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Sample records for academic tertiary referral

  1. Neurosarcoidosis in a Tertiary Referral Center

    PubMed Central

    Leonhard, Sonja E.; Fritz, Daan; Eftimov, Filip; van der Kooi, Anneke J.; van de Beek, Diederik; Brouwer, Matthijs C.

    2016-01-01

    Abstract The aim of this study was to evaluate clinical characteristics, diagnostic strategy, and treatment in patients with neurosarcoidosis in a tertiary referral centre. In a cross-sectional study, we included all patients with neurosarcoidosis treated at our tertiary referral center between September 2014 and April 2015. We identified 52 patients, among them 1 patient was categorized as having definite neurosarcoidosis, 37 probable neurosarcoidosis, and 14 possible neurosarcoidosis. Neurologic symptoms were the first manifestation of sarcoidosis in 37 patients (71%). Chronic aseptic meningitis was the most common presentation (19/52 patients [37%]), followed by cranial neuropathy (16/52 patients [31%]). Serum angiotensin-converting enzyme and lysozyme levels were elevated in 18 of 41 (44%) and 12 of 26 cases (46%). Pulmonary or lymph node sarcoidosis was identified by chest X-ray in 21 of 39 cases (54%) and by computed tomography of the chest in 25 of 31 cases (81%); 18Fluorodeoxyglucose-Positron emission tomography showed signs of sarcoidosis in 15 of 19 cases (79%). Thirty-one of the 46 cases receiving treatment (67%) improved, 13 cases (28%) stabilized, and 2 cases (4%) deteriorated. First-line treatment with corticosteroids resulted in satisfactory reduction of symptoms in 21 of 43 patients (49%). Seventeen patients (33%) needed second-line cytostatic treatment, and 10 patients (19%) were treated with tumor necrosis factor-α inhibitors. The majority of patients with neurosarcoidosis present with chronic meningitis without a history of systemic sarcoidosis. The diagnosis can be difficult to make because of the poor sensitivity of most diagnostic tests. Half of patients had a satisfactory reduction of symptoms on first-line therapy. PMID:27057889

  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. Academic Performance Difficulties: Age and Grade at First Referral

    ERIC Educational Resources Information Center

    Harman, Marsha J.; Kordinak, S. Thomas; Bruce, A. Jerry

    2008-01-01

    Archival records of 43 children referred for diagnosis and treatment for academic difficulties were examined. Results revealed a significant difference for age at first referral and diagnoses. Those with disorders such as learning disability and severe emotional disturbance tended to be older, while the ADHD and dysthymic disorders tended to be…

  4. 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

  5. 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

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

    PubMed Central

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

    2010-01-01

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

  7. Adenocarcinoma in Crohn's disease: the pathologist's experience in a tertiary referral centre of inflammatory bowel disease.

    PubMed

    Malvi, Deborah; Vasuri, Francesco; Mattioli, Benedetta; Gruppioni, Elisa; Fiorentino, Michelangelo; Gionchetti, Paolo; Grigioni, Walter F; Poggioli, Gilberto; D'Errico-Grigioni, Antonia

    2014-08-01

    The aim of the present study is to describe the histological and mutational characteristics of a series of both large and small bowel adenocarcinomas in patients with Crohn's disease from a tertiary referral centre of inflammatory bowel disease. Bowel adenocarcinoma was diagnosed in 11 (1.7%) of 660 consecutive patients submitted to surgery for histologically proven Crohn's disease in 5 years. The following data were collected: tumour site, stage and grade, intracellular/extracellular mucin, lymphovascular invasion, immunohistochemistry for keratin 7, keratin 20 and CDX-2, mutation analyses of KRAS, B-RAF, PI3K and microsatellite instability. A strong predominance of male gender was observed (10/11). Four (36.4%) adenocarcinomas arose in the small bowel, five (45.4%) in the anus/rectum, and two (18.2%) in anastomosis. Furthermore, all cases of anorectal adenocarcinoma showed >50% of extracellular mucin, with associated KRAS mutations in three of five. No influence in cancer incidence by infliximab therapy was observed.Our series, one of the largest on the topic with immunomorphological and molecular deepening, showed that bowel adenocarcinomas in Crohn's disease have an aggressive behaviour and a strong predominance of extracellular mucin. In surgical specimens from Crohn's disease patients, mucinous-looking anal fistulas and ileal areas of adhesion/retraction should always be extensively sampled. PMID:24977730

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

    PubMed Central

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

    2015-01-01

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

  9. 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…

  10. Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital

    PubMed Central

    Yokogawa, Hideaki; Kobayashi, Akira; Yamazaki, Natsuko; Masaki, Toshinori; Sugiyama, Kazuhisa

    2014-01-01

    Purpose To report surgical therapies for corneal perforations in a tertiary referral hospital. Methods Thirty-one eyes of 31 patients (aged 62.4±18.3 years) with surgically treated corneal perforations from January 2002 to July 2013 were included in this study. Demographic data such as cause of corneal perforation, surgical procedures, and visual outcomes were retrospectively analyzed. Results The causes of corneal perforation (n=31) were divided into infectious (n=8, 26%) and noninfectious (n=23, 74%) categories. Infectious causes included fungal ulcer, herpetic stromal necrotizing keratitis, and bacterial ulcer. The causes of noninfectious keratopathy included corneal melting after removal of a metal foreign body, severe dry eye, lagophthalmos, canaliculitis, the oral anticancer drug S-1, keratoconus, rheumatoid arthritis, neurotrophic ulcer, atopic keratoconjunctivitis, and unknown causes. Initial surgical procedures included central large corneal graft (n=17), small corneal graft (n=7), and amniotic membrane transplantation (n=7). In two cases the perforation could not be sealed during the first surgical treatment and required subsequent procedures. All infectious keratitis required central large penetrating keratoplasty to obtain anatomical cure. In contrast, several surgical options were used for the treatment of noninfectious keratitis. After surgical treatment, anatomical cure was obtained in all cases. Mean postoperative best corrected visual acuity was better at 6 months (logMAR 1.3) than preoperatively (logMAR 1.8). Conclusion Surgical therapies for corneal perforations in our hospital included central large lamellar/penetrating keratoplasty, small peripheral patch graft, and amniotic membrane transplantation. All treatments were effective. Corneal perforation due to the oral anticancer drug S-1 is newly reported. PMID:25378903

  11. Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei.

    PubMed

    Sun, C C; Guo, Y L; Lin, R S

    1995-12-01

    Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.

  12. 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

  13. Outcome of treatment in patients with methamphetamine poisoning in an Iranian tertiary care referral center

    PubMed Central

    Paydar, Parva; Sabzghabaee, Ali Mohammad; Paydar, Hooman; Eizadi-Mood, Nastaran; Joumaa, Ali

    2015-01-01

    Objective: Methamphetamine is the second most widely abused drug worldwide. We performed a study on the treatment outcome of acute methamphetamine intoxication in a referral tertiary care University hospital in Iran. Methods: In this hospital-based, retrospective study which was carried out from 2012 to 2013, medical records of all patients aged 18 to 65 years who were admitted with a reliable history and clinical diagnosis of acute methamphetamine intoxication were abstracted and analyzed. Patients’ data included gender, age, type and route of poisoning, clinical manifestations, duration of hospitalization, and the treatment outcome. ANOVA, Chi-square, and binary logistic regression statistical tests were used for data analysis. Findings: A total of 129 patients with a mean age of 30.70 ± 0.93 (mean ± standard error), including 111 (86%) males, had been fully evaluated. Most of the patients had intentional poisoning (93.7%). In 42.6% of patients, inhalation was the main route of exposure. Most of the patients had complete improvement without any complication (89.1%). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI] 1.006–1.099), suicide history (OR, 30.33; 95% CI 3.11–295.24), route of poisoning ([ingestion: OR, 0.21; 95% CI 0.05–0.87], [inhalation: OR, 0.19; 95% CI 0.04–0.78]), and pulmonary system manifestations (OR 1.84; 95% CI 1.15–2.93) were predictive in patients outcome (P < 0.05). Conclusion: Methamphetamine poisoning was more common in males with intentional poisoning. Age, past history of suicide, route of poisoning, and pulmonary manifestations on admission could be considered as important predictive factors in patients’ outcome. PMID:26312257

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

    PubMed Central

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

    2016-01-01

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

  15. Objective and subjective factors in the disproportionate referral of children for academic problems.

    PubMed

    Wisniewski, J J; Andrews, T J; Mulick, J A

    1995-12-01

    R. S. Drabman, K. J. Tarnowski, and P. A. Kelly (1987) and K. J. Tarnowski, D. F. Anderson, R. S. Drabman, and P. A. Kelly (1990) examined children's month of birth in relation to referral for psychological services and found that younger children in the classroom were disproportionately referred for services. No differences were found between younger and older students on standardized measures of intelligence or academic achievement. Results of a replication and extension of these studies indicated (a) that younger children in the classroom were referred at a disproportionately higher rate, (b) that the referral pattern could not be explained by differences in children's competencies, (c) that Caucasian students were referred at disproportinately higher rates than minority students, and (d) a trend in which the proportionate referral rate of students as height or weight increased. Results are discussed within the context of teacher expectancies. PMID:8543706

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

    ERIC Educational Resources Information Center

    Backes-Gellner, Uschi; Geel, Regula

    2014-01-01

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

  17. Multidrug-Resistant Tuberculosis in Admitted Patients at a Tertiary Referral Hospital of Bangladesh

    PubMed Central

    Banu, Sayera; Mahmud, Asif Mujtaba; Rahman, Md. Toufiq; Hossain, Arman; Uddin, Mohammad Khaja Mafij; Ahmed, Tahmeed; Khatun, Razia; Akhanda, Wahiduzzaman; Brosch, Roland

    2012-01-01

    Background This study was set out to investigate the magnitude, patterns and molecular characterization of drug-resistant Mycobacterium tuberculosis strains at a tertiary referral hospital in Bangladesh. Methods Pulmonary tuberculosis (TB) patients admitted at National Institute of Diseases of the Chest and Hospital from February 2002 to September 2005 with or without previous history of TB and/or other complications were randomly interviewed. Among 265 participants enrolled, M. tuberculosis isolates from 189 patients were finally tested for susceptibility to rifampicin (RMP), isoniazid (INH), ethambutol (ETM) and streptomycin (STM). Genotyping of M. tuberculosis was done using deletion analysis and spoligotyping. Results Eighty-eight percent (n = 167) of the patients had history of previous anti-TB treatment while the remaining 12% were new TB cases. Of the 189 isolates, 9% were fully susceptible to the first line anti-TB drugs and 73.5% were multi-drug resistant TB. Other susceptibility results showed 79.4%, 77.2%, 76.7% and 78.8% resistance to INH, RMP, ETM and STM respectively. Multi-drug resistance was significantly higher among the 130 (78%) patients with previous history of anti-tuberculosis treatment (95% confidence interval, p = 0.001). Among the 189 analyzed isolates, 69% were classified as “modern” M. tuberculosis strains (i.e. TbD1- strains, lacking the M. tuberculosis-deletion region TbD1), whereas the remaining 31% were found to belong to the “ancestal” TbD1+ M. tuberculosis lineages. One hundred and five different spoligotype patterns were identified in which 16 clusters contained 100 strains and 89 strains had unique pattern. Strains with a spoligotype characteristic for the “Beijing” cluster were predominant (19%) and most of these strains (75%) were multi-drug resistant (MDR). Conclusions A high level of drug resistance observed among the re-treatment patients poses a threat of transmission of resistant strains to susceptible

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

    PubMed Central

    2013-01-01

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

  19. 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…

  20. Head and neck histoplasmosis--a nightmare for clinicians and pathologists! Experience at a tertiary referral cancer centre.

    PubMed

    Viswanathan, Seethalakshmi; Chawla, Naveen; D'Cruz, Anil; Kane, Shubhada V

    2007-12-01

    Histoplasmosis is a rarely reported deep mycotic infection in the Indian context. Oral or oropharyngeal manifestation can occur as an isolated symptom or as part of a disseminated process associated with immunosuppression especially with HIV and diabetes. Five cases of head and neck histoplasmosis accrued over 6 years in a tertiary referral cancer institute were reviewed. All these patients presented clinically as cancer. In three patients, the marked pseudoepitheliomatous hyperplasia led to a mistaken biopsy diagnosis of malignancy following which definitive surgical treatment was performed. The subsequent excision revealed typical features of histoplasmosis. Isolated oral presentation of histoplasmosis can mimic malignancy both clinically as well as pathologically, leading to potentially disastrous consequences. A high index of suspicion in those with overt or hidden immunosuppression and a deep wedge biopsy to demonstrate the organisms in the subepithelial tissue is recommended.

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

    PubMed Central

    Ooi, Marie; Thomson, Andrew

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Birch, Elisa R.; Miller, Paul W.

    2006-01-01

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

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

    PubMed

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

    2009-01-01

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

  4. 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

  5. Employment of 16 S rDNA gene sequencing techniques to identify culturable environmental eubacteria in a tertiary referral hospital.

    PubMed

    Xu, J; Smyth, C L; Buchanan, J A; Dolan, A; Rooney, P J; Millar, B C; Goldsmith, C E; Elborn, J S; Moore, J E

    2004-05-01

    Universal or 'broad-range' eubacterial polymerase chain reaction (PCR) was performed on 53 isolates from environmental water-associated sites in a haematology unit (N = 22) and the outer surfaces of cleaning lotion containers sited throughout a tertiary referral hospital (N = 31) 16 S rDNA PCR was performed using two sets of universal primers, including the novel reverse primer, XB4, to generate a composite amplicon of 1068 bp, which was sequenced to obtain each isolate's identity. Sequence analysis was able to identify 51 isolates. Most (75% from the haematology unit and 81% from cleaner containers) were Gram-positive. Nine different genera were identified from the haematology unit and 13 from the cleaning lotion containers. This study provides the first reports of Terrabacter spp. and Brachybacterium paraconglomeratum isolated from a hospital environment. As unusual and difficult-to-identify environmental organisms are unlikely to be clinically significant, and molecular identification is costly and labour-intensive, we recommend that molecular methods are only used as an adjunct to first-line phenotypic identification schemes where a definitive identification is required. Where molecular identification methods are justified, partial 16 S rDNA PCR and sequencing employing the novel universal primer XB4, is a valuable and reliable technique.

  6. 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

  7. 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

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

    PubMed

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

    2013-09-01

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

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

    PubMed

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

    2013-09-01

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

  10. 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…

  11. 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…

  12. What is the role of a specialist regional mesothelioma multidisciplinary team meeting? A service evaluation of one tertiary referral centre in the UK

    PubMed Central

    Bibby, Anna C; Williams, Katie; Smith, Sarah; Bhatt, Nidhi; Maskell, Nick A

    2016-01-01

    Background Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting. Objectives To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment. Design and setting A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England. Participants All cases discussed between 1/1/2014 and 31/12/2015. Outcome measures The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected. Results A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was <2 weeks in 75% of cases. Conclusions This specialist mesothelioma multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core

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

    PubMed Central

    Telford, Robert; Viney, Richard; Patel, Prashant

    2016-01-01

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

  14. A service evaluation of women attending the menopause/premature ovarian failure clinic of a tertiary referral centre.

    PubMed

    Cartwright, B; Holloway, D; Grace, J; Robinson, J; Rymer, J

    2012-05-01

    This service evaluation aimed to characterise the referrals to the premature ovarian failure clinic, including the type of referral and patient needs, in order to plan for future service provision. The majority of women seen in the clinic experienced idiopathic premature ovarian failure, were aged 30-39 and were nulliparous at the time of diagnosis. Our service requires to be tailored to their needs. For many women, this includes a fertility consultation in the clinic and this part of the service is well used. Our data support the long-term follow-up of women both on treatment and those who initially decline treatment. Most women who initially decline treatment accept it after a few clinic visits. This may be due to consistent advice on the benefits of oestrogen treatment or due to yearly bone scans showing a change in bone density. There was a high non-attendance rate in this group: 21% of appointments were not attended. PMID:22519481

  15. 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.

  16. 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.

