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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.

  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. Primary thrombophilia in Mexico: a single tertiary referral hospital experience.

    PubMed

    Lacayo-Leñero, Dennis; Hernández-Hernández, Darinel; Valencia-Martínez, Andrés; Barrales-Benítez, Olga; Vargas-Ruiz, Angel G

    2016-12-01

    Thrombophilia is a complex hypercoagulable state that increases the risk of thrombosis. Most reports in medical literature of the Mexican population with this disease lack statistical validity. Therefore, the aim of this study is to describe the prevalence of primary thrombophilia in a tertiary referral hospital in Mexico. This is a study of patients referred to our hospital because of a hypercoagulable state and who later on were diagnosed with primary thrombophilia. The thrombophilia workup included methylenetetrahydrofolate reductase (MTHFR) C677T, antiphospholipid antibodies, protein C, protein S, antithrombin, factor VIII, factor V Leiden, prothrombin mutation G20210A, activated protein C resistance, JAK2 V617F and homocysteine. Ninety-five individuals were tested. The MTHFR C677T polymorphism was the most frequent anomaly in 84.1% of the tested individuals. There was a relatively low prevalence of factor V Leiden (5.2%) and anticoagulant protein deficiency (8.3%). The MTHFR C677T polymorphism has a very high prevalence compared with the low prevalence of anticoagulant protein deficiency and factor V Leiden mutation in Mexicans.

  4. 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.

  5. 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

  6. 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

  7. Audit of an inpatient neurology consultation service in a tertiary referral centre: value of the consulting neurologist.

    PubMed

    Costello, D J; Renganathan, R; O'Hare, A; Murray, B; Lynch, T

    2005-05-01

    The Mater Misericordiae Hospital is a 575-bed tertiary referral centre with busy medical and surgical subspecialty services (including the national cardiac, cardiothoracic, spinal cord injury and pulmonary hypertension units). An audit of in-patient referrals to a neurology service was carried out over the twelve-month period of January to December 2002 inclusively. Five hundred and seventy seven inpatients were evaluated and managed in conjunction with the referring services. Consultation by the neurological service led to a significant contribution in the management of clinical cases in one of three ways: establishing a de novo diagnosis in patients admitted with active neurological symptoms where no working diagnosis exists (40.7% of referrals), significant alteration in diagnosis where the referring service have already established a specific working diagnosis (11.1% of referrals), or offering advice in the ongoing management of active neurological symptoms when the diagnosis is historically established and secure (48.2% of referrals). In order of frequency the most common reason for referral was stroke (131 cases (22.7%)), seizures unrelated to alcohol (59 cases (10.2%)), alcohol-related neurological problems (55 cases (9.5%)), movement disorders (41 cases (7.1%)), neuromuscular (40 cases (6.9%)), coma (35 cases (6%)), disorders of cognition (31 cases (5.3%)), acute headache (28 case (4.8%)) and functional neurological syndromes (26 cases (4.5%)). This audit highlights the value of a consulting neurology service in a multidisciplinary tertiary referral setting.

  8. 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

  9. Pattern of inpatient referrals to dermatology at a tertiary care centre of South Rajasthan

    PubMed Central

    Balai, Manisha; Gupta, Lalit K.; Khare, Ashok K.; Mittal, Asit; Mehta, Sharad; Bharti, Garima

    2017-01-01

    Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other departments. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of South Rajasthan during a 5-year period from October 2008 to September 2013. Results: A total of 1560 consultations with 1603 diagnoses were recorded. Most (770; 49.3%) consultations were received from internal medicine, followed by surgery (177; 11.3%), pediatrics (104; 6.7%), psychiatry (86; 5.5%) and gynecology (69; 4.4%) wards. Infectious skin diseases were most common (29.7%) followed by eczema (12.0%) and drug reactions (9.0%). Conclusion: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care. PMID:28217467

  10. The process, logistics and challenges of implementing clinical supervision in a generalist tertiary referral hospital.

    PubMed

    Brunero, Scott; Lamont, Scott

    2012-03-01

    Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses.

  11. Characteristics of a large population of patients with refractory epilepsy attending tertiary referral centers in Italy.

    PubMed

    Alexandre, Veriano; Capovilla, Giuseppe; Fattore, Cinzia; Franco, Valentina; Gambardella, Antonio; Guerrini, Renzo; La Briola, Francesca; Ladogana, Marianna; Rosati, Eleonora; Specchio, Luigi Maria; Striano, Salvatore; Perucca, Emilio

    2010-05-01

    The characteristics of 1,124 consecutive adults and children with refractory epilepsy attending 11 tertiary referral centers in Italy were investigated at enrollment into a prospective observational study. Among 933 adults (age 16-86 years), the most common syndromes were symptomatic (43.7%) and cryptogenic (39.0%) focal epilepsies, followed by idiopathic (8.1%) and cryptogenic/symptomatic generalized (6.2%) epilepsies. The most common syndrome among 191 children was symptomatic focal epilepsy (35.1%), followed by cryptogenic focal (18.8%), cryptogenic/symptomatic generalized (18.3%), undetermined whether focal or generalized (16.8%), and idiopathic generalized (7.3%). Primarily and secondarily generalized tonic-clonic seizures were reported in 27.8% of adults and 16.8% of children. The most commonly reported etiologies were mesial temporal sclerosis (8.0%) and disorders of cortical development (6.2%) in adults, and disorders of cortical development (14.7%) and nonprogressive encephalopathies (6.8%) in children. More than three-fourths of subjects in both age groups were on antiepileptic drug (AED) polytherapy.

  12. A five-year review of necrotising fasciitis in a tertiary referral unit

    PubMed Central

    Swain, RA; Hatcher, JC; Azadian, BS; Soni, N

    2013-01-01

    Introduction Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system. Methods A retrospective analysis of patient notes over the five-year period from October 2006 to October 2011 was undertaken. The LRINEC score was calculated for each patient to evaluate its usefulness. Results Overall, 15 patients were diagnosed with necrotising fasciitis. Three patients died. The median age of patients was 51.0 years (range: 34–76 years). There were no obvious predisposing factors in 8 cases but patients had a median of 2.0 co-morbidities. The most common infective agent, present in five patients, was Group A Streptococcus. Other monomicrobial agents included Group G Streptococcus and Klebsiella pneumoniae. Polymicrobial infections were less common than monomicrobial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. Although the LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified as low likelihood. Conclusions This limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis. PMID:23317730

  13. 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…

  14. 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…

  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. Epidemiology and clinical features of pediatric psoriasis in tertiary referral psoriasis clinic.

    PubMed

    Kwon, Hyuck Hoon; Na, Sun Jae; Jo, Seoung Jin; Youn, Jai Il

    2012-03-01

    Few epidemiological studies of pediatric patients with moderate to severe psoriasis have been available despite there being no approved systemic therapy for these patients. The aim of the present study was to elucidate clinical features of pediatric psoriasis in a tertiary referral psoriasis clinic. We analyzed the clinical data of 358 patients under 18 years of age referred to our clinic from other private clinics and medical centers. Our data showed a male :female ratio of 1.06:1 and a peak age of onset of 10-11 years. Of the patients, 32.4% had a positive family history. The most prevalent phenotype was plaque type (67.3%) and the mean Psoriasis Area and Severity Index score was 17.2 ± 12.7. The most frequently affected body part was the trunk (69.5%), followed by the legs (65.3%). Exposure to sunlight and summer season improved psoriatic lesions, while stress and winter season aggravated the clinical course. Only 26.0% of patients received systemic therapy or phototherapy during the therapeutic course. Oral acitretin (11.2%) was most frequently used followed by ultraviolet B phototherapy (7.3%). The childhood group (<13 years) showed higher prevalence of guttate and generalized pustular phenotypes and more severe clinical course compared with the adolescent group (13-18 years). In conclusion, our patients showed distinctive features in clinical phenotypes, disease severity and affected body parts compared with previous reports. We also found that clinical application of systemic therapies were limited considering the severe disease state of our patients, demanding a need for more research on treatment of pediatric psoriasis.

  17. The value of repeat neuroimaging for epilepsy at a tertiary referral centre: 16 years of experience☆

    PubMed Central

    Winston, Gavin P.; Micallef, Caroline; Kendell, Brian E.; Bartlett, Philippa A.; Williams, Elaine J.; Burdett, Jane L.; Duncan, John S.

    2013-01-01

    Summary Purpose Magnetic resonance imaging (MRI) is the investigation of choice for detecting structural lesions that underlie and may accompany epilepsy. Despite advances in imaging technology, 20–30% of patients with refractory focal epilepsy have normal MRI scans. We evaluated the role of repeated imaging with improved MRI technology – an increase in field strength from 1.5 T to 3 T and superior head coils – in detecting pathology not previously seen. Methods Retrospective review of a large cohort of patients attending a tertiary epilepsy referral centre who underwent MRI at 1.5 T (1995–2004) and subsequently 3 T (2004–2011) with improved head coils. Scan reports were reviewed for the diagnoses and medical notes for the epilepsy classification. Results 804 patients underwent imaging on both scanners, the majority with focal epilepsy (87%). On repeat scanning at 3 T, 37% of scans were normal and 20% showed incidental findings. Positive findings included hippocampal sclerosis (13%), malformations of cortical development (8%), other abnormalities (4%) and previous surgery (18%). A total of 37 (5%) relevant new diagnoses were made on the 3 T scans not previously seen at 1.5 T. The most common new findings were hippocampal sclerosis, focal cortical dysplasia and dysembryoplastic neuroepithelial tumour. These findings affected patient management with several patients undergoing neurosurgery. Conclusions The higher field strength and improved head coils were associated with a clinically relevant increased diagnostic yield from MRI. This highlights the importance of technological advances and suggests that rescanning patients with focal epilepsy and previously negative scans is clinically beneficial. PMID:23538269

  18. 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

  19. Ten-year experience of retrievable inferior vena cava filters in a tertiary referral center

    PubMed Central

    Tse, George; Cleveland, Trevor; Goode, Stephen

    2017-01-01

    PURPOSE A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed. METHODS Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital. Results of all clinical investigations (including computed tomography, magnetic resonance imaging, ultrasonography, and plain radiography) while the IVC filters were in situ were reviewed. RESULTS In total, 393 retrievable IVC filters were inserted, 254 with the indication of preoperative thromboembolic prophylaxis. Recurrent PE was reported in five patients (1.9%) despite the IVC filter. Of the 254 retrievable filters inserted prior to surgery, an attempt at retrieval was made in 168 filters (66.1%). Successful retrieval at the first attempt occurred in 143 cases (85.1%), while 25 cases failed or were aborted (14.9%). No attempt at retrieval was made in 86 (33.9%) patients and a significant proportion of these patients had undergone cancer surgery (P < 0.0107). In those patients where there was no attempt at retrieval, there was an association between cancer surgery and a shorter absolute survival time (P < 0.0001). CONCLUSION The majority of attempted filter retrievals were successful, and a proportion of nonretrieved IVC filters are accounted for in patients who underwent cancer surgery and ultimately died with the filter in situ. A departmental protocol is recommended to ensure the filter is removed where appropriate and possible. PMID:28093377

  20. Impact of catheter and surgical ablation on arrhythmia treatment in a tertiary referral centre.

    PubMed Central

    Cunningham, D; Rowland, E

    1992-01-01

    Invasive cardiac electrophysiology studies began as diagnostic studies. The past decade has seen the introduction of several new treatments which have broadened the scope of invasive electrophysiology studies. In particular, the development of catheter ablation techniques increasingly allows curative treatment to be delivered in the catheter laboratory. The workload of electrophysiological procedures has steadily increased in our tertiary referral centre. Over 1000 patients have been treated in the past 20 years and it is projected that 219 new patients will be treated in 1991 and 342 procedures will be carried out. Over 25% of patients now receive either catheter or surgical ablation and almost 80% of these are cured permanently without the need for further drug treatment. The development of safer techniques for catheter ablation has led to its increased use and a decline in surgical ablations. Because catheter ablation is a much simpler and less traumatic procedure than surgical ablation there are great advantages both for the patient and in terms of cost-effectiveness. Antitachycardia pacing, relatively common in 1985, has now largely been supplanted by ablation and implantation of defibrillators. As the tendency to non-pharmacological treatment increases and evidence mounts that cost-effectiveness is greater for electrophysiological treatments, the implications for the funding of electrophysiology services grow. The initially high cost of curative treatment needs to be balanced against the longer term and potentially higher costs of palliative drug treatment. The potential to cure patients with catheter procedures may lead to a greater demand for this expertise and a need for an increase in training and facilities. PMID:1739536

  1. The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period

    PubMed Central

    Miles, Merinda; Dung, Khu Thi Khanh; Ha, Le Thi; Liem, Nguyen Thanh; Ha, Khu; Hunt, Rod W.; Mulholland, Kim; Morgan, Chris

    2017-01-01

    Objective To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam. Design A prospective hospital based observational study. Setting The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam. Patients All admissions to the Neonatal Department over a 12 month period. Main outcome measures Cause-specific morbidity and mortality; deaths. Results There were 5064 admissions with the commonest discharge diagnoses being infection (32%) and prematurity (29%). The case fatality ratio (CFR) was 13.9% (n = 703). Infection (38%), cardio/respiratory disorders (27%), congenital abnormalities (20%) and neurological conditions (10%) were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3%) occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR. Conclusions The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes. PMID:28282433

  2. 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…

  3. The natural history of neural tube defects in the setting of an Irish tertiary referral foetal medicine unit.

    PubMed

    Anglim, B; Mandiwanza, T; Miletin, J; Turner, M; Kennelly, M M

    2016-01-01

    Neural tube defects (NTDs) carry a heavy burden for affected individuals and their family. Physical and neurological outcome measures may help in counselling couples. The aim of this audit was to review all cases of NTDs seen at a tertiary referral foetal medicine unit. Cases were identified from obstetric, neonatal and neurosurgical records. Thirty-six cases of NTDs were identified. Of the 36, 25% (n = 9, one trisomy 18) opted for termination of pregnancy abroad. Of the remaining 27, 19% (n = 5) died in the antepartum period. 81% (n = 22) were liveborn with four neonatal deaths (one trisomy 18). Of 15 cases, 14 had neurosurgical repair within a median time of 3 days and 9 of these also had a ventriculoperitoneal shunt inserted. Antenatal ultrasound accurately diagnosed lesion level in the majority of cases. The survival rate for babies diagnosed with non-lethal neural tubes defects is high when multidisciplinary care is initiated early.

  4. 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

  5. Extramural Pilot Project: Designated On-Call Intensivist in Tertiary Care Centre Improves Access to Critical Care Consultation/Referral and Resources.

    PubMed

    Sharpe, Michael D; Jeffreys, Carrie; Martin, Claudio; Barrett, Michael; Priestap, Fran; Pierce, Michelle; Kojlak, Judy

    2015-01-01

    Timely consultation with an intensivist will promote early and appropriate management of critically ill patients. We determined whether implementing a call roster of intensivists who did not have on-call responsibilities in an intensive care unit (ICU) and who received referrals from community physicians would improve access to critical care services. This program created efficiencies to critical care services by: timely access to consultation with an intensivist (<10 minutes) and/or subspecialist, timely referral to an appropriate institution (<30 minutes) and optimal resource utilization by determining the availability of ICU beds at non-tertiary care hospitals capable of providing the care needs of the patient, thus relieving pressure on the neighbouring tertiary/quaternary care centre.

  6. Fuchs' Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis.

    PubMed

    Accorinti, Massimo; Spinucci, Giovanni; Pirraglia, Maria Pia; Bruschi, Simone; Pesci, Francesca Romana; Iannetti, Ludovico

    2016-01-01

    Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs' Heterochromic Iridocyclitis (FHI). Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis. Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (p = 0.02). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical (p < 0.001) and systemic (p < 0.001) corticosteroids therapy were used less frequently than before referral. Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes.

  7. Fuchs' Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis

    PubMed Central

    Spinucci, Giovanni; Pirraglia, Maria Pia; Bruschi, Simone; Pesci, Francesca Romana; Iannetti, Ludovico

    2016-01-01

    Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs' Heterochromic Iridocyclitis (FHI). Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis. Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (p = 0.02). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical (p < 0.001) and systemic (p < 0.001) corticosteroids therapy were used less frequently than before referral. Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes. PMID:27781126

  8. 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

  9. 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

  10. Outcome of primary rhegmatogenous retinal detachment surgery in a tertiary referral centre in Northern Ireland – A regional study

    PubMed Central

    Mikhail, Michael A; Mangioris, George; Casalino, Giuseepe; McGimpsey, Stuart; Sharkey, James; Best, Richard

    2017-01-01

    Purpose To report the primary and final success, functional outcome and complication rates of patients with primary rhegmatogenous retinal detachment (RRD) who underwent retinal detachment surgery in a tertiary referral centre in Northern Ireland. Venue Vitreoretinal service, Royal Victoria Hospital, Belfast, Northern Ireland. Methods This is a retrospective case series of all patients who underwent primary RRD repair between 1st of January 2013 and 31st of December 2013. Charts were reviewed. Patients’ demographics, overall primary and final success, functional outcome, complication rates were identified and recorded. Subgroup analysis according to lens status and foveal attachment was also performed. Results A total of 212 cases of primary RRD were included. Mean age at time of surgery was 56.6 years (range 9-90 years); 175(82.5%) had pars plana vitrectomy (PPV), 27 (12.5%), scleral buckle (SB) repair and 10 (5%) pneumatic retinopexy (PR). Overall primary and final success rate were 86% and 95.6% respectively. Overall mean visual acuity improved from 1.1 to 0.4 LogMAR postoperatively after a mean follow-up of 9 months. There was no significant difference in the primary success rate in relation to the baseline lens status (χ2 = 3.4, P = 0.2) and to the baseline macular status (χ2 = 0.6, P = 0.7). Presence of proliferative vitreoretinopathy (PVR) negatively affected the primary success rate (χ2=7.2, P = 0.03). Poor prognostic factors for success were PVR at presentation, inferior breaks and increasing number of detached quadrants. Conclusions This study demonstrates a success rate comparable with other centres with a low rate of final failure. Despite sub-specialism and the great advances in VR surgery, the biology of RRD dictates a failure rate. New therapies may improve results in the future. PMID:28298707

  11. 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…

  12. 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…

  13. What is the role of general internists in the tertiary or academic setting?

    PubMed

    Tanriover, Mine Durusu; Rigby, Shirley; van Hulsteijn, L Harry; Ferreira, Faustino; Oliveira, Narcisso; Schumm-Draeger, Petra-Maria; Weidanz, Frauke; Kramer, Mark H H

    2015-01-01

    The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system.

  14. 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

  15. The value of specialist care-infectious disease specialist referrals-why and for whom? A retrospective cohort study in a French tertiary hospital.

    PubMed

    Sasikumar, M; Boyer, S; Remacle-Bonnet, A; Ventelou, B; Brouqui, P

    2017-04-01

    This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = -19.06%) and cost of stay (average treatment effect (ATE) = - €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = -8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = -1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.

  16. 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.

  17. 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.

  18. 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.

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

    PubMed Central

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

    2015-01-01

    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

  20. Profile of microorganisms and antimicrobial resistance at a tertiary care referral burn centre in Iran: emergence of Citrobacter freundii as a common microorganism.

    PubMed

    Khorasani, G; Salehifar, E; Eslami, G

    2008-11-01

    Infection and antimicrobial resistance are important issues in severe burn. The aims of this prospective study were to investigate the profile of microorganisms and resistance to antimicrobial agents in a tertiary referral burn centre; 113 people aged >10 years, with partial- or full-thickness burns, were included in the study. A total of 733 samples including 275 swabs, 164 tissue biopsies, 258 urine samples, 26 blood samples and 10 sputum samples were collected, from which 124 microorganisms were isolated. Pseudomonas aeruginosa and Citrobacter spp were the most prevalent isolates (57.3% and 35.5%, respectively); 95.5% of Citrobacter. isolates were Citrobacter freundii. Antibiogram results obtained from 15 antimicrobial agents demonstrated that imipenem was the most effective agent against P. aeruginosa, followed by ciprofloxacin and piperacillin/tazobactam (67.9%, 43% and 37.5% sensitive, respectively). At least 60% of all Citrobacter isolates were sensitive to various antimicrobial agents, the highest sensitivity being obtained by ceftazidime and cefepime (81.6% and 78.4%, respectively). Sensitivity of P. aeruginosa isolates to the agents of each antimicrobial class was significantly different (p<0.001). The incidence of C. freundii and the resistance of P. aeruginosa to anti-pseudomonas agents were exceptionally high.

  1. A retrospective epidemiological study of skin diseases among pediatric population attending a tertiary dermatology referral center in Northern Greece

    PubMed Central

    Vakirlis, Efstratios; Theodosiou, Grigorios; Apalla, Zoe; Arabatzis, Michael; Lazaridou, Elizabeth; Sotiriou, Elena; Lallas, Aimilios; Ioannides, Demetrios

    2017-01-01

    Background The incidence of skin diseases in children is influenced by hereditary, social, and environmental factors. The objective of this study was to determine the incidence of pediatric dermatoses at a University Hospital in Northern Greece. Patients and methods We reviewed epidemiologic data of 940 patients, aged 0–18 years, who were referred to the outpatient clinic of a University Hospital between January 2013 and December 2015. Demographic data and the frequency of the various diagnoses in various age groups were studied. Results Nine hundred and forty children and adolescents with 1020 diagnoses were included in the study (52.8% females and 47.2% males). The 10 most frequent diagnoses were: dermatitis/eczema (31.5%), viral infections (12.5%), pigmentary disorders (7.4%), melanocytic nevi (5.8%), alopecia areata (5.8%), acne (5.6%), nail disorders (3.3%), vascular malformations and hemangiomas (2.9%), psoriasis (2.6%), and bacterial infections (2.6%). Atopic dermatitis was the most prevalent dermatosis in all age groups accounting for a total of 20.9% of the study population. A remarkably high incidence of various forms of mastocytosis (2.2%) was seen in our data. Conclusion Atopic dermatitis is the most frequent pediatric dermatosis in all age groups. Viral infections, pigmentary disorders, and nevi account for a significant proportion of the referrals. The high incidence of mastocytosis in our study may be attributed to overdiagnosis, overestimation due to the relatively small study population, or it may represent the real incidence of mastocytosis in our region. The low incidence of acne in our study may be attributed to the fact that only severe cases are referred to our hospital.

  2. Long-Term Outcomes of Diabetic Patients With Critical Limb Ischemia Followed in a Tertiary Referral Diabetic Foot Clinic

    PubMed Central

    Uccioli, Luigi; Gandini, Roberto; Giurato, Laura; Fabiano, Sebastiano; Pampana, Enrico; Spallone, Vincenza; Vainieri, Erika; Simonetti, Giovanni

    2010-01-01

    OBJECTIVE We describe the long-term outcomes of 510 diabetic patients with critical limb ischemia (CLI) and an active foot ulcer or gangrene, seen at the University Hospital of Rome Tor Vergata, a tertiary care clinic. RESEARCH DESIGN AND METHODS These patients were seen between November 2002 and November 2007 (mean follow-up 20 ± 13 months [range 1–66 months]). The Texas Wound Classification was used to grade these wounds that were either class C (ischemia) and D (ischemia+infection) and grade 2–3 (deep–very deep). This comprehensive treatment protocol includes rapid and extensive initial debridement, aggressive use of peripheral percutaneous angioplasty, empirical intravenous antibiotic therapy, and strict follow-up. RESULTS The protocol was totally applied (with percutaneous angioplasty [PA+]) in 456 (89.4%) patients and partially (without percutaneous angioplasty [PA−]) in 54 (10.6%) patients. Outcomes for the whole group and PA+ and PA− patients are, respectively: healing, n = 310 (60.8%), n = 284 (62.3%), and n = 26 (48.1%); major amputation, n = 80 (15.7%), n = 67 (14.7%), and n = 13 (24.1%); death, n = 83 (16.25%), n = 68 (14.9%), and n = 15 (27.8%); and nonhealing, n = 37 (7.25%), n = 37 (8.1%), and n = 0 (0%) (χ2 <0.0009). Predicting variables at multivariate analysis were the following: for healing, ulcer dimension, infection, and ischemic heart disease; and for major amputation, ulcer dimension, number of minor amputations, and age. Additional predicting variables for PA+ patients were the following: for healing, transcutaneous oxygen tension [ΔTcPo2]; and for major amputation, basal TcPo2, basal A1C, ΔTcPo2, and percutaneous angioplasty technical failure. CONCLUSIONS Early diagnosis of CLI, aggressive treatment of infection, and extensive use of percutaneous angioplasty in ischemic affected ulcers offers improved outcome for many previously at-risk limbs. Ulcer size >5 cm2 indicates a reduced chance of healing and increased risk of major

  3. The association between fecal incontinence and sexual activity and function in women attending a tertiary referral center

    PubMed Central

    Cichowski, Sara B.; Komesu, Yuko M.; Dunivan, Gena C.; Rogers, Rebecca G.

