Katsuhiko; NARIMATSU, Eichi; MAEKAWA, Kunihiko; USUI, Keiko; MIZOBUCHI, Masahiro

    2016-01-01

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9–52 years; interquartile range (IQR), 24–45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5–30; IQR, 3–21), and the median disease duration was 25 years (4–38; IQR, 6–32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  7. Special Education Referrals for African American Students: Behavior versus Academic Performance

    ERIC Educational Resources Information Center

    Curtis, Charmaine D.

    2012-01-01

    A higher percentage of African American students in a local school district were referred to special education than were students in other ethnic groups. Placement of a student in a special education program results in that student receiving a curriculum that has modified achievement standards. This correlational study examined patterns in…

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

    PubMed

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

    2010-07-01

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

  9. 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

  10. [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

  11. 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

  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. West Hackberry Tertiary Project, Class I

    SciTech Connect

    Haley, Kenneth A.; Gillham, Travis H.; Yannimaras, Demetrios

    2002-03-04

    The West Hackberry Tertiary Project is a field test of the concept that air injection can generate tertiary oil recovery through the Double Displacement Process. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil through gravity drainage. The novel aspect of this project is the use of air as the injection fluid. In Gulf Coast oil reservoirs with pronounced bed dip, reservoir performance has shown that gravity drainage recoveries average 80% to 90% of the original oil in place while water drive recoveries average 50% to 60% of the original oil in place. The target for tertiary oil recovery with the Double Displacement Process is the incremental oil between the 50% to 60% water drive recoveries and the 80% to 90% gravity drainage recoveries.

  15. Tertiary aralkyl urethanes and isocyanates derived therefrom

    SciTech Connect

    Singh, B.; Chang, L.W.; Forgione, P.S.

    1984-03-27

    Production of tertiary aralkyl isocyanates, such as tetramethyl xylylene diisocyanates, by thermal cracking of corresponding urethanes formed by addition of corresponding olefins and carbamic acid esters at moderate temperatures and in the presence of acid catalyst.

  16. 17 CFR 247.701 - Exemption from the definition of “broker” for certain institutional referrals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... institutional customer. (iii) Suitability or sophistication determination by broker or dealer—(A) Contingent referral fees. In any case in which payment of the referral fee is contingent on completion of a securities... securities transaction. (B) Non-contingent referral fees. In any case in which payment of the referral fee...

  17. 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

  18. 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…

  19. 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

  20. Comparison of Teachers' and School Psychologists' Accuracy in Assigning Basic Academic Tasks to Underlying CHC-Model Cognitive Abilities

    ERIC Educational Resources Information Center

    Petruccelli, Meredith Lohr; Fiorello, Catherine A.; Thurman, S. Kenneth

    2010-01-01

    Teacher perceptions of their students' cognitive abilities affect the referrals they make and intervention strategies they implement. In this study, teachers and school psychologists were asked to sort basic academic tasks into categories on the basis of the Cattell-Horn-Carroll (CHC) broad cognitive abilities, such as fluid reasoning and…

  1. Burden of Ocular Motility Disorders at a Tertiary Care Institution: A Case to Enhance Secondary Level Eye Care

    PubMed Central

    Saxena, Rohit; Singh, Digvijay; Gantyala, Shiva Prasad; Aggarwal, Sneha; Sachdeva, Murli Manohar; Sharma, Pradeep

    2016-01-01

    Aim: To evaluate the profile of strabismus and amblyopia in patients presenting to a tertiary care institution in order to understand the disease burden. Materials and Methods: A retrospective, prospective hospital-based observational study was conducted at a tertiary level eye care hospital in India. All patients with strabismus or amblyopia who presented over a 1-year period were identified and referred to the squint clinic, where they were evaluated with a detailed clinical history and examination. Results: A total of 24475 patients were evaluated, of which 1950 had strabismus or amblyopia. The overall magnitude of amblyopia and strabismus was 2.0% [95% confidence interval (CI), 1.8-2.2)] and 6.9% (95% CI, 6.6-7.2), respectively. About 20% of those seeking an ophthalmic consultation were children and they constituted over half of the population referred to the squint clinic. Among younger children, the burden of amblyopia and strabismus was 84.4% and 26.6%, respectively. Among the referred patients, strabismus was noted in 84.6% (N = 1649), most of the cases of which was of the comitant subtype (78.1%, N = 1288) with an equal distribution of exotropia and esotropia. Paralytic [12.9% (N = 251)] and restrictive [4.7% (N = 85)] squint constituted the remaining burden of strabismus. Conclusion: Strabismus and amblyopia affect a sizeable proportion of patients presenting to a tertiary care ophthalmology setup. A significantly higher burden is present in the pediatric population. The majority of the cases of strabismus are of a comitant variety, which do not merit tertiary level eye care. There is a need to improve pediatric eye care at a secondary level to reduce the immense burden on tertiary referral centers. PMID:27051084

  2. Academic Productivity as Perceived by Malaysian Academics

    ERIC Educational Resources Information Center

    Hassan, Aminuddin; Tymms, Peter; Ismail, Habsah

    2008-01-01

    The purpose of this research is to explore the perspectives of Malaysian academics in relation to academic productivity and some factors affecting it. A large scale online questionnaire was used to gather information from six public universities. The most productive role in the eyes of the academics was found to be teaching, with research and…