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

    PubMed Central

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

    2014-01-01

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

  18. Factors Associated with Outcome in Patients with Acute Upper Gastrointestinal Bleeding in a Tertiary Referral Center in Northern Iran

    PubMed Central

    Baradaran, Fatemeh; Norouzi, Alireza; Tavassoli, Samaneh; Baradaran, Abdolvahab; Roshandel, Gholamreza

    2016-01-01

    BACKGROUND Upper gastrointestinal bleeding (UGIB) is a major healthcare problem and is the most frequent gastrointestinal reason for admission to hospital. We aimed to investigate the prognosis of patients with UGIB referred to a referral hospital in northern Iran in 2013. METHODS All patients with UGIB who admitted to Sayyad Shirazi Hospital, in Gorgan, northern Iran, in 2013 were enrolled. The patients’ demographic data as well as data about admission, diseases, drug history, and patients’ prognosis were collected by structured questionnaire using information in hospital files. The relationships between different factors with the proportion of mortality and recurrence were assessed using Chi-square test. RESULTS In total, 168 patients were enrolled of whom 109 (64.9%) were male. The mean (SD) age of the patients was 59.4 (18.2) years. Mortality and recurrence occurred in 23.2% and 34.5% of the subjects, respectively. We found significant relationships between older age and diagnosis of malignancy with mortality (p =0.03 and p <0.01) and recurrence (p<0.01 and p <0.01). CONCLUSION We found relatively high rates of mortality and recurrence among patients with UGIB. Our results suggested older age and diagnosis of malignancy as the most important indicators of mortality and recurrence in such patients. Considering these factors in clinical settings may result in better and more effective management of patients with UGIB.

  19. Some sociological aspects of cutaneous leishmaniasis in patients attending a tertiary referral centre in Colombo, Sri Lanka.

    PubMed

    Fernando, S D; Siriwardana, H V Y D; Guneratne, K A R C W; Rajapaksa, L C

    2010-03-01

    Over 1800 clinically suspected cases of cutaneous leishmaniasis have been referred to the Department of Parasitology, Faculty of Medicine, Colombo, Sri Lanka for investigation since 2001. This study analyses some sociological aspects of 120 patients with laboratory confirmed cutaneous leishmaniasis. This information is important to design and implement control programmes. The disease was predominant among males. In females lesions occurred mainly on the face, while in men they were seen mainly on the limbs. Immediate medical advice was sought by 13% of the population; the others sought treatment when the skin lesion grew or failed to heal. Females delayed seeking treatment as they probably misinterpreted the lesion as a pimple. Only 39% were referred to a Consultant Dermatologist by a medical officer during the first visit. The mean duration of time from the detection of the lesion to referral was approximately eight months. Psychologically, the presence of the lesion affected less than 20% of individuals. Costs related to treatment were relatively low in Sri Lanka. Late presentation and diagnostic delay was related to lack of awareness. Educational programmes should be carried out, aimed both at health care workers and the community to ensure early diagnosis and treatment for cutaneous leishmaniasis.

  20. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan.

    PubMed

    Mata-Mbemba, Daddy; Mugikura, Shunji; Nakagawa, Atsuhiro; Murata, Takaki; Kato, Yumiko; Tatewaki, Yasuko; Takase, Kei; Kushimoto, Shigeki; Tominaga, Teiji; Takahashi, Shoki

    2016-01-01

    We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13-15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient's score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings. Only the Canadian was significantly associated with important CT findings in multivariate analyses and showed higher area under the receiver operating characteristic curve (AUC) either in all 142 patients (GCS 13-15: P = 0.0130; AUC = 0.69) or in the 67 with a GCS = 15 (P = 0.0128, AUC = 0.73). Of items, ">60 years" or "≥65 years" included in either guideline was the strongest predictor of important CT finding, followed by "GCS < 15 after 2 h" included only in the CCHR. In a tertiary referral hospital in Japan, CCHR had higher performance than the NOC in predicting important CT findings. PMID:27026873

  1. 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.

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    2016-01-01

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

  5. Cigarette smoking adversely affects disease activity and disease-specific quality of life in patients with Crohn’s disease at a tertiary referral center

    PubMed Central

    Quezada, Sandra M; Langenberg, Patricia; Cross, Raymond K

    2016-01-01

    Purpose Smoking has a negative impact on disease activity in Crohn’s disease (CD). Smoking may also affect the quality of life, but this has not been evaluated using validated measures over time. We assessed the relationship between smoking and disease-specific quality of life over time in a tertiary referral inflammatory bowel disease cohort. Patients and methods Retrospective cohort study from July 2004 to July 2009 in patients with CD identified from the University of Maryland, Baltimore, Institutional Review Board-approved University of Maryland School of Medicine Inflammatory Bowel Disease Program database. Smoking status was classified as current, former, and never. Age was categorized as <40 years, 40–59 years, and ≥60 years. Index visit disease activity and quality of life was measured with the Harvey–Bradshaw index, and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Repeated measures linear regression was used to assess the association between smoking and quality of life over time after adjustment for confounding variables. Results A total of 608 patients were included, of whom 42% were male; 80% were Caucasian; 22% were current smokers; 24% were former smokers; and 54% were never smokers. Over time, adjusted Harvey–Bradshaw index scores declined in all patients, but current smokers had consistently higher scores. After adjustment for sex, age, and disease duration, never smokers had higher mean SIBDQ scores at index visit compared to former and current smokers (P<0.0001); all increased over time but SIBDQ scores for never smokers remained consistently highest. Conclusion Smoking has a negative impact on disease activity and quality of life in patients with CD. Prospects of improved disease activity and quality of life should be proposed as an additional incentive to encourage smoking cessation in patients with CD. PMID:27703391

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

    PubMed Central

    2015-01-01

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

  7. 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

  8. 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

  9. 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…

  10. 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…

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

    PubMed

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

    2015-05-01

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

  12. 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.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Wang, Zhenlin; Brown, Gavin T. L.

    2014-01-01

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

  15. 'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist

    PubMed Central

    Dhar, Shabir Ahmed; Bhat, Masood Iqbal; Mustafa, Ajaz; Mir, Mohammed Ramzan; Butt, Mohammed Farooq; Halwai, Manzoor Ahmed; Tabish, Amin; Ali, Murtaza Asif; Hamid, Arshiya

    2008-01-01

    Background Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma. Results At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality. Conclusion In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases. PMID:18271951

  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. 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…

  18. 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…

  19. Reframing Academic Literacy: Re-Examining a Short-Course for "Disadvantaged" Tertiary Students

    ERIC Educational Resources Information Center

    Henderson, Robyn; Hirst, Elizabeth

    2007-01-01

    This paper revisits a successful short-course in academic literacy that was conducted for 50 "disadvantaged" students enrolled in the first year of an education degree at an Australian regional university (see Hirst, Henderson, Allan, Bode & Kocatepe, 2004). Based on a sociocultural approach to learning and drawing on a conceptualisation of…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  3. Adult tonic-clonic convulsive status epilepticus over the last 11 years in a resource-poor country: a tertiary referral centre study from southern Thailand.

    PubMed

    Phabphal, Kanitpong; Geater, Alan; Limapichart, Kitti; Sathirapanya, Pornchai; Setthawatcharawanich, Suwanna

    2013-09-01

    Status epilepticus is a common condition in patients admitted to hospital in resource-poor countries and reports indicate that aetiology, factors of poor outcome, and treatment strategies are variable. To date, there is no report of a prospective study in Thai adults. Herein, we investigated the aetiology, clinical features, factors of predicted poor outcome, and treatment strategies in Thai adult patients who presented with convulsive status epilepticus. A total of 180 patients, whose ages ranged from 15 to 106 years, were included. Of these, 121 patients (67.2%) had acute symptomatic aetiology. The most common aetiology of status epilepticus was encephalitis (36.1%), followed by scarring of the cerebral hemisphere (15%). The median duration of status epilepticus before treatment was three hours. The rate of mortality in the study was 26.7%. Poor outcome was identified in 112 (62.2%) patients. For referral patients, all received only intravenous drugs before referral. The variables that correlated with poor outcome were aetiology and duration of status epilepticus. An approach to incorporate improved prevention of encephalitis, a more effective transportation system, and provision of the essential intravenous antiepileptic drugs would effectively increase the response to treatment.

  4. 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.

  5. 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.

  6. Incongruous referrals.

    PubMed

    Hannay, D R; Maddox, E J

    1975-12-13

    A survey of 1344 patients registered at a new health centre in Glasgow assessed the prevalence of symptoms and referrals together with subjective, gradings of medical symptoms in terms of pain, disability, and perceived seriousness, and of social symptoms in terms of worry or inconvenience. These grading scales were used to define referral behaviour which appeared to be incongruous in the light of the respondents' own perceptions of their symptoms. In this way incongruous referrals indicated the size of the medical and social symptom "iceberg" and "trivia". For both medical and social symptoms the "icebergs" were larger than the "trivia"; the medical-symptom "iceberg" was two to three times greater than the medical-symptom "trivia".

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

    PubMed

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

    2015-04-01

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

  8. Repeat Procedures Within 30 days in Patients Stented for Malignant Distal Biliary Strictures: Experience of 508 Patients at a Tertiary Referral Center

    PubMed Central

    Byrne, Michael F; Chan, Calvin HY; Branch, Malcolm S; Jowell, Paul S; Baillie, John

    2012-01-01

    Background Stent related occlusion and migration remains a problem despite attempts to improve stent design over this time period. Flanged polyethylene plastic stents (FPS) remains the stent of choice in most centers. Early failure of stents placed for malignant extrahepatic biliary strictures (MEBS) has not previously been studied in detail. We set out to determine the incidence and reasons for biliary stent change within 30 days of the index procedure in a large tertiary center population during a period where (FPS) was the sole plastic stent used. Methods Retrospective analysis of endoscopic retrograde cholangiography (ERCP) was undertaken in patients who were stented for presumed or known MEBS between 1993 and 2001. Patients who required repeat stenting within 30 days were identified. Results All 508 patients were stented for MEBS. 5.7% of patients had a total of 34 repeat stenting procedures within 30 days of the index procedure; 27of 29 index stents were plastic, 2 were self-expandable metal stents (SEMS), 20 (3.9%) patients had stent failure as the reason for a stent exchange (plastic stent occlusion n = 15, mean time to stent change 14 ± 8.3 days; metal stent occlusion n = 2, mean time to stent change 24.5 ± 7.8 days; plastic stent migration n = 3, mean time to stent change 25 ± 5.3 days). There was a statistically significant difference in the time to stent change between the occluded plastic stent and migrated plastic stent cases (P = 0.045, 95% CI -21.7 to -0.29). 6 patients spent at least 2 additional days in hospital as a result of stent failure. Conclusions Early stent failure is an uncommon problem, especially in patients with SEMS. Early plastic stent failure appears to occur sooner with stent occlusion than with stent migration. Early stent failure is associated with significant morbidity and bears an economic impact in additional procedures and hospital stay.

  9. Prevalence of Colonic Motor or Evacuation Disorders in Patients Presenting with Chronic Nausea and Vomiting Evaluated by a Single Gastroenterologist in a Tertiary Referral Practice

    PubMed Central

    Kolar, Gururaj J.; Camilleri, Michael; Burton, Duane; Nadeau, Ashley; Zinsmeister, Alan R.

    2013-01-01

    Background Nausea and vomiting are thought to result from upper gastrointestinal dysfunctions. Our clinical observations led to the hypothesis that colonic motor dysfunction is associated with nausea and vomiting. Methods We reviewed electronic medical records (EMR) of 149 patients presenting with complaints of nausea and/or vomiting in a tertiary gastroenterology practice to investigate the association with disorders of colonic motor or evacuation disorders. We extracted demographics, gastric emptying (GE in 149) and colonic transit (CT in 138) of solids, ascending colon emptying half time (AC t1/2), rectal evacuation by anorectal manometry (ARM) in 91 and balloon expulsion test (BE) in 55 patients. We estimated the proportions with delayed GE or CT, based on the 5th percentile of GE (in 319) and CT in 220 healthy volunteers using same method. Key Results Among 11 patients with nausea and/or vomiting with only GE measured, 5 had delayed and 6 normal GE. Among the 149 patients, 77 (52%) patients had evacuation disorders, confirmed by objective tests in 68 patients, and clinical examination in 9 patients. In the 138 patients with both GE and CT measured, 106 (76%) had both normal GE and CT, 11 (8%) only delayed GE, 16 (11%) normal GE with delayed CT, and 5 (3%) delayed GE and CT. Among 21 patients (15%) with delayed CT, 9 had slow AC t1/2 and 12 evacuation disorder. Conclusions & Inferences In patients with chronic nausea and/or vomiting in gastroenterology practice, evaluation of colonic motility and rectal evacuation should be considered, since about half the patients have abnormal functions that conceivably contribute to the presenting nausea and/or vomiting. PMID:24118658

  10. Primary Pulmonary Synovial Sarcoma in a Tertiary Referral Center: Clinical Characteristics, CT, and 18F-FDG PET Findings, With Pathologic Correlations.

    PubMed

    Kim, Gun Ha; Kim, Mi Young; Koo, Hyun Jung; Song, Joon Seon; Choi, Chang-Min

    2015-08-01

    The purpose of this study was to describe the patient characteristics, computed tomography (CT) and F-fluorodeoxyglucose positron emission tomography (FDG PET) findings, and clinical outcomes of primary pulmonary synovial sarcoma (PPSS), together with their pathologic correlations. The medical records of 14 patients with pathologically proven PPSS in a tertiary hospital from January 1997 to December 2014 were retrospectively reviewed. The CT findings were evaluated. The maximum standardized uptake value (maxSUV) of the tumors was obtained, and clinical outcomes with respect to tumor recurrence and mortality were assessed by Kaplan-Meier analysis. The median tumor size was 10.2 cm and the most common anatomic location was the lung followed by the pleura/chest wall and mediastinum. Most of the tumors appeared as single lesions and had circumscribed margins. All the cases showed heterogeneous enhancement with necrotic or cystic portions, and intratumoral vessels were frequently seen. Half of the tumors had intratumoral calcifications, and tumor rupture, pleural/chest wall extension, and pleural effusion occurred frequently. However, lymph node enlargement was rare. The median maxSUV of the tumors was 4.35. Patient outcomes with respect to tumor recurrence (n = 8, 57.1%) and death (n = 3, 21.4%) were poor despite their young age, and the mean follow-up period was 28.5 months.In conclusion, PPSS usually occurs in young adults, generally in the lung, presents as a large, circumscribed mass, and tumor rupture or extension of the pleura/chest wall may occur. The tumors often contain calcifications and vessels; they may exhibit triple attenuation on enhanced CT images, and clinical outcomes are poor. PMID:26313782

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

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Smith, Debra Messenger

    2010-01-01

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

  13. 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…

  14. Inclusion and Discipline Referrals.

    ERIC Educational Resources Information Center

    Krank, H. Mark; Moon, Charles E.; Render, Gary F.

    2002-01-01

    Discipline referrals for special needs students and other students in a rural K-8 school were examined before and after the school shifted to inclusive-school policies and practices. In the year after the shift, discipline referrals declined sharply for special needs students and slightly for other students, reflecting positive social outcomes of…

  15. Safety referral procedures clarified.

    PubMed

    2014-12-01

    Two types of referrals are available for the purpose of harmonising pharmacovigilance decisions across the EU: the urgent procedure and the "normal" procedure. In both cases, the Pharmacovigilance Risk Assessment Committee (PRAC) issues a recommendation that the marketing authorisation committees concerned must take into account when formulating their opinions. If Member States disagree in their decisions, a final referral is available, although it lacks transparency. The European Commission's final decision is binding on all Member States. PMID:25629154

  16. A Comparative Study Between Longitudinal Pancreacticojejunostomy v/s Lateral Pancreaticogastrostomy as a Drainage Procedure for Pain Relief in Chronic Pancreatitis Done in a Tertiary Referral Centre of Eastern India.