    2013-01-01

    Introduction and hypothesis To determine whether fecal incontinence (FI) is associated with sexual activity and to compare sexual function in women with and without FI. Methods We conducted a retrospective chart review of all new patients seen in an academic urogynecology clinic. Women who reported fecal incontinence, as defined by loss of fecal material on the Wexner scale, were compared with those without fecal incontinence. We compared sexual activity and Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12 (PISQ-12) scores between groups. Results In our population of women with pelvic floor disorder, 588 women reported FI compared with 527 who did not. On multivariate analysis, FI was not associated with sexual activity status, but was associated with worsened PISQ-12 scores (p<0.001). PISQ-12 item analysis found that women with FI reported more dyspareunia, fear, and avoidance of sexual activity with greater partner problems (all p <0.05) than women without FI. Conclusions Women with FI were as likely to engage in sexual relations as women without FI; however, sexually active women with FI had poorer sexual function than those without FI. PMID:23389640

  4. Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore

    PubMed Central

    Agrawal, Rupesh; Wei, Ho Sue; Teoh, Stephen

    2013-01-01

    Objective: To evaluate the factors influencing final vision outcome after surgical repair of open globe injuries and to correlate the Ocular trauma score. Materials and Methods: Retrospective case analysis of patients with open globe injuries at a tertiary referral eye care centre in Singapore was performed. Pre-operative factors affecting final vision outcome in patients with open globe injury and correlation of ocular trauma score in our study with international ocular trauma scoring system was performed. Results: Case records of 172 eyes with open globe injury were analyzed. Mean age was 36. 67 years. Mean follow up was 12.26 m. Males were pre-dominantly affected. Initial visual acuity was ≥20/40, 20/50 < 20/200, 20/200- CF, HM– PL and NLP in 24 (14%), 39 (22.7%), 16 (9.3%), 66 (38.4%) and 27 (15.7%) eyes respectively. Final visual acuity was ≤20/40, 20/50 < 20/200, 20/200- 1/200, HM– PL and NLP in 76 (44.2%), 28 (16.3%), 11 (6.4%), 30 (17.4%) and 27 (15.7%) eyes respectively. Ocular trauma score in our study correlates with international ocular trauma scoring system. Conclusion: The present study showed pre-operative variables such as mode of injury, pre-operative visual acuity, traumatic cataract, hyphaema, relative afferent papillary defect, vitreous lossand vitreous hemorrhage to be adversely affecting the final vision outcome. Our study showed a good synchrony with international ocular trauma score (OTS) and based on this study we were able to validate application of OTS in Singapore population. Recognizing these factors can help the surgeon in evidence based counseling. PMID:24104709

  5. Outcome of Referrals for Non-Responsive Celiac Disease in a Tertiary Center: Low Incidence of Refractory Celiac Disease in the Netherlands

    PubMed Central

    van Wanrooij, R L J; Bouma, G; Bontkes, H J; Neefjes-Borst, A; van Grieken, N C; von Blomberg, B M E; Mulder, C J J

    2017-01-01

    Objectives: Refractory celiac disease (RCD) is a severe cause of non-responsive celiac disease (CD) due to its association with the enteropathy associated T-cell lymphoma (EATL). Conflicting data exist on the prevalence and the clinical manifestations of RCD type I (RCD I) and type II (RCD II). The aim of the current study was to provide insight in the incidence of RCD and in the distinction with other causes of non-responsive CD. Methods: A total of 106 CD patients were referred to our tertiary referral center between January 2006 and December 2011 for evaluation of non-responsive CD. In addition, a questionnaire was sent to all 82 gastroenterology departments in the Netherlands to reveal whether a patient with RCD was currently being evaluated or had been treated between 2006 and 2012. Results: During a 6 year period, a total of 31 patients were diagnosed with RCD (19 RCD I and 12 RCD II). The nationwide survey revealed 5 additional patients with RCD I and one patient with RCD II. This leads to an annual incidence of RCD of 0.83/10.000 CD patients. The remaining patients were diagnosed with involuntary gluten ingestion (21.7%), delayed mucosal recovery (11.3%), enteropathy associated T-cell lymphoma (7.5%) and autoimmune enteropathy (1.8%). Conclusions: This nationwide study reveals a low incidence of RCD in the Netherlands. Nevertheless, RCD is a clinically relevant disease entity in CD patients non-responsive to the gluten-free diet. PMID:28125074

  6. Long-term Formation of Aggressive Bony Lesions in Dogs with Mid-Diaphyseal Fractures Stabilized with Metallic Plates: Incidence in a Tertiary Referral Hospital Population

    PubMed Central

    Gilley, Robert S.; Hiebert, Elizabeth; Clapp, Kemba; Bartl-Wilson, Lara; Nappier, Michael; Werre, Stephen; Barnes, Katherine

    2017-01-01

    The incidence of complications secondary to fracture stabilization, particularly osteolytic lesions and bony tumor formation, has long been difficult to evaluate. The objective of this study was to describe the long-term incidence of aggressive bony changes developing in dogs with long bone diaphyseal fractures stabilized by metallic bone plates compared to a breed-, sex-, and age-matched control group. The medical records of a tertiary referral center were retrospectively reviewed for dogs that matched each respective criterion. Signalment, history, cause of death (if applicable), and aggressive bony changes at previous fracture sites were recorded. Ninety dogs met the criteria for inclusion in the fracture group and were matched with appropriate control dogs. Four of the dogs in the fracture group developed aggressive bony changes at the site of previous fracture repairs most consistent with osseous neoplasia. One lesion was confirmed with cytology as neoplastic. The population of dogs was mixed with regard to breed and body weight, but all dogs with aggressive bony lesions were male. Incidence of aggressive bony lesion formation in the fracture group was 4 (4.4%) and was 0 (0%) in the control group; three (75%) of the affected dogs in the fracture group included cerclage as a component of their primary fracture stabilizations. Incidence of aggressive bony lesions in the fracture group compared to the control group was determined to be statistically significant (p = 0.0455), as was the incidence of cerclage among dogs affected by aggressive bony lesions compared to the rest of the fracture group (p = 0.0499). Development of aggressive bony lesions is an uncommon complication of fracture fixation. Additional research is needed to further identify and elucidate the long-term effects of metallic implants in dogs. PMID:28197406

  7. Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit.

    PubMed

    Ong, G M; Lowry, K; Mahajan, S; Wyatt, D E; Simpson, C; O'Neill, H J; McCaughey, C; Coyle, P V

    2004-01-01

    The impact of shedding of herpes simplex virus type 1 (HSV-1) on hospital survival of patients receiving assisted ventilation in an adult tertiary referral, acute trauma intensive care unit was assessed. The study was designed to address a clinical impression linking HSV-1 recovery with poor survival. Two hundred and forty-one males and 152 females were enrolled into a longitudinal cohort study. Combined throat swabs and tracheal secretions were tested for HSV-1 shedding using a nested nucleic acid amplification protocol; patients were ranked as nonshedders, shedders, and high-level shedders. Nonparametric analysis assessed the impact of shedding on hospital survival and logistic regression measured the confounding influence of sex, age, and the Acute Physiology, Age and Chronic Health Evaluation (APACHE II) score. Linear-by-linear association determined the influence of the level of shedding on hospital survival. The observed mortality rate was 113/393 (28.8%). Patients shedding HSV-1 106/393 (27%) had a significant reduction in hospital survival 66/106 (62%) in HSV-1 shedders compared with 217/287 (75.6%) in nonshedders (P = 0.002). This difference remained significant when adjusted for age and sex (P = 0.026). Respective mortality figures for HSV-1 shedders and nonshedders were 43/106 (40.6%) and 70/287 (24.4%) (P = 0.002). HSV-1 shedding was associated with a significant reduction in hospital survival amongst patients receiving assisted ventilation. Hospital mortality in HSV-1 shedders was increased by 16.2% over nonshedders. The role of HSV-1 in this setting needs to be addressed.

  8. Long-term Formation of Aggressive Bony Lesions in Dogs with Mid-Diaphyseal Fractures Stabilized with Metallic Plates: Incidence in a Tertiary Referral Hospital Population.

    PubMed

    Gilley, Robert S; Hiebert, Elizabeth; Clapp, Kemba; Bartl-Wilson, Lara; Nappier, Michael; Werre, Stephen; Barnes, Katherine

    2017-01-01

    The incidence of complications secondary to fracture stabilization, particularly osteolytic lesions and bony tumor formation, has long been difficult to evaluate. The objective of this study was to describe the long-term incidence of aggressive bony changes developing in dogs with long bone diaphyseal fractures stabilized by metallic bone plates compared to a breed-, sex-, and age-matched control group. The medical records of a tertiary referral center were retrospectively reviewed for dogs that matched each respective criterion. Signalment, history, cause of death (if applicable), and aggressive bony changes at previous fracture sites were recorded. Ninety dogs met the criteria for inclusion in the fracture group and were matched with appropriate control dogs. Four of the dogs in the fracture group developed aggressive bony changes at the site of previous fracture repairs most consistent with osseous neoplasia. One lesion was confirmed with cytology as neoplastic. The population of dogs was mixed with regard to breed and body weight, but all dogs with aggressive bony lesions were male. Incidence of aggressive bony lesion formation in the fracture group was 4 (4.4%) and was 0 (0%) in the control group; three (75%) of the affected dogs in the fracture group included cerclage as a component of their primary fracture stabilizations. Incidence of aggressive bony lesions in the fracture group compared to the control group was determined to be statistically significant (p = 0.0455), as was the incidence of cerclage among dogs affected by aggressive bony lesions compared to the rest of the fracture group (p = 0.0499). Development of aggressive bony lesions is an uncommon complication of fracture fixation. Additional research is needed to further identify and elucidate the long-term effects of metallic implants in dogs.

  9. 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

  10. 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

    Choudhury, Debarati; Das Talukdar, Anupam; Dutta Choudhury, Manabendra; Maurya, Anand Prakash; Paul, Deepjyoti; Dhar Chanda, Debadatta; Chakravorty, Atanu; Bhattacharjee, Amitabha

    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

  11. 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

  12. 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…

  13. 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…

  14. 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.

  15. 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…

  16. 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…

  17. 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…

  18. Predictors of Tertiary Accounting Students' Academic Performance: A Comparison of Year 12-to-University Students with TAFE-to-University Students

    ERIC Educational Resources Information Center

    Tickell, Geoffrey; Smyrnios, Kosmas X.

    2005-01-01

    Awareness of factors associated with academic performance in tertiary accounting education courses is useful for selection officers, educators, administrators and students. Yet research shows findings relating to this topic area to be inconclusive. Also, investigations are typically cross-sectional rather than longitudinal, and as such can have…

  19. A Review of Psychometric Data Analysis and Applications in Modelling of Academic Achievement in Tertiary Education

    ERIC Educational Resources Information Center

    Gray, Geraldine; McGuinness, Colm; Owende, Philip; Carthy, Aiden

    2014-01-01

    Increasing college participation rates, and diversity in student population, is posing a challenge to colleges in their attempts to facilitate learners achieve their full academic potential. Learning analytics is an evolving discipline with capability for educational data analysis that could enable better understanding of learning process, and…

  20. Understanding the Integrated Learning Course Model: "Academic Transition to Tertiary Education"

    ERIC Educational Resources Information Center

    Arendale, David R.

    2014-01-01

    In 1972, the TRIO program leaders at the University of Minnesota (UMN) developed the Integrated Learning (IL) course to meet academic and cultural transition needs of their Upward Bound (UB) secondary school students. These courses were offered during the UB summer bridge program for students who were concurrently enrolled in…

  1. 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…

  2. 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.

  3. Implementation of a Prolonged Infusion Guideline for Time-Dependent Antimicrobial Agents at a Tertiary Academic Medical Center.

    PubMed

    Hohlfelder, Benjamin; Kubiak, David W; Degrado, Jeremy R; Reardon, David P; Szumita, Paul M

    Administration of time-dependent beta-lactam antibiotic as a prolonged infusion may maximize the pharmacodynamic target of time above the minimum inhibitory concentration. We describe the implementation of a prolonged infusion at a tertiary academic medical center, and a 1-year compliance analysis with the guideline. After performing a thorough literature search, a guideline was developed by members of the Department of Infectious Diseases and Department of Pharmacy. Approval and endorsement of the guideline was obtained by the Antimicrobial Subcommittee and Pharmacy and Therapeutics Committee. Physical champions were instrumental in the implementation of the guideline institution-wide. We then performed a 1-year retrospective analysis of guideline compliance from January 1, 2011 to December 31, 2011. Noncompliant administrations were obtained from smart infusion pumps. The total number of doses administered was taken from pharmacy information resources. In total, nearly 85,000 time-dependent doses were administered. Compliance with the prolonged infusion guideline was 89%. Rates of compliance did not significantly differ between medications (P = 0.555). Obtaining support from key stakeholders in collateral services and institutional leadership was vital for the success of this guideline. Compliance with the guideline 1 year after implementation was high. Implementation of a prolonged infusion guideline is feasible with institutional support and motivation.

  4. 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.

  5. Pattern of antibiotic prescription and resistance profile of common bacterial isolates in the internal medicine wards of a tertiary referral centre in Nigeria.

    PubMed

    Iliyasu, Garba; Dayyab, Farouq M; Bolaji, Tiamiyu A; Habib, Zaiyad G; Takwashe, Isa M; Habib, Abdulrazaq G

    2015-06-01

    Indiscriminate and excessive use of antibiotics is the major driver to the development of bacterial resistance, which is now a global challenge. Information regarding antibiotic use in Nigerian hospitals is lacking. This study examined the pattern of antibiotic prescription in a tertiary hospital in Nigeria. In a retrospective survey, case records of patients who were admitted into the medical wards over a 6-month period were reviewed. A pre-formed questionnaire was administered that sought information such as sociodemographic data, drug data, basis of prescription and other relevant information on all patients who received antibiotics. Data were analysed using SPSS for Windows v.16. Of 412 patients admitted into the internal medicine ward during the study period, 202 (49.0%) received antibiotics, of whom 125 (61.9%) received more than one antibiotic. Overall there were 334 antibiotic prescriptions. Community-acquired pneumonia (67/202; 33.2%) was the leading cause of antibiotic prescription, and ceftriaxone (132/334; 39.5%) was the most commonly prescribed antibiotic. The parenteral route was the commonest route of administration (270/334; 80.8%) and most of the prescriptions were empirical (323/334; 96.7%). Antimicrobial resistance among common bacterial isolates was noted. Inappropriate antibiotic prescription is common. There was frequent use of third-generation cephalosporins as empirical therapy, with de-escalation in only a handful of cases. This highlights the need for introduction of antibiotic guidelines.

  6. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center.

    PubMed

    Artenstein, Andrew W; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul

    2016-10-01

    Background.  Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005-2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results.  We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions.  Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

  7. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center

    PubMed Central

    Artenstein, Andrew W.; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul

    2016-01-01

    Background. Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005–2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods. Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results. We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions. Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA. PMID:28018923

  8. 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

  9. Using Needs Assessment to Develop Curricula for Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Academic and Community Health Settings

    ERIC Educational Resources Information Center

    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…

  10. Tertiary Entrance Scores Need Not Determine Academic Success: An Analysis of Student Performance in an Equity and Access Program

    ERIC Educational Resources Information Center

    Levy, Stuart; Murray, Julie

    2005-01-01

    The Diploma of Foundation Studies (DoFS) is an established regional equity and access program with a four- year record of enabling students with a low Equivalent National Entry Rank (ENTER) to undertake full-time tertiary study in a range of disciplinary areas. Preliminary analysis indicates this program has been successful, with three-quarters of…

  11. The Impact of Angelina Jolie (AJ)'s Story on Genetic Referral and Testing at an Academic Cancer Centre in Canada.

    PubMed

    Raphael, Jacques; Verma, Sunil; Hewitt, Paul; Eisen, Andrea

    2016-12-01

    In May 2013, Angelina Jolie revealed to the media that she had undergone preventive double mastectomy after testing positive for a BRCA1 gene mutation. Media coverage has been extensive, but it is not clear how such a personal story affected the public and cancer genetics clinics. We conducted a retrospective review using data from the clinical database of the Familial Cancer Program at our centre. The impact of Ms. Jolie's story on genetic counseling referrals and the appropriateness of such referrals were assessed and reported. The number of women referred for genetic counseling increased by 90 % after 6 months and remained high one year after AJ's story with an increase of 88 % from baseline. The number of women who qualified for genetic testing increased by 105 % after 6 months; this increase persisted but was somewhat lower after one year with an increase of 68 % from baseline. Furthermore the number of BRCA1/2 carriers identified increased by 110 % after 6 months and by 42 % after one year.The effect of Mrs. Jolie's story persisted one year after its release; however in the latter half of the year, the hereditary cancer risk of referred women was significantly lower than initially observed. The next challenge for our health care system will not only be to meet the increased demand for cancer genetic services in our region, but also to ensure that referrals and hence use of genetic counseling resources are appropriate.

  12. 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…

  13. Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality

    PubMed Central

    Çalık Başaran, Nursel; Karaağaoğlu, Ergun; Hasçelik, Gülşen; Durusu Tanrıöver, Mine; Akova, Murat

    2016-01-01

    Objective: We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. Materials and Methods: We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. Results: We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN) was observed in 196 (51%) of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively). Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. Conclusion: Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gram-negative bacteria were the most predominant microorganisms among cancer patients in our institute. PMID:27095391

  14. Practices and attitudes of doctors and patients to downward referral in Shanghai, China

    PubMed Central

    Yu, Wenya; Li, Meina; Nong, Xin; Ding, Tao; Ye, Feng; Liu, Jiazhen; Dai, Zhixing; Zhang, Lulu

    2017-01-01

    Objectives In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. Methods Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ2 test and stepwise logistic regression analysis were employed for statistical analysis. Results Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. Conclusions To increase the rate of downward referral, the Chinese government should optimise the current referral system and

  15. Idiopathic pulmonary fibrosis: Early detection and referral

    PubMed Central

    Oldham, Justin M.; Noth, Imre

    2016-01-01

    Summary Idiopathic pulmonary fibrosis (IPF), a devastating progressive interstitial lung disease (ILD) with no known cause or cure, is the most common and deadly of the idiopathic interstitial pneumonias. With a median survival of 3–5 years following diagnosis, IPF is characterized by a progressive decline in lung function and quality of life in most patients. Vigilance among clinicians in recognizing IPF early in the disease course remains critical to properly caring for these patients, as this provides the widest range of management options. When IPF is suspected, a multidisciplinary evaluation (MDE) by a clinician, radiologist and pathologist with ILD expertise should occur, as this improves diagnostic agreement in both community and academic settings. When community MDE is not possible, or diagnostic doubt exists, referral to an ILD center should be considered. ILD center referral may also provide access specialized care, including clinical trials and lung transplantation, and should be considered for any patient with an established diagnosis of IPF. PMID:24746629

  16. Fresh frozen plasma use in a tertiary referral hospital.

    PubMed

    Nicholls, M D; Au-Yeung, D; Iannella, M

    1994-06-01

    Hospital transfusion practice is directed towards the optimization of transfusion therapy. A fresh frozen plasma (FFP) usage audit was performed on 316 consecutive FFP units, transfused in 119 transfusion episodes to 75 patients (January-April 1992). All patients had coagulation tests before and after FFP administration; 76% of the coagulation tests were abnormal and of the 24% patients with normal coagulation tests 83% required a massive blood transfusion. Prophylactic to therapeutic and surgical (pre, intra, post) to medical use was 48%:52% and 56%:44%, respectively. From 1988 to 1992 there has been a 42% fall in the hospital's usage of FFP and the FFP to red cell usage is 1:10. In this audit four groups of patients received FFP appropriately for the following indications: coagulation factor deficiency (40%); acute reversal of anticoagulation therapy (19%); massive blood transfusion (27%) and complex medical problems including intensive plasmapheresis (12%). Only 2 patients received FFP (4 units) inappropriately. A total of 98.7% of the FFP units were considered appropriately transfused.

  17. 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

  18. 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…

  19. Informational influences on physician referrals.

    PubMed

    Beltramini, R F; Sirsi, A K

    1992-01-01

    Today's health care marketers are devoting significant resources to increase physician referrals, an area vital to their continued survival. The goal of this investigation was to integrate the findings of previous research on physician referrals, and to provide an up-to-date assessment of those influences underlying physician referral behavior. A questionnaire was mailed to 1,800 physicians differing in specialty and years in practice. Three informational influences were found to affect physician referrals: Program Information, Patient Input, and Location. The results suggest a need for specialists and other organizations interested in managing physician referrals to (a) establish and maintain a network of relationships among those physicians referring patients and specialists being referred to through personal communication, (b) maintain a pool of knowledgeable professionals willing to supply relevant and current information to physicians, and (c) provide complete and prompt feedback information to the referring physician. Managerial implications and directions for future research are also discussed.

  20. Retinoblastoma Referral Pattern in Kenya

    PubMed Central

    Nyamori, Joseph M.; Kimani, Kahaki; Njuguna, Margaret W.; Dimaras, Helen

    2014-01-01

    Purpose: Kenya is a large country with a widely dispersed population. As retinoblastoma requires specialized treatment, we determined the referral pattern for patients with retinoblastoma in Kenya to facilitate the formulation of a national policy. Materials and Methods: A retrospective study was performed for retinoblastoma patients who presented from January 1, 2006 to December 31, 2007. Data were collected on the referral process from presenting health facility to the hospital where patient was treated. Data were also collected on the time interval when the first symptoms were noticed to the time of presentation at a health facility (lag time). For cases that could be traced to a referral hospital, the time delay due to referral (referral lag time) was recorded. Results: There were 206 patients diagnosed with retinoblastoma in 51 Kenyan and 2 foreign healthcare facilities, and they received final treatment at a Kenyan hospital. Mean lag time was 6.8 months (±6.45). Of all patients, 18% (38/206) were treated at the hospital where they first presented and 82% (168/206) were referred elsewhere. Of those referred, 35% (58/168) were lost to follow-up. The mean referral lag time was 1.7 months (±2.5). Conclusions: A significant proportion of cases presented late, and either delayed seeking further treatment or were lost after initial referral. We recommend the implementation of a national strategy that emphasizes early detection, documentation and follow up of retinoblastoma patients. PMID:25371638

  1. 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…

  2. Implementation and performance of the BioFire FilmArray® Blood Culture Identification panel with antimicrobial treatment recommendations for bloodstream infections at a midwestern academic tertiary hospital.

    PubMed

    Southern, Timothy R; VanSchooneveld, Trevor C; Bannister, Dianna L; Brown, TeAnne L; Crismon, Amy S; Buss, Sarah N; Iwen, Peter C; Fey, Paul D

    2015-02-01

    The FilmArray® Blood Culture Identification (BCID) panel was recently implemented at a midwestern academic tertiary care hospital to provide rapid identification (ID) of common pathogens from positive blood cultures. This study evaluated the clinical performance of the BCID panel compared to culture-based ID methods. One hundred thirty-eight monomicrobial and 8 polymicrobial blood cultures were evaluated during the 30-day study resulting in the ID of 152 total organisms by culture with 115 organisms correctly identified using the BCID panel. The BCID panel had sensitivities of 80.4% (115/152) for all organisms identified during the study and 94.6% (115/122) when considering only on-panel organisms. BCID panel specificity was 100%. Implementation of the BCID panel was coupled with the development of empiric therapy recommendations for bloodstream infections by the antimicrobial stewardship team. Based on this study, the FilmArray® BCID panel is a rapid and reliable test for the detection of common bloodstream pathogens, and therapeutic decisions can be based upon panel results.

  3. An Exploratory Study of Collaboration in New Zealand Tertiary Libraries

    ERIC Educational Resources Information Center

    Finnerty, Colleen

    2005-01-01

    The shift in policy from market driven behaviour towards a more cooperative tertiary sector is having an effect on New Zealand academic libraries and their relationships. Despite this, there has been no investigation of collaboration specifically targeting New Zealand tertiary libraries. This research project examine the state of collaboration…

  4. 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…

  5. Referral Practices of School Counselors.

    ERIC Educational Resources Information Center

    Ritchie, Martin H.; Partin, Ronald L.