  3. 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

  4. A qualitative evaluation of general practitioners’ views on protocol-driven eReferral in Scotland

    PubMed Central

    2014-01-01

    Background The ever increasing volume of referrals from primary care to specialist services is putting considerable pressure on resource-constrained health services while effective communication across fragmented services remains a substantial challenge. Previous studies have suggested that electronic referrals (eReferral) can bear important benefits for cross-organisational processes and patient care management. Methods We conducted 25 semi-structured interviews and 1 focus group with primary care providers to elucidate General Practitioners’ (GPs) perspectives on information management processes in the patient pathway in NHSScotland, 1 focus group with members of the Scottish Electronic Patient Record programme and one interview with a senior architect of the Scottish Care Information national eReferral System (SCI Gateway). Using Normalisation Process Theory, we performed a qualitative analysis to elucidate GPs’ perspectives on eReferral to identify the factors which they felt either facilitated or hindered referral processes. Results The majority of GPs interviewed felt that eReferral substantially streamlined communication processes, with the immediate transfer of referral documents and the availability of an electronic audit trail perceived as two substantial improvements over paper-based referrals. Most GPs felt that the SCI Gateway system was reasonably straightforward to use. Referral protocols and templates could be perceived as useful by some GPs while others considered them to be cumbersome at times. Conclusion Our study suggests that the deployment and adoption of eReferral across the NHS in Scotland has been achieved by a combination of factors: (i) a policy context – including national mandatory targets for eReferral – which all NHS health-boards were bound to operationalise through their Local Delivery Plans and also (ii) the fact that primary care doctors considered that the overall benefits brought by the deployment of eReferral throughout

  5. Implementation of a "learner-driven" curriculum: an screening, brief intervention, and referral to treatment (SBIRT) interdisciplinary primary care model.

    PubMed

    Stanton, Marina R; Atherton, W Leigh; Toriello, Paul J; Hodgson, Jennifer L

    2012-01-01

    Although screening, brief intervention, and referral to treatment (SBIRT) has been a popular model to address potential substance abuse issues in primary care, there is a need for innovative approaches for training providers and staff on SBIRT protocols. An interdisciplinary approach to SBIRT training, named ICARE, was implemented at 3 different medical settings. The ICARE team trained 85 employees at an academic family medicine residency center and 37 employees across 2 rural community health care clinics. Using an innovative "learner-driven" approach, the authors implemented a combination of didactic and interactive training strategies that included on-site coaching, patient simulation exercises, as well as large- and small-group learning. PMID:22738012

  6. Non-Traditional Students in Tertiary Education: Inter-Disciplinary Collaboration in Curriculum and Pedagogy in Community Services Education in Australia

    ERIC Educational Resources Information Center

    Daddow, Angela; Moraitis, Peter; Carr, Amanda

    2013-01-01

    Education policy in Australia has accelerated its aim to increase participation of under-represented groups in tertiary education including students who are culturally and linguistically diverse and have low socio-economic status. These students generally have not had prior access to privileged academic discourse, which can further disadvantage…

  7. RADIOGUIDED PARATHYROIDECTOMY FOR TERTIARY HYPERPARATHYROIDISM

    PubMed Central

    Somnay, Yash R.; Weinlander, Eric; Alfhefdi, Amal; Schneider, David; Sippel, Rebecca S.; Chen, Herbert

    2015-01-01

    Background Tertiary hyperparathyroidism (3HPT) is defined as the persistent hyper-production of parathyroid hormone (PTH) and resulting hypercalcemia following renal transplantation. Here, we examine the utility of radioguided parathyroidectomy (RGP) in patients with 3HPT. Materials and Methods We reviewed a prospective surgery database containing 80 3HPT patients who underwent RGP from January 2001 to July 2014 at our institution. We evaluated patient demographics, operative management, radioguided neoprobe utilization and operative outcomes. Data are reported as mean ± SEM. Results The mean age of the patients was 52 ± 1 years, and 46% were male. 69 patients had hyperplasia and received subtotal parathyroidectomy, while 5 patients had double adenomas and 6 patients had single adenomas. The average calcium level among 3HPT patients was 10.8± 0.1 mg/dl preoperatively and 8.7 ± 0.1 mg/dl postoperatively. In vivo radioguided counts normalized to background counts averaged 145 ± 4%, while ex vivo counts normalized to background counts averaged 69 ± 5%. All but one ex vivo count was >20%. Ectopically located glands were successfully localized in 38 patients using the gamma probe. Ex vivo percentage did not correlate with parathyroid gland weight, preoperative PTH or preoperative calcium. Our radioguided approach achieved normocalcemia in 96% of 3HPT patients undergoing radioguided parathyroidectomy; 2 patients developed recurrent disease. Conclusions In this series, all enlarged parathyroid glands were localized and resected using the gamma probe. Thus, RGP reliably localizes adenomatous, hyperplastic and ectopically located glands in patients with 3HPT, resulting in high cure rate following resection. PMID:25770735

  8. Academic detailing.

    PubMed

    Shankar, P R; Jha, N; Piryani, R M; Bajracharya, O; Shrestha, R; Thapa, H S

    2010-01-01

    There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations. PMID:21209521

  9. 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

  10. Transcription of Case Report Forms from Unstructured Referral Letters: A Semantic Text Analytics Approach.

    PubMed

    Abidi, Syed Sibte Raza; Singh, Abhinav Kumar; Christie, Sean

    2016-01-01

    In this paper we present a framework for the semi-automatic extraction of medical entities from referral letters and use them to transcribe a case report form. Our framework offers the functionality to: (a) extract the medical entity from the unstructured referral letters, (b) classify them according to their semantic type, and (c) transcribe a case report form based on the extracted information from the referral letter. We take a semantic text analytics approach where SNOMED-CT ontology is used to both classify referral concepts and to establish semantic similarities between referral concepts and CRF elements. We used 100 spine injury referral letters, and a standard case report form used by Association of Dalhousie Neurosurgeons, Dalhousie University. PMID:27577396