    PubMed

    Halder, Shyamal Kumar; Bhattacharjee, Prosanta Kumar; Bhar, Partha; Das, Cinjini; Pandey, Pranjal; Rakshit, Krishna Pada; Pachaury, Anadi

    2015-04-01

    Chronic pancreatitis (CP) is a chronic inflammation of pancreas that leads to progressive fibrosis of pancreatic parenchyma. Commonest indication of surgery in chronic pancreatitis is intractable pain. Choice of procedure depends upon the main pancreatic duct (MPD) morphology. Decompression is useful in dilated and obstructed ducts. Traditional form of decompression is construction of a pancreatico-jejunal anastomosis (LPJ). Another method to achieve ductal decompression is by a pancreaticogastrostomy (LPG) and this study will try to evaluate its effectiveness against pancreaticojejunostomy. To compare the effectiveness of LPG and LPJ in relieving intractable abdominal pain in patients with CP and their respective post-operative complications. This prospective study was done over a period of 4 years from Jan 2007 to Dec 2010 at IPGME & R (SSKM), a tertiary hospital of eastern India. Patients with diagnosis of CP with or without duct calculi and MPD diameter ≥7 mm with intractable pain were included. 70 patients were randomly allocated for LPJ and LPG operation by lottery method. Study tools were questionnaires, blood and radiological investigations and standard instruments for open surgery. The patients were prospectively analyzed for duration of surgery and hospital stay, operative/postoperative complications and assessment of postoperative pain relief. Pain relief was assessed as complete (no analgesic requirement), satisfactory (tolerable pain with normal daily activities) and unsatisfactory (hospitalization, narcotics or hampered daily activities). 1. Operative time was shorter in LPG than LPJ (Median 85 vs. 110 min). 2. Incidence of ileus was lesser in LPG group (p = .054). Other complications were comparable in both groups. 3. LPG was associated with shorter duration of hospital stay (Mean 6 vs. 8 days). 4. Pain relief was comparable in LPG and LPJ. LPG is a good alternative to LPJ for CP. PMID:26139966

  17. Dealing with extracontractual referrals.

    PubMed Central

    Williamson, J D

    1991-01-01

    OBJECTIVE--To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements. DESIGN--Description of the procedures for managing extracontractual referrals and the decisions made on requests submitted to the district health authority between 1 April and 30 June 1991. RESULTS--235 requests were submitted, 79 for emergency care. 156 requests were clearly for elective treatments and, of these, 61 were ultimately refused, 20 because the district health authority was not liable to pay. Of the remaining 41, 17 were appealed successfully and three unsuccessfullly. More than half of the elective extracontractual referrals correctly submitted were to either orthopaedics, general surgery, oral surgery, gynaecology, or plastic surgery. Overall, the district health authority approved three quarters of the requests for which it would be financially liable; this was the predicted workload for the period. CONCLUSIONS--The management of extracontractual referral requests is complex and time consuming for clinicians and managers alike. Patient choice is clearly being limited to some extent, but this is necessary if the number of requests is not to exceed the levels on which funding is based. PMID:1912860

  18. Referral expectations of radiology.

    PubMed

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

    1992-08-01

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

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

    ERIC Educational Resources Information Center

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

    2002-01-01

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

  20. Morbidities of cervical cerclage: experience at a tertiary referral center.

    PubMed

    Mubasshir, Saba; Munim, Shama; Zainab, Ghulam

    2012-06-01

    The Perinatal morbidity and mortality associated with pre-term delivery is well known. Cervical incompetence or short cervix is a risk factor for the condition and cervical cerclage is the management option for such cases. The objective of the study was to determine the frequency of operative morbidities of cervical cerclage. All women undergoing cervical cerclage from April 2007 to December 2009 at the Aga Khan University Hospital served as the study subjects. Findings suggested that the risk of developing ruptured membranes after cervical cerclage was 10% and that of pregnancy loss was 8.6%. The risk of cerclage-associated complications like rupture of membranes, bleeding and chorioamnionitis was small. The risk of delivery before 34 weeks of gestation was 15.7%.

  1. 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.

  2. 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…

  3. 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…

  4. Oncologist Factors That Influence Referrals to Subspecialty Palliative Care Clinics

    PubMed Central

    Schenker, Yael; Crowley-Matoka, Megan; Dohan, Daniel; Rabow, Michael W.; Smith, Cardinale B.; White, Douglas B.; Chu, Edward; Tiver, Greer A.; Einhorn, Sara; Arnold, Robert M.

    2014-01-01

    Purpose: Recent research and professional guidelines support expanded use of outpatient subspecialty palliative care in oncology, but provider referral practices vary widely. We sought to explore oncologist factors that influence referrals to outpatient palliative care. Methods: Multisite, qualitative interview study at three academic cancer centers in the United States with well-established palliative care clinics. Seventy-four medical oncologists participated in semistructured interviews between February and October 2012. The interview guide asked about experiences and decision making regarding outpatient palliative care use. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine themes related to palliative care referral decisions. Results: We identified three main oncologist barriers to subspecialty palliative care referrals at sites with comprehensive palliative care clinics: persistent conceptions of palliative care as an alternative philosophy of care incompatible with cancer therapy, a predominant belief that providing palliative care is an integral part of the oncologist's role, and a lack of knowledge about locally available services. Participants described their views of subspecialty palliative care as evolving in response to increasing availability of services and positive referral experiences, but emphasized that views of palliative care as valuable in addition to standard oncology care were not universally shared by oncologists. Conclusions: Improving provision of palliative care in oncology will likely require efforts beyond increasing service availability. Raising awareness of ways in which subspecialty palliative care complements standard oncology care and developing ways for oncologists and palliative care physicians to collaborate and integrate their respective skills may help. PMID:24301842

  5. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  6. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  7. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  8. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  9. 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…

  10. HMO physicians' use of referrals.

    PubMed

    Bachman, K H; Freeborn, D K

    1999-02-01

    Clinical uncertainty is a source of variation in medical decision-making as well as a source of work-related stress. Increasing enrollment in organized health care systems has intensified interest in understanding referral utilization as well as issues such as physician dissatisfaction and burnout. We examined whether primary care physicians' affective reactions to uncertainty and their job characteristics were associated with use of referrals and burnout. Data came from mail surveys of primary care physicians practicing in two large group model health maintenance organizations (HMOs) in the USA. Consistent with past research, we found that younger physicians had higher referral rates than older physicians, and that general internists had higher rates than either family practitioners or pediatricians. Greater stress from uncertainty increased referrals and referrals were negatively correlated with heavier work demands (patient visits per hour). Greater stress from uncertainty, perceived workload (too high) and a sense of loss of control over the practice environment were associated with higher levels of burnout.

  11. "The Friendly Clergy": Characteristics and Referral.

    ERIC Educational Resources Information Center

    Faiver, Christopher M.; O'Brien, Eugene M.; McNally, Christopher J.

    1998-01-01

    Among the recommendations possible in assessment of clients' religious beliefs is that of referral to the "friendly clergy." Delineates guidelines for referral as well as ideal characteristics of that spiritual profession. (Author)

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

    ERIC Educational Resources Information Center

    Roberts, Peter

    2013-01-01

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

  13. 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…

  14. MEDICATION HISTORY DOCUMENTATION IN REFERRAL LETTERS OF CHILDREN PRESENTING AT THE EMERGENCY UNIT OF A TEACHING HOSPITAL IN LAGOS, NIGERIA

    PubMed Central

    Oshikoya, K.A.; Orji, M.U.; Oreagba, I.A.

    2016-01-01

    Background: Medical literature has demonstrated that referral hospitals often receive inadequate information about the care and medications their patients received from referring hospitals. Objective: This study aimed to assess the completeness of referral letters, especially the medication history, for patient presenting at the children emergency room of a teaching hospital in Lagos, Nigeria. Method: A pro forma form was developed to obtain from the referral letters the demographic information of children referred to the emergency room of the Lagos University Teaching Hospital (LUTH), Idiaraba, over a period of three months. The nature of the referring centre, tentative diagnoses made at the referring centre, duration of illness prior to referral, vital signs and physical examination findings, investigation results, and treatment given were also extracted from the letters. In addition, we extracted from the letters the name, dosage, frequency and duration of use of medicines administered at the referring centres. Parents were also interviewed about the details of medicines used prior to presentation of their child at the referring centres. Results: Among those referred with a letter, 100 patients met the inclusion criteria and constituted those evaluated in this study. Most of the patients were referred from general hospitals (31%), another tertiary hospital (29%), and private hospitals/clinics (24%). Gender (30%) and tentative diagnoses (12%) were omitted in the referral letters. However, information about the weight (82%), vital signs (57%), physical examination findings (44%), treatment given (92%), and medication history (71%) were much more omitted in the referral letters. Conclusion: Medication history as well as many other data points is infrequently reported in referral letters to a tertiary care hospital in Lagos, Nigeria. Standard referral guidelines may be useful to improve documentation of medication history. PMID:27721681

  15. 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…

  16. Practice variation in physician referral for allogeneic hematopoietic cell transplantation.

    PubMed

    Pidala, J; Craig, B M; Lee, S J; Majhail, N; Quinn, G; Anasetti, C

    2013-01-01

    Hematological malignancy patients not referred by their primary hematologist/medical oncologist suffer disparate access to allogeneic hematopoietic cell transplantation (HCT). However, investigation into physician, system and patient factors relevant to this decision making is lacking. We surveyed a national randomized sample of practicing hematologists/medical oncologists identified through the AMA (American Medical Association) masterfile. A modified Dillman approach was utilized to encourage survey response. From 1200 surveyed, a total of 113 physicians responded. In all, 68% were male, 62% identified as White/non-Hispanic, 79% practiced in non-academic settings and 80% reported spending 75-100% of their professional effort in clinical care. Using clinical vignettes, we detected significantly increased odds for HCT non-referral according to age (age 60 vs 30, odds ratio (OR) 8.3, 95% confidence interval (CI): 5.9-11.7, P<0.0001), insurance coverage (no coverage vs coverage, OR 6.9, 95% CI: 5.2-9.1, P<0.0001) and race (African-American vs Caucasian, OR 2.4, 95% CI: 1.9-2.9, P<0.0001). Physician (perception of HCT risks), system (insurance coverage) and patient (age, social support and co-morbid illness) factors were strongly endorsed by respondents as important determinants of their HCT referral practices. These data speak to important factors relevant to HCT referral practices, and highlight several opportunities for education and intervention to reduce current disparities.

  17. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1992-01-01

    In this, the concluding article of a six-part series on a longitudinal study of 50 referrals from family physicians in Ontario and Manitoba, the end of the referral process and responsibility for it are examined. Referral seemed to function as a process that, sometimes inappropriately, restored faith or held out hope that medical solutions could be found for difficult, chronic problems. Outcomes were linked to patient agendas and expectations.

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

    PubMed

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

    2015-12-01

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

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

    2016-01-01

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

  2. Marketing a physician referral service.

    PubMed

    Wiggins, C

    1988-01-01

    A recent survey of 670 CEOs revealed that 51 percent had already established physician referral services and 65.2 percent were involved in various activities geared towards strengthening physician relations, one of which was increasing staff personnel to perform these functions (Hospitals March 20, 1987). It is apparent that PRPs have gained wide acceptance and have proved helpful in bettering relations between hospitals and physicians and, at the same time, helped both of them to offer better health care to the public. These programs can be very beneficial to patients and help make the referral system more organized and formal, based on relevant data and knowledge of patients' needs and physicians' needs, qualifications and specialties. Current literature on PRPs is appearing more frequently. Enough hospitals have begun such programs that a new PRP director should be able to research the subject quite thoroughly and become familiar with the possible strengths and weaknesses. Software for PRPs has been developed by various companies which should make the program more useful in terms of data collection, follow-up and provision of feedback. In my opinion PRPs are needed, and if they are marketed correctly, to the physicians initially and then to patients, such programs will prove extremely advantageous to all involved: hospitals, physicians and patients.

  3. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Initial referral. 549.62 Section 549.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES 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...

  4. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Initial referral. 549.62 Section 549.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES 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...

  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. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 31 CFR 904.1 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... COLLECTION STANDARDS (DEPARTMENT OF THE TREASURY-DEPARTMENT OF JUSTICE) REFERRALS TO THE DEPARTMENT OF JUSTICE § 904.1 Prompt referral. (a) Agencies shall promptly refer to the Department of Justice for... interest and penalties, shall be referred to the Civil Division or other division responsible...

  11. 38 CFR 1.950 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Referrals to Gao, Department of Justice, Or Irs § 1.950 Prompt referral. (a) VA shall promptly refer debts to Department of Justice (DOJ) for litigation where aggressive collection activity has been taken in... may direct, exclusive of interest and other late payment charges, shall be referred to the...

  12. 48 CFR 919.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. 48 CFR 619.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  14. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  15. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  16. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  17. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  18. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  19. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  20. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  1. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  2. 48 CFR 1319.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SMALL BUSINESS PROGRAMS Certificates of Competency and Determination of Responsibility 1319.602-1 Referral. When the contracting officer determines that the successful small business offeror lacks certain... cognizant Small Business Administration Government Contracting Area Office. A copy of the referral shall...

  3. Market conditions and general practitioners' referrals.

    PubMed

    Iversen, Tor; Ma, Ching-to Albert

    2011-12-01

    We study how market conditions influence referrals of patients by general practitioners (GPs). We set up a model of GP referral for the Norwegian health care system, where a GP receives capitation payment based on the number of patients in his practice, as well as fee-for-service reimbursements. A GP may accept new patients or close the practice to new patients. We model GPs as partially altruistic, and compete for patients. We show that a GP operating in a more competitive market has a higher referral rate. To compete for patients and to retain them, a GP satisfies patients' requests for referrals. Furthermore, a GP who faces a patient shortage will refer more often than a GP who does not. Tests with Norwegian GP radiology referral data support our theory. PMID:22009482

  4. 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…

  5. 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.

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

    PubMed

    Jung, Minsoo; Choi, Mankyu

    2010-01-01

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

  7. 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…

  8. 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…

  9. 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…

  10. 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,...

  11. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  12. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  13. 29 CFR 20.105 - Minimum referral amount.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false Minimum referral amount. 20.105 Section 20.105 Labor Office... referral amount. The IRS annually establishes the minimum amount for debts otherwise eligible for referral. Minimum referral amounts are established separately for individual debts and business debts, as set...

  14. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  15. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  16. 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…

  17. Tertiary Basins of Spain

    NASA Astrophysics Data System (ADS)

    Friend, Peter F.; Dabrio, Cristino J.

    1996-01-01

    During the Tertiary, Spain suffered compressional collision between France and Africa, and its Atlantic and Mediterranean coasts have been further modified by extensional rifting. Because it includes sectors of two separate foreland basins, and an intervening craton with basins that have been influenced by extensional and strikeSHslip deformation, Spain provides excellent material for the development and testing of theories on the study of sedimentary basin formation and filling. This book is one of the few studies available in English of the important Tertiary geology of Spain.

  18. 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…

  19. Referral guidelines: carpal tunnel syndrome.

    PubMed

    Laws, E R

    1997-07-15

    The contribution on the postoperative management and rehabilitation of patients with carpal tunnel syndrome should be carefully considered by every surgeon. The operation is simply not over when the last stitch goes in; careful postoperative management is quite important if one is to obtain optimal surgical results. The principles outlined here are valuable and help to explain the occasional poor outcome. We have become convinced that the use of a dorsal splint in the 1st week to 10 days following surgery is a helpful measure. It is designed to prevent the median nerve from prolapsing forward and becoming adherent to or trapped by the edges of the severed transverse carpal ligament. With regard to surgical management of carpal tunnel syndrome. It is exceedingly important to continue producing outcome studies showing that our interventions really do eliminate the problem and allow people to return to productive work. Templates for outcome assessment are under development by the Outcomes Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and also by the American College of surgeons. Hopefully, they can be applied to the treatment of carpal tunnel syndrome. The following segment represents some suggested referral guidelines for patients with carpal tunnel syndrome. The present differential diagnosis, methods of confirming the diagnosis, and appropriate indications for considering surgery. These guidelines have been reviewed by the various authors who have contributed to this issue of Neurosurgical Focus and other colleagues in neurosurgery, orthopedics, plastic surgery, neurology, and occupational therapy. It is hoped that they will be a reasonable start in our efforts to inform referring physicians as to the nature of median thenar neuropathy and its overall management.