    1994-01-01

    Surveyed school counselors (n=149) concerning their referral practices. Found that average number of students that counselors reported referring to other professionals during typical year was 30 (average of 6.5% of students they served). Emotional concerns, family concerns, alcoholism or drug abuse, and suspected child abuse were concerns most…

  6. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR 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...

  7. 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…

  8. 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…

  9. 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…

  10. Automatic referral to cardiac rehabilitation.

    PubMed

    Fischer, Jane P

    2008-01-01

    The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.

  11. Effects of Child Gender and Symptom Type on Referrals for ADHD by Elementary School Teachers

    ERIC Educational Resources Information Center

    Sciutto, Mark J.; Nolfi, Cara J.; Bluhm, Carla

    2004-01-01

    In this study, the authors investigated the effects of child gender and attention-deficit/hyperactivity disorder (ADHD) symptom type on elementary school teachers' referral decisions. Participants (N =199) read a profile of a fictional child's academic record and rated the likelihood of referring the child for an evaluation. The profiles varied by…

  12. 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…

  13. 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

  14. 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

  15. GPs' payment contracts and their referral practice.

    PubMed

    Mariñoso, Begoña Garcia; Jelovac, Izabela

    2003-07-01

    This paper compares the role of general practitioners in determining access to specialists in two types of health care systems: gate-keeping systems, where a general practitioner (GP) referral is compulsory to visit a specialist, and non-gate-keeping systems, where this referral is optional. We model the dependence between the GP's diagnosis effort and her referral behaviour, and identify the optimal contracts that induce the best behaviour from a public insurer's point of view, where there is asymmetry of information between the insurer and the GP regarding diagnosis effort and referral decisions. We show that gate keeping is superior wherever GP's incentives matter.

  16. Development of a quarterly referral productivity report.

    PubMed

    Wu, Cai; Sandoval, Alex; Hicks, Katrina N; Edwards, Tim J; Green, Lyle D

    2007-10-11

    The Office of Physician Relations at The University of Texas M. D. Anderson Cancer Center (MDACC) has developed a dynamic referral productivity reporting tool for its Multidisciplinary Care Centers (MCC). The tool leverages information within the institution's Enterprise Information Warehouse (EIW) using business intelligent software Hyperion Intelligent Explorer Suite 8.3. the referral productivity reports are intended to provide each MCC with detailed referral and registration data outlining how, and from where, patients arrive here for treatment. The reports supports operational and strategic initiatives aimed at improving referral processes and market related program development.

  17. Referral to pediatric surgical specialists.

    PubMed

    Klein, Michael D

    2014-02-01

    The American Academy of Pediatrics, with the collaboration of the Surgical Sections of the American Academy of Pediatrics, has created referral recommendations intended to serve as voluntary practice parameters to assist general pediatricians in determining when and to whom to refer their patients for pediatric surgical specialty care. It is recognized that these recommendations may be difficult to implement, because communities vary in terms of access to major pediatric medical centers. Limited access does not negate the value of the recommendations, however, because the child who needs specialized surgical and anesthetic care is best served by the skills of the appropriate pediatric surgical team. Major congenital anomalies, malignancies, major trauma, and chronic illnesses (including those associated with preterm birth) in infants and children should be managed by pediatric medical subspecialists and pediatric surgical specialists at pediatric referral centers that can provide expertise in many areas, including the pediatric medical subspecialties and surgical specialties of pediatric radiology, pediatric anesthesiology, pediatric pathology, and pediatric intensive care. The optimal management of the child with complex problems, chronic illness, or disabilities requires coordination, communication, and cooperation of the pediatric surgical specialist with the child's primary care pediatrician or physician.

  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. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved AWARD TERM FOR TRAFFICKING IN PERSONS § 175.20 Referral. An agency official should inform the...

  20. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS AWARD TERM FOR TRAFFICKING IN PERSONS § 175.20 Referral....

  1. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  2. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  3. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  4. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  5. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  6. 28 CFR 35.174 - Referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Referral. 35.174 Section 35.174 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES Compliance Procedures § 35.174 Referral. If the public entity declines to enter into...

  7. 28 CFR 35.174 - Referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Referral. 35.174 Section 35.174 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES Compliance Procedures § 35.174 Referral. If the public entity declines to enter into...

  8. 28 CFR 35.174 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Referral. 35.174 Section 35.174 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES Compliance Procedures § 35.174 Referral. If the public entity declines to enter into...

  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. 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…

  11. 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.

  12. 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.

  13. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.

    PubMed

    Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia

    2008-08-01

    The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary.

  14. 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…

  15. 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…

  16. 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…

  17. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... classified information from inadvertent disclosure. (b) Automatic declassification. The referral process for records subject to automatic declassification entails identification of records containing classified... be completed prior to the date of automatic declassification established by section 3.3(a) of...

  18. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... classified information from inadvertent disclosure. (b) Automatic declassification. The referral process for records subject to automatic declassification entails identification of records containing classified... be completed prior to the date of automatic declassification established by section 3.3(a) of...

  19. 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,...

  20. 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,...

  1. 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.

  2. 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…

  3. 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…

  4. Multi-institutional Study of Voice Disorders and Voice Therapy Referral: Report from the CHEER Network

    PubMed Central

    Misono, Stephanie; Marmor, Schelomo; Roy, Nelson; Mau, Ted; Cohen, Seth M.

    2017-01-01

    Objectives To assess perspectives of patients with voice problems and identify factors associated with the likelihood of referral to voice therapy via the CHEER (Creating Healthcare Excellence through Education and Research) practice-based research network infrastructure. Study Design Prospectively enrolled cross-sectional study of CHEER patients seen for a voice problem (dysphonia). Setting The CHEER network of community and academic sites. Methods Patient-reported demographic information, nature and severity of voice problems, clinical diagnoses, and proposed treatment plans were collected. The relationship between patient factors and voice therapy referral was investigated. Results Patients (N = 249) were identified over 12 months from 10 sites comprising 30 otolaryngology physicians. The majority were women (68%) and white (82%). Most patients reported a recurrent voice problem (72%) and symptom duration >4 weeks (89%). The most commonly reported voice-related diagnoses were vocal strain, reflux, and benign vocal fold lesions. Sixty-seven percent of enrolled patients reported receiving a recommendation for voice therapy. After adjusting for sociodemographic and other factors, diagnoses including vocal strain/excessive tension and vocal fold paralysis and academic practice type were associated with increased likelihood of reporting a referral for voice therapy. Conclusions The CHEER network successfully enrolled a representative sample of patients with dysphonia. Common diagnoses were vocal strain, reflux, and benign vocal fold lesions; commonly reported treatment recommendations included speech/voice therapy and antireflux medication. Recommendation for speech/voice therapy was associated with academic practice type. PMID:27371624

  5. Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

    PubMed Central

    Ausania, F; White, SA; French, JJ; Jaques, BC; Charnley, RM; Manas, DM

    2015-01-01

    Introduction Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. Methods The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19–9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. Results Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19–9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. Conclusions In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability. PMID:25723690

  6. 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…

  7. 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.

  8. 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…

  9. Prevalence, Causes and Effects of Bullying in Tertiary Institutions in Cross River State, Nigeria

    ERIC Educational Resources Information Center

    Ada, Mary Juliana; Okoli, Georgina; Obeten, Okoi Okorn; Akeke, M. N. G.

    2016-01-01

    This research is an evaluation of the impact of causes, consequences and effects of bullying in academic setting on student academic performance in tertiary institutions in Cross River State, Nigeria. The research made use of purposive and random sampling techniques made up of 302 students. Questionnaire served as the data collection instrument.…

  10. 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…

  11. 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.

  12. 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

  13. 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:…

  14. USAR Nurse Referral and Retention Program.

    PubMed

    Foley, J E; Foley, B J

    1992-09-01

    In 1987, the 804th Hospital Center made alleviating the shortfall of registered nurses in the Command a priority. The Command had only 79% of its registered nurse positions filled at the time. Using the recruitment strategies of an employee referral program and a mailing list, the Command reached 100% fill in 2 years and maintained those gains for an additional year. Retention strategies were also implemented which lowered the attrition rate. This paper describes the Army Nurse Referral and Retention Program developed and implemented at the 804th Hospital Center that relieved the shortfall of registered nurses in the United States Army Reserve in New England.

  15. Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral

    PubMed Central

    Gatzoulis, M; Hechter, S; Siu, S; Webb, G

    1999-01-01

    Objective—To examine the evolving role of specialised outpatient services for adult patients with congenital heart disease.
Design—A retrospective analysis of all patients attending the Toronto Congenital Cardiac Centre for Adults over three corresponding three month periods in 1987, 1992, and 1997.
Setting—A tertiary referral centre.
Main outcome measures—Patient demographics, residence, medical and surgical history, type and source of referral, and investigations performed.
Results—In all, 570 patients were seen at the clinic during these three periods. There was a 44% and a 269% increase in workload between 1987 to 1992 and 1992 to 1997, respectively. There was a steady fall in mean age of patients seen at the clinic with time (38.5, 33.6, and 31.7 years in 1987, 1992, and 1997, respectively, p < 0.001). New referrals from community cardiologists and family physicians increased more in relative terms than did referrals from the Hospital for Sick Children, Toronto (6.7%, 15%, and 37.5%, p = 0.02). There was a steady increase in patients with previous reparative surgery (48.9%, 59.2%, and 69.2%, p < 0.002). The proportion of patients with previous reoperations also increased (2.3%, 10%, and 9.2%, p < 0.01). Echocardiography remained the predominant method of diagnosis. The diagnostic mix did not change with time.
Conclusions—Over the past 10 years there has been a large increase in adults with congenital heart disease requiring and seeking specialised care in a tertiary health centre, with a concomitant evolution of referral patterns. These data may be helpful in planning of similar paediatric and adult cardiac services for this expanding population.

 Keywords: congenital heart disease;  ambulatory clinics PMID:10220546

  16. 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....

  17. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved AWARD TERM FOR TRAFFICKING IN PERSONS §...

  18. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS NATIONAL POLICY REQUIREMENTS AWARD TERM FOR TRAFFICKING...

  19. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS NATIONAL POLICY REQUIREMENTS AWARD TERM FOR TRAFFICKING...

  20. 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

  1. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... an NDC database system. (3) Notification of referral of records accessioned into NARA or in the... unmarked Restricted Data or Formerly Restricted Data shall be referred to the Department of Energy through the NDC. If the Department of Energy confirms that the document contains Restricted Data or...

  2. 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…

  3. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure....

  4. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure....

  5. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure....

  6. 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…

  7. 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.

  8. West Hackberry Tertiary Project

    SciTech Connect

    Kenneth Haley; Travis Gillham; Demetrios Yannimaras

    1999-03-31

    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. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil by gravity drainage. In reservoirs with pronounced bed dip such as those found in West Hackberry and other Gulf Coast salt dome fields, reservoir performance has shown that gravity drainage recoveries average 80% to 90% of the original oil in place while waterdrive recoveries average 50% to 60% of the original oil in place. The target for tertiary oil recovery in the Double Displacement Process is the incremental oil between the 50% to 60% waterdrive recoveries and the 80% to 90% gravity drainage recoveries. In previous field tests, the Double Displacement Process has proven successful in generating tertiary oil recovery. The use of air injection in this process combines the benefits of air's low cost and universal accessibility with the potential for accelerated oil recovery from the combustion process. If successful, this project will demonstrate that utilizing air injection in the Double Displacement Process will result in an economically viable tertiary process in reservoirs (such as Gulf Coast salt dome reservoirs) where any other tertiary process is presently uneconomic. Air injection on the West Hank began in November of 1994. Although West Flank air injection has increased reservoir pressure by 500 pounds per square inch (psi), production response has not yet occurred. The gas cap on the West Flank has not expanded sufficiently to push the oil rim down to the nearest down structure well. Cumulative injection to date is 1.6 BCF, only approximately 50% of the projected volume required to establish oil production response. Additional air injection is required to further expand the gas cap and thereby

  9. 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.

  10. 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...

  11. 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...

  12. 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...

  13. 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

  14. 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.

  15. [Appropriateness of referrals for magnetic resonance imaging in Latium, Italy].

    PubMed

    Prota, Federica; Rosano, Aldo; San Martini, Elena; Cau, Norberto; Guasticchi, Gabriella

    2012-01-01

    Long wait times for access to Nuclear Magnetic resonance imaging (MRI) examinations are a concern and for this reason the project "Appropriateness of referrals for MRI examinations" has been launched in Latium (Italy). The aim of this preliminary study was to describe the main characteristics of MRI referrals in the region. Findings highlight a large variation in referral rates across the region, with 80% of MRI referrals being ordered by general practitioners and family pediatricians. The latter points to the possibility of inappropriate referrals for MRI imaging in Latium.

  16. Mediastinal Pseudocyst: Varied Presentations and Management—Experience from a Tertiary Referral Care Centre in India

    PubMed Central

    Abdul Jameel, Abdul Rehman; Kannan, Naveen; Anbalagan, Amudhan; Duraisamy, Benet; Raju, Prabhakaran

    2017-01-01

    Pseudocysts are a recognised complication following acute or chronic pancreatitis. Usually located in peripancreatic areas, they have also been reported to occur in atypical regions like liver, pelvis, spleen, and mediastinum. Mediastinal pseudocysts are a rare entity and present with myriad of symptoms due to their unique location. They are a clinical challenge to diagnose and manage. In this paper, we describe the clinical and radiological characteristics of mediastinal pseudocysts in 7 of our patients, as well as our experience in managing these patients along with their clinical outcome. PMID:28392624

  17. 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.

  18. Inappropriateness of Cardiovascular Radiological Imaging Testing; A Tertiary Care Referral Center Study

    PubMed Central

    Carpeggiani, Clara; Marraccini, Paolo; Morales, Maria Aurora; Prediletto, Renato; Landi, Patrizia; Picano, Eugenio

    2013-01-01

    Aims Radiological inappropriateness in medical imaging leads to loss of resources and accumulation of avoidable population cancer risk. Aim of the study was to audit the appropriateness rate of different cardiac radiological examinations. Methods and Principal Findings With a retrospective, observational study we reviewed clinical records of 818 consecutive patients (67±12 years, 75% males) admitted from January 1-May 31, 2010 to the National Research Council – Tuscany Region Gabriele Monasterio Foundation cardiology division. A total of 940 procedures were audited: 250 chest x-rays (CXR); 240 coronary computed tomographies (CCT); 250 coronary angiographies (CA); 200 percutaneous coronary interventions (PCI). For each test, indications were rated on the basis of guidelines class of recommendation and level of evidence: definitely appropriate (A, including class I, appropriate, and class IIa, probably appropriate), uncertain (U, class IIb, probably inappropriate), or inappropriate (I, class III, definitely inappropriate). Appropriateness was suboptimal for all tests: CXR (A = 48%, U = 10%, I = 42%); CCT (A = 58%, U = 24%, I = 18%); CA (A = 45%, U = 25%, I = 30%); PCI (A = 63%, U = 15%, I = 22%). Top reasons for inappropriateness were: routine on hospital admission (70% of inappropriate CXR); first line application in asymptomatic low-risk patients (42% of CCT) or in patients with unchanged clinical status post-revascularization (20% of CA); PCI in patients either asymptomatic or with miscellaneous symptoms and without inducible ischemia on non-invasive testing (36% of inappropriate PCI). Conclusion and Significance Public healthcare system – with universal access paid for with public money – is haemorrhaging significant resources and accumulating avoidable long-term cancer risk with inappropriate cardiovascular imaging prevention. PMID:24312272

  19. 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

  20. A clinical audit on the practice of platelet transfusions at a tertiary paediatric referral centre.

    PubMed

    Jamal, R; Hoe, T S; Ong, L C; Afifah, I; Khuzaiah, R; Doraisamy, G

    1998-06-01

    Platelet transfusions are indicated in a wide variety of clinical conditions especially those with thrombocytopenia. However, without proper clinical practice guidelines, inappropriate transfusions are bound to happen. To ascertain the provision of a quality and appropriate practice of platelet transfusions, an audit study was carried out over a period of one month at the Paediatric Institute, Kuala Lumpur Hospital. A prospective audit was performed during that period whilst a retrospective collection of data was carried out for the previous month for comparison. Based on a set of criteria agreed upon by the audit committee, it was found that in 18.5% (22 of 119) of the cases, the indications for platelet transfusions were inappropriate. The audit committee concluded that there is a need for a more detailed clinical practice guideline for local use to reduce or lower the incidence of inappropriate transfusions of platelets.

  1. An audit of preoperative fasting compliance at a major tertiary referral hospital in Singapore

    PubMed Central

    Lim, Hsien Jer; Lee, Hanjing; Ti, Lian Kah

    2014-01-01

    INTRODUCTION To avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients’ knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting. METHODS Patients scheduled for ‘day surgery’ or ‘same day admission surgery’ under general or regional anaesthesia were surveyed over a four-week period. The patients were asked to answer an eighteen-point questionnaire on demographics, preoperative fasting and attitudes toward fasting. RESULTS A total of 130 patients were surveyed. 128 patients fasted before surgery, 111 patients knew that they needed to fast for at least six hours before surgery, and 121 patients believed that preoperative fasting was important, with 103 believing that preoperative fasting was necessary to avoid perioperative complications. However, patient understanding was poor, with only 44.6% of patients knowing the reason for fasting, and 10.8% of patients thinking that preoperative fasting did not include abstinence from beverages and sweets. When patients who did and did not know the reason for fasting were compared, we did not find any significant differences in age, gender or educational status. CONCLUSION Despite the patients’ poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance. PMID:24452973

  2. Cutaneous malignant melanoma: clinical and histopathological review of cases in a Malaysian tertiary referral centre.

    PubMed

    Pailoor, Jayalakshmi; Mun, Kein-Seong; Leow, Margaret

    2012-12-01

    Melanoma is a lethal skin cancer that occurs predominantly among Caucasians. In Malaysia, the incidence of melanoma is low. This is a retrospective study of clinical and histopathological features of patients with cutaneous melanoma who were seen at the University Malaya Medical Centre from 1998 to 2008. Thirty-two patients with cutaneous melanoma were recorded during that period. Of these, 24 had sought treatment at the onset of disease at our centre. Chinese patients constituted the largest group (19 cases). The median age of these 24 patients at the time of presentation was 62 years. 16 patients had melanoma involving the lower limb with 12 affecting the sole of the foot. None had melanoma arising from the face. Histopathology showed nodular melanoma in 22 cases (91.6%), with superficial spreading and acral lentiginous melanoma diagnosed in 1 case each. The majority of patients (62.5%) were found to be in Stage III of the disease at the time of diagnosis.

  3. Delirium after Cardiac Surgery: A Pilot Study from a Single Tertiary Referral Center

    PubMed Central

    Kumar, Ashok K; Jayant, Aveek; Arya, VK; Magoon, Rohan; Sharma, Ridhima

    2017-01-01

    Background: Advances in cardiac surgery has shifted paradigm of management to perioperative psychological illnesses. Delirium is a state of altered consciousness with easy distraction of thoughts. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The goal of the present study was to prospectively identify the incidence, motoric subtypes, and risk factors associated with development of delirium in cardiac surgical patients admitted to postoperative cardiac intensive care, using a validated delirium monitoring instrument. Materials and Methods: This is a prospective, observational study. This study included 120 patients of age 18–80 years, admitted to undergo cardiac surgery after applying inclusion and exclusion criteria. Specific preoperative, intraoperative, and postoperative data for possible risk factors were obtained. Once in a day, assessment of delirium was done. Continuous variables were measured as mean ± standard deviation, whereas categorical variables were described as proportions. Differences between groups were analyzed using Student's t-test, Mann–Whitney U-test, or Chi-square test. Variables with a P < 0.1 were then used to develop a predictive model using stepwise logistic regression with bootstrapping. Results: Delirium was seen in 17.5% patients. The majority of cases were of hypoactive delirium type (85.72%). Multiple risk factors were found to be associated with delirium, and when logistic regression with bootstrapping applied to these risk factors, five independent variables were detected. History of hypertension (relative risk [RR] =6.7857, P = 0.0003), carotid artery disease (RR = 4.5000, P < 0.0001) in the form of stroke or hemorrhage, noninvasive ventilation (NIV) use (RR = 5.0446, P < 0.0001), Intensive Care Unit (ICU) stay more than 10 days (RR = 3.1630, P = 0.0021), and poor postoperative pain control (RR = 2.4958, P = 0.0063) was associated with postcardiac surgical delirium. Conclusions: Patients who developed delirium had systemic disease in the form of hypertension and cerebrovascular disease. Delirium was seen in patients who had higher postoperative pain scores, longer ICU stay, and NIV use. This study can be used to develop a predictive tool for diagnosing postcardiac surgical delirium. PMID:28074801

  4. [Characteristics of patients with refractory epilepsy attended in a tertiary referral center in Costa Rica].

    PubMed

    Sanabria-Castro, A; Henriquez-Varela, F; Lara-Maier, S; Monge-Bonilla, C; Sittenfeld-Appel, M

    2016-07-16

    Introduccion. El 30% de los pacientes con epilepsia presenta convulsiones recurrentes, porcentaje que representa aproximadamente a 15 millones de personas en el mundo y constituye una poblacion escasamente descrita. Objetivo. Caracterizar sociodemografica y clinicamente la poblacion de pacientes diagnosticados con epilepsia refractaria en un hospital terciario de Costa Rica. Pacientes y metodos. Se analizan los registros medicos de los pacientes con epilepsia refractaria valorados en la unidad de epilepsia del Hospital San Juan de Dios de la Caja Costarricense del Seguro Social desde agosto de 2012 a octubre de 2014. Resultados. Se incluyen los expedientes clinicos de 91 pacientes. La edad media de inicio fue de 13,1 ± 11,1 años. Las crisis secundariamente generalizadas constituyen el tipo predominante (81,3%), la etiologia mas frecuente es la esclerosis mesial temporal (48,3%) y la mayoria de los pacientes presentaba examenes neurologicos normales y valoraciones neuro­psicologicas normales o bajas. Alrededor de la mitad (48,8%) de los pacientes habia sido medicada con un rango de 4-6 farmacos antiepilepticos, y los mas prescritos fueron lamotrigina, carbamacepina, acido valproico y fenitoina. Las principales recomendaciones en estos pacientes fueron: optimizacion de tratamiento, neurocirugia y reingreso. Se observan diferencias entre la edad de inicio y el sexo, la frecuencia de las crisis y el sexo, el tiempo de evolucion de la patologia y la cantidad de tratamientos fallidos, y el tiempo de evolucion de la enfermedad y la ocupacion. Conclusiones. Las caracteristicas sociodemograficas, el manejo de los pacientes, los farmacos antiepilepticos utilizados y las diferencias encontradas son similares a las descritas en otras latitudes.

  5. 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

  6. Epileptic spasms in paediatric post-traumatic epilepsy at a tertiary referral centre.

    PubMed

    Park, Jun T; Chugani, Harry T

    2017-03-17

    To recognize epileptic spasms (ES) as a seizure type after traumatic brain injury (TBI), accidental or non-accidental, in infants and children. In the process, we aim to gain some insight into the mechanisms of epileptogenesis in ES. A retrospective electronic chart review was performed at the Children's Hospital of Michigan from 2002 to 2012. Electronic charts of 321 patients were reviewed for evidence of post-traumatic epilepsy. Various clinical variables were collected including age at TBI, mechanism of trauma, severity of brain injury, electroencephalography/neuroimaging data, and seizure semiology. Six (12.8%) of the 47 patients diagnosed with post-traumatic epilepsy (PTE) had ES. Epileptic spasms occurred between two months to two years after TBI. All patients with ES had multiple irritative zones, manifesting as multifocal epileptiform discharges, unilateral or bilateral. Cognitive delay and epileptic encephalopathy were seen in all six patients, five of whom were free of spasms after treatment with vigabatrin or adrenocorticotropic hormone. The risk of PTE is 47/321(14.6%) and the specific risk of ES after TBI is 6/321 (1.8%). The risk of ES appears to be high if the age at which severe TBI occurred was during infancy. Non-accidental head trauma is a risk factor of epileptic spasms. While posttraumatic epilepsy (not ES) may start 10 years after the head injury, ES starts within two years, according to our small cohort. The pathophysiology of ES is unknown, however, our data support a combination of previously proposed models in which the primary dysfunction is a focal or diffuse cortical abnormality, coupled with its abnormal interaction with the subcortical structures and brainstem at a critical maturation stage.

  7. 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.

