48 CFR 36.601-4 - Implementation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... engineering nature associated with design or construction of real property. (3) Other professional services of..., investigations, surveying and mapping, tests, evaluations, consultations, comprehensive planning, program management, conceptual designs, plans and specifications, value engineering, construction phase services...

48 CFR 36.601-4 - Implementation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... engineering nature associated with design or construction of real property. (3) Other professional services of..., investigations, surveying and mapping, tests, evaluations, consultations, comprehensive planning, program management, conceptual designs, plans and specifications, value engineering, construction phase services...

48 CFR 36.601-4 - Implementation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... engineering nature associated with design or construction of real property. (3) Other professional services of..., investigations, surveying and mapping, tests, evaluations, consultations, comprehensive planning, program management, conceptual designs, plans and specifications, value engineering, construction phase services...

48 CFR 36.601-4 - Implementation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... engineering nature associated with design or construction of real property. (3) Other professional services of..., investigations, surveying and mapping, tests, evaluations, consultations, comprehensive planning, program management, conceptual designs, plans and specifications, value engineering, construction phase services...

75 FR 11917 - Chrysler LLC, Technology Center, Including On-Site Leased Workers from Aerotek, Ajilon, Altair...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

..., Cer-Cad Engineering Resources, Computer Consultants of America, Computer Engrg Services, Compuware..., Automated Analysis Corp/Belcan, Bartech Group, CAE Tech, CDI Information Services, CER-CAD Engineering...

77 FR 41806 - RG Steel Sparrows Point LLC, Formerly Known as Severstal Sparrows Point LLC, a Subsidiary of RG...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-16

... Leased Workers From Echelon Service Company, Sun Associated Industries, INC., MPI Consultants LLC... International, including on-site leased workers from Echelon Service Company, Sun Associated Industries, Inc... Company, Sun Associated Industries, Inc., MPI Consultants LLC, Alliance Engineering, Inc., Washington...

18 CFR 367.9230 - Account 923, Outside services employed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... subaccounts must be provided for auditing, legal, engineering, management consulting fees and any other fees... showing the nature of service, identity of the person furnishing the service, affiliation to the service...

17 CFR 256.923 - Outside services employed.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., engineering, management consulting fees and, if material in amount, any other fees of professional or outside services. (b) Records shall be so maintained to permit ready analysis showing nature of service, identity...

48 CFR 9.501 - Definition.

Code of Federal Regulations, 2012 CFR

2012-10-01

... consultant when rendering— (1) Services excluded in subpart 37.2; (2) Routine engineering and technical services (such as installation, operation, or maintenance of systems, equipment, software, components, or...

48 CFR 9.501 - Definition.

Code of Federal Regulations, 2014 CFR

2014-10-01

... consultant when rendering— (1) Services excluded in subpart 37.2; (2) Routine engineering and technical services (such as installation, operation, or maintenance of systems, equipment, software, components, or...

48 CFR 9.501 - Definition.

Code of Federal Regulations, 2013 CFR

2013-10-01

... consultant when rendering— (1) Services excluded in subpart 37.2; (2) Routine engineering and technical services (such as installation, operation, or maintenance of systems, equipment, software, components, or...

48 CFR 9.501 - Definition.

Code of Federal Regulations, 2011 CFR

2011-10-01

... consultant when rendering— (1) Services excluded in subpart 37.2; (2) Routine engineering and technical services (such as installation, operation, or maintenance of systems, equipment, software, components, or...

48 CFR 9.501 - Definition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... consultant when rendering— (1) Services excluded in subpart 37.2; (2) Routine engineering and technical services (such as installation, operation, or maintenance of systems, equipment, software, components, or facilities); (3) Routine legal, actuarial, auditing, and accounting services; and (4) Training services. [55...

Louisiana Department Of Transportation and Development in-house versus consultant design cost study.

DOT National Transportation Integrated Search

1998-06-01

The use of consultants in providing pre-construction engineering design services for the state's Departments of Transportation has increased over the last twenty years. This has resulted in several investigations into the cost-effectiveness of this t...

A Preliminary Look at How Non-Academic, Off-Campus Patrons Use College and University Library Engineering Materials and Services.

ERIC Educational Resources Information Center

Franklin, Hugh

Libraries at 52 U.S. colleges and universities offering engineering programs were surveyed by mail to determine how they handled the engineering information needs of off-campus, nonacademic users. Twenty-five provided usable responses. For this sample, 60.4% of the estimated service is to companies, 18.8% to consultants/entrepreneurs/inventors,…

Architectural & engineering handbook

DOT National Transportation Integrated Search

2003-05-21

The Architectural and Engineering (A&E) Handbook provides an overview of the contracting process for A&E consultant services. Produced by the Division of Procurement and Contracts, this handbook provides guidance and a structured process for the plan...