  20. Diversification of Tertiary Education.

    ERIC Educational Resources Information Center

    Crausaz, Roselyne

    A working party of representatives from the Federal Republic of Germany, France, Norway, Switzerland, and the United Kingdom, visited five capitals to hear accounts of noteworthy innovations or experiments at the tertiary (post secondary) level of education. Diversification as opposed to expansion is currently being tried in many countries because…

  1. 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…

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

    ERIC Educational Resources Information Center

    Nguyen, Thanh Tien

    2016-01-01

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

  3. Visibility of natural tertiary rainbows.

    PubMed

    Lee, Raymond L; Laven, Philip

    2011-10-01

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

  4. Visibility of natural tertiary rainbows.

    PubMed

    Lee, Raymond L; Laven, Philip

    2011-10-01

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

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

    PubMed Central

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  7. 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:…

  8. Asynchronous Telepsychiatry in Maharashtra, India: Study of Feasibility and Referral Pattern

    PubMed Central

    Balasinorwala, Vanshree Patil; Shah, Nilesh B.; Chatterjee, Soumya D.; Kale, Vinayak P.; Matcheswalla, Yusuf A.

    2014-01-01

    Context: There is a paucity of published telepsychiatry results in India. Aims: This study was conducted to assess the feasibility of asynchronous telepsychiatry and to study the referral patterns. Settings and Design: This study was conducted in the telemedicine unit of a tertiary care center and design was retrospective analysis of 94 cases, which were diagnosed and treated by telepsychiatry. Materials and Methods: All 94 patients who were referred between January 2007 and August 2013 for telepsychiatry consultations were retrospectively analyzed to assess the referral pattern and feasibility. Statistical Analysis Used: Comparisons between demographic parameters and psychiatric diagnosis was done using Chi-square test. Results: In 89 out of 94 (95%) patients it was possible to make a definitive diagnosis and recommend appropriate treatment only on the basis of data received from the primary care physician by telepsychiatry. This indicates the feasibility of telepsychiatry. The most common problems for which referrals were made included schizophrenia and other psychotic disorders, mood disorders and substance related disorders. Conclusions: This study demonstrates the feasibility of Asynchronous telepsychiatry. Additional Indian studies should be conducted to build the evidence base for the best use of asynchronous telepsychiatry. PMID:25035555

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  11. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  12. Physiatrist referral preferences for postacute stroke rehabilitation.

    PubMed

    Cormier, David J; Frantz, Megan A; Rand, Ethan; Stein, Joel

    2016-08-01

    This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician demographic characteristics or geography.A cross-sectional survey study was developed with 5 fictional case vignettes that included information about medical, social, and functional domains. Eighty-six physiatrist residents, fellows, and attendings were asked to select the most appropriate postacute rehabilitation setting and also to rank, by importance, 15 factors influencing the referral decision. Chi-square bivariate analysis was used to analyze the data.Eighty-six surveys were collected over a 3-day period. Bivariate analysis (using chi-square) showed no statistically significant relationship between any of the demographic variables and poststroke rehabilitation preference for any of the cases. The prognosis for functional outcome and quality of postacute facility had the highest mean influence ratings (8.63 and 8.31, respectively), whereas location of postacute facility and insurance had the lowest mean influence ratings (5.74 and 5.76, respectively).Physiatrists' referral preferences did not vary with any identified practitioner variables or geographic region; referral preferences only varied significantly by case. PMID:27537563

  13. 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... compliance negotiations or if negotiations are unsuccessful, the designated agency shall refer the matter...

  14. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  15. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  16. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  17. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  18. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

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

  19. Gifted Girls: Gender Bias in Gifted Referrals

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  20. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and, in... Department of Justice of any payments credited by the Department to the debtor's account. Pursuant to 31 CFR... Department of Justice § 30.33 Prompt referral. (a)(1) The Secretary promptly shall refer to Justice...

  1. Descriptive Analysis of Selected Data Referral Networks.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

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

  2. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  3. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  4. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  5. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  6. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  7. 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…

  8. 48 CFR 1419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  9. 48 CFR 419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  10. 48 CFR 2819.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  11. 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

  12. Information and Referral Services: The Resource File.

    ERIC Educational Resources Information Center

    Long, Nicholas; And Others

    This manual was prepared to assist managers of information and referral (I&R) services to develop and maintain an adequate file of resources for the I&R center. Topics covered include preliminary planning, time estimates for set-up and file up-dating; the concept of recruiting volunteers to help operate the center and training that would be…

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  14. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  15. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  16. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  17. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  18. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  19. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 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...

  20. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  1. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 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...

  2. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 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...

  3. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 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...

  4. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  5. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 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...

  6. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 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...

  7. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 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...

  8. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 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...

  9. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Referral for Hearing § 500.224 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 500.224 Section...

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

    ERIC Educational Resources Information Center

    Altus, Grace T.; Altus, William D.

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

  11. 44 CFR 6.10 - Assistance and referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Assistance and referrals. 6.10 Section 6.10 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... referrals. Requests for assistance and referral to the responsible system manager or other FEMA...

  12. Does early sexual debut reduce teenagers' participation in tertiary education? Evidence from the SHARE longitudinal study

    PubMed Central

    Parkes, Alison; Wight, Daniel; Henderson, Marion; West, Patrick

    2010-01-01

    Negative effects of early sexual debut on academic outcomes can extend beyond secondary school, although concurrent changes in other psychosocial risk factors have not been investigated. Data from three waves of a longitudinal survey of Scottish teenagers were used to examine associations between early sexual debut (first heterosexual intercourse) and both expectations for (N = 5,061) and participation in (N = 2,130) tertiary education at college or university. Early debut was associated with reduced tertiary education, after adjusting for academic performance and wave 1 confounders relating to social background, attitudes and behaviours. Pregnancy/partner pregnancy did not explain all of this finding, as many sexually experienced teenagers opted out of tertiary education after leaving school early for other reasons. Changes in other psychosocial risk factors between waves 1 and 2 mediated much of the association found. Early sexual experience may predict disengagement from tertiary education, although further research is needed to explore causal pathways. PMID:19897236

  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. 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…

  15. 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.

  16. [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.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2003-04-01

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

  19. 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

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

    PubMed Central

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

    2014-01-01

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

  1. 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

  2. Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre

    PubMed Central

    Marks, Daniel J. B.; Fisk, Marie D.; Koo, Chieh Y.; Pavlou, Menelaos; Peck, Lorraine; Lee, Simon F.; Lawrence, David; Macrae, M. Bruce; Wilson, A. Peter R.; Brown, Jeremy S.; Miller, Robert F.; Zumla, Alimuddin I.

    2012-01-01

    Background Empyema is an increasingly frequent clinical problem worldwide, and has substantial morbidity and mortality. Our objectives were to identify the clinical, surgical and microbiological features, and management outcomes, of empyema. Methods A retrospective observational study over 12 years (1999–2010) was carried out at The Heart Hospital, London, United Kingdom. Patients with empyema were identified by screening the hospital electronic ‘Clinical Data Repository’. Demographics, clinical and microbiological characteristics, underlying risk factors, peri-operative blood tests, treatment and outcomes were identified. Univariable and multivariable statistical analyses were performed. Results Patients (n = 406) were predominantly male (74.1%); median age = 53 years (IQR = 37–69). Most empyema were community-acquired (87.4%) and right-sided (57.4%). Microbiological diagnosis was obtained in 229 (56.4%) patients, and included streptococci (16.3%), staphylococci (15.5%), Gram-negative organisms (8.9%), anaerobes (5.7%), pseudomonads (4.4%) and mycobacteria (9.1%); 8.4% were polymicrobial. Most (68%) cases were managed by open thoracotomy and decortication. Video-assisted thoracoscopic surgery (VATS) reduced hospitalisation from 10 to seven days (P = 0.0005). All-cause complication rate was 25.1%, and 28 day mortality 5.7%. Predictors of early mortality included: older age (P = 0.006), major co-morbidity (P = 0.01), malnutrition (P = 0.001), elevated red cell distribution width (RDW, P<0.001) and serum alkaline phosphatase (P = 0.004), and reduced serum albumin (P = 0.01) and haemoglobin (P = 0.04). Conclusions Empyema remains an important cause of morbidity and hospital admissions. Microbiological diagnosis was only achieved in just over 50% of cases, and tuberculosis is a notable causative organism. Treatment of empyema with VATS may reduce duration of hospital stay. Raised RDW appears to associate with early mortality. PMID:22276145

  3. Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore.

    PubMed

    Lim, S W; Goh, C L

    2000-12-01

    In a retrospective epidemiologic study of 202 patients with eczematous cheilitis attending a patch test clinic, females (182 (90%)) predominated over males (20 (10%)). The mean age of our patients was 30.9 years. There was no significant difference between the mean age of females (31 years) presenting with cheilitis compared to males (29 years). Endogenous cheilitis (53%) was the commonest diagnosis, followed by allergic contact dermatitis (34%) and irritant contact dermatitis (5.4%). A personal history of atopy was recorded in 33%. There was no significant difference in the prevalence of atopy between the sexes or among the diagnoses. The mean duration of cheilitis was 16.4 months. The duration was significantly longer in males (29 months) than in females (15 months) (p=0.004). The mean number of positive patch test reaction in patients with allergic contact cheilitis (2.8) was significantly higher than in those with irritant contact cheilitis (0.2) (p = 0.012) or endogenous cheilitis (0.5) (p = 0.00). The commonest cause of allergic contact cheilitis were lip cosmetics, including lipsticks and lipbalms, followed by toothpastes. The commonest cause of irritant contact cheilitis was lip-licking, lipsticks and medication. In 81/202 (40%) patients, 1 or more causes of contact cheilitis could be ascertained. In females, lip cosmetics were the commonest cause, accounting for 54% (44/81) of cases. Toothpastes accounted for 21% (17/81), followed by topical medication 7% (6/81). For males, toothpastes were the commonest cause of allergic contact cheilitis. Ricinoleic acid and the patient's own lip preparations were the commonest relevant contact allergens.

  4. 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

  5. An audit of fresh frozen plasma usage in a tertiary referral centre in a developing country.

    PubMed

    Prathiba, R; Jayaranee, S; Ramesh, J C; Lopez, C G; Vasanthi, N

    2001-06-01

    This paper evaluates the practice of fresh frozen plasma (FFP) transfusion at the University Hospital, Kuala Lumpur, and analyses its usage by the various clinical departments. The aim of this study is to identify where it is inappropriately used and the clinical indications in which such misuse is common. A retrospective analysis of the blood bank request forms and work sheets during a 6-month period between January 1998 and June 1998 formed the basis of this study. Overall, 40% of 2665 units transfused were considered appropriate. However, out of the 931 episodes of FFP transfusions only 31% were for appropriate indications. The average FFP requirement when used for appropriate indication was about 4 units per episode, whereas for inappropriate indication it was 2.5 units per episode. Inappropriate use in terms of the number of units was highest by the surgical services (68%) and Orthopaedics (64%), while the Department of Paediatrics had the lowest incidence of inappropriate use (40%). When Paediatrics was used as the benchmark, the incidence of inappropriate use by other departments was significantly higher (p < 0.01). As for FFP usage in common clinical indications, there was a high incidence of inappropriate use in burns (82%), perioperative period (73%), cardiac surgery (68%), massive bleeding (62%) and trauma (60%). The findings in this study, specifically the use of FFP for volume support in trauma, massive bleeding and burns, routine requests without identified indication in cardiac bypass surgery, and prophylactic use in the perioperative period can be the basis for recommendations to minimize the inappropriate use of FFP in the future.

  6. 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.

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

    PubMed Central

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

    2016-01-01

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

  8. 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.

  9. Breast clinic triage tool: telephone assessment of new referrals.

    PubMed

    Cusack, Leila; Brennan, Meagan; Weissenberg, Leisha; Moore, Katrina

    2012-04-01

    Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone.

  10. 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…

  11. Comparison of specialty referral patterns of primary care providers.

    PubMed

    Fisher, Linda W

    2002-01-01

    Difficulty, perceived by 17 treatment facilities, of obtaining specialty referral appointments at Dwight David Eisenhower Army Medical Center (DDEAMC), a major referral center, prompted this study that utilizes provider profiling as a tool to answer three questions that examine the problem: (1) Is the difficulty in obtaining referral appointments real or perceived? (2) Are the referral patterns of the providers contributing factors in the perceived inability to meet the demand for specialty appointments? (3) If the providers' referral patterns are a contributing factor, which provider behaviors need to be modified? Major findings of the study included: 1. the referral rate of the primary care providers was 8 percent, compared to the national average of 7.5 percent; 2. interns and residents were provider outliers with referral rates of 11.7 percent and 13.5 percent, respectively; and 3. of the 32,182 referral appointments requested during Fiscal Year 1999, slightly less than 2.4 percent were disengaged. Data analysis indicates opportunities for improvement of referral rates in DDEAMC's department of primary care by addressing the referral practices of residents and interns, which will therefore decrease the number of disengaged patients. By decreasing the number of referrals, the organization will more effectively control internal costs in an era of shrinking budgets. PMID:12055901

  12. Improving referral compliance after public cholesterol screening.

    PubMed Central

    Maiman, L A; Hildreth, N G; Cox, C; Greenland, P

    1992-01-01

    BACKGROUND. Noncompliance with referral to a physician for retesting and diagnosis is a concern in public cholesterol screening. METHODS. Participants (n = 2109) were referred by a health professional or lay communicator and randomly assigned to a coupon offer, referral reminder letter, or control group. A questionnaire was completed at screening, and a telephone interview was conducted 5 months later. RESULTS. Physician visit rates showed no professional or lay differences. For "no history" subjects, the behavioral interventions were effective compared with controls (coupon = 60.7% and reminder = 57.7% vs control = 46.1%). With professional counseling, only the coupon was effective; for lay counseling, both coupon and reminder yielded higher visit rates. Adjusted for sociodemographics, heart disease risk factors, and health perceptions, the intervention effects remained (professional-coupon offer: odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.21, 3.09; professional-reminder letter: OR = 1.04, 95% CI = 0.67, 1.63; lay-coupon offer: OR = 2.52, 95% CI = 1.52, 4.18; and lay-reminder letter: OR = 3.10, 95% CI = 1.83, 5.22). CONCLUSIONS. For unaware participants, lay counselors and referral follow-up efforts tailored to specific cholesterol risk groups are indicated. PMID:1316721

  13. 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…

  14. Challenges of Student Selection: Predicting Academic Performance

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  15. 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.

  16. Academic Jibberish

    ERIC Educational Resources Information Center

    Krashen, Stephen

    2012-01-01

    In this article, the author talks about academic jibberish. Alfie Kohn states that a great deal of academic writing is incomprehensible even to others in the same area of scholarship. Academic Jibberish may score points for the writer but does not help research or practice. The author discusses jibberish as a career strategy that impresses those…

  17. 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…

  18. 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…

  19. 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

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

    PubMed

    Borus, Joshua; Parhami, Iman; Levy, Sharon

    2016-10-01

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

  1. Physician Factors Associated with Outpatient Palliative Care Referral

    PubMed Central

    Ahluwalia, Sangeeta C.; Fried, Terri R.

    2010-01-01

    Background Outpatient palliative care can provide significant benefits to seriously ill patients, but several barriers to appropriate referrals remain. No study has examined the physician factors associated with referral to outpatient palliative care. Objective To determine physician factors, with a focus on physician beliefs, associated with referral to palliative care. Design Cross-sectional study of 170 primary care physicians at Kaiser Permanente (KP), a large nonprofit health maintenance organization (HMO), using a self-administered questionnaire. Results Of the 145 respondents, 100 (70%) reported referring any patients to the palliative care program in the prior year, with a median of 3 referrals (interquartile range 2, 6). Factors associated with referral included working at KP between 10 and 20 years as compared to <10 years [Odds ratio [OR] 6.29 (95% confidence interval [CI] 1.38, 28.6)] and having personal experience with palliative care [OR 2.13 (95% CI 0.95, 4.976)]. None of the beliefs scales was associated with referral. Conclusions Physician characteristics other than their beliefs about palliative care played a significant role in determining referral. Palliative care programs should aim to increase their visibility in the outpatient setting to increase referrals by primary care physicians. Tools that help physicians identify seriously ill patients who could benefit from palliative care may also serve to increase appropriate referrals. PMID:19460830

  2. 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…

  3. Information and Referral Services: Information-Giving and Referral (Working Draft, 2nd Revision).

    ERIC Educational Resources Information Center

    Tessari, Diane C.; And Others

    The basic linkage service of an information and Referral (I and R) center is discussed in this manual. By itself, information-giving can be very important. It helps make people in a community more aware of the services available to them, and it can go a long way toward making their lives healthier and happier. In addition, if records are properly…

  4. 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…

  5. 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.