  8. The challenge of managing headache disorders in a tertiary referral neurology clinic in Rwanda

    PubMed Central

    Kaputu-Kalala-Malu, Célestin; Walker, Timothy D.; Ntumba-Tshitenge, Olga; Mafuta, Eric M.; Tugirimana, Pierrot L.; Misson, Jean P.

    2016-01-01

    Objective: To determine the pattern, management, and outcome of headaches among patients treated at Outpatient Neurology Clinic. Methods: A retrospective study was conducted at the Out-Patient Neurology Clinic of the Butare University Teaching Hospital, University of Rwanda, Butare, Rwanda between February and May 2015. We extracted the demographic data, headache characteristics, and associated conditions, prior pain-relieving medication use, waiting time before consultation, the results of paraclinical investigations, final diagnosis according to the International Classification of Headache Disorders, management, and 3-month clinical outcome from the medical records of all patients who consulted for headache over 36-month period. Epi Data and Statistical package for Social sciences software version 21.0 (SPSS Inc, Chicago, IL, USA) software were used for data processing. Results: Headache disorders represent a quarter of all neurological consultations. Patients were predominantly female (67%) and young (78% <45 years old). One-third (34%) presented with chronic tension-type headache. Neuroimaging demonstrated an abnormality in a significant minority (14%). Amitriptyline was the most commonly used drug (60%) in management. Forty percent of those patients followed for 3 months did not experience any clinical improvement. Conclusion: Headache is among the most common medical complaints in the Outpatient Neurology Clinic, with a wide array of underlying diagnoses, and a significant yield on neuroimaging. A significant proportion of those suffering from headache disorders have poor short-term outcomes. Novel approaches, such as headache support groups and alternative pharmacological agents, should be investigated for these patients. PMID:27094526

  9. 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.

  10. Depression in older adults: screening and referral.

    PubMed

    Vieira, Edgar Ramos; Brown, Ellen; Raue, Patrick

    2014-01-01

    Depression is related to disability and affects rehabilitation participation, outcomes, and compliance with treatment. Improving older adult depression detection and referral requires knowledge, skills, supportive organizational policies, and access to mental health experts. This review provides a selected overview of evidence-based approaches for screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals and discusses procedures to refer suspected cases to primary care providers and/or mental health specialists for evaluation, including resources and a tool to assist in communicating depression-related information to the primary care provider or mental health specialist. We hope that this review will promote the incorporation of evidence-based screening and referral of suspected cases of depression in older adults into routine practice.

  11. Academic Blogging: Academic Practice and Academic Identity

    ERIC Educational Resources Information Center

    Kirkup, Gill

    2010-01-01

    This paper describes a small-scale study which investigates the role of blogging in professional academic practice in higher education. It draws on interviews with a sample of academics (scholars, researchers and teachers) who have blogs and on the author's own reflections on blogging to investigate the function of blogging in academic practice…

  12. 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…

  13. Differences in MRSA prevalence and resistance patterns in a tertiary center before and after joining an international program for surveillance of antimicrobial resistance.

    PubMed

    Djuric, Olivera; Jovanovic, Snezana; Stosovic, Branka; Tosic, Tanja; Jovanovic, Milica; Nartey, Naomi; Todorovic, Jovana; Markovic-Denic, Ljiljana

    2016-12-08

    Methicillin-resistant Staphylococcus aureus (MRSA) emerged as one of the most important causes of hospital-acquired bloodstream infections (BSIs), especially the multidrug resistant clones. The aim of the present study was to compare prevalence and resistance patterns of MRSA bacteremia in the major tertiary-care academic and referral center in Serbia before and after implementing an active antimicrobial resistance (AMR) surveillance. Laboratory-based before-after study was conducted during a two-year period (January 2012 to December 2013) in Clinical Centre of Serbia. Isolation and identification of bacterial strains were done following standard microbiological procedures. During the AMR surveillance, nearly twice more bloodstream samples were collected compared to the year without surveillance (1,528 vs. 855). In total, 43 isolates of MRSA were identified. MRSA was significantly more prevalent during the AMR surveillance compared to the previous year [14 (66.7%) to 29 (76.3%); P = 0.046]. During the AMR surveillance, MRSA more frequently originated from medical departments compared to intensive care unit, surgical department, and internal medicine (P = 0.027) indicating increasing MRSA infections in patients with less severe clinical condition and no apparent risk factors. Higher prevalence of MRSA and its lower susceptibility to erythromycin were revealed by implementation of active AMR surveillance, which may reflect more thoughtful collection of bloodstream samples from patients with suspected BSI.

  14. 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…

  15. Collaborative Writing to Enhance Academic Writing Development through Project Work

    ERIC Educational Resources Information Center

    Robayo Lun, Alma Milena; Hernandez Ortiz, Luz Stella

    2013-01-01

    Advanced students at university level struggle with many aspects of academic writing in English as a foreign language. The purpose of this article is to report on an investigation aimed at analyzing what collaborative writing through project work tells us about students' academic writing development at the tertiary level. The compositions written…

  16. 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.

  17. Emergency peripartum hysterectomy: experience of a major referral hospital in Ankara, Turkey.

    PubMed

    Danisman, N; Baser, E; Togrul, C; Kaymak, O; Tandogan, M; Gungor, T

    2015-01-01

    The objective of this study was to report and discuss the incidence, clinical characteristics and outcomes of emergency peripartum hysterectomies (EPH) performed at a tertiary referral hospital in Ankara, Turkey. The labour and delivery unit database was retrospectively analysed for emergency peripartum hysterectomies (EPH) performed between January 2008 and January 2013, at the Zekai Tahir Burak Women's Health Training and Research Hospital. A total of 92,887 deliveries were accomplished within the study period. EPH was performed in 48 cases, and the incidence was 0.51 in 1,000. Abnormal placentation was the most common indication for EPH. Most common complications were blood product transfusion and postoperative fever. None of the cases resulted in maternal mortality. Serious maternal complication rates were relatively low in our study. In cases that are unresponsive to initial conservative measures, EPH should be performed without delay and a multidisciplinary team approach should be conducted whenever possible.

  18. 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

  19. Variation in periodontal referral by general dental practitioners.

    PubMed

    Linden, G J

    1998-08-01

    This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.

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

    ERIC Educational Resources Information Center

    Jennings, Danielle J.; Hanline, Mary Frances

    2013-01-01

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

  1. 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…

  2. 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…

  3. Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer.

    PubMed

    Kennedy, Ann-Maree; Aziz, Abdul; Khalid, Sameena; Hurman, David

    2012-05-01

    We adapted the 2002 Scottish Referral Guidelines for suspected squamous cell carcinoma of the head and neck (SCCHN) as a set of "alarm symptoms." These were then incorporated into a new Suspected Cancer Urgent Referral Electronically (SeCURE) system enabling immediate electronic referral from primary care to the appropriate hospital-based multi-disciplinary cancer team. All referrals made via the SeCURE system during the first year of its implementation were reviewed retrospectively. One hundred and ninety patients were urgently referred, of whom 15 (8%) were ultimately diagnosed with SCCHN. This audit demonstrated overall poor compliance with the referral guidelines. Although the electronic referral system helped for speedy clinic appointments, there was a low pick up rate of positive head and neck cancer cases. Continuing education for GPs is important and following discussion with colleagues in primary care, steps have been taken to reinforce awareness and more appropriate use of the SeCURE system.

  4. Primary, secondary, and tertiary hyperparathyroidism.

    PubMed

    Ahmad, Rehan; Hammond, James M

    2004-08-01

    Primary, secondary, and tertiary hyperparathyroidism have evolved since their original description. What was once a debilitating disease has now become one with few symptoms on initial presentation. Complications from these disorders have decreased significantly because of earlier detection. Improved management of patients with chronic renal disease has also limited complications among those with secondary and tertiary hyperparathyroidism. Appropriate management is essential even in the early phase of the disorder to minimize the morbidities that may result if left untreated.

  5. 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

  6. 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.

  7. 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

  8. Academic writing

    NASA Astrophysics Data System (ADS)

    Eremina, Svetlana V.

    2003-10-01

    The series of workshops on academic writing have been developed by academic writing instructors from Language Teaching Centre, Central European University and presented at the Samara Academic Writing Workshops in November 2001. This paper presents only the part dealing with strucutre of an argumentative essay.

  9. Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions

    PubMed Central

    2011-01-01

    Background Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD) may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR) rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. Methods We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine) on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR < 30 to ≥ 30 mL/min/1.73m2) of their recommended referrals based on their use of creatinine versus eGFR. Results Primary care physicians recommended subspecialty referrals later (CKD more advanced) when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m2, p < 0.001]. Forty percent of primary care physicians significantly improved the timing of their referrals when basing their recommendations on eGFR. Improved timing occurred more frequently among primary care physicians practicing in academic (versus non-academic) practices or presented with White (versus African American) hypothetical patients [adjusted percentage(95% CI): 70% (45-87) versus 37% (reference) and 57% (39-73) versus 25% (reference), respectively, both p ≤ 0.01). Conclusions Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine) to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead

  10. 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…

  11. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Referrals to civilian lawyers. 727.9 Section 727... ASSISTANCE § 727.9 Referrals to civilian lawyers. (a) General. If it is determined that the legal assistance... the assistance requested, the client should be referred to a civilian lawyer. When the client does...

  12. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Referrals to civilian lawyers. 727.9 Section 727... ASSISTANCE § 727.9 Referrals to civilian lawyers. (a) General. If it is determined that the legal assistance... the assistance requested, the client should be referred to a civilian lawyer. When the client does...

  13. 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. 1620.8 Section 1620.8 Protection of Environment CHEMICAL SAFETY AND HAZARD INVESTIGATION BOARD ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice....

  14. User Satisfaction with Referrals at a Collaborative Virtual Reference Service

    ERIC Educational Resources Information Center

    Kwon, Nahyun

    2006-01-01

    Introduction: This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference…

  15. 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...

  16. 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...

  17. 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. 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...

  18. 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. 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...

  19. 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...

  20. 5 CFR 831.1309 - Referral for litigation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Referral for litigation. 831.1309 Section 831.1309 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Collection of Debts § 831.1309 Referral for litigation. From time to time and in...

  1. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section 3.21... and Compromise of Claims § 3.21 Referrals of Debts to Justice. An agency shall promptly refer to Justice for litigation debts on which aggressive collection activity has been taken in accordance...

  2. 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...

  3. 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...

  4. 29 CFR 502.37 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 502.37 Section 502.37... § 502.37 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing filed... Judge, for a determination in an administrative proceeding as provided herein. The notice...

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 801.63 Section 801.63... § 801.63 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing filed... Judge, for a determination in an administrative proceeding as provided herein. The notice...

  6. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 500.224 Section 500... Hearing § 500.224 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing... Administrative Law Judge, for a determination in an administrative proceeding as provided herein. The notice...

  7. 29 CFR 580.10 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 580.10 Section 580.10... Referral to Administrative Law Judge. (a) Upon receipt of a timely exception to a determination of... Administrative Law Judge, for a determination in an administrative proceeding as provided herein. A copy of...

  8. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to the contracting officer. 733.7 Section 733.7 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting... misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 45 CFR 1619.3 - Referral to the Corporation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Referral to the Corporation. 1619.3 Section 1619.3 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION DISCLOSURE OF INFORMATION § 1619.3 Referral to the Corporation. If a person requests information, not...

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

    ERIC Educational Resources Information Center

    Smith, Vernon

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

  16. Identifying Tertiary Bridging Students at Risk of Failure in the First Semester of Undergraduate Study

    ERIC Educational Resources Information Center

    Whannell, Robert; Whannell, Patricia

    2014-01-01

    This study presents the findings of the second phase of a project examining the attrition and progression of two cohorts of students in a tertiary bridging program at a regional university in Australia. The first phase of the study (Whannell, 2013) based on data collected up to week 5 of the bridging program identified age, academic achievement on…

  17. 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…

  18. 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…

  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. 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…

  1. Tertiary EE Student Projects: What the Academics Learnt

    ERIC Educational Resources Information Center

    Meehan, Barry; Thomas, Ian

    2006-01-01

    Problem solving and teamwork abilities are important skills for graduates entering the environment profession. Through a problem based learning approach small groups of students from the environmental courses at RMIT University have been gaining these professional skills by undertaking projects in Vietnam. With three years experience in running…

  2. 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.

  3. 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…

  4. Barriers to referral in patients with angina: qualitative study

    PubMed Central

    Gardner, Katy; Chapple, Alison

    1999-01-01

    Objectives To explore barriers to patients being referred for possible revascularisation. Design Qualitative study using semi-structured interviews. Participants 16 patients aged under 75 years with stable angina and their doctors. Setting General practice in Toxteth, Liverpool. Results Fear of both hospitals and medical tests was common and largely hidden from the doctors. Patients felt they were old, had low expectations of treatment, viewed angina as a chronic illness, and knew little about new developments in angina treatment. Patients and doctors had difficulty in recognising angina symptoms that were not textbook definitions amid multiple comorbidity. Patients saw doctors as busy and did not want to bother them with their condition. Cultural gaps and communication difficulties existed despite all but one patient having English as their first language. Conclusions Listening to patients is vital to address inequitable access to health services: how patients are treated by doctors today affects acceptability of referral tomorrow. Primary care groups in deprived areas should work with communities to address local fears. This will involve collaboration between primary, secondary, and tertiary care. Cultural gaps exist between patients and doctors in deprived areas, and diagnostic confusion can occur particularly in the presence of other psychological and physical morbidity. Adequate time and resources—for example, education for doctors and patients and provision of interpreters—need to be provided if inequitable access to revascularisation procedures is to be addressed. Key messages In different communities and patient groups different myths and fears operate and need to be addressed, as experiences of hospital can profoundly affect patients’ confidence Patients in deprived areas with high mortality rates perceive themselves as “old” at a young age, and expectations of treatment are limited Angina symptoms in inner city primary care may not be the same

  5. 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.

  6. 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

  7. Examining the variation in GPs’ referral practice: a cross-sectional study of GPs’ reasons for referral

    PubMed Central

    Ringberg, Unni; Fleten, Nils; Førde, Olav Helge

    2014-01-01

    Background There is a large variation in referral rates to secondary care among GPs, which is partly unexplained. Aim To explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics. Design and setting A cross-sectional study in Northern Norway. Method Data were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses. Results Medical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge. Conclusion There are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients. PMID:24982495

  8. Nurture personal referrals--your best source of new patients.

    PubMed

    Jameson, C

    1996-01-01

    In your morning meetings, identify those patients who would be a great person to ask for a referral--patients who have expressed pleasure in receiving treatment from you. Then, determine who is going to ask for that referral. You wouldn't want to have EVERY-ONE ask them for a referral, so give someone that responsibility. Be sure that you have done some role playing and have practiced the verbal skills of "asking" for a referral. Get comfortable asking. Know that you will never know what you will get unless you ASK!!! All good businesses ask for referrals from their best customers. Learn from the masters. Pattern your own behavior after those who have acquired admirable results. When you identify patients who have accepted and have been pleased with your treatment, have come to their appointments on time, have gladly paid their bills, and have been a joy to treat, ASK these folks for a referral. More than likely they will refer others to you who are of like character. You can build a practice "on good patients just like you" and expect that to happen!!! Together, as a team, develop ways of acknowledging and nurturing your referral sources. If these wonderful people provide 70+ percent of your new patients, it benefits you to invest time and money in maximizing this source of practice growth.

  9. Brazilian Specialists’ Perspectives on the Patient Referral Process

    PubMed Central

    Juliani, Carmen; MacPhee, Maura; Spiri, Wilza

    2017-01-01

    Since 1988, healthcare has been considered a citizen’s right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world’s fifth largest population. The coordination of effective communications between primary care physicians, specialists and patients is a significant challenge, particularly the referral process. Our study objective was to understand the facilitators and barriers associated with referral process communications between primary care physicians and regional university hospital specialists in the State of Sao Paulo. This paper reports specialists’ perspectives of the referral process. This was a phenomenological study that employed a qualitative research method with three components (description, reduction and comprehension). We conducted focus groups with 54 hospital residents from different specialties (surgery, medicine, obstetrics/gynecology, pediatrics) from July to October 2014. The main results showed lack of an adequate referral-return referral process resulting in treatment delays and inappropriate use of emergency services. Communications were impeded by lack of integrated, computerized booking and standardized referral-return referral processes; underlying lack of trust in primary care physicians; and patients’ inappropriate use of healthcare services. Although computerized systems will facilitate communications between primary and specialty care, other strategies are needed to promote collaboration between services, and ensure appropriate utilization of them. PMID:28146046

  10. Determining factors for implant referral rates.

    PubMed

    Levin, Roger P

    2002-01-01

    The research findings indicate that the field of implant dentistry will only grow at a moderately low level unless certain changes are made. Findings indicated that the effort by the implant companies has been nothing short of dramatic, and yet almost 60% of restorative doctors do not participate annually in any implant case. There was no clear indication that younger restorative doctors will significantly increase the number of implant referrals, as their overall implant education has not dramatically differed from those dentists who graduated in earlier years. Once the research was completed, it became obvious to Levin Group that the driving force behind implant referral growth will be implant surgeons, because of their one-to-one relationship with restorative doctors. The Levin Group Implant Management and Marketing Consulting Program is based on approaching restorative doctors in several different levels, starting with awareness all the way through to case facilitation and long-term tracking and communication. Finally, a continuing marketing/education effort needs to be consistently in place with effective materials, not only to create a high level of awareness, but also to motivate restorative doctors to refer cases and then work through the case with the implant surgeon to a satisfactory completion for the restorative doctor, implant surgeon, and patient. While the surgical insertion of implants may seem to carry a high-profit margin relative to the restoration of implants, the truth is that the restoration of implants usually provides a 40% higher profit margin for the restorative doctor than traditional dental services. One of the key issues is that referring doctors have not necessarily learned how to set fees and present cases with regard to implant dentistry. The key factor here is to ensure that the patient understands that implant services involve higher fees than traditional services, because of the necessarily higher levels of experience, education

  11. 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…

  12. 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…

  13. Tertiary Literacy on the Cusp.

    ERIC Educational Resources Information Center

    Absalom, Doug; Golebiowski, Zosia

    2002-01-01

    Outlines recent concerns regarding a perceived decline in literacy standards in Australia, with reference to changing literacy abilities and standards in tertiary education. Summarizes and critiques current discussions on changes in literacy expectations and contemporary notions of literacy. Concludes with discussion of three important agents of…

  14. [Urine incontinence referral criteria for primary care].

    PubMed

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-01-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

  15. [Urine incontinence referral criteria for primary care].

    PubMed

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-05-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

  16. 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

  17. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEDURES FOR CORPORATE DEBT COLLECTION Tax Refund Offset § 313.123 Certification and referral of debt. When... judgment debt or as otherwise allowed by law, the debt is referred for offset within ten years after...

  18. 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)

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Referrals to the Department of Justice... COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral. The... Justice, Washington, DC 20530. (2) Unless otherwise provided by DOJ regulations or procedures, EPA...

  20. Online referrals one way capitated groups gain efficiencies, reduce errors.

    PubMed

    2002-08-01

    An online referral system is just the latest money and time-saving tool in the e-commerce arsenal at Hill Physicians Medical Group. Using a modified version of Healinx Corp.'s secure e-mail messaging platform, Hill is testing a custom-made online referral system at two primary care practices that appear to be helping the practice boost its bottom line under capitation.

  1. 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

  2. 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.

  3. 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)

  4. 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)

  5. 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.

  6. Academic dentistry.

    PubMed

    Rushton, Vivian E; Horner, Keith

    2008-07-01

    Since 1988, thirteen dental schools have provided dental undergraduate programmes within the United Kingdom (UK). In 2006, two new dental schools were created supporting dental education in the community. A further new dental school in Scotland will be accepting students in autumn 2008. In the past 25 years, extensive reorganisation of the NHS has resulted in long-term implications for the training of medical and dental academic staff. The number of academic clinicians is below the minimum viable level and external constraints, combined with a lack of suitable applicants, have led to a moratorium on academic recruitment within some Dental Schools. A detailed review of the historical and associated factors which have led to the problems presently besetting academic dentistry are discussed along with the initiatives introduced in the last 10 years to revitalise the speciality. Also, the present and future outlook for academic dentistry in other countries are discussed. Opinion is divided as to the appropriate setting for the training of undergraduate students between those who support community-based dental education and those who believe dental education should remain within research led dental establishments. External factors are moulding an unsatisfactory situation that is proving increasingly unattractive to the potential dental academic and the case for reform is obvious.

  7. A Social Constructionist Approach to Teaching and Learning Vocabulary for Italian for Academic Purposes

    ERIC Educational Resources Information Center

    Xerou, Eftychia; Papadima-Sophocleous, Salomi; Parmaxi, Antigoni

    2016-01-01

    This study presents the way Parmaxi and Zaphiris's (2015) social constructionist framework was used in order to teach and learn vocabulary in an Italian for Specific Academic Purposes (ISAP) tertiary course. The participants (beginner students) were guided to build in groups an artifact, i.e a specific academic vocabulary collection. To do so,…

  8. 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…

  9. Providing Electronic Writing Resources for Academic Purposes: Issues of Control and Flexibility.

    ERIC Educational Resources Information Center

    Bruce, Nigel

    2001-01-01

    Reviews "Academic Writing: An Interactive Language Based CD-ROM for Teaching Academic Writing Skills to University Students." Suggests language teachers in the tertiary sector are required to accommodate the specific disciplinary needs of their students, and that it is rare for most commercial textbooks to find their way into an English for…

  10. 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.

  11. 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…

  12. 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.

  13. Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

    PubMed Central

    Cox, Jonathan MS; Steel, Nicholas; Clark, Allan B; Kumaravel, Bharathy; Bachmann, Max O

    2013-01-01

    Background Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. Aim To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and setting A retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. Method The age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. Results Referral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). Conclusion Referral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review. PMID:23735409

  14. Old boys' network in general practitioners' referral behavior?

    PubMed

    Hackl, Franz; Hummer, Michael; Pruckner, Gerald J

    2015-09-01

    We analyzed the impact of social networks on general practitioners' (GPs) referral behavior based on administrative panel data from 2,684,273 referrals to specialists made between 1998 and 2007. For the definition of social networks, we used information on the doctors' place and time of study and their hospital work history. We found that GPs referred more patients to specialists within their personal networks and that patients referred within a social network had fewer follow-up consultations and less inpatient days thereafter. The effects on patient outcomes (e.g. waiting periods, days in hospital) of referrals within personal networks and affinity-based networks differed. Specifically, whereas empirical evidence showed a concentration on high-quality specialists for referrals within the personal network, suggesting that referrals within personal networks overcome information asymmetry with respect to specialists' abilities, the empirical evidence for affinity-based networks was different and less clear. Same-gender networks tended to refer patients to low-quality specialists.

  15. Women's experiences with cervical cancer screening in a colposcopy referral clinic in Cape Town, South Africa: a qualitative analysis

    PubMed Central

    Momberg, Mariette; Botha, Matthys H; Van der Merwe, Frederick H; Moodley, Jennifer

    2017-01-01

    Objective The aim of this study was to explore and understand women's experience with cervical cancer screening and with the referral pathways for abnormal Papanicolau (Pap) smears. Design and setting Focus group discussions were conducted with first time colposcopy clinic attendees at a tertiary hospital colposcopy clinic in Cape Town, South Africa during November 2014. A thematic analysis was conducted to identify key themes. Initial coding categories were drawn from the interview guide. Participants 27 women participated in 4 focus group discussions. Results Participants mean age was 34 years, most did not complete secondary level education and were unemployed. Negative community opinions relating to Pap smears and colposcopy referral might deter women from seeking treatment. Having a gynaecological symptom was the most commonly cited reason for having a Pap smear. Fear of having a HIV test performed at the same time as Pap smear and low encouragement from peers, were factors identified as potential access barriers. Participants commented on insufficient or lack of information from primary providers on referral to the colposcopy clinic and concerns and apprehension during waiting periods between receiving results and the colposcopy appointment were discussed. Conclusions There is a strong and urgent need to improve current knowledge about cervical cancer and Pap smears and the necessity and benefits of timely access to screening programmes, results and treatment. Strategies such as community health education programmes and mass media interventions could be employed to disseminate cervical cancer information and address negative community perceptions. Better training and support mechanisms to equip healthcare providers with the skills to convey cervical cancer information to women are needed. The use of short message service (SMS) to deliver Pap smear results and provide patients with more information should be considered to improve waiting times for results

  16. Development of an algorithm to identify urgent referrals for suspected cancer from the Danish Primary Care Referral Database

    PubMed Central

    Toftegaard, Berit Skjødeberg; Guldbrandt, Louise Mahncke; Flarup, Kaare Rud; Beyer, Hanne; Bro, Flemming; Vedsted, Peter

    2016-01-01

    Background Accurate identification of specific patient populations is a crucial tool in health care. A prerequisite for exploring the actions taken by general practitioners (GPs) on symptoms of cancer is being able to identify patients urgently referred for suspected cancer. Such system is not available in Denmark; however, all referrals are electronically stored. This study aimed to develop and test an algorithm based on referral text to identify urgent cancer referrals from general practice. Methods Two urgently referred reference populations were extracted from a research database and linked with the Primary Care Referral (PCR) database through the unique Danish civil registration number to identify the corresponding electronic referrals. The PCR database included GP referrals directed to private specialists and hospital departments, and these referrals were scrutinized. The most frequently used words were integrated in the first version of the algorithm, which was further refined by an iterative process involving two population samples from the PCR database. The performance was finally evaluated for two other PCR population samples against manual assessment as the gold standard for urgent cancer referral. Results The final algorithm had a sensitivity of 0.939 (95% confidence intervals [CI]: 0.905–0.963) and a specificity of 0.937 (95% CI: 0.925–0.963) compared to the gold standard. The positive and negative predictive values were 69.8% (95% CI: 65.0–74.3) and 99.0% (95% CI: 98.4–99.4), respectively. When applying the algorithm on referrals for a population without earlier cancer diagnoses, the positive predictive value increased to 83.6% (95% CI: 78.7–87.7) and the specificity to 97.3% (95% CI: 96.4–98.0). Conclusion The final algorithm identified 94% of the patients urgently referred for suspected cancer; less than 3% of the patients were incorrectly identified. It is now possible to identify patients urgently referred on cancer suspicion from

  17. Prediction of Mental Health Services Use One Year After Regular Referral to Specialized Care Versus Referral to Stepped Collaborative Care.