  11. Referral system for hard exudates in eye fundus.

    PubMed

    Naqvi, Syed Ali Gohar; Zafar, Muhammad Faisal; Haq, Ihsan ul

    2015-09-01

    Hard exudates are one of the most common anomalies/artifacts found in the eye fundus of patients suffering from diabetic retinopathy. These exudates are the major cause of loss of sight or blindness in people having diabetic retinopathy. Diagnosis of hard exudates requires considerable time and effort of an ophthalmologist. The ophthalmologists have become overloaded, so that there is a need for an automated diagnostic/referral system. In this paper a referral system for the hard exudates in the eye-fundus images has been presented. The proposed referral system works by combining different techniques like Scale Invariant Feature Transform (SIFT), K-means Clustering, Visual Dictionaries and Support Vector Machine (SVM). The system was also tested with Back Propagation Neural Network as a classifier. To test the performance of the system four fundus image databases were used. One publicly available image database was used to compare the performance of the system to the existing systems. To test the general performance of the system when the images are taken under different conditions and come from different sources, three other fundus image databases were mixed. The evaluation of the system was also performed on different sizes of the visual dictionaries. When using only one fundus image database the area under the curve (AUC) of maximum 0.9702 (97.02%) was achieved with accuracy of 95.02%. In case of mixed image databases an AUC of 0.9349 (93.49%) was recorded having accuracy of 87.23%. The results were compared to the existing systems and were found better/comparable. PMID:26231313

  12. Barriers of Referral System to Health Care Provision in Rural Societies in Iran

    PubMed Central

    Eskandari, Manijeh; Abbaszadeh, Abbas; Borhani, Fariba

    2013-01-01

    Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran. Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients) were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis. Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found. Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential. PMID:25276731

  13. The geography of genetics: an analysis of referral patterns to a cancer genetics service

    PubMed Central

    Iredale, Rachel; Higgs, Gary

    2008-01-01

    This study uses a geographical information system (GIS) and statistical analysis to look for patterns in referrals to a British cancer genetics service. In this case, familial cancers are taken to be those that can develop when an individual inherits DNA mutations that cause an increased risk of cancer. Between 1998 and 2006 the Cancer Genetics Service for Wales received nearly 11,000 referrals for patients resident in Wales and it is the service database recording those referrals which is the subject of this secondary analysis. Using postcodes to match referred patients to areas, deprivation scores were assigned. Referral rates per 10,000 head of population across the 8-year study period by unitary authority are presented, as is information on referrals from primary and secondary care sources by year. Each patient referred has their family history of cancer recorded and is assigned to a risk category; high, medium or average. There are correlations between number of GPs (General Practitioners) in a practice, number of patients referred from a practice, and deprivation as measured by the overall Welsh Index of Multiple Deprivation 2005, such that the two former factors increase as deprivation decreases. Over time there were changes in referral sources, with referrals from primary care overtaking those from secondary care in percentage and absolute terms. There were also changes in the types of cancer referred, risk categories seen and to which centre referrals were made. Referral patterns reveal an inverse relationship between deprivation and health service availability and use. PMID:18923938

  14. 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

  15. Obstructive jaundice in adult Ethiopians in a referral hospital.

    PubMed

    Bekele, Z; Yifru, A

    2000-10-01

    Forty-nine adult Ethiopians with obstructive jaundice were studied. Right upper quadrant pain was the main presenting complaint (89%). Most (94%) of the jaundiced patients had right upper quadrant tenderness. In 87% the obstruction was corroborated by ultrasonographic examination, but causal factors were identified in only 39%. Operative findings showed that choledocholithiasis (41%) and malignant conditions (22%) were the two important causes of obstructive jaundice among the adult patients seen at a referral hospital in Addis Ababa. The causes and the outcome of the different types of surgical procedures used in the management are discussed. PMID:11125501

  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. Referring physician satisfaction: toward a better understanding of hospital referrals.

    PubMed

    Ponzurick, T G; France, K R; Logar, C M

    1998-01-01

    Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians. PMID:10186254

  18. [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

  19. Suicide Prevention Referrals in a Mobile Health Smoking Cessation Intervention.

    PubMed

    Christofferson, Dana E; Hamlett-Berry, Kim; Augustson, Erik

    2015-08-01

    Automated mobile health (mHealth) programs deliver effective smoking cessation interventions through text message platforms. Smoking is an independent risk factor for suicide, so the Department of Veterans Affairs incorporated information about the Veterans Crisis Line into its SmokefreeVET smoking cessation text messaging program. Almost 7% of all SmokefreeVET enrollees have accessed this information. Because of the reach and automated nature of this and similar programs, we recommend including a referral to a suicide prevention hotline for all smoking cessation mHealth interventions. PMID:26066949

  20. Cooperative Tertiary Interaction Network Guides RNA Folding

    SciTech Connect

    Behrouzi, Reza; Roh, Joon Ho; Kilburn, Duncan; Briber, R.M.; Woodson, Sarah A.