  6. 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

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

    PubMed

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

    2015-08-01

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

  8. Sustaining Academic Life: A Case for Applying Principles of Social Sustainability to the Academic Profession

    ERIC Educational Resources Information Center

    Hammond, Cathryn; Churchman, Deborah

    2008-01-01

    Purpose: This paper aims to examine the social sustainability of academic work in Australian tertiary institutions, in addition to offering a summary of recent research on social sustainability with a particular emphasis on Barron and Gauntlett's work. Design/methodology/approach: Barron and Gauntlett's principles of social sustainability are used…

  9. Dropping the Baton: Specialty Referrals in the United States

    PubMed Central

    Mehrotra, Ateev; Forrest, Christopher B; Lin, Caroline Y

    2011-01-01

    Context: In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the frequency of referrals and the importance of the specialty-referral process, the process itself has been a long-standing source of frustration among both primary care physicians (PCPs) and specialists. These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines. Methods: This article reviews the literature on the specialty-referral process in order to better understand what is known about current problems with the referral process and what solutions have been proposed. The article first provides a conceptual framework and then reviews prior literature on the referral decision, care coordination including information transfer, and access to specialty care. Findings: PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist's role during the referral episode (e.g., single consultation or continuing co-management). Conclusions: There are breakdowns and inefficiencies in all components of the specialty-referral process. Despite many promising mechanisms to improve the referral process, rigorous evaluations of these improvements are needed. PMID:21418312

  10. 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…

  11. 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…

  12. 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…

  13. 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…

  14. 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…

  15. The Relationship of Season of Birth and Special Education Referral.

    ERIC Educational Resources Information Center

    Wallingford, Elizabeth L.; Prout, H. Thompson

    2000-01-01

    Study evaluated referrals of students (N=1,222) for special education from grades K-5 to determine if youngest children were experiencing a higher rate of referral. Data confirmed the hypothesis that children referred for evaluations within the 5- to 7-year-old-group had summer birthdates. Article discusses ways of providing educational services…

  16. 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…

  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... DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five person Dispute Resolution Committee membership shall be determined according to Compact Article VI (g). Should...

  18. 29 CFR 1601.29 - Referral to the Attorney General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral to the Attorney General. 1601.29 Section 1601.29... of Civil Actions § 1601.29 Referral to the Attorney General. If the Commission is unable to obtain... shall inform the Attorney General of the appropriate facts in the case with recommendations for...

  19. 45 CFR 30.36 - Minimum amount of referrals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Minimum amount of referrals. 30.36 Section 30.36... to the Department of Justice § 30.36 Minimum amount of referrals. (a) Except as in paragraph (b) of... such other amount as the Attorney General may prescribe, shall not be referred for litigation. (b)...

  20. 29 CFR 102.172 - Minimum referral amount.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Minimum referral amount. 102.172 Section 102.172 Labor... Procedures By Federal Income Tax Refund Offset § 102.172 Minimum referral amount. The minimum amount of a... business debtors. The amount referred may include the principal portion of the debt, as well as any...

  1. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Referrals to civilian lawyers. 727.9 Section 727.9 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL LEGAL ASSISTANCE § 727.9 Referrals to civilian lawyers. (a) General. If it is determined that the legal...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Certification and referral of debt. 31.4 Section... § 31.4 Certification and referral of debt. (a) Certification. The Secretary shall certify to FMS that: (1) The debt is past-due and legally enforceable in the amount submitted and that the Department...

  3. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 2 2011-04-01 2011-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  4. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 2 2013-04-01 2013-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  5. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 2 2012-04-01 2012-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  6. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  7. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  8. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  9. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  10. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  11. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  12. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... applies when a Federal, State, or local court holds in abeyance, or refers to the Commissioner, any matter... promptly agree or decline to accept a court referral. Whenever feasible in light of agency priorities and resources, the Commissioner shall agree to accept a referral and shall proceed to determine the...

  13. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... applies when a Federal, State, or local court holds in abeyance, or refers to the Commissioner, any matter... promptly agree or decline to accept a court referral. Whenever feasible in light of agency priorities and resources, the Commissioner shall agree to accept a referral and shall proceed to determine the...

  14. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... applies when a Federal, State, or local court holds in abeyance, or refers to the Commissioner, any matter... promptly agree or decline to accept a court referral. Whenever feasible in light of agency priorities and resources, the Commissioner shall agree to accept a referral and shall proceed to determine the...

  15. 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...

  16. 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...

  17. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  18. Best practices in developmental screening and referral for young children.

    PubMed

    Myers, Lynnea

    2014-12-13

    Developmental screening is recommended by the American Academy of Pediatrics as best practice to identify children with developmental delays. Nurse practitioners play a critical role in developmental screening and referral. This article describes best practices in developmental screening and referral resources available to NPs performing developmental screening. PMID:25397740

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  4. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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...

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

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 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...

  6. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 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...

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2012-01-01 2012-01-01 false Referrals of Debts to Justice. 3.21 Section...

  8. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2013-01-01 2013-01-01 false Referrals of Debts to Justice. 3.21 Section...

  9. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2014-01-01 2014-01-01 false Referrals of Debts to Justice. 3.21 Section...

  10. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 1 2012-07-01 2012-07-01 false 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... Referral to Department of Justice. An award, compromise or settlement of a claim under section 2672...

  11. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  12. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  13. 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...

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  15. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

  16. 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...

  17. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  18. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section...

  19. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 34 2012-07-01 2012-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  20. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  1. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  2. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 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...

  3. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2011-01-01 2011-01-01 false Referrals of Debts to Justice. 3.21 Section...

  4. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... importance and request the referring and lead agencies to pursue their decision process. (5) Determine that... Procedure for referrals and response. (a) A Federal agency making the referral to the Council shall: (1...) Contain a finding by the agency whether the issue raised is of national importance because of the...

  5. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CLAIMS Jurisdiction of Arbitrator, Referral of Claims, and Appointment of Arbitrator § 304.21 Referral of... submitted pursuant to the procedures established by this part by an Arbitrator appointed pursuant to § 304... effective, any such modification must be signed by the Arbitrator and all other parties. The joint...

  6. Developing At-Risk Referral Procedures for Rural Areas.

    ERIC Educational Resources Information Center

    Olson, Jennifer; Bostick, Mary

    1986-01-01

    A screening and referral procedure for rural, at-risk infants was developed by a three-step process that: (1) identified key professionals; (2) educated rural medical personnel regarding benefits and strategies of early intervention; and (3) implemented a screening and referral system with low temporal and monetary costs for hospital personnel.…

  7. 32 CFR 516.36 - Referral to Litigation Division.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Referral to Litigation Division. 516.36 Section... Property Claims Assertion of Other Claims § 516.36 Referral to Litigation Division. (a) General. The... channels to Litigation Division with a litigation report. (See § 516.23 of this part). (b)...

  8. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  9. 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... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... 49 Transportation 3 2010-10-01 2010-10-01 false Referral, evaluation, and treatment....

  10. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  11. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  12. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  13. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  14. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  15. Online referral and OPD booking from the GP desktop.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Wright, Bernadette; Mainwaring, Paul; Holliday, Dimity; Lankowski, Andrew; Kardash, Christine

    2006-08-01

    The Brisbane Inner South E-referral Project (BISEP) developed an application which allowed general practitioners, from their desktop, to successfully search for and book an available hospital outpatient appointment for patients with suspected cancer, send the referral electronically, and inform the patient of both the appointment and referral during the consultation. The hospital changed their outpatient department processes to allow such functionality for local GPs with patients with suspected cancer, working from a mutually agreed set of best practice referral criteria. A group of 19 GPs participated in an 11-week pilot implementation of the application, and were enthusiastic about continuing and expanding the approach. Patient satisfaction measures post intervention indicated that they perceived no major disadvantage in this form of outpatient department referral. PMID:16879099

  16. 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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  18. 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…

  19. Academic Decathlon.

    ERIC Educational Resources Information Center

    Association of California School Administrators.

    This position paper from the Research, Evaluation, and Accreditation Committee of the Association of California School Administrators (ACSA) presents a description of the Academic Decathlon program and offers recommendations for improving the program and ways that ACSA can assist the program. The description of the Academic Decathlon, a ten-event…

  20. 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…

  1. 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

  2. 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)

  3. [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.

  4. [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.

  5. Surgeon Specialty Influences Referral Rate for Osteoporosis Management following Vertebral Compression Fractures

    PubMed Central

    Daffner, Scott D.; Karnes, Jonathan M.; Watkins, Colleen M.

    2015-01-01

    Study Design  Retrospective chart review. Objective  To evaluate the referral rate for long-term osteoporosis management following vertebral compression fracture treated by different specialties at a single academic institution. Methods  Patients undergoing vertebral cement augmentation for painful osteoporotic compression fractures from 2009 to 2014 were identified. Medical records were reviewed to determine if the treating surgeon discussed and/or referred the patient for long-term osteoporosis management. Any referral for or mention of medical long-term osteoporosis management was counted as a positive response. Results were statistically analyzed with chi-square test. Results  Two hundred fourteen patients underwent vertebral cement augmentation; 150 met inclusion criteria. Orthopedic surgeons treated 88 patients, neurosurgeons treated 39, and interventional radiology or pain management physicians treated 23. Orthopedic surgeons referred 82% of patients for osteoporosis management, neurosurgeons referred 36%, and interventional radiology/pain management referred 17%. The referral rate was significantly higher for orthopedic surgeons compared with either of the other two groups; there was no significant difference between neurosurgery and interventional radiology/pain management. Conclusions  Among physicians who treat osteoporotic vertebral compression fractures, orthopedic surgeons more frequently address osteoporosis or refer patients for osteoporosis management compared with neurosurgeons and interventional radiologists or pain management physicians. The results of this study shed light on the disparity in how different specialties approach treatment of osteoporosis in patients with fractures painful enough to require surgery and highlight potential areas for improvement in osteoporosis awareness training. PMID:27555992

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  8. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  9. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  10. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  11. Making effective referrals: a knowledge-management approach.

    PubMed Central

    Einbinder, J. S.; Klein, D. A.; Safran, C. S.

    1997-01-01

    Patients and physicians often choose specially consultants with only limited knowledge of the available options. Access to information about specialists that was directly relevant to patient and clinician preferences could improve the effectiveness of the referral process. We have developed a prescriptive representation of the process of selecting consultants. This "referral map," based on decision theory, uses patient and provider preferences elicited through a literature review and interviews with physicians and provides a formal framework for representing referral knowledge and for evaluating referral options. Our method suggests that the goals and processes of selecting consultants can be managed more systematically using explicit repositories. Such systematic management promises to have a beneficial impact on the delivery of health care, as well as on patient satisfaction. PMID:9357642

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Referrals to the Department of Justice... 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...

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

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Referrals to the Department of Justice... 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...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Referrals to the Department of Justice... 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...

  15. 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...

  16. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Referrals to the Department of Justice... 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...

  17. 10 CFR 820.72 - Referral to the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Referral to the Attorney General. 820.72 Section 820.72 Energy DEPARTMENT OF ENERGY PROCEDURAL RULES FOR DOE NUCLEAR ACTIVITIES Criminal Penalties § 820.72 Referral to the Attorney General. If there is reason to believe a criminal violation of the Act or the DOE Nuclear Safety Requirements has occurred,...

  18. Parathyroid carcinoma in tertiary hyperparathyroidism.

    PubMed

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

    2016-10-01

    Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography-computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis. PMID:27664600

  19. 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

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

    PubMed

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

    2016-01-01

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

  1. The Spectrum of Central Nervous System Infections in an Adult Referral Hospital in Hanoi, Vietnam

    PubMed Central

    Taylor, Walter R.; Nguyen, Kinh; Nguyen, Duc; Nguyen, Huyen; Horby, Peter; Nguyen, Ha L.; Lien, Trinh; Tran, Giang; Tran, Ninh; Nguyen, Ha M.; Nguyen, Thai; Nguyen, Ha H.; Nguyen, Thanh; Tran, Giap; Farrar, Jeremy; de Jong, Menno; Schultsz, Constance; Tran, Huong; Nguyen, Diep; Vu, Bich; Le, Hoa; Dao, Trinh; Nguyen, Trung; Wertheim, Heiman

    2012-01-01

    Objectives To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam. Methods From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent routine testing, staining (Gram, Ziehl-Nielsen, India ink), bacterial culture and polymerase chain reaction targeting Neisseria meningitidis, Streptococcus pneumoniae, S. suis, Haemophilus influenzae type b, Herpes simplex virus (HSV), Varicella Zoster virus (VZV), enterovirus, and 16S ribosomal RNA. Blood cultures and clinically indicated radiology were also performed. Patients were classified as having confirmed or suspected bacterial (BM), tuberculous (TBM), cryptococcal (CRM), eosinophilic (EOM) meningitis, aseptic encephalitis/meningitis (AEM), neurocysticercosis and others. Results 352 (male: 66%) patients were recruited: median age 34 years (range 13–85). 95/352 (27.3%) diagnoses were laboratory confirmed and one by cranial radiology: BM (n = 62), TBM (n = 9), AEM (n = 19), CRM (n = 5), and neurocysticercosis (n = 1, cranial radiology). S. suis predominated as the cause of BM [48/62 (77.4%)]; Listeria monocytogenese (n = 1), S. pasteurianus (n = 1) and N. meningitidis (n = 2) were infrequent. AEM viruses were: HSV (n = 12), VZV (n = 5) and enterovirus (n = 2). 5 patients had EOM. Of 262/352 (74.4%) patients with full clinical data, 209 (79.8%) were hospital referrals and 186 (71%) had been on antimicrobials. 21 (8%) patients died: TBM (15.2%), AEM (10%), and BM (2.8%). Conclusions Most infections lacked microbiological confirmation. S. suis was the most common cause of BM in this setting. Improved diagnostics are needed for meningoencephalitic syndromes to inform treatment and prevention strategies. PMID:22952590

  2. 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.

  3. 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…

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

    ERIC Educational Resources Information Center

    Lee, Benny P. H.

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Shore, Cris; Davidson, Miri

    2014-01-01

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

  6. Psychological and physiological characteristics of a proposed object-referral/self-referral continuum of self-awareness.

    PubMed

    Travis, Frederick; Arenander, Alarik; DuBois, David

    2004-06-01

    This research extends and confirms recent brainwave findings that distinguished an individual's sense-of-self along an Object-referral/Self-referral Continuum of self-awareness. Subjects were interviewed and were given tests measuring inner/outer orientation, moral reasoning, anxiety, and personality. Scores on the psychological tests were factor analyzed. The first unrotated PCA component of the test scores yielded a "Consciousness Factor," analogous to the intelligence "g" factor, which accounted for over half of the variance among groups. Analysis of unstructured interviews of these subjects revealed fundamentally different descriptions of self-awareness. Individuals who described themselves in terms of concrete cognitive and behavioral processes (predominantly Object-referral mode) exhibited lower Consciousness Factor scores, lower frontal EEG coherence, lower alpha and higher gamma power during tasks, and less efficient cortical preparatory responses (contingent negative variation). In contrast, individuals who described themselves in terms of an abstract, independent sense-of-self underlying thought, feeling and action (predominantly Self-referral mode) exhibited higher Consciousness Factor scores, higher frontal coherence, higher alpha and lower gamma power during tasks, and more efficient cortical responses. These data suggest that definable states of brain activity and subjective experiences exist, in addition to waking, sleeping and dreaming, that may be operationally defined by psychological and physiological measures along a continuum of Object-referral/Self-referral Continuum of self-awareness.