    PubMed

    van Orden, Mirjam; Leone, Stephanie; Haffmans, Judith; Spinhoven, Philip; Hoencamp, Erik

    2017-04-01

    Referral to collaborative mental health care within the primary care setting is a service concept that has shown to be as effective as direct referral to specialized mental health care for patients with common mental disorders. Additionally it is more efficient in terms of lower mental health services use. This post-hoc analysis examines if treatment intensity during 1-year of follow-up can be predicted prospectively by baseline characteristics. With multilevel multivariate regression analyses baseline characteristics were examined as potential predictors of visit counts. Results showed that only the enabling factors service concept and referral delay for treatment had a significant association with mental health visit counts, when outcome was dichotomized in five or more visits. Inclusion of the outcome variable as a count variable confirmed the predictive value of service concept and referral delay, but added marital status as a significant predictor. Overall, enabling factors (service concept and referral delay) seem to be important and dominant predictors of mental health services use.

  18. 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.…

  19. Risk Factors and Consequent Outcomes of Placenta Previa: Report From a Referral Center.

    PubMed

    Saleh Gargari, Soraya; Seify, Zahra; Haghighi, Ladan; Khoshnood Shariati, Maryam; Mirzamoradi, Masoumeh

    2016-11-01

     Because of an unknown factor, the frequency of complicated pregnancy with placenta previa has been raised during past decade. This study was designed to deepen our understanding of risk factors and outcomes of placenta previa in our country. This study investigated 694 cases of placenta previa comparing with 600 healthy pregnant women with not overlie placenta in two referral and tertiary Obstetrics and Gynecological Hospital in Iran on the basis of the clinical and para-clinical analysis, in order to find the probable risk factors for occurrence of placenta previa and its effect on maternal and neonatal complications. The most important risk factor for the occurrence of placenta previa was advanced maternal age (P<0.001) and history of stillbirth (OR=117.2, CI=58.3-236.0). In the other hand, the most substantial outcome of this disorder was a reduction of gestational age (P<0.001) and low birth weight neonatally (P<0.001). The conservative follow-up should be programmed for women with placenta previa based on the type of risk factors which can provide the best possible management to decrease the morbidity and mortality of their related complications.

  20. 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

  1. Leading Academics.

    ERIC Educational Resources Information Center

    Middlehurst, Robin

    This book aims to increase the level of interest and understanding of leadership within the academic context and to demonstrate the relevance of leadership for contemporary United Kingdom universities. The book considers the concept of leadership and its appropriateness and usefulness for nonprofit professional organizations such as universities,…

  2. 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…

  3. 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…

  4. Asymmetric synthesis of tertiary thiols and thioethers

    PubMed Central

    MacLellan, Paul

    2011-01-01

    Summary Enantiomerically pure tertiary thiols provide a major synthetic challenge, and despite the importance of chiral sulfur-containing compounds in biological and medicinal chemistry, surprisingly few effective methods are suitable for the asymmetric synthesis of tertiary thiols. This review details the most practical of the methods available. PMID:21647256

  5. 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

  6. 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…

  7. 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…

  8. 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,…

  9. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Referral of claims. 304.21 Section 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  10. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Referral of claims. 304.21 Section 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  11. 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 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  12. The Teacher Assistance Team: A Pre-Referral Support System.

    ERIC Educational Resources Information Center

    Hayek, Robert A.

    1987-01-01

    Use of building-level teacher assistance teams (TATs) to provide suggested alternative instructional strategies and support services to regular teachers with problem learners prior to referral to special education is discussed in terms of relationship to special education, purposes, organization and operation, staff training, attitudinal issues,…

  13. Safety Tips: The ACS Chemical Health and Safety Referral Service.

    ERIC Educational Resources Information Center

    Gallagher, Barbara

    1984-01-01

    Describes an American Chemical Society (ACS) service which helps individuals not familiar with the resources of safety information. The service, which provides referrals to literature, films, educational courses, or organizations that can provide answers, exists to help in complying with legislation and dealing with all aspects of chemical health…

  14. Underdiagnosis and Referral Bias of Autism in Ethnic Minorities

    ERIC Educational Resources Information Center

    Begeer, Sander; El Bouk, Saloua; Boussaid, Wafaa; Terwogt, Mark Meerum; Koot, Hans M.

    2009-01-01

    This study examined (1) the distribution of ethnic minorities among children referred to autism institutions and (2) referral bias in pediatric assessment of autism in ethnic minorities. It showed that compared to the known community prevalence, ethnic minorities were under-represented among 712 children referred to autism institutions. In…

  15. Sound-Field Amplification: Preliminary Information Regarding Special Education Referrals

    ERIC Educational Resources Information Center

    Flexer, C.; Long, S.

    2004-01-01

    In this clinical exchange, the authors discuss acoustic accessibility and sound-field amplification in general education classrooms. They bridge theory to practice by presenting preliminary information from two different school systems demonstrating how an improved signal-to-noise ratio can have a positive impact on special education referrals.

  16. 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... associated with the misuse of alcohol, including the names, addresses, and telephone numbers of substance... alcohol misuse. (c)(1) Before a covered employee returns to duty requiring the performance of a...

  17. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... associated with the misuse of alcohol, including the names, addresses, and telephone numbers of substance... alcohol misuse. (c)(1) Before a covered employee returns to duty requiring the performance of a...

  18. Outpatient nephrology referral rates after acute kidney injury.

    PubMed

    Siew, Edward D; Peterson, Josh F; Eden, Svetlana K; Hung, Adriana M; Speroff, Theodore; Ikizler, T Alp; Matheny, Michael E

    2012-02-01

    AKI associates with an increased risk for the development and progression of CKD and mortality. Processes of care after an episode of AKI are not well described. Here, we examined the likelihood of nephrology referral among survivors of AKI at risk for subsequent decline in kidney function in a US Department of Veterans Affairs database. We identified 3929 survivors of AKI hospitalized between January 2003 and December 2008 who had an estimated GFR (eGFR) <60 ml/min per 1.73 m(2) 30 days after peak injury. We analyzed time to referral considering improvement in kidney function (eGFR ≥60 ml/min per 1.73 m(2)), dialysis initiation, and death as competing risks over a 12-month surveillance period. Median age was 73 years (interquartile range, 62-79 years) and the prevalence of preadmission kidney dysfunction (baseline eGFR <60 ml/min per 1.73 m(2)) was 60%. Overall mortality during the surveillance period was 22%. The cumulative incidence of nephrology referral before dying, initiating dialysis, or experiencing an improvement in kidney function was 8.5% (95% confidence interval, 7.6-9.4). Severity of AKI did not affect referral rates. These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI. Determining how to best identify survivors of AKI who are at highest risk for complications and progression of CKD could facilitate early nephrology-based interventions.

  19. 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…

  20. Tennis Anyone? A Case Study of Inaccurate Patron Referrals

    ERIC Educational Resources Information Center

    Turner, Deborah

    2004-01-01

    This case study examines how analyzing inaccurate referrals can provide key insights into managing change. The author analyzes what went wrong in an attempt to identify opportunities for an Access Services department to consider how it might adapt to constant change. She wishes to show how the nature of change today demands that one pay…

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

  2. GP Exercise Referral Schemes: Improving the Patient's Experience

    ERIC Educational Resources Information Center

    Wormald, Helen; Ingle, Lee

    2004-01-01

    Objective: The main objective of this study was to explore patients' perceptions of general practitioner (GP) exercise referral (ER) schemes with a view to providing a better service for future patients. Design: A qualitative focus group methodology. Setting: Meeting rooms or communal areas in leisure centres across North Yorkshire. Method: Thirty…

  3. 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...

  4. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System for Inpatient Operating Costs § 412.96 Special...

  5. 17 CFR 143.6 - Referral for litigation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Referral for litigation. 143.6 Section 143.6 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION COLLECTION OF CLAIMS OWED THE UNITED STATES ARISING FROM ACTIVITIES UNDER THE COMMISSION'S JURISDICTION General...

  6. 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...

  7. 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…

  8. 29 CFR 501.37 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 501.37 Section 501.37... to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing filed pursuant to and... shall be filed of record in the Office of the Chief Administrative Law Judge and shall, respectively,...

  9. 29 CFR 530.404 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 530.404 Section 530... Administrative Law Judge. Upon receipt of a timely request for a hearing, the request and a copy of the notice of... Law Judge, for a determination in an administrative proceeding as provided herein. The notice...

  10. Referrals to the Marie Curie nursing service in North Yorkshire.

    PubMed

    Hanratty, B; Feather, J; Ward, C

    2000-01-01

    District and Marie Curie nurses participated in a small-scale study to describe referrals to a Marie Curie service in one English health district over a 3-month period. The number of new patients referred was small; they were geographically clustered and had widely differing life expectancies. Anecdotal reports of difficulties with the 'Nurselink' referral system were not confirmed, and in situations where the system was in operation, Marie Curie nurses were more likely to speak directly to the referring nurse. The most frequently cited reason for referral was general nursing needs; however, Marie Curie nurses felt that they were most often involved to provide family support. These findings suggest that there may not be a shared understanding of the Marie Curie nurse's role, and that equity in community palliative nursing care merits examination. Defining and publicizing the role of the Marie Curie nurse, providing guidance for referrals and prioritizing communication between professionals are proposed not only to enhance the service locally but to ensure that the service is available to all. This article illustrates the value of research to identify ways to improve service delivery.

  11. 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…

  12. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Referral of questions by superintendent. 217.3 Section 217.3 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF... his analysis of alternative solutions to each question or problem, to the business committee and...

  13. 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…

  14. 49 CFR 825.10 - Referral of record.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Referral of record. 825.10 Section 825.10 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL TRANSPORTATION SAFETY BOARD RULES OF PROCEDURE FOR MERCHANT MARINE APPEALS FROM DECISIONS OF THE COMMANDANT, U.S. COAST GUARD §...

  15. 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…

  16. 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...

  17. Musculoskeletal clinic in general practice: study of one year's referrals.

    PubMed Central

    Peters, D; Davies, P; Pietroni, P

    1994-01-01

    BACKGROUND. A musculoskeletal clinic, staffed by a general practitioner trained in osteopathy, medical acupuncture and intralesional injections, was set up in an inner London general practice in 1987. AIM. A retrospective study was undertaken of one year's referrals to the clinic in 1989-90 to determine how general practitioners were using the clinic in terms of problems referred; consultation patterns of patients attending the clinic and 12 months after initially being seen; and how access to the clinic influenced referrals to relevant hospital departments. METHOD. Day sheets were studied which recorded information on demographic characteristics of patients referred to the clinic and their problems, diagnoses made, duration of symptoms, number and range of treatments given, and recurrence of problems. Use of secondary referral sources was also examined. RESULTS. During the study year 154 of 3264 practice patients were referred to the musculoskeletal clinic, and attended a mean of 3.5 times each. Of all the attenders 64% were women and 52% were 30-54 years old. Eighty one patients (53%) presented with neck, back or sciatic pain. A specific traumatic, inflammatory or other pathological process could be ascribed to only 19% of patients. Regarding treatment, 88% of patients received osteopathic manual treatment or acupuncture, or a combination of these treatments and 4% received intralesional injections. Nine patients from the clinic (6%) were referred to an orthopaedic specialist during the year, two with acute back pain. Referrals to orthopaedic specialists by the practice as a whole were not significantly lower than the national average, although the practice made fewer referrals to physiotherapy and rheumatology departments than national figures would have predicted. Seventeen patients (11%) returned to the clinic with a recurrence of their main complaint within a year of their initial appointment; second courses of treatment were usually brief. CONCLUSION. The

  18. An Examination of Referral Physician Attitudes Toward Brooke Army Medical Center as a Tertiary Care Medical Center

    DTIC Science & Technology

    1986-09-01

    in only the rarest of instances will this relationship continue--i.e., if the consultant has a unique area of expertise or if the consultant is so...Marketing Planning in Non Profit Organizations: A Case Study of the Red Cross Blood Proyrdm." Hospital & Health Services Administration 26 (Fall 1981

  19. Clinical and Laboratory Features of Acute Porphyria: A Study of 36 Subjects in a Chinese Tertiary Referral Center

    PubMed Central

    Yang, Jing; Chen, Qianlong; Yang, Hang; Hua, Baolai; Zhu, Tienan; Zhao, Yongqiang; Yu, Xuezhong; Zhang, Li

    2016-01-01

    Porphyria is a group of eight metabolic disorders characterized by defects in heme biosynthesis. The presentation of porphyria is highly variable, and the symptoms are nonspecific, which accounts in part for delays in establishing a diagnosis. In this study, we report the characteristics of 36 Chinese acute porphyria patients. Most of them were female (33/36), and the median age was 25.3 years (range 18–45 years). The most frequent presenting symptom was abdominal pain (32/36). Hyponatremia was the most common electrolyte abnormality (29/36), and the serum sodium concentration was significantly negatively correlated with convulsion (p = 0.00). Genetic testing provided a precise diagnosis of the patients. Genetic analysis of the porphobilinogen deaminase (PBGD) gene was performed for 10 subjects. Of them, 9 were found to harbor a mutation in the PBGD gene, proving a diagnosis of acute intermittent porphyria, and, in 1 case, a novel Cys209Term mutation was found. PMID:28025645

  20. 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.

  1. Time trends in the treatment and prognosis of resectable pancreatic cancer in a large tertiary referral centre

    PubMed Central

    Barugola, Giuliano; Partelli, Stefano; Crippa, Stefano; Butturini, Giovanni; Salvia, Roberto; Sartori, Nora; Bassi, Claudio; Falconi, Massimo; Pederzoli, Paolo

    2013-01-01

    Objectives Mortality in pancreatic cancer has remained unchanged over the last 20–30 years. The aim of the present study was to analyse survival trends in a selected population of patients submitted to resection for pancreatic cancer at a single institution. Methods Included were 544 patients who underwent pancreatectomy for pancreatic cancer between 1990 and 2009. Patients were categorized into two subgroups according to the decade in which resection was performed (1990–1999 and 2000–2009). Predictors of survival were analysed using univariate and multivariate analyses. Results Totals of 114 (21%) and 430 (79%) resections were carried out during the periods 1990–1999 and 2000–2009, respectively (P < 0.0001). Hospital length of stay (16 days versus 10 days; P < 0.001) and postoperative mortality (3% versus 1%; P = 0.160) decreased over time. Median disease-specific survival significantly increased from 16 months in the first period to 29 months in the second period (P < 0.001). Following multivariate analysis, poorly differentiated tumour [hazard ratio (HR) 3.1, P < 0.001], lymph node metastases (HR = 1.9, P < 0.001), macroscopically positive margin (R2) resection (HR = 3.2, P < 0.0001), no adjuvant therapy (HR = 1.6, P < 0.001) and resection performed in the period 1990–1999 (HR = 2.18, P < 0.001) were significant independent predictors of a poor outcome. Conclusions Longterm survival after surgery for pancreatic cancer significantly improved over the period under study. Better patient selection and the routine use of adjuvant therapy may account for this improvement. PMID:23490217

  2. HIV-Associated Facial Lipodystrophy: Experience of a Tertiary Referral Center With Fat and Dermis-Fat Compound Graft Transfer

    PubMed Central

    Casal, Diogo; Bexiga, Joaquim; Sousa, Juliana; Martins, João; Teófilo, Eugénio; Maltez, Fernando; Germano, Isabel; Videira e Castro, José

    2016-01-01

    Objectives: HIV-associated lipodystrophy is a common comorbidity in HIV-infected patients, having a profound impact on every aspect of patients’ lives, particularly when involving the face. Hence, it is of the utmost importance to evaluate the result of any potential therapies that may help solve HIV-associated facial lipodystrophy. The aim of this article was to evaluate the outcome of patients undergoing facial lipodystrophy correction surgery within our institution. Methods: A retrospective analysis of the clinical charts and iconographic information of patients regarding demographics, morphologic changes, surgical option, postoperative complications, results, and patient satisfaction assessed by a 1- to 10-point scale and by the Assessment of Body Change and Distress questionnaire. Results: Twenty-three patients were operated on from March 2011 to April 2015. Seventy-five percent of cases were treated with fat graft injection, whereas dermis-fat grafts were applied in 25% of patients. The former had their fat harvested more commonly from the abdomen, whereas in the latter case, the graft was harvested mostly from the inner aspect of arms. The mean volume of fat injected on each side of the face was 28.5 ± 22.7 mL. On a scale from 1 to 10, mean patient satisfaction was 7.7 ± 2.8. The Assessment of Body Change and Distress questionnaire revealed statistically significant improvements. Complications occurred in 25% of cases, the most frequent being significant reabsorption. No major complications occurred. Conclusions: Treatment of HIV-associated facial lipodystrophy with autologous fat or dermis-fat compound graft is a safe procedure with long-lasting results and unquestionable aesthetic and social benefits. PMID:28123628

  3. 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

  4. Perceptions and Practices regarding Breastfeeding among Postnatal Women at a District Tertiary Referral Government Hospital in Southern India

    PubMed Central

    Kamath, Sowmini P.; Garg, Dikshy; Khan, Mohd. Khursheed; Baliga, B. Shantharam

    2016-01-01

    Background. Breastfeeding is the optimal method for achieving a normal growth and development of the baby. This study aimed to study mothers' perceptions and practices regarding breastfeeding in Mangalore, India. Methodology. A cross-sectional study of 188 mothers was conducted using a structured proforma. Results. Importance of breast feeding was known to most mothers. While initiation of breast feeding within one hour of birth was done by majority of mothers, few had discarded colostrum and adopted prelacteal feeding. Mothers opined that breast feeding is healthy for their babies (96.3%) and easier than infant feeding (79.8%), does not affect marital relationship (51%), and decreases family expenditure (61.1%). However, there were poor perceptions regarding the advantages of breast milk with respect to nutritive value, immune effect, and disease protection. Few respondents reported discontinuation of breastfeeding in previous child if the baby had fever/cold (6%) or diarrhea (18%) and vomiting (26%). There was a statistically significant association between mother's educational level and perceived importance of breastfeeding and also between the mode of delivery and initiation of breast feeding (p < 0.05). Conclusion. Importance of breast feeding was known to most mothers. Few perceptions related to breast milk and feeding along with myths and disbeliefs should be rectified by health education. PMID:27840770

  5. Clinical and Laboratory Features of Acute Porphyria: A Study of 36 Subjects in a Chinese Tertiary Referral Center.

    PubMed

    Yang, Jing; Chen, Qianlong; Yang, Hang; Hua, Baolai; Zhu, Tienan; Zhao, Yongqiang; Zhu, Huadong; Yu, Xuezhong; Zhang, Li; Zhou, Zhou

    2016-01-01

    Porphyria is a group of eight metabolic disorders characterized by defects in heme biosynthesis. The presentation of porphyria is highly variable, and the symptoms are nonspecific, which accounts in part for delays in establishing a diagnosis. In this study, we report the characteristics of 36 Chinese acute porphyria patients. Most of them were female (33/36), and the median age was 25.3 years (range 18-45 years). The most frequent presenting symptom was abdominal pain (32/36). Hyponatremia was the most common electrolyte abnormality (29/36), and the serum sodium concentration was significantly negatively correlated with convulsion (p = 0.00). Genetic testing provided a precise diagnosis of the patients. Genetic analysis of the porphobilinogen deaminase (PBGD) gene was performed for 10 subjects. Of them, 9 were found to harbor a mutation in the PBGD gene, proving a diagnosis of acute intermittent porphyria, and, in 1 case, a novel Cys209Term mutation was found.

  6. Crohn’s disease in the elderly: Clinical presentation and manifestations from a tertiary referral center in Turkey

    PubMed Central

    Saygili, Fatih; Saygili, Saba Mukaddes; Tenlik, Ilyas; Yuksel, Mahmut; Kilic, Zeki Mesut Yalin; Ozin, Yasemin Ozderin; Kayacetin, Ertugrul

    2016-01-01

    OBJECTIVE: There is no precise consensus at present on age to define elderly patients with inflammatory bowel disease (IBD), but recently, age of more than 60 years has been widely accepted. Characteristics of IBD in the elderly are somewhat different from what is seen in younger patients. The elderly have milder disease activity, and therapeutic options are fewer because of their age and features such as comorbidities, drug interactions, and loss of organ function. There are few reports on Crohn’s disease in the elderly. Herein, first report on this topic with respect to population of this country is presented. METHODS: Characteristics of 95 patients with Crohn’s disease, who were over age 60 from 3125 patients with IBD treated in our clinic between 1996 and 2015 were analyzed. Research was performed using patient files, and outpatient clinic visits, when possible. RESULTS: Median age of the group was 66 years, and male:female ratio was 1.6. Of the total, 48.4% of the patients had colonic disease, 37.9% had ileocolonic disease, and 13.7% had small bowel disease. Data indicated that 23.1% of patients had undergone surgical procedures, which were primarily right hemicolectomy and ileotransversostomy. Disease was most often managed with mesalazine or azathioprine. It was also determined that 12.6% patients had 2 or more comorbidities, and findings indicated coronary heart disease and hypertension were most prevalent. CONCLUSION: Analysis revealed similar features in characteristics of disease compared with recent knowledge reported in the literature. This is the first report from our country to describe Crohn’s disease in the elderly population, and the number of patients is sufficient to provide general information about this group. PMID:28275749

  7. Outcome of rhegmatogenous retinal detachment repair by scleral buckling: The experience of a tertiary referral center in Scotland

    PubMed Central

    Shankar, Vikas; Lim, Lik Thai; Ah-Kee, Elliott Yann; Hammer, Harold

    2014-01-01

    Purpose: The primary aim of this study is to report the outcome of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling (SB) surgery. Methods: This is a retrospective noncomparative case series study of all patients who underwent RRD repair by primary SB between March 2008 and February 2009. Patient demographics, visual outcome, complications, and failure rates were identified and recorded. Results: A total of 65 patients underwent RRD repair by SB, with a mean age of 44.44 years. Results showed that the primary outcome (primary anatomical success following index surgery) was 90.77%, while the secondary outcome (anatomical success following repeat surgery) was 98.46%. Conclusion: The study showed a high-success rate of SB in phakic eyes both in terms of postoperative best-corrected visual acuity and complication rates. We recommend the continued use of this technique in selected cases of RRD. PMID:25378877

  8. Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

    PubMed Central

    Bian, Sai-Nan; Zhang, Li-Fan; Zhang, Yue-Qiu; Yang, Qi-Wen; Wang, Peng; Xu, Ying-Chun; Shi, Xiao-Chun; Liu, Xiao-Qing

    2016-01-01

    Background: Nontuberculous Mycobacterium (NTM) bloodstream infection (BSI) is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI. Methods: We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series of NTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ± standard deviation (SD). Data of nonnormal distribution were expressed by median and interquartile range (IQR). Results: Among the ten patients with NTM BSI, the median age was 51 years (IQR 29–57 years) and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus (HIV) infection (one patient), rheumatic diseases (two patients), breast cancer (one patient), myelodysplastic syndrome (two patients), and aplastic anemia (two patients). Other organ(s) involved were lung (two patients), endocardium (two patients), brain, spinal cord, and soft tissue (one each patient). The median lymphocyte was 0.66 × 109/L (IQR 0.24–1.93 × 109/L). The median cluster of differentiation 4 (CD4) cell count was 179/mm3 (IQR 82–619/mm3). Five patients died (three with hematological diseases, one with breast cancer, and one with rheumatic disease), three recovered, and two were lost to follow-up. Conclusions: We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases. PMID:27625095

  9. Outcomes of Chopart Amputation in a Tertiary Referral Diabetic Foot Clinic: Data From a Consecutive Series of 83 Hospitalized Patients.