    2013-04-08

    Noncoding RNAs form unique 3D structures, which perform many regulatory functions. To understand how RNAs fold uniquely despite a small number of tertiary interaction motifs, we mutated the major tertiary interactions in a group I ribozyme by single-base substitutions. The resulting perturbations to the folding energy landscape were measured using SAXS, ribozyme activity, hydroxyl radical footprinting, and native PAGE. Double- and triple-mutant cycles show that most tertiary interactions have a small effect on the stability of the native state. Instead, the formation of core and peripheral structural motifs is cooperatively linked in near-native folding intermediates, and this cooperativity depends on the native helix orientation. The emergence of a cooperative interaction network at an early stage of folding suppresses nonnative structures and guides the search for the native state. We suggest that cooperativity in noncoding RNAs arose from natural selection of architectures conducive to forming a unique, stable fold.

  1. Correlation of tertiary formations of Alaska

    USGS Publications Warehouse

    MacNeil, F.S.; Wolfe, J.A.; Miller, D.J.; Hopkins, D.M.

    1961-01-01

    Recent stratigraphic and paleontologic studies have resulted in substantial revision of the age assignments and inter-basin correlations of the Tertiary formations of Alaska as given in both an earlier compilation by P. S. Smith (1939) and a tentative chart prepared for distribution at the First International Symposium on Arctic Geology at Calgary, Alberta (Miller, MacNeil, and Wahrhaftig, 1960). Current work in Alaska by the U. S. Geological Survey and several oil companies is furnishing new information at a rapid rate and further revisions may be expected. The correlation chart (Fig. 1), the first published chart to deal exclusively with the Tertiary of Alaska, had the benefit of a considerable amount of stratigraphic data and fossil collections from some oil companies, but recent surface mapping and drilling by other oil companies in several Tertiary basins undoubtedly must have produced much more information. Nevertheless, the extent of available data justifies the publication of a revised correlation chart at this time.

  2. Writing Strategy Instruction: Its Impact on Writing in a Second Language for Academic Purposes

    ERIC Educational Resources Information Center

    De Silva, Radhika

    2015-01-01

    Writing for academic purposes in a second/foreign language is a major challenge faced by many students at both secondary and tertiary levels. This suggests that displaying content knowledge and understanding of a subject through a second language is a very complex process. This article discusses the findings of a longitudinal intervention study…

  3. The Antecedents of Organizational Commitment: The Case of Australian Casual Academics

    ERIC Educational Resources Information Center

    Joiner, Therese A.; Bakalis, Steve

    2006-01-01

    Purpose: Despite the increasing attention of organizational commitment in the management literature, most studies predominantly focus on full-time workers in traditional work settings. This paper examined the antecedents of organizational commitment among casual academics working in the tertiary education sector in Australia.…

  4. Metaphors Used by Some Engineering Academics in Australia for Understanding and Explaining Sustainability

    ERIC Educational Resources Information Center

    Carew, Anna L.; Mitchell, Cynthia A.

    2006-01-01

    Metaphors can be powerful teaching and learning tools which may help us to understand novel, complex or abstract concepts using familiar language and thought structures. Academics routinely use metaphors in their university teaching to explain new or difficult ideas to students. In this article the authors argue that tertiary teachers' metaphors…

  5. Teaching-Focused Science Academics Supervising Research Students in Science Education: What's the Problem?

    ERIC Educational Resources Information Center

    Rowland, Susan

    2012-01-01

    Academics who specialise in improving the teaching of "hard" sciences like chemistry, biology, maths and physics are increasing in number and influence at Australian universities. Those in academia who have channelled their energies into teaching are delighted with this development. It means that many committed tertiary teachers can now look…

  6. Academic Difficulties Encountered by East Asian International University Students in New Zealand

    ERIC Educational Resources Information Center

    Lee, Boram; Farruggia, Susan P.; Brown, Gavin T. L.

    2013-01-01

    The study focused on learning difficulties experienced by East Asian International (EAI) students. Participants were 117 EAI students undertaking tertiary study at a major university, all were surveyed and 21 students were interviewed. The findings suggest that language limitations, academic content and learning styles were associated with…

  7. A Survey of New Zealand Academic Reference Librarians: Current and Future Skills and Competencies

    ERIC Educational Resources Information Center

    Chawner, Brenda; Oliver, Gillian

    2013-01-01

    A survey of New Zealand academic subject/reference librarians was conducted in mid-2011 to identify the most highly valued knowledge, skills and competencies of reference librarians working in libraries in the tertiary sector. The project was part of an international collaborative project involving 13 countries. The results from New Zealand show…

  8. ZERODUR for lightweight secondary/tertiary mirrors

    NASA Astrophysics Data System (ADS)

    Morian, Hans F.; Mackh, Reiner

    1998-08-01

    ZERODUR, the glass ceramic, with CTE values near zero, has excellent performance up to 8.2 m primary mirrors as well as for lightweight (LW) mirrors for Secondaries and Tertiaries. The high homogeneity of major properties of ZERODUR is an important prerequisite for the LW production and application. The production of CNC grinding and subsequent lightening via acid etching for additional weight reduction will be discussed. Results of Secondary and Tertiary LW mirrors for advanced technology telescopes like 8 m, 6.5 m and 3.5 m telescopes will be addressed. This paper presents also some examples of space based satellites with LW Zerodur mirrors in use since several years.