Integrating ergonomics knowledge into business-driven design projects: The shaping of resource constraints in engineering consultancy.

PubMed

Hall-Andersen, Lene Bjerg; Neumann, Patrick; Broberg, Ole

2016-10-17

The integration of ergonomics knowledge into engineering projects leads to both healthier and more efficient workplaces. There is a lack of knowledge about integrating ergonomic knowledge into the design practice in engineering consultancies. This study explores how organizational resources can pose constraints for the integration of ergonomics knowledge into engineering design projects in a business-driven setting, and how ergonomists cope with these resource constraints. An exploratory case study in an engineering consultancy was conducted. A total of 27 participants were interviewed. Data were collected applying semi-structured interviews, observations, and documentary studies. Interviews were transcribed, coded, and categorized into themes. From the analysis five overall themes emerged as major constituents of resource constraints: 1) maximizing project revenue, 2) payment for ergonomics services, 3) value of ergonomic services, 4) role of the client, and 5) coping strategies to overcome resource constraints. We hypothesize that resource constraints were shaped due to sub-optimization of costs in design projects. The economical contribution of ergonomics measures was not evaluated in the entire life cycle of a designed workplace. Coping strategies included teaming up with engineering designers in the sales process or creating an alliance with ergonomists in the client organization.

15 CFR 801.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and wholesale trade, advertising, accounting, construction, design, engineering, management consulting, real estate, professional services, entertainment, education, and health care. (h) International...

15 CFR 801.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... and wholesale trade, advertising, accounting, construction, design, engineering, management consulting, real estate, professional services, entertainment, education, and health care. (h) International...

15 CFR 801.7 - General definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., transportation, communications and data processing, retail and wholesale trade, advertising, accounting, construction, design, engineering, management consulting, real estate, professional services, entertainment...

15 CFR 801.7 - General definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., transportation, communications and data processing, retail and wholesale trade, advertising, accounting, construction, design, engineering, management consulting, real estate, professional services, entertainment...

The Institute for Software Engineering.

ERIC Educational Resources Information Center

Inselbert, Armond

1982-01-01

The Institute for Software Engineering, a data processing education, publishing and consulting organization with offices and members worldwide, is described. The goal of the Institute is to assist data processing management and staff in providing the service levels required to support an organization's business needs. (Author/MLW)

Managing a Standards Collection in an Engineering Consulting Firm.

ERIC Educational Resources Information Center

Hamilton, Beth A.

1983-01-01

Summarizes efforts to identify, acquire, and organize a standards collection, with emphasis on provision of information services to staff and clientele of the Forensic Engineering and Science Center, Triodyne, Inc., who provide expert testimony in court cases involving accidents caused by defective products and equipment failures. References are…

STATION BUILDING. United Engineering Company Ltd., Alameda Shipyard, Ship Repair ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

STATION BUILDING. United Engineering Company Ltd., Alameda Shipyard, Ship Repair Facilities. Plan, elevations, sections, details. Austin Willmott Earl, Consulting Engineer, 233 Sansome Street, San Francisco, California. Drawing no. 504. Various scales. January 20, 1945, no revisions. U.S. Navy, Bureau of Yards & Docks, Contract no. bs 76, amendments 4 & 5. blueprint - United Engineering Company Shipyard, Electrical Services & Switching Station, 2900 Main Street, Alameda, Alameda County, CA

Solidification/Stabilization Use at Superfund Sites

EPA Pesticide Factsheets

To provide interested stakeholders such as project managers, technology service providers, consulting engineers, site owners, and the general public with the most recent information about solidification/stabilization applications at Superfund sites...

Resource Management

NASA Technical Reports Server (NTRS)

1993-01-01

Summit Envirosolutions of Minneapolis, Minnesota, used remote sensing images as a source for groundwater resource management. Summit is a full-service environmental consulting service specializing in hydrogeologic, environmental management, engineering and remediation services. CRSP collected, processed and analyzed multispectral/thermal imagery and aerial photography to compare remote sensing and Geographic Information System approaches to more traditional methods of environmental impact assessments and monitoring.

Materials Science Laboratory

NASA Technical Reports Server (NTRS)

Jackson, Dionne

2005-01-01

The NASA Materials Science Laboratory (MSL) provides science and engineering services to NASA and Contractor customers at KSC, including those working for the Space Shuttle. International Space Station. and Launch Services Programs. These services include: (1) Independent/unbiased failure analysis (2) Support to Accident/Mishap Investigation Boards (3) Materials testing and evaluation (4) Materials and Processes (M&P) engineering consultation (5) Metrology (6) Chemical analysis (including ID of unknown materials) (7) Mechanical design and fabrication We provide unique solutions to unusual and urgent problems associated with aerospace flight hardware, ground support equipment and related facilities.