    PubMed

    Faglia, Ezio; Clerici, Giacomo; Frykberg, Robert; Caminiti, Maurizio; Curci, Vincenzo; Cetta, Francesco; Prisco, Vincenzo; Greco, Rosaria; Prisco, Marco; Morabito, Alberto

    2016-01-01

    The purpose of the present retrospective study was to evaluate the outcomes (ie, ulcer recurrence, major amputation, death) in diabetic patients undergoing Chopart amputation because of deep infection or gangrene extending to the midfoot. From 2009 to 2011, 83 patients, aged 71.4 ± 9.3 years, underwent a midtarsal amputation and were followed up until December 31, 2012 (mean follow-up 2.8 ± 0.8 years). Of the 83 patients, 26 were female, 61 required insulin, 47 had renal insufficiency, 19 underwent hemodialysis, 65 had hypertension, 34 had a history of cardiac disease, and 4 had a history of stroke. Chopart amputation was performed in 38 patients (45.8%) with gangrene, 31 (37.4%) with abscess, and 14 (16.9%) with osteomyelitis. Urgent surgery was performed in 56 patients (67.5%). Effective revascularization was performed in 64 patients (77.1%) patients. Of the 83 patients, 47 had healed at a mean period of 164.7 (range 11 to 698) days. Ulcer recurrence developed in 15 patients (31.9%). A major amputation was necessary in 23 patients (27.7%), with an annual incidence of 13.0%. None of the included variables on logistic regression analysis was significantly associated with proximal amputation. Of the 83 patients, 38 (45.8%) died, with an annual incidence of 25.8%. On logistic regression analysis, age (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01 to 1.16), history of stroke (OR 9.94, 95% CI 3.16 to 31.24), and urgent surgery (OR 2.60, 95% CI 1.14 to 5.93) were associated with mortality. Chopart amputation represents the last chance to avoid major amputation for diabetic patients with serious foot complications. Our success rate was great enough to consider Chopart amputation a viable option for limb salvage in this high-risk population.

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

    PubMed Central

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

    2015-01-01

    Abstract 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

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

    PubMed

    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.

  12. 20 CFR 702.504 - Vocational rehabilitation; referrals to State Employment Agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Vocational rehabilitation; referrals to State... AND PROCEDURE Vocational Rehabilitation § 702.504 Vocational rehabilitation; referrals to State Employment Agencies. Vocational rehabilitation advisers will arrange referral procedures with...

  13. 10 CFR 15.67 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Referral to the Department of Justice. 15.67 Section 15.67 Energy NUCLEAR REGULATORY COMMISSION DEBT COLLECTION PROCEDURES Referral of a Claim § 15.67 Referral to... be given as part of a demand letter or as a separate document. (d) The NRC shall preserve all...

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 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 § 1.953 Minimum amount of referrals to the Department of Justice. (a) Except as otherwise provided in...

  15. 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...

  16. 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...

  17. Attitudes Associated With Alcohol and Marijuana Referral Actions by Resident Assistants

    PubMed Central

    Osborn, Cynthia J.; Rossheim, Matthew E.; Suzuki, Sumihiro

    2014-01-01

    This exploratory study examined associations between resident assistant (RA) attitudes and referral actions to identify training strategies for strengthening the ability of these paraprofessionals to recognize and refer college students in their living units who misuse alcohol and marijuana. The study’s hypotheses were that (1) referral self-efficacy and perceived referral norms would be positively associated with RA referral actions and (2) perceived referral barriers and referral anticipatory anxiety would be negatively associated with RAs’ referral actions. A total of 317 RAs at eight residential campuses in different regions of the U.S. took part in the study. All participating RAs had at least one semester of work experience. Just prior to the Fall semester of 2012, RA’s responded to an online survey that assessed their alcohol and marijuana referral attitudes and referral actions. Overall, RAs reported considerable anxiety about approaching and referring students who may have an alcohol and/or marijuana problem. Perceived referral norms among RAs indicated substantial variability in perceptions about others’ expectations of them for referring students who may have alcohol and marijuana problems. Results from two multivariable logistic regression analyses showed that referral self-efficacy distinguished RAs who took alcohol referral actions and marijuana referral actions from those who did not do so. Neither length of RA service nor time spent on campus was associated with referral actions. RA training programs could give attention to strengthening referral self-efficacy through a series of increasingly difficult skill-building activities during pre- and in-service training. In addition, senior residence life and housing professional staff may consider assessing the extent to which RAs under their supervision follow established protocols for assisting students with possible alcohol and marijuana problems. The development of evidence-based RA training

  18. Neonatal Transport - Experience of a Tertiary Care Hospital of Bangladesh.

    PubMed

    Dey, S K; Sharker, S; Jahan, I; Moni, S C; Shabuj, K H; Chisti, M J; Mannan, M A; Shahidullah, M

    2017-01-01

    Safe transportation is mostly an unnoticed neonatal health issue in Bangladesh and no documentation is available regarding the existing practices. So this study was intended to document transport status of the referred newborn to a tertiary care hospital. This observational study included 150 out born neonates over 12 months period transported from various places to NICU, Bangabandhu Sheikh Mujib Medical University (BSMMU) from May 2015 to April 2016. A structured data collection form was used to record information categorized into pre-transport, during transport and at admission. At admission detailed clinical assessment of the baby was done and recorded. Outcome was determined as discharge or death. Of 150 transported neonates, two-third were preterm 115(77%) & LBW 113(75%). Common indications for referral were prematurity and sepsis. Most of the patients were referred from private hospital 107(71%). Majority of newborns (86%) were referred from hospitals of Dhaka city while only 14% were referred from outside Dhaka. Referral notes were supplied in most of the cases 134(89%) but comprehensive information was obtainable only in 3 cases. Although main transport vehicle was ambulance 130(87%), medical personnel accompanied the sick baby only in 6(4%) of cases. The distance traveled was less than 10 kilometers (kms) in 95(63%) and more than 100 km in 10(7%) of enrolled neonates. Transport time was less than 1 hour in 72(48%), 1-6 hours in 66(44%) and more than 6 hours in 12(8%) of cases. Nearly two third of newborn were transported after office period, 107(72%). At admission 21(14%) babies had hypothermia, 8(7.62%) hypoglycemia, 16(11%), poor perfusion 28(19%), low saturation 27(18%). Hyperthermia & hyperglycemia were observed in 8(5%) & 7(5%) cases respectively. Of the total 150 babies referred, 17(11%) died. While comparing with discharged newborn, died newborn were more frequent sufferer of hypothermia (p value 0.007) and low saturation (p value 0.049) at

  19. Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals

    PubMed Central

    2014-01-01

    Background In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy. Methods This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. Results Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities. Conclusion This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of

  20. 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.

  1. The current state of electronic consultation and electronic referral systems in Canada: an environmental scan.

    PubMed

    Liddy, Clare; Hogel, Matthew; Blazkho, Valerie; Keely, Erin

    2015-01-01

    Access to specialist care is a point of concern for patients, primary care providers, and specialists in Canada. Innovative e-health platforms such as electronic consultation (eConsultation) and referral (eReferral) can improve access to specialist care. These systems allow physicians to communicate asynchronously and could reduce the number of unnecessary referrals that clog wait lists, provide a record of the patient's journey through the referral system, and lead to more efficient visits. Little is known about the current state of eConsultation and eReferral in Canada. The purpose of this work was to identify current systems and gain insight into the design and implementation process of existing systems. An environmental scan approach was used, consisting of a systematic and grey literature review, and targeted semi-structured key informant interviews. Only three eConsultation/eReferral systems are currently in operation in Canada. Four themes emerged from the interviews: eReferral is an end goal for those provinces without an active eReferral system, re-organization of the referral process is a necessity prior to automation, engaging the end-user is essential, and technological incompatibilities are major impediments to progress. Despite the acknowledged need to improve the referral system and increase government spending on health information technology, eConsultation and eReferral systems remain scarce as Canada lags behind the rest of the developed world.

  2. Asymmetric Synthesis of Tertiary Benzylic Alcohols

    PubMed Central

    Antczak, Monika I.; Cai, Feng; Ready, Joseph M.

    2010-01-01

    Vinyl, aryl and alkynyl organometallics add to ketones containing a stereogenic sulfoxide. Tertiary alcohols are generated in diastereomerically and enantiomerically pure form. Reductive lithiation converts the sulfoxide into a variety of useful functional groups. PMID:21142190

  3. Tertiary interactions within the ribosomal exit tunnel.

    PubMed

    Kosolapov, Andrey; Deutsch, Carol

    2009-04-01

    Although tertiary folding of whole protein domains is prohibited by the cramped dimensions of the ribosomal tunnel, dynamic tertiary interactions may permit folding of small elementary units within the tunnel. To probe this possibility, we used a beta-hairpin and an alpha-helical hairpin from the cytosolic N terminus of a voltage-gated potassium channel and determined a probability of folding for each at defined locations inside and outside the tunnel. Minimalist tertiary structures can form near the exit port of the tunnel, a region that provides an entropic window for initial exploration of local peptide conformations. Tertiary subdomains of the nascent peptide fold sequentially, but not independently, during translation. These studies offer an approach for diagnosing the molecular basis for folding defects that lead to protein malfunction and provide insight into the role of the ribosome during early potassium channel biogenesis.

  4. Oncology social workers' attitudes toward hospice care and referral behavior.

    PubMed

    Becker, Janet E

    2004-02-01

    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care, yet the average proportion of terminally ill patients whom they referred to hospice was only 49.5 percent. The worker's HPS score was related significantly, although weakly, to the likelihood of referral. A follow-up study was undertaken to determine the reasons for the discrepancy between the workers' self-reported favorable attitudes toward hospice and their relatively low rate of patient referral. The factor identified most frequently was resistance from families because of the requirement that hospice patients discontinue active treatment.

  5. 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.

  6. [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.

  7. Follow-up Actions on Electronic Referral Communicationin a Multispecialty Outpatient Setting

    PubMed Central

    Esquivel, Adol; Sittig, Dean F.; Murphy, Daniel; Kadiyala, Himabindu; Schiesser, Rachel; Espadas, Donna; Petersen, Laura A.

    2010-01-01

    ABSTRACT OBJECTIVES Electronic health records (EHR) enable transmission and tracking of referrals between primary-care practitioners (PCPs) and subspecialists. We used an EHR to examine follow-up actions on electronic referral communication in a large multispecialty VA facility. METHODS We retrieved outpatient referrals to five subspecialties between October 2006 and December 2007, and queried the EHR to determine their status: completed, discontinued (returned to PCP), or unresolved (no action taken by subspecialist). All unresolved referrals, and random samples of discontinued and completed referrals were reviewed to determine whether subspecialists took follow-up actions (i.e., schedule appointments anytime in the future) within 30 days of referral-receipt. For referrals without timely follow-up, we determined whether inaction was supported by any predetermined justifiable reasons or associated with certain referral characteristics. We also reviewed if PCPs took the required action on returned information. RESULTS Of 61,931 referrals, 22,535 were discontinued (36.4%), and 474 were unresolved (0.8%). We selected 412 discontinued referrals randomly for review. Of these, 52% lacked follow-up actions within 30 days. Appropriate justifications for inaction were documented in 69.8% (150/215) of those without action and included lack of prerequisite testing by the PCP and subspecialist opinion that no intervention was required despite referral. We estimated that at 30 days, 6.3% of all referrals were associated with an unexplained lack of follow-up actions by subspecialists. Conversely, 7.4% of discontinued referrals returned to PCPs were associated with an unexplained lack of follow-up. CONCLUSIONS Although the EHR facilitates transmission of valuable information at the PCP-subspecialist interface, unexplained communication breakdowns in the referral process persist in a subset of cases. PMID:20848235

  8. Outpatient Nephrology Referral Rates after Acute Kidney Injury

    PubMed Central

    Siew, Edward D.; Peterson, Josh F.; Eden, Svetlana K.; Hung, Adriana M.; Speroff, Theodore; Ikizler, T. Alp

    2012-01-01

    AKI associates with an increased risk for the development and progression of CKD and mortality. Processes of care after an episode of AKI are not well described. Here, we examined the likelihood of nephrology referral among survivors of AKI at risk for subsequent decline in kidney function in a US Department of Veterans Affairs database. We identified 3929 survivors of AKI hospitalized between January 2003 and December 2008 who had an estimated GFR (eGFR) <60 ml/min per 1.73 m2 30 days after peak injury. We analyzed time to referral considering improvement in kidney function (eGFR ≥60 ml/min per 1.73 m2), dialysis initiation, and death as competing risks over a 12-month surveillance period. Median age was 73 years (interquartile range, 62–79 years) and the prevalence of preadmission kidney dysfunction (baseline eGFR <60 ml/min per 1.73 m2) was 60%. Overall mortality during the surveillance period was 22%. The cumulative incidence of nephrology referral before dying, initiating dialysis, or experiencing an improvement in kidney function was 8.5% (95% confidence interval, 7.6–9.4). Severity of AKI did not affect referral rates. These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI. Determining how to best identify survivors of AKI who are at highest risk for complications and progression of CKD could facilitate early nephrology-based interventions. PMID:22158435

  9. 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

  10. Bell's palsy: a summary of current evidence and referral algorithm.

    PubMed

    Glass, Graeme E; Tzafetta, Kallirroi

    2014-12-01

    Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases.

  11. Investigating referral pathways from primary care to consumer health organisations.

    PubMed

    Young, Charlotte E; Mutch, Allyson J; Boyle, Frances M; Dean, Julie H

    2010-01-01

    While chronic disease places an increasing burden on Australia's primary care system it is unrealistic to expect GPs to meet the range of support needs experienced by patients managing chronic conditions. Consumer health organisations (CHO) have the potential to augment clinical care by providing a variety of supportive services; however, they are underutilised by patients and GPs. This qualitative study investigates GPs' knowledge and perceptions of CHO and their contributions to chronic disease care. The study involved semi-structured interviews with 10 GPs. Overall, participants demonstrated clear understanding of the role of CHO in chronic disease management, but a critical finding was the way GPs' view of their own chronic care role appears to influence referral practices. GPs operating in a traditional role were less likely to refer to CHO than those who had adopted a chronic care approach. A second key finding related to GPs' views of Diabetes Australia. All GPs identified this organisation as an important referral point, providing some reassurance that CHO can be integrated into the primary care sector. Further research is needed to determine how the 'definite advantages' associated with Diabetes Australia can be used to extend GP referral and enhance the health system's integration of other CHO.

  12. Computational Prediction of RNA Tertiary Structure

    NASA Astrophysics Data System (ADS)

    Zhao, Yunjie; Gong, Zhou; Chen, Changjun; Xiao, Yi

    2012-02-01

    RNAs have been found to be involved in the biological processes. The large RNA usually consists of two basic elements: RNA hairpins and duplex. Due to the experimental determination difficulties, the few RNA tertiary structures limit our understanding of the specific regulation mechanisms and functions. Therefore, RNA tertiary structure prediction is very important for understanding RNA biological functions. Since RNA often folds hierarchically, one of the possible RNA structure prediction approaches is through the hierarchical steps. Here, we focus on the prediction method of RNA tertiary hairpin and duplex structures in which assembles the small tertiary structure fragments from well-defined RNA structural motifs. In a benchmark test with known experiment structures, more than half of the cases agree with the experimental structure better than 3 å RMSD over all the heavy atoms. The prediction results also reproduce the native like complementary base pairs of the secondary structures. Most importantly, the method performs the atomic accuracy of tertiary structures by about several minutes. We expect that the method will be a useful resource for RNA tertiary structure prediction and helpful to the biological research community.

  13. Corneal Transplantation at an Ophthalmological Referral Center in Colombia: Indications and Techniques (2004-2011)

    PubMed Central

    Galvis, Virgilio; Tello, Alejandro; Gomez, Augusto José; Rangel, Carlos Mario; Prada, Angélica María; Camacho, Paul Anthony

    2013-01-01

    Purpose: To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period. Methods: A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011. Results: During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK). Conclusions: Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantation in this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers. PMID:23898357

  14. 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…

  15. 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

  16. Biomaterials use in Mulago National Referral Hospital in Kampala, Uganda: Access and affordability.

    PubMed

    Bakwatanisa, Bosco; Enywaku, Alfred; Kiwanuka, Martin; Lamunu, Claire; Mbowa, Nicholas; Mukiibi, Denis; Namayega, Catherine; Ngabirano, Beryl; Ntambi, Henry; Reichert, William

    2016-01-01

    Students in Biomaterials BBE3102 at Makerere University in Kampala, Uganda were assigned semester long group projects in the first semester of the 2014-15 academic year to determine the biomaterials type and usage in Mulago National Referral Hospital, which is emblematic of large public hospitals across East Africa. Information gathering was conducted through student interviews with Mulago physicians because there were no archival records. The students divided themselves into seven project groups covering biomaterials use in the areas of wound closure, dental and oral surgery, cardiology, burn care, bone repair, ophthalmology and total joint replacement. As in the developed world, the majority of biomaterials used in Mulago are basic wound closure materials, dental materials, and bone fixation materials, all of which are comparatively inexpensive, easy to store, and readily available from either the government or local suppliers; however, there were significant issues with the implant supply chain, affordability, and patient compliance and follow-up in cases where specialty expertise and expensive implants were employed.

  17. Challenges of becoming a regional referral system: the University of Kentucky as a case study.

    PubMed

    Edwards, Robert L; Lofgren, Richard P; Birdwhistell, Mark D; Zembrodt, James W; Karpf, Michael

    2014-02-01

    The U.S. health care system must change because of unsustainable costs and limited access to care. Health care legislation and the recognition that health care costs must be curbed have accelerated the change process. How should academic medical centers (AMCs) respond? Teaching hospitals are a heterogeneous group, and the leaders of each must understand their institution's goals and the necessary resources to achieve them. Clinical leaders and staff at one AMC, the University of Kentucky (UK), committed to transforming the AMC into a regional referral center. To achieve this goal, UK leaders integrated the clinical enterprise, focused recruitment on advanced subspecialists, and initiated productive relationships with other providers. Attracting adequate numbers of destination patients with complex illnesses required UK to have a "market space" of five to seven million people. The resources required to effect such progress have been daunting. Relationships with providers and payers have been necessary to forge a network. These relationships have been challenging to establish and manage and have evolved over time. Most AMCs are not-for-profit public good entities that nevertheless exist in an industry driven by competition in quality and cost, and therefore scale and access to capital are paramount. AMC leaders must understand their institutions as both part of an industry and as a public good in order to adapt to the changing health care system. Although the experience of any particular AMC is inherently unique, UK's journey provides a useful case study in establishing institutional goals, outlining a strategy, and identifying required resources.

  18. Can teachers' global ratings identify children with academic problems?

    PubMed

    Glascoe, F P

    2001-06-01

    Physicians often elicit ratings from teachers when making diagnostic, treatment, or referral decisions. The purpose of this study was to view the relationship between teachers' ratings and children's academic skills, assess the utility of teacher ratings in detecting academic problems, and thus determine whether physicians can depend on teacher ratings when making decisions about patients' needs. Subjects were a national sample of 80 teachers and 934 children between 6 and 13 years of age participating in a test standardization study. Families were representative of United States demographics in terms of parental level of education, income, and ethnicity, and sites were geographically diverse elementary schools. Children were administered the Comprehensive Inventory of Basic Skills--Revised (CIBS-R), a diagnostic academic achievement test. Teachers rated children's academic performance on a five-point scale ranging from far above average to far below average and were blinded to the results of the CIBS-R. Teacher ratings varied significantly with children's performance for all academic domains. Logistic regression revealed that teacher ratings were best predicted by children's performance in basic reading skills, followed by math skills, and were not influenced by race, parents' level of education, history of retention, or gender. Participation in Title I services, testing in winter or spring, and parents who spoke a language other than English produced significantly lower ratings. Nevertheless, teachers rated as average many students with mild to moderate academic difficulties. School system personnel and health care providers should avoid sole dependence on global teacher ratings when deciding which students need special education referrals or other services. Supplementing teacher ratings with standardized screening test results is needed to ensure accurate decision-making.

  19. 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

  20. 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.

  1. Characteristics of Referrals for Gender Dysphoria Over a 13-Year Period

    PubMed Central

    Chen, Melinda; Fuqua, John; Eugster, Erica A.

    2017-01-01

    Purpose Our Pediatric Endocrinology Clinic has seen a sharp increase in referrals for gender dysphoria (GD) during recent years. However, the frequency and characteristics of referrals have not been objectively examined. Methods A retrospective chart review of referrals for GD during the past 13 years was performed. Variables analyzed included numbers of referrals per year, patient characteristics, comorbid conditions, and hormonal therapy. Timing of referral and eligibility for treatment were measured against established recommendations. Results Of 38 patients, 74% were referred during the last 3 years. Most patients presented late in puberty before a GD-specific psychological evaluation and few were eligible for hormonal treatment at baseline. Over half had psychiatric and/or developmental comorbidities. Conclusions A dramatic increase in referrals for GD since 2002 was confirmed. Enhanced provider education and outreach regarding care of patients with GD are needed. PMID:26903434

  2. Clinical Characteristics of Diabetic Patients Transferred to Korean Referral Hospitals

    PubMed Central

    Oh, Min Young; Kim, Sang Soo; Lee, In Kyu; Baek, Hong Sun; Lee, Hyoung Woo; Chung, Min Young

    2014-01-01

    Background We evaluated the disease profile and clinical management, including the status of both glycemic control and complications, in patients with diabetes who were transferred to referral hospitals in Korea. Methods Patients referred to 20 referral hospitals in Gyeongsangnam/Gyeongsangbuk-do and Jeollanam/Jeollabuk-do with at least a 1-year history of diabetes between January and June 2011 were retrospectively reviewed using medical records, laboratory tests, and questionnaires. Results A total of 654 patients were enrolled in the study. In total, 437 patients (67%) were transferred from clinics and 197 (30%) patients were transferred from hospitals. A total of 279 patients (43%) visited higher medical institutions without a written medical request. The main reason for the referral was glycemic control in 433 patients (66%). Seventy-three patients (11%) had received more than one session of diabetic education. Only 177 patients (27%) had been routinely self-monitoring blood glucose, and 146 patients (22%) were monitoring hemoglobin A1c. In addition, proper evaluations for diabetic complications were performed for 74 patients (11%). The most common complication was neuropathy (32%) followed by nephropathy (31%). In total, 538 patients (82%) had been taking oral hypoglycemic agents. A relatively large number of patients (44%) had been taking antihypertensive medications. Conclusion We investigated the clinical characteristics of diabetic patients and identified specific problems in diabetic management prior to the transfer. We also found several problems in the medical system, which were divided into three medical institutions having different roles in Korea. Our findings suggested that the relationships among medical institutions have to be improved, particularly for diabetes. PMID:25349826

  3. 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.