  9. Patient-specific academic detailing for smoking cessation

    PubMed Central

    Jin, Margaret; Gagnon, Antony; Levine, Mitchell; Thabane, Lehana; Rodriguez, Christine; Dolovich, Lisa

    2014-01-01

    Abstract Objective To describe and to determine the feasibility of a patient-specific academic detailing (PAD) smoking cessation (SC) program in a primary care setting. Design Descriptive cohort feasibility study. Setting Hamilton, Ont. Participants Pharmacists, physicians, nurse practitioners, and their patients. Interventions Integrated pharmacists received basic academic detailing training and education on SC and then delivered PAD to prescribers using structured verbal education and written materials. Data were collected using structured forms. Main outcome measures Five main feasibility criteria were generated based on Canadian academic detailing programs: PAD coordinator time to train pharmacists less than 40 hours; median time of SC education per pharmacist less than 20 hours; median time per PAD session less than 60 minutes for initial visit; percentage of prescribers receiving PAD within 3 months greater than 50%; and number of new SC referrals to pharmacists at 6 months more than 10 patients per 1.0 full-time equivalent (FTE) pharmacist (total of approximately 30 patients). Results Eight pharmacists (5.8 FTE) received basic academic detailing training and education on SC PAD. Forty-eight physicians and 9 nurse practitioners consented to participate in the study. The mean PAD coordinator training time was 29.1 hours. The median time for SC education was 3.1 hours. The median times for PAD sessions were 15 and 25 minutes for an initial visit and follow-up visit, respectively. The numbers of prescribers who had received PAD at 3 and 6 months were 50 of 64 (78.1%) and 57 of 64 (89.1%), respectively. The numbers of new SC referrals at 3 and 6 months were 11 patients per FTE pharmacist (total of 66 patients) and 34 patients per FTE pharmacist (total of 200 patients), respectively. Conclusion This study met the predetermined feasibility criteria with respect to the management, resources, process, and scientific components. Further study is warranted to determine

  10. Accuracy of telepsychiatric assessment of new routine outpatient referrals

    PubMed Central

    Singh, Surendra P; Arya, Dinesh; Peters, Trish

    2007-01-01

    Background Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews. Method This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases fulfilling the selection criteria went through a complete set of independent face to face and video assessments by the researchers who were blind to each other's findings. Results The accuracy ratio of the pooled results for DSM-IV diagnoses, risk assessment, non-drug and drug interventions were all above 0.76, and the combined overall accuracy ratio was 0.81. There were substantial intermethod agreements for Cohen's kappa on all the major components of evaluation except on the Risk Assessment Scale where there was only weak agreement. Conclusion Telepsychiatric assessment is a dependable method of assessment with a high degree of accuracy and substantial overall intermethod agreement when compared with standard face to face interview for new routine outpatient psychiatric referrals. PMID:17919329

  11. 10 rare tumors that warrant a genetics referral.

    PubMed

    Banks, Kimberly C; Moline, Jessica J; Marvin, Monica L; Newlin, Anna C; Vogel, Kristen J

    2013-03-01

    The number of described cancer susceptibility syndromes continues to grow, as does our knowledge on how to manage these syndromes with the aim of early detection and cancer prevention. Oncologists now have greater responsibility to recognize patterns of cancer that warrant referral for a genetics consultation. While some patterns of common cancers are easy to recognize as related to hereditary cancer syndromes, there are a number of rare tumors that are highly associated with cancer syndromes yet are often overlooked given their infrequency. We present a review of ten rare tumors that are strongly associated with hereditary cancer predisposition syndromes: adrenocortical carcinoma, carcinoid tumors, diffuse gastric cancer, fallopian tube/primary peritoneal cancer, leiomyosarcoma, medullary thyroid cancer, paraganglioma/pheochromocytoma, renal cell carcinoma of chromophobe, hybrid oncocytoic, or oncocytoma histology, sebaceous carcinoma, and sex cord tumors with annular tubules. This review will serve as a guide for oncologists to assist in the recognition of rare tumors that warrant referral for a genetic consultation. PMID:23377869

  12. Methods to obtain referral criteria in growth monitoring.

    PubMed

    van Dommelen, Paula; van Buuren, Stef

    2014-08-01

    An important goal of growth monitoring is to identify genetic disorders, diseases or other conditions that manifest themselves through an abnormal growth. The two main conditions that can be detected by height monitoring are Turner's syndrome and growth hormone deficiency. Conditions or risk factors that can be detected by monitoring weight or body mass index include hypernatremic dehydration, celiac disease, cystic fibrosis and obesity. Monitoring infant head growth can be used to detect macrocephaly, developmental disorder and ill health in childhood. This paper describes statistical methods to obtain evidence-based referral criteria in growth monitoring. The referral criteria that we discuss are based on either anthropometric measurement(s) at a fixed age using (1) a Centile or a Standard Deviation Score, (2) a Standard Deviation corrected for parental height, (3) a Likelihood Ratio Statistic and (4) an ellipse, or on multiple measurements over time using (5) a growth rate and (6) a growth curve model. We review the potential uses of these methods, and outline their strengths and limitations. PMID:23376959