  7. 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…

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

    PubMed

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

    2004-08-01

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

  9. Cancer genetics evaluation: barriers to and improvements for referral.

    PubMed

    Brandt, Rachael; Ali, Zonera; Sabel, Allison; McHugh, Terri; Gilman, Paul

    2008-03-01

    Despite the availability of cancer susceptibility testing, little information exists regarding physicians' selection and referral of eligible patients. This study provides insight into whom, why, and when physicians refer for cancer genetics evaluation, as well as their comfort level within this role. Eighty-two physicians (51 primary care, 15 gynecology, 11 surgery and 5 oncology) completed a survey (response rate: 34%) regarding cancer genetics referral practices. Of these, 59% reported an awareness of the hospital's cancer genetics program. Program awareness was greater among oncologists, surgeons, and gynecologists than among primary care physicians (p < 0.0001). Patients were referred for enhanced risk assessment (88%), improved medical management (85%), and concern for family members (83%). Patient eligibility was based on family cancer history (96%), patient cancer history (83%), and patient request (73%). Patients were not referred mainly due to patient disinterest (54%) or physician concern about either insurance coverage (44%) or insurance discrimination (31%). Primary care physicians were less comfortable with identifying patients for referral (p < 0.001) and with discussing genetics (p < 0.002) than specialists. The largest barriers to referral were lack of program awareness and limited knowledge regarding patient eligibility, improved insurance coverage, and antidiscrimination legislation. Physician-targeted marketing and education may improve the referral process. PMID:18373400

  10. Criminal justice referral and incentives in outpatient substance abuse treatment

    PubMed Central

    DeFulio, Anthony; Stitzer, Maxine; Roll, John; Petry, Nancy; Nuzzo, Paul; Schwartz, Robert P.; Stabile, Patricia

    2013-01-01

    A substantial number of substance abusers entering outpatient psychosocial counseling treatment are referred from the criminal justice (CJ) system. This secondary analysis of previously published findings from a large (N=415) multi-site trial of a prize-based abstinence incentive intervention (Petry et al., 2005) examined the influence of CJ referral on usual care outcomes and response to the incentive procedure. CJ referrals (n=138) were more likely than those not CJ referred (n=277) to provide stimulant negative urine samples whether missing samples were counted as positive (50 versus 41%, p=.016) or as missing (96 versus 91%, p<.001). A significant interaction term was found only for percentage of treatment completers (p=.027). However, on that retention variable, and three additional drug use measures, significant incentive effects were confined to participants who entered treatment without referral from the criminal justice system. The study suggests that abstinence incentives should be offered as a first priority to stimulant users entering treatment without criminal justice referral. However, incentives can be considered for use with CJ-referred stimulant users based on the observation that best outcomes were obtained in CJ referrals who also received the abstinence incentive program. PMID:23433822

  11. 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…

  12. Academic Cloning.

    ERIC Educational Resources Information Center

    Sikula, John P.; Sikula, Andrew F.

    1980-01-01

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

  13. Academic Culture.

    ERIC Educational Resources Information Center

    Clark, Burton R.

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

  14. Academic Politics.

    ERIC Educational Resources Information Center

    Brown, William R.

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

  15. Academic Freedom.

    ERIC Educational Resources Information Center

    Tobin, Brian G.

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

  16. Prospective evaluation of the value of direct referral hearing aid clinic in management of young patients with bilateral hearing loss.

    PubMed

    Abdelkader, M; McEwan, M; Cooke, L

    2004-06-01

    The purpose of this study was to evaluate the value and effectiveness of a direct referral hearing aid clinic (DRHAC) in providing appropriate hearing aids to young patients aged 18-60 years while at the same time identifying patients with significant ear disease who need an otologist's opinion. The patients were referred to a tertiary referral hearing assessment clinic. A total of 137 patients (18-60 years) met the criteria to be included in the study to be assessed in the clinic by both an audiometrician and an otologist. The main outcome measures were hearing evaluation and audiometrician's management. Of them, 114 patients attended the research clinic (83%), 23 patients (17%) did not attend the clinic and 57 patients (51%) did not need any treatment or further investigation as their hearing was normal or near normal. Thirty patients (27%) were given hearing aids. Twenty-five patients (22%) failed the audiometrician assessment and were referred to the otologist. Only 13 (18%) of the 25 patients referred for an otological opinion actually required further investigations, medical or surgical treatment. DRHAC is as viable a system in the younger as in the elderly population.

  17. 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.…

  18. Referrals from general practitioners to a social services department.

    PubMed

    Sheppard, M G

    1983-01-01

    One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem.

  19. Tertiary hypothyroidism in a dog

    PubMed Central

    2007-01-01

    A nine-year-old male entire Labrador was diagnosed with pituitary dependent hyperadrenocorticism. Following seven months of successful mitotane therapy, the dog presented with marked weight gain, seborrhoea and alopecia. Routine clinicopathological analyses revealed marked hypercholesterolaemia. Serum total and free thyroxine (T4) concentrations were below their respective reference ranges. Serum thyroid stimulating hormone (cTSH) concentration was within reference range. TSH and thyrotropin releasing hormone (TRH) response tests revealed adequate stimulation of total T4 in both, and cTSH in the latter test. Magnetic resonance imaging revealed a mass arising from the pituitary fossa, with suprasellar extension. A diagnosis of tertiary hypothyroidism was made. Following four weeks of levothyroxine therapy, circulating cholesterol concentration had declined, weight loss had ensued and dermatological abnormalities had improved. Euthanasia was performed four months later due to the development of neurological signs. A highly infiltrative pituitary adenoma, with effacement of the overlying hypothalamus was identified on post mortem examination. Tertiary hypothyroidism has not been previously reported in dogs. PMID:21851691

  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. Appropriateness of referrals for removal of wisdom teeth.

    PubMed

    Westcott, K; Irvine, G H

    2002-08-01

    A 6-month prospective study of 166 patients was undertaken to assess whether general dental practitioners who referred patients for removal of wisdom teeth were following current national guidelines. It was found that 92% of referrals followed the guidelines of the Faculty of Dental Surgery of the Royal College of Surgeons of England and the National Institute for Clinical Excellence. There were 13 inappropriate referrals - 3 patients were asymptomatic, 9 patients had a single episode of pericoronitis and 1 had crowding of the lower anterior incisors. General dental practitioners in this study seem to be following current guidelines consistently. No teeth were removed prophylactically.

  2. 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…

  3. Towards Tertiary Education. Staff and Staff Development.

    ERIC Educational Resources Information Center

    Ratcliffe, Joan

    This report is intended as a resource for all those interested in staff development, especially in the tertiary education context. It describes the staff development project in the first two years of a new tertiary college--Harlow Technical College in England. An introduction and a description of the context of the project begin the report.…

  4. Engaging Heterogeneity: Tertiary Literacy in New Times.

    ERIC Educational Resources Information Center

    Hirst, Elizabeth Wyshe

    The "massification" of higher education in Australia and the associated increasing student diversity have significant implications for tertiary education. In particular, students seem to be struggling with the demands of tertiary literacy with commentators claiming that literacy standards are in decline. The solution has been to provide study…

  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. Changing Tertiary Education in Modern European Society.

    ERIC Educational Resources Information Center

    Council for Cultural Cooperation, Strasbourg (France).

    Reports on recent developments and problems in the diversification of tertiary education in seven Western European countries are presented by members of the Working Party on the Diversification of Tertiary Education. Policy analysis and evaluation and recommendations for future policy are also provided. As a policy, diversification refers to the…

  7. Nodular tertiary syphilis in an immunocompetent patient.

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  10. Comparing academic and community-based hospitalists.

    PubMed

    Malkenson, David; Siegal, Eric M; Leff, Jared A; Weber, Rachel; Struck, Rhonda

    2010-01-01

    In 2006, hospitalist programs were formally introduced at both an academic and community hospital in the same city providing an opportunity to study the similarities and differences in workflows in these two settings. The data were collected using a time-flow methodology allowing the two workflows to be compared quantitatively. The results showed that the hospitalists in the two settings devoted similar proportions of their workday to the task categories studied. Most of the time was spent providing indirect patient care followed by direct patient care, travel, personal, and other. However, after adjusting for patient volumes, the data revealed that academic hospitalists spent significantly more time per patient providing indirect patient care (Academic: 54.7 +/- 11.1 min/patient, Community: 41.9 +/- 9.8 min/patient, p < 0.001). Additionally, we found that nearly half of the hospitalists' time at both settings was spent multitasking. Although we found subtle workflow differences between the academic and community programs, their similarities were more striking as well as greater than their differences. We attribute these small differences to the higher case mix index at the academic program as well greater complexity and additional communication hand-offs inherent to a tertiary academic medical center. It appears that hospitalists, irrespective of their work environment, spend far more time documenting, communicating and coordinating care than they do at the bedside raising the question, is this is a necessary feature of the hospitalist care model or should hospitalists restructure their workflow to improve outcomes?

  11. Interviewer's Handbook for Selection and Referral to Training and Placement.

    ERIC Educational Resources Information Center

    Manpower Administration (DOL), Washington, DC. U.S. Training and Employment Service.

    This handbook is designed to assist local employment service personnel in effective selection and referral of applicants to training and job opportunities. Guidelines for placement are combined with detailed information on training programs. General guidelines for the identification of disadvantaged applicants are supplemented with a discussion of…

  12. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... the assistance requested, the client should be referred to a civilian lawyer. When the client does not... organization, lawyer referral service, legal aid society, or other local organization for assistance in... organization. (b) Fees charged by civilian lawyers. Legal assistance clients being referred to a...

  13. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral and scheduling for hearing. 1603.201 Section 1603... scheduling for hearing. (a) Upon request by the complainant under paragraph (b) of this section or if the... of Federal Operations shall transmit the complaint file to an administrative law judge,...

  14. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 4 2011-07-01 2011-07-01 false Referral and scheduling for hearing. 1603.201 Section 1603... scheduling for hearing. (a) Upon request by the complainant under paragraph (b) of this section or if the... of Federal Operations shall transmit the complaint file to an administrative law judge,...

  15. 29 CFR 1603.103 - Referral of complaints.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... EXEMPT STATE AND LOCAL GOVERNMENT EMPLOYEE COMPLAINTS OF EMPLOYMENT DISCRIMINATION UNDER SECTION 304 OF THE GOVERNMENT EMPLOYEE RIGHTS ACT OF 1991 Administrative Process § 1603.103 Referral of complaints. (a) The Commission will notify an FEP agency, as defined in 29 CFR 1601.3(a), when a complaint...

  16. 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…

  17. 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.

  18. 45 CFR 30.36 - Minimum amount of referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to the Department of Justice § 30.36 Minimum amount of referrals. (a) Except as in paragraph (b) of this section, claims of less than $2,500 exclusive of interest, penalties, and administrative costs, or... the Financial Litigation Staff of the Executive Office for United States Attorneys in Justice prior...

  19. 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…

  20. 49 CFR 825.10 - Referral of record.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 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 §...

  1. 38 CFR 1.920 - Referral of VA debts.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... purpose of salary offset shall be done in accordance with 38 CFR 1.980 through 1.995 and regulations prescribed by the Director of the Office of Personnel Management (OPM) in 5 CFR part 550, subpart K... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Referral of VA debts....

  2. 38 CFR 1.920 - Referral of VA debts.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... purpose of salary offset shall be done in accordance with 38 CFR 1.980 through 1.995 and regulations prescribed by the Director of the Office of Personnel Management (OPM) in 5 CFR part 550, subpart K... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Referral of VA debts....

  3. 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…

  4. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Referral of questions by superintendent. 217.3 Section 217.3 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE INDIAN TRIBE, UINTAH AND OURAY RESERVATION, UTAH, BY THE TRIBE AND THE...

  5. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Referral of questions by superintendent. 217.3 Section 217.3 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE INDIAN TRIBE, UINTAH AND OURAY RESERVATION, UTAH, BY THE TRIBE AND THE...

  6. Disagreement Rules, Referral Rules and the Spanish Feminine Article "el."

    ERIC Educational Resources Information Center

    Harris, J. W.

    1987-01-01

    The Spanish feminine article /el/, ordinarily the singular masculine definite article, has been used as evidence of the need for obligatory disagreement rules. Others explain the anamoly by means of referral rules. A third solution is suggested: an allomorphy rule which can be interpreted syntactically or phonologically. (LMO)

  7. 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...

  8. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false 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 section 2672 title 28, United States...

  9. 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…

  10. 29 CFR 1603.103 - Referral of complaints.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... EXEMPT STATE AND LOCAL GOVERNMENT EMPLOYEE COMPLAINTS OF EMPLOYMENT DISCRIMINATION UNDER SECTION 304 OF THE GOVERNMENT EMPLOYEE RIGHTS ACT OF 1991 Administrative Process § 1603.103 Referral of complaints... filed by a state or local government employee or applicant under this part concerning an...

  11. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 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...

  12. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 382.605... CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING Alcohol Misuse and Controlled Substances Use...

  13. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2011-10-01 2011-10-01 false Referral, evaluation, and treatment. 382.605... CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING Alcohol Misuse and Controlled Substances Use...

  14. 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.

  15. Developing Material and Organizational Resources: The Resource and Referral Service.

    ERIC Educational Resources Information Center

    Hull, William L.

    The Resource and Referral Service (RRS), is a central services contractor to the Research and Development Exchange (RDx), which facilitates the flow of outputs from Research and Development (R&D) based organizations, specializing in fast responses to questions from states transmitted by the Regional Exchanges on R&D in education, testing, and…

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

    ERIC Educational Resources Information Center

    Ysseldyke, James E.; Algozzine, Bob

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

  17. 29 CFR 1425.5 - Referral to FSIP.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  18. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Program Design Requirements for Programs Under Title II of the Job Training Partnership Act § 628.510 Intake, referrals and targeting. (a) Collection of..., including the Job Corps program. In these cases, information on the full array of services available in...

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

    PubMed

    Devnani, M; Gupta, Ak; Nigah, R

    2010-04-01

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

  20. Prevalence and diagnostic challenge of dystonia in Thailand: a service-based study in a tertiary university referral centre.

    PubMed

    Bhidayasiri, Roongroj; Kaewwilai, Lalita; Wannachai, Natnipa; Brenden, Neil; Truong, Daniel D; Devahastin, Ratanaruedee

    2011-11-01

    Although the subspeciality of movement disorders was established in neurology more than 20 years ago, it is relatively new in Thailand, and while most physicians are generally aware of Parkinson's disease, they often are not familiar with dystonia. As one of the common movement disorders seen in general practice, a number of family and population studies have suggested that as many as two-thirds of patients with dystonia may be underdiagnosed and it is likely that misdiagnosis occurs frequently. Moreover, there is little information on the prevalence of dystonia in Thailand. The purpose of this study was to determine the prevalence and clinical profile of dystonia among Thai patients who came from the southern part of Bangkok, which is in the catchment area of Chulalongkorn University Hospital. In addition, the diagnostic accuracy of dystonia among referred patients was assessed. The medical records of 207 patients were reviewed and it was determined that a large proportion of them (71.9%) had focal dystonia with cervical dystonia being the most common form. Primary dystonia (68.1%) accounted for the majority of the cases. The prevalence of all forms of dystonia, primary dystonia and focal dystonia was 19.9, 13.6 and 14.3 per 100,000 persons, respectively. The diagnostic accuracy of dystonia among referred patients was 85.5%. The most common misdiagnosis was cervical spondylosis, followed by myofascial pain syndrome. Most patients had an average disease duration of 4 years before dystonia was finally diagnosed. Most patients with focal dystonia responded well to botulinum toxin therapy, with 13.3% suffering only mild transient adverse events. In spite of the limitations of this study, this data will initiate a process of increasing both patient and professional awareness of dystonia in Thailand.

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

    PubMed Central

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

    2016-01-01

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

  2. Clinical relevance of positive voltage-gated potassium channel (VGKC)-complex antibodies: experience from a tertiary referral centre

    PubMed Central

    Paterson, Ross W; Zandi, Michael S; Armstrong, Richard; Vincent, Angela; Schott, Jonathan M

    2014-01-01

    Background Voltage-gated potassium channel (VGKC)-complex antibodies can be associated with a range of immunotherapy-responsive clinical presentations including limbic encephalitis, Morvan's syndrome and acquired neuromyotonia. However, there are patients with positive levels in whom the significance is uncertain. Objective To evaluate the clinical significance associated with positive (>100 pM) VGKC-complex antibodies. Methods Over a 4-year period, 1053 samples were sent for testing of which 55 were positive. The clinical presentations, final diagnoses and responses to immunotherapies, when given, were assessed retrospectively and the likelihood of autoimmunity was categorised as definite, possible, unlikely or undetermined (modified from Zuliani et al 2012). Results Only 4 of the 32 patients with low-positive (100–400 pM) levels were considered definitely autoimmune, 3 with peripheral nerve hyperexcitability and 1 with a thymoma; 3 were given immunotherapies. Of the remaining 28 with low-positive levels, 13 (3 of whom had tumours) were considered possibly autoimmune, and 15 were unlikely or undetermined; 1 was given immunotherapy unsuccessfully. Of the 23 patients with high-positive (>400 pM) levels, 12 were given immunotherapies, 11 of whom showed a good response. 11 were considered definitely autoimmune, 10 with limbic encephalitis (antibody specificity: 5 LGI1, 1 contactin2, 2 negative, 2 untested) and 1 with a tumour. In the remaining 12, autoimmunity was considered possible (n=9; most had not received immunotherapies), or unlikely (n=3). Conclusions As antibody testing becomes more widely available, and many samples are referred from patients with less clear-cut diagnoses, it is important to assess the utility of the results. VGKC-complex antibodies in the range of 100–400 pM (0.1–0.4 nM) were considered clinically relevant in rare conditions with peripheral nerve hyperexcitability and appeared to associate with tumours (12.5%). By contrast high-positive (>400 pM; >0.4 nM) levels were considered definitely (38%) or possibly (49%) clinically relevant, but not all patients had a ‘classical’ limbic encephalitis and some did not receive immunotherapies. PMID:23757422

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

    PubMed

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

    2016-06-01

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

  4. 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

  5. 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

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

    PubMed

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

    2013-07-01

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

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

    PubMed Central

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

    2015-01-01

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

  8. 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.