  4. Pre-referral rectal artesunate for severe malaria

    PubMed Central

    Okebe, Joseph; Eisenhut, Michael

    2014-01-01

    Background Severe or complicated malaria is a medical emergency and people die as a result of delays in starting treatment. Most patients need parenteral treatment, and in primary healthcare facilities, where intravenous therapy is not available but intramuscular injections can be given, intramuscular quinine, artesunate, and artemether have been used before transporting patients to hospital. However, in rural settings with limited access to health care, intramuscular injections may also be unavailable. In these situations, rectal artesunate given prior to transfer to hospital by volunteers with little medical training, may be a feasible option. Objectives To evaluate the effects of pre-referral treatment with rectal artesunate on mortality and morbidity in people with severe malaria. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) published in The Cochrane Library; MEDLINE; EMBASE and LILACS up to 21 May 2014. We also searched the WHO clinical trial registry platform and the metaRegister of Controlled Trials (mRCT) for ongoing trials. Selection criteria Individual or cluster-randomized controlled trials comparing pre-referral rectal artesunate with placebo or injectable antimalarials in children and children with severe malaria. Data collection and analysis Two authors independently screened titles and abstracts for potentially eligible trials, and extracted data from the included trials. Dichotomous outcomes were summarized using risk ratios (RR) and presented with 95% confidence intervals (95% CI). Where data allowed, we conducted subgroup analyses by age, trial region and whether participants were included in the trial analysis. We assessed the quality of evidence for the most important outcomes using the GRADE approach. Main results One trial met the inclusion criteria; a placebo-controlled trial of 17,826 children and adults living in rural villages in Ghana and Tanzania (Africa) and Bangladesh (Asia). Villagers with no

  5. Increasing Referrals to a YMCA-Based Diabetes Prevention Program: Effects of Electronic Referral System Modification and Provider Education in Federally Qualified Health Centers

    PubMed Central

    Wylie-Rosett, Judith; Blank, Arthur E.; Ouziel, Judy; Hollingsworth, Nicole; Riley, Rachael W.; Selwyn, Peter A.

    2015-01-01

    Introduction The Diabetes Prevention Program has been translated to community settings with varying success. Although primary care referrals are used for identifying and enrolling eligible patients in the Diabetes Prevention Program, little is known about the effects of strategies to facilitate and sustain eligible patient referrals using electronic health record systems. Methods To facilitate and sustain patient referrals, a modification to the electronic health record system was made and combined with provider education in 6 federally qualified health centers in the Bronx, New York. Referral data from April 2012 through November 2014 were analyzed using segmented regression analysis. Results Patient referrals increased significantly after the modification of the electronic health record system and implementation of the provider education intervention. Before the electronic system modification, 0 to 2 patients were referred per month. During the following year (September 2013 through August 2014), which included the provider education intervention, referrals increased to 1 to 9 per month and continued to increase to 5 to 11 per month from September through November 2014. Conclusions Modification of an electronic health record system coupled with a provider education intervention shows promise as a strategy to identify and refer eligible patients to community-based Diabetes Prevention Programs. Further refinement of the electronic system for facilitating referrals and follow-up of eligible patients should be explored. PMID:26542141

  6. 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.

  7. 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.

  8. Interdepartmental Dermatology: Characteristics and Impact of Dermatology Inpatient Referrals at a Teaching Hospital in Eastern India

    PubMed Central

    Chowdhury, Satyendra Nath; Podder, Indrasish; Saha, Abanti; Bandyopadhyay, Debabrata

    2017-01-01

    Background: Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. Aims: To analyze the causes of inpatient dermatology referrals, departments sending referrals, and impact of dermatology consultation on patient management. Materials and Methods: We conducted a cross-sectional study by analyzing the records of 486 patient referrals over a 4-year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed. Results: Dermatology consultation changed the dermatologic diagnosis and treatment of almost two-thirds of patients. General medicine requested the maximum number of referrals, “skin rash” being the most common cause for referral. Accurate diagnosis on referrals was provided by only 30.2% of nondermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients. Conclusion: While dermatologic referral leads to improved patient care, there is a need for better training of nondermatologists enabling them to recognize and treat common dermatoses. PMID:28216722

  9. Diagnostic accuracy and appropriateness of general practitioner referrals to a dermatology out-patient clinic.

    PubMed

    Basarab, T; Munn, S E; Jones, R R

    1996-07-01

    A study was undertaken of new referrals by GPs to a dermatology clinic in a district general hospital over a 6-month period. Six hundred and eighty-six consecutive referrals to one consultant were analysed for diagnostic accuracy and requirement for referral. Only 47% of referral letters contained the correct diagnosis. Viral warts and psoriasis were best diagnosed (82 and 78%, respectively), but seborrhoeic warts and dermatofibromas caused difficulty (22 and 19%, respectively). Cutaneous malignancy was correctly diagnosed in 45% of referrals, and eczema, the commonest condition referred, in 54% of cases. Sixty-eight percent of referrals required hospital-based facilities for diagnosis (31%) or treatment/management (37%). Twenty-one per cent of patients referred attended for once-only visits, requiring no specialized diagnostic or therapeutic procedures. Such referrals should decrease with improved GP education. Eleven percent of referrals were for minor surgical procedures such as curettage, shave biopsy, or cryotherapy and would become unnecessary if such facilities were available in the community. Our data demonstrate the potential for management of up to one-third of current dermatological referrals within the community by improving education of GPs and providing appropriate facilities within the community. However, over two-thirds of patients required hospital facilities, a finding of considerable relevance to the future location of dermatological services.

  10. Pediatric Hematology Providers on Referral for Transplant Evaluation for Sickle Cell Disease: A Regional Perspective

    PubMed Central

    Mikles, Bethany; Bhatia, Monica; Oyeku, Suzette O.; Jin, Zhezhen; Green, Nancy S.

    2014-01-01

    Summary Hematology referral for evaluation is a key step for hematopoietic stem cell transplantation for sickle cell disease (SCD). Pediatric SCD providers in the US Northeast (New York-Mid-Atlantic and New England regions) were surveyed anony-mously for perspectives and practices regarding transplant referral and compared by whether they practiced at SCD transplant centers. Data were analyzed using the Fisher exact test, χ2 test, and logistic regression. Half of the respondents practiced primarily at transplant sites. Most (79%) were enthusiastic about transplant for SCD and 78% had recently referred ≥1 child for evaluation. Overall, 77% limited referral to certain sickle hemoglobinopathies and 44% preferred referral for β-thalassemia to SCD. Indications selected for referral resembled current transplant criteria, plus family request or poor response to therapy. Referral for children on chronic transfusions predicted enthusiasm and prior referral. Many (66%) referred children with multiple SCD complications, even without matched sibling donors, 37% with sibling donors despite limited disease. Practitioners at transplant centers more commonly accepted event-free survival rates of ≤90% (P = 0.002). North-eastern providers expressed varying enthusiasm for referral for evaluation based on eligibility, donor availability, and acceptable risk, with modestly more interest from practitioners at transplant centers. Differing provider perspectives may affect patient referral for transplant consideration. PMID:24633300

  11. 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

  12. Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

    PubMed

    Larsson, Laura S; Kuster, Emilie

    2013-01-01

    The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

  13. Institutional Influences on Nurse-Academics' Instructional Planning Decisions in the Implementation of Basic Nursing Curricula in Colleges of Advanced Education in New South Wales.

    ERIC Educational Resources Information Center

    Roberts, Kathryn L.

    A study examined institutional influences on the instructional planning decisions of nurse-academics presenting basic nursing curricula in colleges of advanced education (CAEs) in New South Wales. Data were collected from the following sources: survey of 86 selected nurse-academics from 12 of New South Wales' 15 tertiary institutions running basic…

  14. Open to Critique: Predictive Effects of Academic Outcomes from a Bridging/Foundation Programme on First-Year Degree-Level Study

    ERIC Educational Resources Information Center

    Curtis, Elana; Wikaire, Erena; Jiang, Yannan; McMillan, Louise; Loto, Robert; Fonua, Sonia; Herbert, Rowan; Hori, Melissa; Ko, Teri; Newport, Rochelle; Salter, David; Wiles, Janine; Airini; Reid, Papaarangi

    2017-01-01

    Bridging/foundation programmes are often provided by tertiary institutions to increase equity in access and academic performance of students from under-served communities. Little empirical evidence exists to measure the effectiveness of these bridging/foundation programmes on undergraduate academic outcomes. This research identifies the predictive…

  15. 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

  16. Neuropathic Pain Referrals to a Multidisciplinary Pediatric Cancer Pain Service

    PubMed Central

    Anghelescu, Doralina L.; Faughnan, Lane G.; Popenhagen, Mark P.; Oakes, Linda L.; Pei, Deqing; Burgoyne, Laura L.

    2012-01-01

    Objectives Neuropathic pain (NP) in children with cancer is not well characterized. We describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center’s pain management service. Methods Retrospective review of patient data from a 3.5-year period. Results Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients, 17%; 34 male, 22 female). The NP patient group had 1401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consult (p=0.008) and significantly more days (median) of pain service follow-up (p <0.001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacological management of NP was complex, often comprising 3 medications. Nonpharmacological approaches were used for 57.6% of NP referrals. Discussion NP is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow up, more clinical visits, complex pharmacological management, and the frequent addition of non-pharmacological interventions. PMID:24602431

  17. 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…

  18. 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.…

  19. 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…

  20. Graduate Students' Needs and Preferences for Written Feedback on Academic Writing

    ERIC Educational Resources Information Center

    Singh, Manjet Kaur Mehar

    2016-01-01

    The aim of this research is to examine graduate students' needs and preferences for written feedback on academic writing from their lecturers and thesis supervisors. Quantitative method via survey questionnaire was used to collect data from 21 respondents. The data collection involved Master and Doctorate students at a tertiary level institution…

  1. 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…

  2. 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…

  3. 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

  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. 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.

  6. Quarterly Technical Progress Report - West Hackberry Tertiary Project

    SciTech Connect

    Demetrois Yannimaras; Travis Gillham

    1998-04-15

    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.

  7. 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…

  8. 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…

  9. 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…

  10. 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)

  11. Adapting Cooperative Learning in Tertiary ELT

    ERIC Educational Resources Information Center

    Ning, Huiping

    2011-01-01

    An updated guideline for tertiary ELT in China has shifted the emphasis to the development of learners' ability to communicate in English. Using group work and getting learners actively involved in the actual use of English are highlighted more than before. This article focuses on adapting cooperative learning methods for ELT with tertiary…

  12. 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…

  13. 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.

  14. 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…

  15. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  16. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  17. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  18. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  19. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  20. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  1. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  2. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  3. 22 CFR 224.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referral of complaint and answer to the ALJ. 224.11 Section 224.11 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 224.11 Referral of complaint and answer to the ALJ. Upon receipt of...

  4. 75 FR 50880 - TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-18

    ... for authorizing certified physician assistants and certified nurse practitioners (non-physicians) to... certified nurse practitioners will be allowed to issue referrals to patients for physical therapy... if based on a referral from a certified physician assistant or certified nurse practitioner....

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

    ERIC Educational Resources Information Center

    Gardner, John A.

    1991-01-01

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

  6. Community Information in the 80s: Towards the Automation of Information and Referral Files.

    ERIC Educational Resources Information Center

    Shroder, Emelie J.; And Others

    1981-01-01

    Four papers describe systems adopted by public libraries in the United States for computerizing community information services and information and referral programs. Word processing at the Fresno County Information and Referral Network and the automation of library processes in the Pikes Peak Library District are among the topics discussed. (JL)

  7. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  8. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  9. 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...

  10. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

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

    ERIC Educational Resources Information Center

    Tanidir, Canan; Mukaddes, Nahit M.

    2014-01-01

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

  12. 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…

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

    ERIC Educational Resources Information Center

    Yin, Robert K.; And Others

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

  14. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  15. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  16. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  17. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  18. Effects of Schools Attuned on Special Education Referrals for African American Boys

    ERIC Educational Resources Information Center

    Rodriguez, Andrea B.

    2010-01-01

    This study compared the number of special education referrals for African American boys before and after the implementation of the training program, "Schools Attuned". The purpose of the research was to ascertain if the number of special education referrals for African American boys generated in schools with teachers trained in "Schools Attuned"…

  19. Exploring Primary Referral Source Impact on Student Initial Perceptions of Counseling

    ERIC Educational Resources Information Center

    Blau, Gary; DiMino, John; Sheridan, Natalie; Stein, Alexander; Casper, Steven; Chessler, Marcy; Beverly, Clyde

    2015-01-01

    There has been no published research to date comparing the impact of different primary referral sources for a student seeking counseling services on student initial counseling perceptions. Using 82 undergraduates in counseling, this study partitioned these students into two referral groups, where 1 = self-referred (myself), N = 45 versus 2 =…

  20. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Referral to primary source of records. 20.51... PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of a... primary source of the record or document....

  1. Referral of African American Children for Evaluation of Emotional or Behavioral Concerns

    ERIC Educational Resources Information Center

    Riccio, Cynthia A.; Ochoa, Salvador Hector; Garza, Sylvia G.; Nero, Collette L.

    2003-01-01

    Research indicates that high numbers of African American children receive special education services. To address the overrepresentation of African Americans in special education, this study examined the source of referral and the behaviors that precipitate the referral of African Americans for evaluation due to behavioral or emotional concerns.…

  2. 29 CFR 1614.306 - Referral of case to Special Panel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral of case to Special Panel. 1614.306 Section 1614... SECTOR EQUAL EMPLOYMENT OPPORTUNITY Related Processes § 1614.306 Referral of case to Special Panel. If... shall be immediately certified to the Special Panel established pursuant to 5 U.S.C. 7702(d)....

  3. 5 CFR 1201.171 - Referral of case to Special Panel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Referral of case to Special Panel. 1201... Panel § 1201.171 Referral of case to Special Panel. If the Board reaffirms its decision under § 1201.162... Panel established under 5 U.S.C. 7702(d). Upon certification, the Board, within 5 days...

  4. 45 CFR 96.33 - Referral of cases to the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of cases to the Inspector General. 96.33 Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Vocational rehabilitation; referrals to other... ADMINISTRATION AND PROCEDURE Vocational Rehabilitation § 702.505 Vocational rehabilitation; referrals to other... made by the vocational rehabilitation adviser, where appropriate, on an individual basis when...

  6. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services... are properly preserved. (a) Standard—referral by a physician. Portable X-ray examinations...

  7. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services... are properly preserved. (a) Standard—referral by a physician. Portable X-ray examinations...

  8. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services... are properly preserved. (a) Standard—referral by a physician. Portable X-ray examinations...

  9. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 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...

  10. 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…

  11. The Disproportionality Dilemma: Patterns of Teacher Referrals to School Counselors for Disruptive Behavior

    ERIC Educational Resources Information Center

    Bryan, Julia; Day-Vines, Norma L.; Griffin, Dana; Moore-Thomas, Cheryl

    2012-01-01

    Disproportionality plagues schools nationwide in special education placement, dropout, discipline referral, suspension, and expulsion rates. This study examined predictors of teacher referrals to school counselors for disruptive behavior in a sample of students selected from the Educational Longitudinal Study 2002 (National Center for Education…

  12. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for self-referral and point of... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option. (a)...

  13. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  14. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  15. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  16. Strategies for Students with Behavioral Issues Prior to Referral for Special Education Assessment

    ERIC Educational Resources Information Center

    Vallejos, Antoinette Martinez

    2010-01-01

    By law, public schools need to exhaust all general education services prior to referral for special education services (IDEA, 1990). Unfortunately, many teachers are unaware of the pre-referral interventions they can employ to teach children displaying behavior problems. The review of literature focused on the following: (a) legislative history,…

  17. A Collaborative Process Model for Promoting Successful Referrals in College Counseling

    ERIC Educational Resources Information Center

    Iarussi, Melanie M.; Shaw, Brian M.

    2016-01-01

    The need to refer students to off-campus mental health providers is common in college counseling. Such referrals can be challenging for college counselors who strive to meet students' counseling needs while adhering to ethical and center policy guidelines. In this article, the authors explore the nature and challenges of referral in college…

  18. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... limitations on billing. 411.353 Section 411.353 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... § 411.353 Prohibition on certain referrals by physicians and limitations on billing. (a) Prohibition on...) Limitations on billing. An entity that furnishes DHS pursuant to a referral that is prohibited by paragraph...

  19. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... limitations on billing. 411.353 Section 411.353 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... § 411.353 Prohibition on certain referrals by physicians and limitations on billing. (a) Prohibition on...) Limitations on billing. An entity that furnishes DHS pursuant to a referral that is prohibited by paragraph...

  20. 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 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...

  1. 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...

  2. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 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...

  3. 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...

  4. 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...

  5. 22 CFR 224.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Referral of complaint and answer to the ALJ. 224.11 Section 224.11 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 224.11 Referral of complaint and answer to the ALJ. Upon receipt of...

  6. 22 CFR 35.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Referral of complaint and answer to the ALJ. 35.11 Section 35.11 Foreign Relations DEPARTMENT OF STATE CLAIMS AND STOLEN PROPERTY PROGRAM FRAUD CIVIL REMEDIES § 35.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the...

  7. 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... Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS cross... of Justice's Nationwide Central Intake Facility as required by the Claims Collection...

  8. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to GAO or Justice... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot... to the General Accounting Office in accordance with 31 U.S.C. 71 or to the Department of Justice...

  9. 31 CFR 904.4 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Department of Justice. 904.4 Section 904.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FEDERAL CLAIMS COLLECTION STANDARDS (DEPARTMENT OF THE TREASURY-DEPARTMENT OF JUSTICE) REFERRALS TO THE DEPARTMENT OF JUSTICE § 904.4 Minimum amount of referrals to the Department of Justice....

  10. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action....

  11. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be...

  12. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount is... Justice, Washington, DC 20530. Claims for which the gross original amount is $500,000 or less must...

  13. 45 CFR 5.23 - Referral of requests outside the Department.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of requests outside the Department. 5.23 Section 5.23 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION FREEDOM OF INFORMATION REGULATIONS Obtaining a Record § 5.23 Referral of requests outside the Department. If you request records that were created by,...

  14. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  15. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  16. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  17. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  18. 31 CFR 585.705 - Referral to United States Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Referral to United States Department... HERZEGOVINA SANCTIONS REGULATIONS Penalties § 585.705 Referral to United States Department of Justice. In the... States Department of Justice for appropriate action to recover the penalty in a civil suit in a...

  19. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  20. 31 CFR 16.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Referral of complaint and answer to the ALJ. 16.11 Section 16.11 Money and Finance: Treasury Office of the Secretary of the Treasury REGULATIONS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 16.11 Referral of complaint and...

  1. 29 CFR 22.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 1 2014-07-01 2013-07-01 true Referral of complaint and answer to the ALJ. 22.11 Section 22.11 Labor Office of the Secretary of Labor PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 22.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall...

  2. 14 CFR § 1264.110 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Referral of complaint and answer to the presiding officer. § 1264.110 Section § 1264.110 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL PENALTIES ACT OF 1986 § 1264.110 Referral of...

  3. 14 CFR 1264.110 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Referral of complaint and answer to the presiding officer. 1264.110 Section 1264.110 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL PENALTIES ACT OF 1986 § 1264.110 Referral of...

  4. 7 CFR 1.311 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 1 2013-01-01 2013-01-01 false Referral of complaint and answer to the ALJ. 1.311 Section 1.311 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Procedures Related to Administrative Hearings Under the Program Fraud Civil Remedies Act of 1986 § 1.311 Referral...

  5. 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…

  6. Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

    ERIC Educational Resources Information Center

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

    The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

  7. 7 CFR 1.311 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 1.311 Section 1.311 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Procedures Related to Administrative Hearings Under the Program Fraud Civil Remedies Act of 1986 § 1.311 Referral...

  8. 45 CFR 73.735-1304 - Referral of matters arising under the standards of this part.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to the Department of Justice, suspected violations of the criminal laws regarding employee standards... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of matters arising under the standards of... GENERAL ADMINISTRATION STANDARDS OF CONDUCT Reporting Violations § 73.735-1304 Referral of matters...

  9. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Referral of non-JS-related complaints. 658... Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the... take from MSFWs in writing non-JS related complaints which allege violations of employment related...

  10. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Referral of non-JS-related complaints. 658... Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the... take from MSFWs in writing non-JS related complaints which allege violations of employment related...

  11. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Referral of non-JS-related complaints. 658... Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the... take from MSFWs in writing non-JS related complaints which allege violations of employment related...

  12. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of...

  13. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of...

  14. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  15. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  16. 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...

  17. 28 CFR 115.222 - Policies to ensure referrals of allegations for investigations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Policies to ensure referrals of allegations for investigations. 115.222 Section 115.222 Judicial Administration DEPARTMENT OF JUSTICE... Responsive Planning § 115.222 Policies to ensure referrals of allegations for investigations. (a) The...

  18. Patterns of Risk in Adult Protection Referrals for Sexual Abuse and People with Intellectual Disability

    ERIC Educational Resources Information Center

    Cambridge, Paul; Beadle-Brown, Julie; Milne, Alisoun; Mansell, Jim; Whelton, Beckie

    2011-01-01

    Background: Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods: Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual…

  19. The start of the transplant journey: Referral for pediatric solid organ transplantation

    PubMed Central

    Shellmer, Diana; Brosig, Cheryl; Wray, Jo

    2014-01-01

    The focus of the majority of the psychosocial transplant literature is on post-transplant outcomes but the transplant journey starts much earlier than this, at the point when transplantation is first considered and a referral for transplant evaluation is made. In this review we cover information regarding the meaning of the referral process for solid organ transplantation. We discuss various factors of the referral for transplantation including the impact of referral on the pediatric patient and the family, potential expectations and misconceptions held by pediatric patients and parents, the role of health literacy, decision making factors, and the informational needs of pediatric patients and parents. We elucidate steps that providers can take to enhance transplant referral and provide suggestions for much needed research within this area. PMID:24438194

  20. Improving the effectiveness of electronic health record-based referral processes.

    PubMed

    Esquivel, Adol; Sittig, Dean F; Murphy, Daniel R; Singh, Hardeep

    2012-09-13

    Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted "socio-technical" approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication.

  1. The start of the transplant journey: referral for pediatric solid organ transplantation.

    PubMed

    Shellmer, Diana; Brosig, Cheryl; Wray, Jo

    2014-03-01

    The focus of the majority of the psychosocial transplant literature is on post-transplant outcomes, but the transplant journey starts much earlier than this, at the point when transplantation is first considered and a referral for transplant evaluation is made. In this review, we cover information regarding the meaning of the referral process for solid organ transplantation. We discuss various factors of the referral for transplantation including the impact of referral on the pediatric patient and the family, potential expectations and misconceptions held by pediatric patients and parents, the role of health literacy, decision-making factors, and the informational needs of pediatric patients and parents. We elucidate steps that providers can take to enhance transplant referral and provide suggestions for much needed research within this area.

  2. Predictors of responses to psychotherapy referral of WTC utility disaster workers.

    PubMed

    Jayasinghe, Nimali; Giosan, Cezar; Difede, Joann; Spielman, Lisa; Robin, Lisa

    2006-04-01

    This study examined male utility disaster workers' responses to referral for trauma-specific psychotherapy. Among 328 workers offered referral for symptoms related to the World Trade Center (WTC) attacks during psychological screening, approximately 48% chose to accept, 28% chose to consider only, and 24% chose to decline. Analyses examined predisposing factors, i.e., age, race/ethnicity, marital status, education, previous mental health treatment, and previous disorder; as well as illness level; i.e., posttraumatic stress disorder (PTSD), depression, and general psychiatric distress; current treatment; and time of referral as predictors of referral response. PTSD (specifically reexperiencing and hyperarousal symptoms), depressive symptoms, and previous mental health treatment were positively associated with workers' accepting referral. Implications and limitations of these findings are discussed.

  3. Academic Probation Intervention through Academic Assistance Advising

    ERIC Educational Resources Information Center

    Preuss, Michael; Switalski, Rachael

    2008-01-01

    Retaining and aiding students on academic probation is a concern for all institutions of higher education. Students placed on academic probation by Rockingham Community College (RCC) have been encouraged to participate in an intervention program since the summer of 2006. When treated as an aggregate, the data regarding the program indicates that…

  4. Association of Academic Physiatrists

    MedlinePlus

    Donate Member Portal Search Search » Donate | Member Portal | Sign In | Join Membership Join the AAP Coming Home Member Benefits Top 5 Reasons to Join Categories & Dues Academic Partnership Program Current Academic ...

  5. Statistical analysis of referrals by general practitioner at Health Insurance Organization clinics in Alexandria.

    PubMed

    Abdel Wahab, Moataza M; Nofal, Laila M; Guirguis, Wafaa W; Mahdy, Nehad H

    2004-01-01

    Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. The study was conducted at 18 Health Insurance Organization (HIO) comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO (8-17%) revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant.