  13. Diabetes Mellitus in Outpatients in Debre Berhan Referral Hospital, Ethiopia

    PubMed Central

    Habtewold, Tesfa Dejenie; Tsega, Wendwesen Dibekulu; Wale, Bayu Yihun

    2016-01-01

    Introduction. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Objective. To assess the prevalence and associated factors of diabetes mellitus among outpatients of Debre Berhan Referral Hospital. Methods and Materials. A cross-sectional study was conducted from April to June 2015 among 385 patients. Random quota sampling technique was used to get individual patients and risk factors assessment. Patients diabetes status was ascertained by World Health Organization Diabetes Mellitus Diagnostic Criteria. The collected data were entered, cleaned, and analyzed and Chi-square test was applied to test any association between dependent and independent variable. Result. Out of the total 385 study patients, 368 have participated in the study yielding a response rate of 95.3%. Concerning clinical presentation of diabetes mellitus, 13.3% of patients reported thirst, 14.4% of patients declared polyurea, and 14.9% of patients ascertained unexplained weight loss. The statistically significant associated factors of diabetes mellitus were hypertensive history, obesity, the number of parities, and smoking history. Conclusion. The prevalence of diabetes mellitus among outpatients in Debre Berhan Referral Hospital was 0.34% and several clinical and behavioral factors contribute to the occurrence of diabetes mellitus which impose initiation of preventive, promotive, and curative strategies. PMID:26881245

  14. A Descriptive Study of School Discipline Referrals in First Grade

    PubMed Central

    Rusby, Julie C.; Taylor, Ted K.; Foster, E. Michael

    2006-01-01

    School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at risk for developing disruptive behavior problems (n = 186) and a universal sample (n = 531) from 20 schools. Most SDRs were given for physical aggression and the predominant consequence was time out. As expected, boys and at-risk students were more likely to receive an SDR and to have more SDRs than were girls and the universal sample. A large difference between schools regarding the delivery of SDRs was found. A zero-inflated Poisson model clustered by school tested the prediction of school-level variables. Students in schools that had a systematic way of tracking SDRs were more likely to receive one. Also, schools with more low-income students and larger class sizes gave fewer SDRs. SDRs predicted teacher ratings, and to a lesser extent, parent ratings of disruptive behavior at the end of first grade. Practitioners and researchers must examine school-level influences whenever first grade discipline referrals are used to measure problem behavior for the purpose of planning and evaluating interventions. PMID:17372623

  15. Surfing Stark II: prohibition against self-referrals.

    PubMed

    Swibel, H J; Zaremski, M J

    1995-02-01

    In 1989, the Chairman of the House Ways and Means Subcommittee on Health, Fortney (Pete) Stark (D.-Calif.), turned the health care industry on its ear by introducing the "Ethics in Patient Referrals Act" to Congress. The bill, commonly known as "Stark I," prohibited physician referrals to entities in which they held a financial interest. As Stark's bill made its way through Congress, its substance was dramatically reduced by the legislative process. Ultimately, the law was incorporated as part of the Omnibus Budget Reconciliation Act of 1990. Stark I's main thrust is that it bars physicians from referring Medicare patients to clinical laboratories with which they have a financial relationship. Furthermore, laboratories providing those services must report information concerning any ownership arrangements between the referring physician and the laboratory. Now, to complicate the picture, providers must contend with amendments to the original law that extend the reach of its prohibitions. Called "Stark II," these amendments took effect on January 1, 1995. In this article, guidelines for dealing successfully with the requirements of the law are outlined. PMID:10140213

  16. AB074. Registry of congenital adrenal hyperplasia at the north pediatric referral centre of Vietnam during 15 years

    PubMed Central

    Dung, Vu Chi; Thao, Bui Phuong; Ngoc, Can Thi Bich; Khanh, Nguyen Ngoc; Dat, Nguyen Phu; Hoan, Nguyen Thi; Mai, Do Thanh; Huong, Bui Thi

    2015-01-01

    The National Hospital of Pediatrics (NHP), Hanoi, Vietnam is a 1,200 bed tertiary referral centre servicing approximately 30 million people from northern provinces of Vietnam. This audit was undertaken to analyze anecdotal reports of increasing patient numbers. Retrospective review of all congenital adrenal hyperplasia (CAH) patients registered at NHP from 1999-2014. Ethical clearance was granted by the NHP Directorate. At the start of 1999 there were 90 children with CAH managed at NHP. By May 2014 this increased to 715 including 375 (52%) male patients and 340 (48%) female patients. Number of cases with 21α-hydroxylase deficiency (21-OHD), 11β-hydroxylase deficiency and 3β-hydroxysteroid dehydrogenase deficiency was 703 (98.3%); 9 (1.3%) and 3 (0.4%), respectively. Among cases with 21-OHD, 72% were salt wasting and 28% were simple virilisation). Total number of cases represents a more than seven folds increase over 14 years. Number of new cases doubled from 30 to 67 in 2013. Most children (85%) were diagnosed at less than 12 months of age (55% at less than 1 month of age); 70% of all children were younger than 10 years. Formal mortality figures were low (seven known deaths). The caseload of CAH at NHP has increased since 1999 and additional capacity is needed for patient care. Introduction of NBS would enable more accurate estimation of CAH incidence, reduce infant mortality and minimize trauma to affected infants and their families.

  17. 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

  18. Quarterly Technical Progress Report - West Hackberry Tertiary Project

    SciTech Connect

    Bruce Cerveny; Tor Kragas; Travis Gillham

    1997-07-10

    The West Hackberry Tertiary Project is a field test of the concept that air injection can generate tertiary oil recovery through the Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil through gravity discharge. The novel aspect of this project is the use of air as the injection fluid.

  19. Tertiary Education in the Czech Republic: The Pathway to Change

    ERIC Educational Resources Information Center

    Pesik, Richard; Gounko, Tatiana

    2011-01-01

    This article analyzes recent policy proposals to reform Czech tertiary education. A brief overview of the evolution of Czech tertiary education presents the background against which emerging policy trends in education are examined. We relate the changes in tertiary education to the policy framework and recommendations of the OECD, underpinned by…

  20. 21 CFR 522.1885 - Prednisolone tertiary butylacetate suspension.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 6 2011-04-01 2011-04-01 false Prednisolone tertiary butylacetate suspension. 522... ANIMAL DRUGS § 522.1885 Prednisolone tertiary butylacetate suspension. (a) Specifications. Prednisolone...) suspension contains 20 milligrams of prednisolone tertiary butylacetate per milliliter. It is sterile....