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

    PubMed

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

    2016-05-01

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

  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. Tumors of the Central Nervous System: An 18-Year Retrospective Review in a Tertiary Pediatric Referral Center

    PubMed Central

    AGHAYAN GOLKASHANI, Hosein; HATAMI, Hossein; FARZAN, Abdonaser; MOHAMMADI, Hassan Reza; NILIPOUR, Yalda; KHODDAMI, Maliheh; JADALI, Farzaneh

    2015-01-01

    Objective Few studies exist on the demographics and trends of pediatric central nervous system (CNS) tumors in Iran. In this study, we retrospectively reviewed all cases with confirmed CNS tumors admitted to Mofid Pediatric Hospital, Tehran, Iran during the last 18 years. Materials & Methods Data on gender, age of diagnosis, pathologic classification and tumor location were extracted from the available medical records. We used the last version of International Classification of Childhood Cancer. Result Overall, 258 (81.9%) brain tumors and 57 (18.1%) spinal tumors were identified. Our subjects comprised of 147 (46.7%) female and 168 (53.3%) male children. More male dominancy was observed in brain tumors with a male to female ratio of 1.2 compared with 1.03 of spinal tumors. Malignant CNS tumors were most common in 1-4 yr age group. The four most common brain tumors in our subjects were astrocytomas, medulloblastoma, ependymoma and craniopharyngioma. Overall, 53.1% of the brain tumors were supratentorial. Gliomas, PNET and neuroblastma were the most frequent primary spinal tumors in our study. We observed an increasing trend for both brain and spinal tumors that was moreremarkable in the last 5 years. Conclusion Our results are comparable with similar single center studies on CNS tumors during childhood. The observed disparities could be attributed to the single center nature of our study and geographical, environmental and racial variations in pediatric CNS tumors. The increasing trend of both brain and spinal tumors could warrant further investigations at provincial and national levels to investigate probable contributing environmental risk factors. PMID:26401150

  12. Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years’ experience from a tertiary referral unit

    PubMed Central

    English, James; Sajid, Muhammad S.; Lo, Jenney; Hudelist, Guy; Baig, Mirza K.; Miles, William A.

    2014-01-01

    Background. The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection (LSARR) depending upon the extent and severity of the disease. Objective. To report the efficacy of LSARR in terms of pain, quality of life and short- and long-term complications—in particular, those pertaining to bowel function. Methods. The case notes of all patients undergoing LSARR were reviewed. The analysed variables included surgical complications, overall symptomatic improvement rate, dysmenorrhoea, dyspareunia, and dyschezia. Chronic pain was measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre (MSKCC) questionnaire. Results. Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study. Sixty-nine (93.2%) women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem. Approximately 42% of women who wished to conceive had at least one baby. The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score. Post-operative complications were recorded in 14.9% of cases. Conclusions. LSARR for rectal endometriosis is associated with a high degree of symptomatic relief. Pain relief achieved following LSARR does not appear to degrade with time. As anticipated, some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction. PMID:25146341

  13. 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

  14. 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

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

    ERIC Educational Resources Information Center

    Cattell, Karin

    2013-01-01

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

  16. Referrals for obstetrical complications from Ejisu district, Ghana.

    PubMed

    Martey, J O; Djan, J O; Twum, S; Browne, E N; Opoku, S A

    1998-01-01

    A study of referrals due to obstetrical complications from the Ejisu district, Ashanti region, Ghana was done to determine the institutions that receive them, their outcome and the effectiveness of the referral system. This formed part of a multidisciplinary research on the prevention of maternal mortality in the district. It covered 15 health facilities in the district. The receiving institutions identified in the study were Komfo Anokye teaching Hospital (KATH) in Kumasi, Agogo Presbyterian Hospital in the neighbouring Ashanti Akim district and the St. Michael's Hospital at Pramso in the same district. In the period under review, there were 192 referrals from the district, 139 to KATH with 87 (63%) reporting, 19 to Pramso with 14 (74%) reporting and 34 to Agogo with 17 (50%) reporting. The 3 most important complications referred were maternal haemorrhage (29%), high-risk pregnancy (24%) and delayed second stage (21%). The referring institutions had a defaulting rate varying from 8-56% with a median of 42%. This study did not specifically investigate the factors influencing the high defaulting rates in some institutions. However, focus-group discussions (FGDs) held in selected communities revealed the following factors as inhibiting the utilization of health services: * prohibitive hospital fees; * illegal fees and bribes; * irregular transport and uncooperative drivers; * poor and unmotorable roads; * lack of drugs and essential supplies and; * negative staff attitudes. Those health facilities with low defaulting rates had their own transport or were close to major trunk roads. From the study, the referral system was very weak. It is also possible that some of the referrals reported at the receiving institutions but were not classified as such. Interventions to improve the situation are currently being implemented.

  17. Is Self-Referral Associated with Higher Quality Care?

    PubMed Central

    Pollack, Craig Evan; Rastegar, Afshin; Keating, Nancy L; Adams, John L; Pisu, Maria; Kahn, Katherine L

    2015-01-01

    Objective To assess the extent to which patients self-refer to cancer specialists and whether self-referral is associated with better experiences and quality of care. Data Sources Data from surveys and medical record abstraction collected through the Cancer Care Outcomes Research and Surveillance Consortium. Study Design Observational study of patients with lung and colorectal cancer diagnosed from 2003 through 2005 in five geographically defined regions and five integrated health care delivery systems. Methods Multivariable logistic regression models used to assess factors associated with self-referral and propensity score-weighted doubly robust models to test the association between self-referral and experiences/quality of care. Principal Findings Among 5,882 patients, 9.7 percent of lung cancer patients and 14.9 percent of colorectal cancer patients self-referred to at least one cancer specialist. Black patients were less likely to self-refer than white patients (odds ratio: 0.48, 95 percent confidence interval: 0.35, 0.64); patients with high incomes (vs. low) and with a college degree (vs. non-high school graduates) were significantly more likely to self-refer. Self-referral was associated with lower ratings of overall physician communication for patients with lung cancer but, conversely, higher odds of curative surgery among patients with stage I/II lung cancer. Conclusions A small but significant proportion of patients self-referred to their cancer specialists; rates varied by patient race and socioeconomic status. To the extent that self-referral is associated with quality, it may reinforce disparities in care. PMID:25759002

  18. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Referral/10_CPI-U_Updates.asp. (3) Where an entity has inadvertently provided nonmonetary compensation to a... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... remuneration (consisting of items and services in the form of hardware, software, or information technology...

  19. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Referral/10_CPI-U_Updates.asp. (3) Where an entity has inadvertently provided nonmonetary compensation to a... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... remuneration (consisting of items and services in the form of hardware, software, or information technology...

  20. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... nonmonetary compensation limit on the physician self-referral Web site: http://www.cms.hhs.gov/PhysicianSelf... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... than the physician) that is providing malpractice insurance (including a self-funded...

  1. 20 CFR 702.504 - Vocational rehabilitation; referrals to State Employment Agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Vocational rehabilitation; referrals to State... AND PROCEDURE Vocational Rehabilitation § 702.504 Vocational rehabilitation; referrals to State Employment Agencies. Vocational rehabilitation advisers will arrange referral procedures with...

  2. 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...

  3. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  4. 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...

  5. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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...

  6. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive...

  8. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  9. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 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...

  10. 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...

  11. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 6 Domestic Security 1 2011-01-01 2011-01-01 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...

  12. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  13. 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...

  14. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 6 Domestic Security 1 2014-01-01 2014-01-01 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...

  15. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 6 Domestic Security 1 2013-01-01 2013-01-01 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...

  16. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 6 Domestic Security 1 2012-01-01 2012-01-01 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. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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...

  18. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  19. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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...

  20. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  1. Patient variables and referral paradigms associated with osteoporosis screening and treatment in neurosurgical patients undergoing kyphoplasty.

    PubMed

    Morr, Simon; Shakir, Hakeem J; Lipinski, Lindsay J; Dimopoulos, Vassilios G; Leonardo, Jody; Pollina, John

    2015-12-01

    OBJECT Vertebral fractures are the most common osteoporotic fracture. Bone density testing and medical treatment with bisphosphonates or parathormone are recommended for all patients with an osteoporotic fracture diagnosis. Inadequate testing and treatment of patients presenting with low-impact fractures have been reported in various specialties. Similar data are not available from academic neurosurgery groups. The authors assessed compliance with treatment and testing of osteoporosis in patients with vertebral compression fractures evaluated by the authors' academic neurosurgery service, and patient variable and health-systems factors associated with improved compliance. METHODS Data for patients who underwent percutaneous kyphoplasty for compression fractures was retrospectively collected. Diagnostic and medical interventions were tabulated. Pre-, intra-, and posthospital factors that had been theorized to affect the compliance of patients with osteoporosis-related therapies were tabulated and statistically analyzed. RESULTS Less than 50% of patients with kyphoplasty received such therapies. Age was not found to correlate with other variables. Referral from a specialist rather than a primary care physician was associated with a higher rate of bone density screening, as well as vitamin D and calcium therapy, but not bisphosphonate/parathormone therapy. Patients who underwent preoperative evaluation by their primary care physician were significantly more likely to receive bisphosphonates compared with those only evaluated by a hospitalist. Patients with unprovoked fractures were more likely to undergo multiple surgeries compared with those with minor trauma. CONCLUSIONS These results suggest poor compliance with current standard of care for medical therapies in patients with osteoporotic compression fractures undergoing kyphoplasty under the care of an academic neurosurgery service.

  2. Impact of a referral management “gateway” on the quality of referral letters; a retrospective time series cross sectional review

    PubMed Central

    2013-01-01

    Background Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care. This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters. Methods Retrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust (PCT) in South-East England. Comparison of a random sample of referral letters at baseline (n = 301) and after seven months of referral management (n = 280). Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality (blood pressure, body mass index, past medical history, medication history) and against research-based quality criteria for referral letters (provision of clinical information and clarity of reason for referral). Results Following introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of ‘past medical history’ (from 71% to 84%, p < 0.001) and ‘medication history’ (78% to 87%, p = 0.006) were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods. Conclusion Introduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement. PMID:23945378

  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. Tertiary Interactions within the Ribosomal Exit Tunnel

    PubMed Central

    Kosolapov, Andrey; Deutsch, Carol

    2009-01-01

    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 β-hairpin as well as an α-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. PMID:19270700

  5. The Cretaceous/Tertiary Extinction Controversy Reconsidered.

    ERIC Educational Resources Information Center

    McCartney, Kevin; Nienstedt, Jeffrey

    1986-01-01

    Reviews varying positions taken in the Cretaceous/Tertiary (K/Y) extinction controversy. Analyzes and contests the meteoritic impact theory known as the Alvarez Model. Presents an alternative working hypothesis explaining the K/T transition. (ML)

  6. Can guidelines improve referral to elective surgical specialties for adults? A systematic review

    PubMed Central

    Blundell, N; Forde, I; Musila, N; Spitzer, D; Naqvi, S; Browne, J

    2010-01-01

    Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving pre-referral investigation and treatment, but there is no strong evidence in favour of other beneficial effects. PMID:20211956

  7. Patient referral patterns by family doctors and to selected specialists in Tajikistan.

    PubMed

    Steinmann, Peter; Baimatova, Malika; Wyss, Kaspar

    2012-12-01

    Referral rates are a key measure for the functioning of a healthcare system. The objective of this study was to assess referral patterns from family doctors (FD) and selected specialists to other specialists and hospitals in two rayons (districts) of Tajikistan. Quantitative data on referral decisions and self-referral was collected among FDs and selected specialists over a 10-workday period in 2008. For comparison, the collected information was contrasted to routinely recorded data and figures from the national health information system (HIS). The mean referral rate of FDs was 20.0% while the referral rate according to the HIS was 4.5%. In one rayon, the majority of the referred patients were sent to hospitals (65.6%) while in the other rayon, 65.9% were advised to see a specialist. Technical diagnostic tests not available at the primary healthcare level triggered the majority of all referrals. A need for diagnosis and treatment by specialists accounted for 19.2% of the referrals. Self-referral was common among patients seen by ophthalmologists and otorhinolaryngologists (76.0%). We conclude that referral rates among Tajik FD patients are high and self-referral of patients to a specialist is the norm. The routine HIS fails to provide accurate data. PMID:24029672

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

    PubMed

    2016-07-01

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

  9. 10 rare tumors that warrant a genetics referral.

    PubMed

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

    2013-03-01

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

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

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

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

  11. [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.

  12. "Stark" reality: self-referral rule holds risk and opportunity.

    PubMed

    Lebowitz, P H

    2001-01-01

    On January 4, 2001, the Health Care Financing Administration (now the Center for Medicare and Medicaid Services or CMS) issued Phase I of the final Stark II regulations (Final Rule). The Final Rule implements the Ethics in Patient Referral Act of 1989 (Stark I), as amended by the Omnibus Budget and Reconciliation Act of 1993 (Stark II), collectively the Stark Law. It is intended to provide more flexibility to providers by interpreting the prohibitions narrowly and the exceptions broadly. Generally, the Stark Law prohibits physicians from referring Medicare or Medicaid patients to an entity for the provision of "designated health services (DHS)" if the physician (or a member of the physician's immediate family) has a direct or indirect financial relationship with the entity. The Final Rule establishes two principal exceptions to the referral prohibition that apply to both ownership/investment interests and compensation arrangements. The physician service exception permits referrals for DHS that are furnished by a member or physician in the same group practice as the referring physician, or under their supervision. The in-office ancillary services exception permits referral for provision of DHS in the same building in which the referring physician or his group routinely provides the full range of the group's or physician's medical services. The final regulations redefine the prior description of radiology and radiation therapy services subject to Stark II. The principal change is to segregate radiation therapy and supplies from radiology and other imaging services. It is uncertain whether Stark Law enforcement will be a priority under the Bush Administration. Nonetheless, because the Final Rule offers more flexibility than the proposed rule, providers and suppliers should revisit proposed and abandoned arrangements that they believed to be prohibited.

  13. Identifying sick children requiring referral to hospital in Bangladesh.

    PubMed Central

    Kalter, H. D.; Schillinger, J. A.; Hossain, M.; Burnham, G.; Saha, S.; de Wit, V.; Khan, N. Z.; Schwartz, B.; Black, R. E.