  6. Treatment and referral patterns for psoriasis in United Kingdom primary care: a retrospective cohort study

    PubMed Central

    2013-01-01

    Background In the UK, referrals to specialists are initiated by general practitioners (GPs). Study objectives were to estimate the incidence of diagnosed psoriasis in the UK and identify factors associated with GP referrals to dermatologists. Methods Newly diagnosed patients with psoriasis were identified in The Health Improvement Network (THIN) database between 01 July 2007-31 Oct 2009. Incidence of diagnosed psoriasis was calculated using the number of new psoriasis patients in 2008 and the mid-year total patient count for THIN in 2008. A nested case–control design and conditional logistic regression were used to identify factors associated with referral. Results Incidence rate of diagnosed adult psoriasis in 2008 was 28/10,000 person-years. Referral rate to dermatologists was 18.1 (17.3-18.9) per 100 person-years. In the referred cohort (N=1,950), 61% were referred within 30 days of diagnosis and their median time to referral was 0 days from diagnosis. For those referred after 30 days (39%, median time to referral: 5.6 months), an increase in the number of GP visits prior to referral increased the likelihood of referral (OR=1.87 95% CI:1.73-2.01). A prescription of topical agents such as vitamin D3 analogues 30 days before referral increased the likelihood of being referred (OR=4.67 95% CI: 2.78-7.84), as did corticosteroids (OR=2.45 95% CI: 1.45-4.07) and tar products (OR=1.95 95% CI: 1.02-3.75). Conclusions Estimates of the incidence of diagnosed adult psoriasis, referral rates to dermatologists, and characteristics of referred patients may assist in understanding the burden on the UK healthcare system and managing this population in primary and secondary care. PMID:23957883

  7. The effects of neglect on academic achievement and disciplinary problems: a developmental perspective.

    PubMed

    Kendall-Tackett, K A; Eckenrode, J

    1996-03-01

    The present study examines the effect of child neglect, alone and in combination with abuse, on academic achievement and school disciplinary problems for elementary, junior high, and senior high students. The sample included 324 neglected children and adolescents, and a matched nonmaltreated sample of 420 children and adolescents. All subjects were in grades K through 12 in a small city in New York state. The results revealed that neglected children did perform more poorly than their nonmaltreated counterparts, having lower grades, more suspensions, more disciplinary referrals, and more grade repetitions, even when controlling for gender of child and SES. Neglect alone and neglect in combination with physical or sexual abuse was related to lower grades and more suspensions. The combination of abuse and neglect had a particularly strong effect on the number of disciplinary referrals and grade repetitions. Abused/neglected students in junior high had the highest number of grade repetitions. The number of disciplinary referrals continued to increase through senior high for both neglected and abused/neglected students. Interestingly, the academic performance of all subjects dropped during junior high. Neglect and neglect in combination with abuse appeared to exacerbate a decline in academic performance that occurs as children enter junior high school.

  8. SCREENING, ASSESSMENT, AND REFERRAL PRACTICES IN ADULT CORRECTIONAL SETTINGS

    PubMed Central

    TAXMAN, FAYE S.; CROPSEY, KAREN L.; YOUNG, DOUGLAS W.; WEXLER, HARRY

    2008-01-01

    The use of screening and assessment tools to gauge substance abuse disorders and the risk for recidivism are two widely recommended practices. A national survey of adult prisons, jails, and community correctional agencies was conducted to examine the practices used to place offenders in appropriate treatment services. Study findings indicate that 58.2% of the surveyed respondents report the use of a standardized substance abuse-screening tool, and that 34.2% use an actuarial risk tool. The provision of higher intensity treatment programs, the use of standardized risk tools, and the provision of more community referral services were all independently associated with the use of a standardized substance abuse-screening tool. Because practices vary considerably, agencies desiring to improve correctional programming should consider different dissemination, implementation, and technology transfer strategies. PMID:18458758

  9. Ammons quick test validity among randomly selected referrals.

    PubMed

    Zagar, Robert John; Kovach, Joseph W; Busch, Kenneth G; Zablocki, Michael D; Osnowitz, William; Neuhengen, Jonas; Liu, Yutong; Zagar, Agata Karolina

    2013-12-01

    After selection using a random number table, from volunteer referrals, 89 Youth (61 boys, 28 girls; 48 African Americans, 2 Asian Americans, 27 Euro-Americans, 12 Hispanic Americans), and 147 Adults (107 men, 40 women; 11 African Americans, 6 Asian Americans, 124 Euro-Americans, 6 Hispanic Americans) were administered the Ammons Quick Test (QT). Means, confidence intervals, standard deviations, and Pearson product-moment correlations among tests were computed. The Ammons QT was moderately to strongly and significantly correlated statistically with: the Peabody Picture Vocabulary Test-3b (PPVT-3b); the Vineland Adaptive Behavior Scales-2 Parent/Teacher Form; the Wechsler Intelligence Scale for Children (WISC-4) or the Wechsler Adult Intelligence Scale (WAIS-4); and the Wide Range Achievement Test-Fourth Edition (WRAT-4) Blue and Green Forms. After 51 years, the original norms for the Ammons QT remain valid measures of receptive vocabulary, verbal intelligence, and auditory information processing useful to clinicians.

  10. ECRS (extra-contractual referrals). Mind the gaps.

    PubMed

    Johnstone, P; Grice, D

    1995-08-10

    METHOD. Buckinghamshire HA's ECR account budget sheet was reviewed for a five-month period from April 1993, to identify adult mental health patients who were residents. Children under 16 and patients with physical disabilities were excluded from the study. All local consultant psychiatrists who either referred the patients or were responsible for their care were interviewed by a public health doctor, using a structured questionnaire. Basic demographic details, diagnoses, details of the ECR request, reasons for referral, current care needs and future patient plans were analysed for patients known by their consultants. RESULTS. Thirty-two patients were identified from the ECR account sheet. Twenty-eight patients were known by a local consultant and included in the analysis. Of the outstanding four patients (14 per cent), one had returned to their local provider unit but was still being invoiced as an ECR patient, and three were long-term chronically ill patients referred before ECRs were introduced.

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

    PubMed

    Homola, Samuel

    2016-02-01

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

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

    PubMed

    Okulate, Gbenga T

    2005-07-01

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

  13. Expert Consensus for Discharge Referral Decisions Using Online Delphi

    PubMed Central

    Bowles, Kathy H.; Holmes, John H.; Naylor, Mary D.; Liberatore, Matthew; Nydick, Robert

    2003-01-01

    This paper describes the results of using a modified Delphi approach designed to achieve consensus from eight discharge planning experts regarding the decision to refer hospitalized older adults for post-discharge follow-up. Experts reviewed 150 cases using an online website designed to facilitate their interaction and efforts to reach agreement on the need for a referral for post-discharge care and the appropriate site for such care. In contrast to an average of eight weeks to complete just 50 cases using the traditional mail method, the first online Delphi round for 150 cases were completed in six weeks. Data provided by experts suggest that online Delphi is a time efficient and acceptable methodology for reaching group consensus. Other benefits include instant access to Delphi decision results, live knowledge of the time requirements and progress of each expert, and cost savings in postage, paper, copying, and storage of paper documents. This online Delphi methodology is highly recommended. PMID:14728143

  14. Different causes of referral to ophthalmology emergency room

    PubMed Central

    Jafari, Alireza Keshtkar; Bozorgui, Shima; Shahverdi, Nooshin; Ameri, Ahmad; Akbari, Mohammad Reza; Salmasian, Hojat

    2012-01-01

    Background: Eye-related complaints compose approximately 1–6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients’ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6%) were males. While 299 patients (9.5%) were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%). In patients referred due to trauma (1950 patients), work-related injuries occurred in 955 patients (49%) and occurred accidentally (by chance) in 819 patients (42%). The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%). The most common etiologies of eye trauma (1950 patients) were metal filings (814 patients; 41.8%), blunt trauma (338 patients; 17.3%), fireworks (236 patients; 12.1%) and sharp objects (222 patients; 11.4%). Globe injury was diagnosed in 1865 patients (95.7%) of trauma cases. In patients referred due to non-traumatic reason (1200 patients), eye infection occurred in 482 patients (40.2%) and 299 patients (24.9%) were referred for non-urgent reasons. There was little difference between

  15. Using MMPI-A Profiles to Predict Success in a Military-Style Residential Treatment Program for Adolescents with Academic and Conduct Problems

    ERIC Educational Resources Information Center

    Weis, Robert; Crockett, Thomas E.; Vieth, Sasha

    2004-01-01

    Military-style residential treatment for adolescents with academic and conduct problems is an increasingly popular alternative to traditional school-based services. However, dropout from "boot camp" programs is a primary reason for their high cost. Social-emotional functioning before referral may differentiate adolescents who…

  16. Academic Inbreeding in Nursing

    ERIC Educational Resources Information Center

    Miller, Michael H.

    1977-01-01

    Academic inbreeding, the employment for faculty positions of persons who receive their graduate training at the same academic institution, is considered detrimental to an institution's academic environment. Results of a study conducted at 54 universities revealed that almost half the faculty (48 percent) in collegiate nursing programs are drawn…

  17. The Academic Adviser

    ERIC Educational Resources Information Center

    Darling, Ruth

    2015-01-01

    In this essay, I explore the idea that "academic" advisers are "academics" who play a major role in connecting the general education curriculum to the students' experience as well as connecting the faculty to the students' holistic experience of the curriculum. The National Academic Advising Association Concept of Academic…

  18. What Is Academic Vocabulary?

    ERIC Educational Resources Information Center

    Baumann, James F.; Graves, Michael F.

    2010-01-01

    In this article, the authors address the construct of "academic vocabulary." First, they attempt to bring some clarity to a constellation of terms surrounding academic vocabulary. Second, they compare and contrast definitions of academic vocabulary. Third, they review typologies that researchers and writers have proposed to organize academic…

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

    ERIC Educational Resources Information Center

    Prandoni, Jogues R.

    1984-01-01

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

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

    ERIC Educational Resources Information Center

    Stansfield, Jois

    2012-01-01

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

  1. Partner referral as a component of integrated sexually transmitted disease services in two Rwandan towns.

    PubMed Central

    Steen, R; Soliman, C; Bucyana, S; Dallabetta, G

    1996-01-01

    OBJECTIVE: To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. METHODS: Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. RESULTS: Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. CONCLUSIONS: Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive

  2. The Tertiary and Quaternary pectens of California

    USGS Publications Warehouse

    Arnold, Ralph

    1906-01-01

    This paper consists of two parts. The first is a brief outline of the different Tertiary and Pleistocene formations of California, giving the type localities, where, when, and by whom first described, their salient characters, where they and their supposed equiyalents are known to occur, the species of Pecten found in them, and their typical fauna as far as known. The second is devoted to the description and illustration of all of the known Tertiary, Pleistocene, and Recent Pectens of the western coast of North America from Alaska to and including the Gulf of California. With the description of each species is also given an account of its geologic and geographic range and, where practicable, its associated fauna.

  3. Decomposition of free chlorine with tertiary ammonium.

    PubMed

    Katano, Hajime; Uematsu, Kohei; Tatsumi, Hirosuke; Tsukatani, Toshihide

    2010-01-01

    The reaction of free chlorine with tertiary ammonium or amine compounds in aqueous solution was studied by the amperometry at a rotating Pt-disk electrode. The amperometric method can be applied to follow the concentration of free chlorine (c(Cl)) even in the presence of chloramine species. By addition of mono- and dibutylammonium to the solution containing free chlorine, the step-like decrease in c(Cl) was observed, indicating the rapid formation of the stable chloramine species. By addition of tributylammonium, the c(Cl) was decreased exponentially to nearly zero even if the free chlorine was present initially in excess. The c(Cl)-t curves can be explained by tributylammonium-species-catalyzed decomposition of free chlorine to chloride ion. The catalytic decomposition was observed also with the tertiary-ammonium-based anion-exchange resins. Furthermore, the anion-exchange resins exhibited the decomposition of not only free chlorine but also chloramines in water.

  4. Intrathyroidal parathyroid hyperplasia in tertiary hyperparathyroidism

    PubMed Central

    Kim, Byung Seup; Ryu, Han Suk; Kang, Kyung Ho; Park, Sung Jun

    2013-01-01

    We report herein a case of intrathyroidal parathyroid hyperplasia in a patient with tertiary hyperparathyroidism. The patient was recommended for parathyroidectomy due to sustained hypercalcemia after kidney transplantation. Preoperative radiologic evaluations showed a benign-looking thyroid mass and three enlarged parathyroid glands. Intraoperative intact parathyroid hormone (iPTH) level and frozen biopsy results indicated a missed parathyroid gland after immediate subtotal parathyroidectomy. Then, a secondary partial resection of thyroid including the thyroid nodule was performed. An excised intrathyroid nodule was diagnosed to be parathyroid hyperplasia by frozen biopsy, and intraoperative iPTH level abruptly decreased. A benign-looking thyroidal mass in patients with secondary or tertiary hyperparathyroidism should be carefully evaluated considering the possibility of an intrathyroidal parathyroid hyperplasia. PMID:24964443

  5. Tertiary serpentinite tectonics in northern Hispaniola

    SciTech Connect

    Nagle, F.; Draper, G.

    1985-01-01

    At least 4 types of serpentinite bodies are found in N. Hispaniola, by different inclusion and Tertiary deformation styles: (1) Narrow slivers occurring on Tertiary faults, rarely containing inclusions, which occur throughout the region. (2) Massive fractured serpentinites associated with a Cretaceous volcanic plutonic and metamorphic basement, and containing rodingite dikes, occurs in the Puerto Plata region. (3) Massive, fractured, but coherent bodies containing Tertiary limestone clasts which apparently the same as nearby limestone overlying the serpentinite occur west of Puerto Plata. (4) Diapirically emplaced bodies in the Gaspar Hernandez region containing both brecciated and massive zones and containing a variety of inclusions. Type 4 bodies protrude into the clastic Upper Eocene Altamira Fm. The most common tectonic inclusions in these bodies are rounded cobbles of diorite and gabbro. Amphibolites are also common, but friable greenschists and blueschists are rare, as are blocks of clastic sediments. The authors suggest that large blocks of the Altamira Fm. were incorporated into the serpentinite during their past Eocene diapirism and that these blocks were deformed in a brittle manner into gouge zones by internal movements in the diapir. Type 4 serpentinites may therefore have incorporated inclusions at high crustal levels by brittle processes. Type 2 bodies, in contrast, may have incorporated inclusions by ductile flow of serpentinite at lower crustal levels. Type 33 bodies are the most enigmatic. They may be sedimentary, but alternatively may have incorporated limestone in a gouge (as for type 4), which has later healed to a coherent mass.

  6. Injury/illness physician referral profile from a youth university-sponsored summer sport camp program.

    PubMed

    Oller, Daria M; Vairo, Giampietro L; Sebastianelli, Wayne J; Buckley, William E

    2013-08-01

    Participation at university-sponsored summer sport camps is popular among youth athletes; however, there is a dearth of information to describe the injuries/illnesses experienced by camp participants. Data from a university-sponsored sport camp program from 2008 to 2011 were accessed retrospectively. The sport camp program had approximately 80 camps for 28 sports over 12 weeks annually. Male and female participants were 10 to 17 years old. Athletic trainers maintained medical documentation and provided medical referrals. Referrals were made for 9.9% (n=478) of all injuries/illnesses. Emergency department referrals were made for 2.9% of injuries/illnesses. University health services received 42.5% of referrals. There were 1.1 referrals per 100 participants. Boys comprised 60.7% of referrals. Rugby had the highest referral rate--5.0 per 100 participants. These data help increase physician preparedness and guide the delivery of sports medicine services for related sport camp programs as a means to improve quality of care delivered to participants.

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

    PubMed

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

    2015-10-01

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

  8. Racial and ethnic differences in reported criminal justice referral at treatment admission.

    PubMed

    Arfken, Cynthia L; Said, Manal; Owens, Darlene

    2012-01-01

    In the U.S. and elsewhere, the criminal justice system is a frequent referral source for substance abuse treatment admission. To expand and improve pathways to treatment, outreach efforts need additional information about different demographic groups. Locally, clinicians observed racial and ethnic differences between minority groups in self-identifying criminal justice as the referral sources for admission. To test this clinical observation, reported criminal justice referral was examined by race/ethnicity and gender in multiple years of both national and local treatment admissions. Confirming the clinical observations, racial/ethnic referral source by gender systematically differed across years nationally (p < .001) and in an examination of verbatim recorded presenting problems locally (p < .001). African Americans and Puerto Ricans were less likely to have criminal justice referral sources than the White reference group, whereas American Indians, Arab Americans, Asian Americans, and other Hispanic ethnicities were more likely to have criminal justice referral sources. Racial/ethnic groups systematically differed in reported criminal justice involvement, suggesting hypotheses potentially impacting clinical treatment and outreach. Published primary referral sources may underestimate criminal justice involvement in treatment admissions.

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

    NASA Astrophysics Data System (ADS)

    Hoffman, Jennifer Marie

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

  10. First quality score for referral letters in gastroenterology—a validation study

    PubMed Central

    Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas

    2016-01-01

    Objective To create and validate an objective and reliable score to assess referral quality in gastroenterology. Design An observational multicentre study. Setting and participants 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Main outcome measure Correlation between the TPS and a visual analogue scale (VAS) for referral quality. Results The 327 referrals had an average TPS of 13.2 (range 1–25) and an average VAS of 4.7 (range 0.2–9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. Conclusions The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. PMID:27855107

  11. Improving referrals for tilt table testing in patients with transient loss of consciousness

    PubMed Central

    Thornton, Luke; Rahunathan, Nithusa; Verma, Narain; Wong, Kenneth

    2016-01-01

    Tilt table testing has been used for over twenty years in the investigation of patients with transient loss of consciousness. The European Society of Cardiology (ESC) recently recommended new guidance regarding indications for tilt table testing. We conducted an educational intervention and produced a new referral proforma that referring clinicians are expected to fill in for all patients referred for tilt table testing. At baseline, 76% (n=84) of referrals for tilt table testing were made in accordance to ESC guidance. Following a simple educational intervention, 100% (n=6) were in line with ESC guidance. After the introduction of the referral proforma, 92% (n=12) of referrals followed ESC guidance. At final data collection, 100% (n=11) of referrals followed ESC guidance. In conclusion, a simple educational intervention and the use of a referral proforma in this quality improvement project have made a sustained difference in improving the appropriateness of referrals for tilt table testing. This has the potential to optimise the efficient use of resources and improve patient care through avoiding unnecessary investigation. PMID:27096093

  12. English Language Learners and Response to Intervention: Referral Considerations

    ERIC Educational Resources Information Center

    Rinaldi, Claudia; Samson, Jennifer

    2008-01-01

    The most salient difficulty in assessing English language learner (ELL) students who exhibit academic difficulties is identifying whether the problem is one of English proficiency or of a learning disability. In many cases, the symptoms are shared and difficult to disentangle, but obtaining a comprehensive picture of the child is vital for…

  13. Pattern of neurological disease seen among patients admitted in tertiary care hospital

    PubMed Central

    2014-01-01

    Background Neurologic disorders are not uncommon at in patient departments of different hospitals. We have conducted the study to see the pattern and burden of neurologic disorders at different inpatient departments of a tertiary care centre. Methodology This retrospective observational study was carried out from the records and referral notes of neurology department of Dhaka Medical College Hospital (DMCH) from July 2011 to June 2012. A total 335 patients were evaluated by consultant neurologists during this period. Result Majority of the patients (59.7%) presented after the age of forty years. The mean age at presentation was 45.11 ± 17.3 years with a male predominance (63.3%). Stroke was the most common condition (47.5%) observed at referral, followed by seizure (9.3%), disease of spinal cord (7.8%) and encephalopathy (6.3%). Even after consultation, 30 patients remained undiagnosed and 6 were diagnosed as functional disorder. Department of Medicine (231, 69%) and Cardiology (61, 18.2%) made most of the calls. More than half (56%) of the stroke patients were referred from medicine and one third (35.2%) from cardiology. Seizure (67.7%), problem in spinal cord (92.3%), coma (50%), encephalopathy (57.1%), motor neuron disease (MND) (72.7%) were common reasons for referral from department of Medicine. Whereas patients with cord disease (7.3%), CNS tumor (40%), seizure disorder (6.5%) and stroke (3.8%) were referred from surgery. Department of Obstetrics and Gynecology sought help for stroke (2.5%), seizure (12.9%), MND (27.3%), coma (16.7%) and encephalopathy (9.5%). Hypertension, diabetes, ischemic heart disease, dyslipidaemia and respiratory problem were significantly associated co-morbid conditions in stroke patients (at 95% CI, p value is <0.001, <0.01, <0.001, <0.05, <0.05 respectively). Hematological disorders were common association among patients with cord problem (<0.05). Conclusion Wide ranges of neurological problems are often managed by physicians

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

    PubMed

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

    2016-01-01

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

  15. The role of academic medicine in improving health care quality.

    PubMed

    Brindis, Ralph G; Spertus, John

    2006-09-01

    Academic medicine, often entrenched in biomedical and clinical research, has largely ignored the development and application of quality metrics to ensure the delivery of high-quality health care. Nevertheless, academic medicine has substantial opportunities to lead the charge in building a quality infrastructure with the goal of delivering high-quality and cost-efficient health care to all Americans. The American College of Cardiology (ACC) and American Heart Association (AHA) have worked jointly to measure and improve the quality of cardiovascular care. This effort has led to the development of clinical practice guidelines, performance measures, data standards, national registries, and appropriateness criteria for cardiovascular care. Academic medicine should actively embrace and promote the type of quality metrics and criteria developed by ACC and AHA and apply this model across the entire academic medicine community. Academic medicine, with its many resources, could lead the way in the expanding field of quality science by supporting fundamental research in quality improvement, supporting academicians to improve quality at their own institutions, developing educational models for quality assessment and improvement, creating and implementing data registries, and serving as a conduit for developing the emerging science of quality assessment. In this and many other ways, academic medicine must offer the health care community leadership for improving our nation's health care quality with the same fervor presently exhibited for the advancement of basic science, the development of specialized and experimental therapy, and as centers for tertiary and quaternary patient care.

  16. Academic Self-Concept, Autonomous Academic Motivation, and Academic Achievement: Mediating and Additive Effects

    ERIC Educational Resources Information Center

    Guay, Frederic; Ratelle, Catherine F.; Roy, Amelie; Litalien, David

    2010-01-01

    Three conceptual models were tested to examine the relationships among academic self-concept, autonomous academic motivation, and academic achievement. This allowed us to determine whether 1) autonomous academic motivation mediates the relation between academic self-concept and achievement, 2) academic self-concept mediates the relation between…

  17. Summary of the proceedings of the international forum 2016: "Imaging referral guidelines and clinical decision support - how can radiologists implement imaging referral guidelines in clinical routine?"

    PubMed

    2017-02-01

    The International Forum is held once a year by the ESR and its international radiological partner societies with the aim to address and discuss selected subjects of global relevance in radiology. In 2016, the issue of implementing imaging referral guidelines in clinical routine was analysed. The legal environment in the USA requires that after January 1, 2017, physicians must consult government-approved, evidence-based appropriate-use criteria through a clinical decision support system when ordering advanced diagnostic imaging exams. The ESR and the National Decision Support Company are developing "ESR iGuide", a clinical decision support system for European imaging referral guidelines using ESR imaging referral guidelines based on ACR Appropriateness Criteria. In many regions of the world, the situation is different and quite diverse, depending on the specific features of health care systems in different countries, but there are, unlike in the USA and EU, no legal obligations to implement imaging referral guidelines into the clinical practice. Imaging referral guidelines and clinical decision support implementation is a complex issue everywhere and the legal environment surrounding it even more so; how they will be implemented into the clinical practice in different areas of the world needs yet to be decided.

  18. Students' Perspectives on Worldwide ``Greening'' of Tertiary Education Curricula

    NASA Astrophysics Data System (ADS)

    Aighewi, Isoken T.; Osaigbovo, Ulamen A.

    2010-11-01

    literate about the science of their surroundings was the most identified reason for supporting the literacy requirement by the students polled. The results of this study thus provide evidence of support by students in the on-going paradigm shift towards “greening” the curricula of tertiary institutions and thus reinforces its implementation by leaders of academe and policy makers worldwide.

  19. Think Stoma Nurse: a tool to trigger referral to specialist care.

    PubMed

    Hanley, Judy; Adams, Jane

    This article describes the initial development and subsequent evolution of a simple referral assessment tool for stoma care. The first author's personal experience identified that there was widespread inconsistency in perceptions of local multidisciplinary teams as to when it was appropriate to refer to specific specialist nursing teams. This resulted in both inappropriate and delayed referrals. A 'Think Specialist Nurse' initiative was developed across the author's trust, building on the traffic light template from the 'ThinkGlucose' tool, to facilitate referrals to clinical nurse specialists. The stoma-care specific tool, 'Think Stoma Nurse', has subsequently evolved beyond its initial audience, and has been adapted into materials aimed at patients and carers.

  20. Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain

    PubMed Central

    2012-01-01

    Background A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. Methods A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Results Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %). Conclusions Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients’ survival rates and