  1. 21 CFR 522.1885 - Prednisolone tertiary butylacetate suspension.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 6 2013-04-01 2013-04-01 false Prednisolone tertiary butylacetate suspension. 522... ANIMAL DRUGS § 522.1885 Prednisolone tertiary butylacetate suspension. (a) Specifications. Prednisolone...) suspension contains 20 milligrams of prednisolone tertiary butylacetate per milliliter. It is sterile....

  2. 21 CFR 522.1885 - Prednisolone tertiary butylacetate suspension.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 6 2012-04-01 2012-04-01 false Prednisolone tertiary butylacetate suspension. 522... ANIMAL DRUGS § 522.1885 Prednisolone tertiary butylacetate suspension. (a) Specifications. Prednisolone...) suspension contains 20 milligrams of prednisolone tertiary butylacetate per milliliter. It is sterile....

  3. 21 CFR 522.1885 - Prednisolone tertiary butylacetate.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 6 2014-04-01 2014-04-01 false Prednisolone tertiary butylacetate. 522.1885... § 522.1885 Prednisolone tertiary butylacetate. (a) Specifications. Each milliliter of suspension contains 20 milligrams (mg) of prednisolone tertiary butylacetate. (b) Sponsor. See No. 050604 in §...

  4. Diversification Management at Tertiary Education Level: A Review

    ERIC Educational Resources Information Center

    Takwate, Kwaji Tizhe

    2016-01-01

    This paper examines the concept of management of diversification at tertiary education level in view of the growth of national secondary education system which vested high scramble for tertiary education was made in relation to question of access and expansion. This paper examines management of diversification at tertiary education level as a…

  5. Smart Utilization of Tertiary Instructional Modes

    ERIC Educational Resources Information Center

    Hamilton, John; Tee, Singwhat

    2010-01-01

    This empirical research surveys first year tertiary business students across different campuses regarding their perceived views concerning traditional, blended and flexible instructional approaches. A structural equation modeling approach shows traditional instructional modes deliver lower levels of student-perceived learning quality, learning…

  6. American Tertiary mollusks of the genus Clementia

    USGS Publications Warehouse

    Woodring, W.P.

    1927-01-01

    Aside from its value as an aid in determining the age of Tertiary beds, the chief interest of the genus Clementia lies in the anomalous features of its present and former distribution. An attempt is made in this paper to trace its geologic history, to point out its paleobiologic significance, and to describe all the known American Tertiary species. The fossils from Colombia used in preparing this report were collected during explorations made under the direction of Dr. 0. B. Hopkins, chief geologist of the Imperial Oil Co. (Ltd.), who kindly donated them to the United States National Museum. Dr. T. Wayland Vaughan, of the Scripps Institution of Oceanography, furnished information relating to specimens collected by him in Mexico. Dr. Bruce L. Clark, of the University of California; Dr. G. Dallas Hanna, of the California Academy of Sciences; Dr. H. A. Pilsbry, of the Philadelphia Academy of Natural Sciences; and Dr. W. D. Matthew, of the American Museum of Natural History, generously loaned type specimens and other material. Doctor Clark and Doctor Hanna also gave information concerning the Tertiary species from California. Mr. Ralph B. Stewart, of the University of California, read the manuscript, and I have taken advantage of his suggestions. I am also indebted to Mr. L. R. Cox, of the British Museum, for information relating to the fossil species from Persia, Zanzibar, and Burma, and to Dr. Axel A. Olsson, of the International Petroleum Co., for data concerning undescribed Tertiary species from Peru.

  7. Sea-Level Changes during the Tertiary.

    ERIC Educational Resources Information Center

    Vail, Peter R.; Hardenbol, Jan

    1979-01-01

    Discussed are research procedures undertaken to determine the magnitude and timing of eustatic sea-level changes during the Tertiary Period. Data now becoming available give scientists a knowledge of conditions that may have been conducive to the formation of petroleum. (BT)

  8. Understanding Australian Aboriginal Tertiary Student Needs

    ERIC Educational Resources Information Center

    Oliver, Rhonda; Rochecouste, Judith; Bennell, Debra; Anderson, Roz; Cooper, Inala; Forrest, Simon; Exell, Mike

    2013-01-01

    Drawing from a study of the experiences of Australian Aboriginal and Torres Strait Islander university students, this paper presents an overview of the specific needs of these students as they enter and progress through their tertiary education. Extracts from a set of case studies developed from both staff and student interviews and an online…

  9. Indigenous Students in the Tertiary Education Sector

    ERIC Educational Resources Information Center

    Bandias, Susan; Fuller, Don; Larkin, Steven

    2014-01-01

    Important recent objectives of indigenous education policy in Australia have been aimed at redressing indigenous economic and social disadvantage through increasing student retention, progression and completion rates in both compulsory and post-compulsory education. The two sectors of the tertiary education system, vocational education and…

  10. Tertiary Education and Training in Australia, 2009

    ERIC Educational Resources Information Center

    National Centre for Vocational Education Research (NCVER), 2011

    2011-01-01

    Sourcing data from the National VET Provider Collection and the Higher Education Statistics Collection, this publication provides a summary of participation in tertiary education and training in Australia. It covers participation in Australian Qualifications Framework certificate I qualifications through to doctorates by research, as well as…

  11. Incorporating Online Tools in Tertiary Education

    ERIC Educational Resources Information Center

    Steenkamp, Leon P.; Rudman, Riaan J.