    1997-01-01

    The object of this study was to evaluate and improve the guidelines for the Integrated Management of Childhood Illness (IMCI) with respect to identifying young infants and children requiring referral to hospital in an area of low malaria prevalence. A total of 234 young infants (aged 1 week to 2 months) and 668 children (aged 2 months to 5 years) were prospectively sampled from patients presenting at a children's hospital in Dhaka, Bangladesh. The study paediatricians obtained a standardized history and carried out a physical examination, including items in the IMCI guidelines developed by WHO and UNICEF. The paediatricians made a provisional diagnosis and judged whether each patient needed hospital admission. Using the paediatrician's assessment of a need for admission as the standard, the sensitivity and specificity of the current and modified IMCI guidelines for correctly referring patients to hospital were examined. The IMCI's sensitivity for a paediatrician's assessment in favour of hospital admission was 84% (95% confidence interval (CI): 75-90) for young infants and 86% (95% CI: 81-90) for children, and the specificity was, respectively, 54% (95% CI: 45-63) and 64% (95% CI: 59-69). One fourth or more in each group had a provisional diagnosis of pneumonia, and the IMCI's specificity was increased without lowering sensitivity by modifying the respiratory signs calling for referral. These results show that the IMCI has good sensitivity for correctly referring young infants and children requiring hospital admission in a developing country setting with a low prevalence of malaria. The guidelines' moderate specificity will result in considerable over-referral of patients not needing admission, thereby decreasing opportunities for successful treatment of patients at first-level health facilities. The impact of the IMCI guidelines on children's health and the health care system must be judged in the light of current treatment practices, health outcomes and referral

  14. Public Library Information and Referral Project: Phase I, Survey.

    ERIC Educational Resources Information Center

    Childers, Thomas

    This study was the first phase of a multiple phase project to generate knowledge about the creation and rapid growth of information and referral (I&R) services in public libraries in the United States in the late 1960s and the 1970s. I&R service is defined as facilitating the link between a person with a need and the resources outside a library to…

  15. 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

  16. 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.

  17. The impact of snow on orthopaedic trauma referrals.

    PubMed

    Weston-Simons, John; Jack, Christopher M; Doctor, Cyrus; Brogan, Kit; Reed, Daniel; Ricketts, David

    2012-07-01

    Adverse weather has been shown to increase orthopaedic referrals and place strain on services. This retrospective study undertaken at a teaching hospital concerned referrals between April 2009 and April 2010 comparing days when snow fell to days when it did not. Referrals increased significantly on snow days (to 74.9 per day) in comparison to normal weather days (33.5 per day). During snow days there were significant increases in the number of distal radius and ankle fractures referred but not of fractured necks of femur. Complications during the snow fall period were related to procedures performed outside of the trauma unit with further difficulties related to a lack of operating equipment and implant availability. As a result of our study, we recommend that during periods of heavy snow fall orthopaedic and trauma units should place senior orthopaedic trainees in Accident and Emergency to review patients as a triage service, organise trauma lists related to surgeon specific expertise and avoid sending trauma patients outside the unit for operation.

  18. 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…

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

    PubMed Central

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

    2016-01-01

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

  20. Paediatric ocular trauma in a tertiary eye care center in Eastern India.

    PubMed

    Chakraborti, Chandana; Giri, Dhananjay; Choudhury, Krittika Pal; Mondal, Maloy; Datta, Jyotirmoy

    2014-01-01

    A retrospective study was performed to assess the pattern of pediatric ocular trauma in a tertiary eye center in eastern India. Records of 672 patients aged 16 years or less with ocular trauma who attended the outpatient department or emergency or treated as inpatients at a tertiary referral center between April 2009 and March 2010 were reviewed. Boys accounted for 70% cases. Most children were of the 5-10 years age group. Closed globe injury was the commonest (418 patients, 62.19%), followed by open globe injuries (127 patients, 19%), orbital injuries (52 patients, 7.67%), superficial foreign bodies (7.14%) and burn (4.01%). Home was found to be the commonest place of injury (44%), and only 51.9% attended the health facility within 24 h. Conservative management was done in 497 (74%) cases, whereas 175 (26%) cases were treated surgically. Final visual outcome of 443 (66%) patients were between 20/20 and 20/50. Sixty-eight patients had worst visual outcome with monocular blindness of the injured eye. Strategies to reduce the incidence of ocular trauma at home should be directed towards raising the parental education and public awareness.

  1. Langerhans cell histiocytosis: a retrospective analysis in a Korean tertiary hospital from 2003 to 2012.

    PubMed

    Kwon, Soon Hyo; Choi, Jae Woo; Kim, Hyo Jin; Youn, Sang Woong

    2013-10-01

    Epidemiological study of Langerhans cell histiocytosis (LCH) has been limited due to its rarity and multisystemic involvement. The aim of this study was to investigate the epidemiological features of LCH via the clinical data warehouse (CDW). Clinical data of 30 LCH patients from the all departments of a tertiary referral hospital between 2003 and 2012 were analyzed retrospectively by searching the CDW. The male-to-female ratio was 2.8:1. The age of onset ranged 7 days to 57 years with a median of 13 years. Of the patients, 36.7% presented initial symptoms before the age of 10 years. The involved organs at diagnosis were: bone (66.7%), skin (16.7%), lungs (13.3%) and lymph node (3.3%). For all of the 30 cases, there were 31 disease sites because of a single case of multisystemic disease involving both skin and bone. Of the 96.7% of patients with single-system disease, 69.0% had bony involvement. This study elucidated the clinical features of LCH from all the departments of a tertiary hospital via the CDW, which suggests a potential role of the CDW as a new epidemiological approach for rare diseases.

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

    ERIC Educational Resources Information Center

    Daddow, Angela; Moraitis, Peter; Carr, Amanda

    2013-01-01

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

  3. Academic detailing.

    PubMed

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

    2010-01-01

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

  4. 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. PMID:11437191

  5. 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. PMID:26190587

  6. Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

    PubMed Central

    2011-01-01

    Background Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills

  7. Tertiary filtration in small wastewater treatment plants.

    PubMed

    Naddeo, V; Belgiorno, V

    2007-01-01

    Tertiary filtration can be proposed in small wastewater treatment plants with impact on protected water bodies. Rotating disk filters may be adopted, in respect to conventional sand filters, when low availability of space and low investment costs are the prevailing conditions. The overall objective of this research was to evaluate the filtration efficiency of rotating disk filters; to compare effectiveness with traditional sand filters; to analyse thoroughly the importance of particle size distribution in wastewater tertiary filtration. In the experimental activity, conventional wastewater quality parameters were investigated and particle size distribution (PSD) was characterized to discuss the filter effectiveness. The effect of design and operation parameters of tertiary filters were discussed related to particle removal curves derived from particles counts. Analysis of particle size distribution can be very useful to help comprehension of filtration processes, design of filtration treatments and to decide the best measures to improve filter performance.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  10. 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

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

    PubMed

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

    2015-08-01

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

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

    PubMed Central

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

    1999-01-01

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

  13. Pediatric hematology providers on referral for transplant evaluation for sickle cell disease: a regional perspective.

    PubMed

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

    2014-10-01

    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 anonymously 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, χ 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). Northeastern 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.

  14. 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.

  15. GP referral to an eating disorder service: why the wide variation?

    PubMed Central

    Hugo, P; Kendrick, T; Reid, F; Lacey, H

    2000-01-01

    BACKGROUND: Early detection and management of patients with eating disorders is thought to improve prognosis, yet little is known about the factors associated with referral of these patients to treatment centres. AIM: To calculate general practitioner (GP) referral rates to a specialist eating disorder service and determine the association between referral rate and general practice and practitioner factors. METHOD: Referral rate was calculated from a database of routine referrals to St George's Hospital Eating Disorder Service from January 1990 to May 1996 and correlated with practice and practitioner details obtained from medical directories and health authority data. RESULTS: There was a wide variation in referral rates. A higher referral rate was found to be associated with practice size, proximity to the clinic, female GPs, GPs having the MRCGP qualification, being United Kingdom qualified, and offering full contraceptive services. Fundholding was associated with lower rates of referral. CONCLUSION: Patients with eating disorders may be at a disadvantage in certain practices. Educational interventions could be targeted towards low referrals. PMID:10897535

  16. 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…

  17. 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…

  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. 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…

  20. 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…

  1. Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice

    PubMed Central

    Mahdavi, Arash; Mohammadzadeh, Ali; Joodi, Golsa; Tabatabaei, Mohammad Reza; Sheikholeslami, Farhad; Motevalli, Marzieh

    2016-01-01

    Background There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. Objectives To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. Patients and Methods Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. Results In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030. Conclusion Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.

  2. Journal publications by Australian chiropractic academics: are they enough?

    PubMed Central

    Hoskins, Wayne; Pollard, Henry; Reggars, John; Vitiello, Andrew; Bonello, Rod

    2006-01-01

    Purpose To document the number of journal publications attributed to the academic faculty of Australian chiropractic tertiary institutions. To provide a discussion of the significance of this output and to relate this to the difficulty the profession appears to be experiencing in the uptake of evidence based healthcare outcomes and cultures. Methods The departmental websites for the three Australian chiropractic tertiary institutions were accessed and a list of academic faculty compiled. It was noted whether each academic held a chiropractic qualification or research Doctoral (not professional) degree qualification A review of the literature was conducted using the names of the academics and cross-referencing to publications listed independently in the PubMed and Index to Chiropractic Literature (ICL) databases (from inception to February 27 2006). Publications were excluded that were duplicates, corrected reprints, conference abstracts/proceedings, books, monographs, letters to the editor/comments or editorials. Using this information an annual and recent publication rate was constructed. Results For the 41 academics there was a total of 155 PubMed listed publications (mean 3.8, annual rate per academic 0.31) and 415 ICL listed publications (mean 10.1, annual rate 0.62). Over the last five years there have been 50 PubMed listed publications (mean 1.2, annual rate 0.24) and 97 ICL listed publications (mean 2.4, annual rate 0.47). Chiropractor academics (n = 31) had 29 PubMed listed publications (mean 2.5, annual rate 0.27) and 265 ICL listed publications (mean 8.5, annual rate 0.57). Academics with a doctoral degree (n = 13) had 134 PubMed listed publications (mean 10.3, annual rate 0.70) and 311 ICL listed publications (mean 23.9, annual rate 1.44). Academics without a Doctoral degree (n = 28) had 21 PubMed listed publications (mean 0.8, annual rate 0.13) and 104 ICL listed publications (mean 3.7, annual rate 0.24). Conclusion While several academics have compiled

  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. 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)

  5. 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.

  6. Rural Professionals: A Tertiary Preparation Model.

    ERIC Educational Resources Information Center

    Krynowsky, Bernie

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

  7. 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…

  8. Understanding Australian Aboriginal Tertiary Student Needs

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  9. Indigenous Students in the Tertiary Education Sector

    ERIC Educational Resources Information Center

    Bandias, Susan; Fuller, Don; Larkin, Steven

    2014-01-01

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

  10. 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…

  11. 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…

  12. Early Tertiary climates of the Arctic Ocean

    SciTech Connect

    Marincovich, L.; Zinsmeister, W.J.

    1985-01-01

    Knowledge of Early Tertiary high latitude marine faunas (north of 65 N) is extremely limited. What published data that are available were based on small collections obtained during the early part of the 20th century. Recent work along the western part of the Arctic Ocean has greatly increased the knowledge of the composition of these faunas and climatic conditions of the high northern latitudes during the Early Tertiary. Early Eocene shallow marine faunas from the Eureka Sound Formation, Ellesmere Island (79/sup 0/ 30'N), together with similar aged faunas from Ocean Point, Alaska (72/sup 0/N) and Spitsbergen trough, Svalbard, (78/sup 0/N) indicate that temperature conditions prevailed in the high Arctic during the early Tertiary. These high latitude temperate conditions are also supported by the presence of a diverse terrestrial mammalian faunas (currently known only from Ellesmere Island) and floras. Preliminary comparisons of these faunas from the Arctic ocean with the diverse subtropical faunas from West Greenland (70/sup 0/N) indicates the presence of a major faunal discontinuity existed in the high northern latitudes during the early Tertiary. The cause of this faunal discontinuity is uncertain. It may be due to the presence of a physical barrier between the Arctic Ocean and the North Atlantic or it may reflect cooler climatic conditions north of 70 N.

  13. The Cretaceous/Tertiary Extinction Controversy.

    ERIC Educational Resources Information Center

    McCartney, Kevin

    1984-01-01

    The cause of the Cretaceous/Tertiary extinction has become a major geologic controversy. Current evidence for the two opposing views is reviewed to provide an introduction to the controversy and to form the basis for a seminar of discussion topic. (Author/JN)

  14. Quarterly Technical Progress Report - West Hackberry Tertiary Project

    SciTech Connect

    Demetrios Yannimaras; Travis Gillham

    1998-07-14

    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.

  15. Quarterly Technical Progress Report - West Hackberry Tertiary Project

    SciTech Connect

    Bruce Cerveny; Tor Kragas; Travis Gillham

    1998-01-13

    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.

  16. 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.

  17. 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.

  18. 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…

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

    PubMed

    Swibel, H J; Zaremski, M J

    1995-02-01

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

  20. Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service.

    PubMed

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

    2014-03-01

    Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, 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. 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 1,401 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 consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain 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 pharmacologic management, and the frequent addition of nonpharmacologic interventions.

  1. Hemicrania continua in a headache clinic: referral source and diagnostic delay in a series of 22 patients.

    PubMed

    Cortijo, Elisa; Guerrero, Angel L; Herrero, Sonia; Mulero, Patricia; Muñoz, Irene; Pedraza, María I; Peñas, María L; Rojo, Esther; Campos, Dulce; Fernández, Rosa

    2012-10-01

    Hemicrania continua (HC) is a unilateral and continuous primary headache with superimposed exacerbations frequently associated with autonomic features. Diagnostic criteria of HC, according to II Edition of International Classification of Headache Disorders require complete response to indomethacin. HC is probably misdiagnosed more often than other primary headaches. We aim to analyze characteristics of a series of 22 consecutive cases of HC. We recruited patients from a headache outpatient clinic in a tertiary hospital over a 3-year period (January 2008 to January 2011). We prospectively gathered demographic and nosological characteristics and considered referral source and delay between onset of headache and diagnosis of HC. Twenty-two patients (14 females, 8 males) out of 1,150, who attended the mentioned clinic during the inclusion period (1.9 %) were diagnosed with HC. All cases responded to indomethacin. No patient received a diagnosis of HC before attending our headache office. Mean latency of diagnosis was 86.1 ± 106.5 months (range 3-360). 11 patients (50 %) were referred from primary care, with 9 (40.9 %) from other neurology clinics and 2 (9.1 %) from other specialities offices. According to our series, HC is not an infrequent diagnosis in a headache outpatient clinic. Diagnostic delay is comparable to data collected in previous studies. As HC is frequently misdiagnosed, we thing there is a need for increasing the understanding of this entity, potentially responsive to indomethacin.

  2. Maternity referral systems in developing countries: current knowledge and future research needs.

    PubMed

    Murray, Susan F; Pearson, Stephen C

    2006-05-01

    A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.

  3. Academic Delay of Gratification and Academic Achievement

    ERIC Educational Resources Information Center

    Bembenutty, Hefer

    2011-01-01

    The ability to delay gratification is the cornerstone of all academic achievement and education. It is by delaying gratification that learners can pursue long-term academic and career goals. In general, "delay of gratification" refers to an individual's ability to forgo immediate rewards for the sake of more valuable ones later (Mischel, 1996).…

  4. Association of Academic Physiatrists

    MedlinePlus

    ... RFC Newsletter - Physiatry in Motion Discussion Forums FileShare Libraries Membership Directory About AAP President's Message Mission & Strategic ... children('.slide-panel.notactive').removeClass('notactive'); autoPlay();}); }); Your Academic Home for Physiatry The Association of Academic Physiatrists ( ...

  5. Success of Academic Failures

    ERIC Educational Resources Information Center

    Meskill, Victor P.

    1971-01-01

    The process of readmission of academically troubled students should be subjected to extensive critical analysis. The human resources represented by the college academic dropout, often overlooked in the past should be reclaimed and channeled into productive areas. (Author)

  6. 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…

  7. 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...

  8. 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...

  9. 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...

  10. Community Determinants of Substance Abuse Treatment Referrals from Juvenile Courts: Do Rural Youths Have Equal Access?

    ERIC Educational Resources Information Center

    Pullmann, Michael D.; Heflinger, Craig Anne

    2009-01-01

    Many youths in juvenile justice are in need of substance use services, yet referral to services is often inadequate. This study examines the ecological factors related to substance use service referrals made through Tennessee's juvenile courts. A series of hierarchical binomial logistic models indicated that individual-level factors accounted for…

  11. 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…

  12. 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…

  13. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Referral to primary source of records. 20.51 Section 20.51 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of...

  14. 7 CFR 1403.20 - Referral of debts to private collection agencies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES DEBT SETTLEMENT POLICIES AND PROCEDURES § 1403.20 Referral of debts to private collection agencies. If CCC's collection efforts... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to private collection...

  15. 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 =…

  16. 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…

  17. 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"…

  18. 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...

  19. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  20. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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