    2013-01-01

    Students currently studying at tertiary institutions have developed a set of attitudes and aptitudes as a result of growing up in an IT and media-rich environment. These attitudes and aptitudes influence how they learn and in order to be effective, lecturers must adapt to address their learning preferences and use the online teaching tools that…

  12. Rural Professionals: A Tertiary Preparation Model.

    ERIC Educational Resources Information Center

    Krynowsky, Bernie

    An outline is proposed for a tertiary course in rural studies for professionals such as teachers, nurses, and social workers that would better prepare them for rural service. The course could be an elective in general studies or give credit toward professional certification. Key components for effective rural preparation of professionals should be…

  13. An Effective Preparation for Tertiary Mathematics

    ERIC Educational Resources Information Center

    Parnell, Sheena; Statham, Moira

    2007-01-01

    The University of Auckland offers a one-year pre-degree Tertiary Foundation Certificate (TFC) Programme, for up to 200 students who are under-prepared for university study. The students may come straight from school without having gained a university entrance qualification, or they may be students returning to education who lack the confidence to…

  14. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Minimum amount of referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs §...

  15. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot be collected, compromised, or terminated in accordance with 4 CFR parts 101 to 105 will be referred... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Referral to GAO or...

  16. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Minimum amount of referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs §...

  17. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot be collected, compromised, or terminated in accordance with 4 CFR parts 101 to 105 will be referred... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to GAO or...

  18. 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…

  19. 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...

  20. 25 CFR 217.4 - Referral of questions by the joint managers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Referral of questions by the joint managers. 217.4... DISTRIBUTION CORP. § 217.4 Referral of questions by the joint managers. The business committee and the board of directors must refer to each other for resolution any questions or problems related to joint management...

  1. 22 CFR 1429.4 - Referral of policy questions to the Board.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral of policy questions to the Board. 1429.4 Section 1429.4 Foreign Relations FOREIGN SERVICE LABOR RELATIONS BOARD; FEDERAL LABOR RELATIONS... AUTHORITY MISCELLANEOUS AND GENERAL REQUIREMENTS Miscellaneous § 1429.4 Referral of policy questions to...

  2. 5 CFR 2429.4 - Referral of policy questions to the Authority.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Referral of policy questions to the Authority. 2429.4 Section 2429.4 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL... REQUIREMENTS Miscellaneous § 2429.4 Referral of policy questions to the Authority. Notwithstanding...

  3. 5 CFR 2429.4 - Referral of policy questions to the Authority.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Referral of policy questions to the Authority. 2429.4 Section 2429.4 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL... REQUIREMENTS Miscellaneous § 2429.4 Referral of policy questions to the Authority. Notwithstanding...

  4. 22 CFR 1429.4 - Referral of policy questions to the Board.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Referral of policy questions to the Board. 1429.4 Section 1429.4 Foreign Relations FOREIGN SERVICE LABOR RELATIONS BOARD; FEDERAL LABOR RELATIONS... AUTHORITY MISCELLANEOUS AND GENERAL REQUIREMENTS Miscellaneous § 1429.4 Referral of policy questions to...

  5. Referral Rates of Senior Family Practice Residents in an Ambulatory Care Clinic.

    ERIC Educational Resources Information Center

    Lawler, Frank H.

    1987-01-01

    A study of patterns in second- and third-year family practice residents' requests for referrals found higher rates for the senior students, suggesting possible differences in approach to case management, lack of experience in referral among younger students, and differences in case mix. (MSE)

  6. 12 CFR 269b.210 - Referral to National Center for Dispute Settlement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Referral to National Center for Dispute... Referral to National Center for Dispute Settlement. (a) Within 5 days after the answer to the charge has... particularized request, to the National Center for Dispute Settlement of the American Arbitration...

  7. 45 CFR 73.735-1304 - Referral of matters arising under the standards of this part.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of matters arising under the standards of this part. 73.735-1304 Section 73.735-1304 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION STANDARDS OF CONDUCT Reporting Violations § 73.735-1304 Referral of matters arising under the standards of this part. (a)...

  8. 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....

  9. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  10. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  11. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  12. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  13. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  14. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  15. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  16. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  17. 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…

  18. The Effects of Implementing a Positive Behavior Intervention Support Program on Office Discipline Referrals

    ERIC Educational Resources Information Center

    Thomas, Cheryl Denise

    2015-01-01

    The purpose of this study was to determine if the implementation of PBIS (Positive Behavioral Intervention Support) program had a positive significant effect in decreasing office discipline referrals in a local elementary school. A sample independent t-Test was used to examine data on the school's average office discipline referrals for two years…

  19. A Qualitative Investigation of the Referral Process from School Counselors to Mental Health Providers

    ERIC Educational Resources Information Center

    Lemberger, Matthew E.; Wachter Morris, Carrie A.; Clemens, Elysia V.; Smith, Allison L.

    2010-01-01

    This qualitative study explores the referral process to mental health providers by school counselors, as perceived by school counselors. Using an open-ended survey instrument, school counselors were asked to describe the referral process, including prevalence, decisional factors, follow-up, and evaluation. Results suggest that school counselors…

  20. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...