48 CFR 836.606-73 - Application of 6 percent architect-engineer fee limitation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (vi) Surveys: topographic, boundary, utilities, etc. (2) Special consultant services that are not... required. (3) Other: (i) Reproduction of approved designs through models, color renderings, photographs, or...) All other services that are not an integral part of the production and delivery of plans, designs, and...

7 CFR Appendix D to Subpart E of... - Alcohol Production Facilities Planning, Performing, Development and Project Control

Code of Federal Regulations, 2014 CFR

2014-01-01

... imposed by construction, equipment, material or service contracts, penalty payments, damage claims, awards... consultants with suitable experience, training and professional competence in the design and construction of... engineering services for design and construction inspection for all project facilities. Resident inspection by...

7 CFR Appendix D to Subpart E of... - Alcohol Production Facilities Planning, Performing, Development and Project Control

Code of Federal Regulations, 2011 CFR

2011-01-01

... imposed by construction, equipment, material or service contracts, penalty payments, damage claims, awards... consultants with suitable experience, training and professional competence in the design and construction of... engineering services for design and construction inspection for all project facilities. Resident inspection by...

10 CFR 800.200 - Maximum loan; allowable costs.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., but are not limited to: (1) Bid bond premiums. (2) Financial, accounting, legal, engineering and other professional, consulting or similar fees and service charges. (3) Printing and reproduction costs. (4) Travel...

10 CFR 800.200 - Maximum loan; allowable costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., but are not limited to: (1) Bid bond premiums. (2) Financial, accounting, legal, engineering and other professional, consulting or similar fees and service charges. (3) Printing and reproduction costs. (4) Travel...

10 CFR 800.200 - Maximum loan; allowable costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., but are not limited to: (1) Bid bond premiums. (2) Financial, accounting, legal, engineering and other professional, consulting or similar fees and service charges. (3) Printing and reproduction costs. (4) Travel...

10 CFR 800.200 - Maximum loan; allowable costs.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., but are not limited to: (1) Bid bond premiums. (2) Financial, accounting, legal, engineering and other professional, consulting or similar fees and service charges. (3) Printing and reproduction costs. (4) Travel...

10 CFR 800.200 - Maximum loan; allowable costs.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., but are not limited to: (1) Bid bond premiums. (2) Financial, accounting, legal, engineering and other professional, consulting or similar fees and service charges. (3) Printing and reproduction costs. (4) Travel...

13 CFR 120.331 - What devices or techniques are eligible for a loan?

Code of Federal Regulations, 2012 CFR

2012-01-01

... heating or production of energy from industrial waste; (f) Hydroelectric power equipment; (g) Wind energy conversion equipment; and (h) Engineering, architectural, consulting, or other professional services...

13 CFR 120.331 - What devices or techniques are eligible for a loan?

Code of Federal Regulations, 2011 CFR

2011-01-01

... heating or production of energy from industrial waste; (f) Hydroelectric power equipment; (g) Wind energy conversion equipment; and (h) Engineering, architectural, consulting, or other professional services...

13 CFR 120.331 - What devices or techniques are eligible for a loan?

Code of Federal Regulations, 2013 CFR

2013-01-01

... heating or production of energy from industrial waste; (f) Hydroelectric power equipment; (g) Wind energy conversion equipment; and (h) Engineering, architectural, consulting, or other professional services...

13 CFR 120.331 - What devices or techniques are eligible for a loan?

Code of Federal Regulations, 2010 CFR

2010-01-01

... heating or production of energy from industrial waste; (f) Hydroelectric power equipment; (g) Wind energy conversion equipment; and (h) Engineering, architectural, consulting, or other professional services...

13 CFR 120.331 - What devices or techniques are eligible for a loan?

Code of Federal Regulations, 2014 CFR

2014-01-01

... heating or production of energy from industrial waste; (f) Hydroelectric power equipment; (g) Wind energy conversion equipment; and (h) Engineering, architectural, consulting, or other professional services...

Engineering management consulting services.

DOT National Transportation Integrated Search

2007-06-01

The Capital Management Division of the New Jersey Department of Transportation (NJDOT) requires that expert and experienced personnel participate in their projects. With the recent and ongoing retirement of many NJDOT personnel, there existed a short...

76 FR 4282 - Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-25

... Northampton, PA 18067. prototyping, prototype development, and manufacturing engineering consulting services.... manufactures various wear and corrosion resistant silicon carbide components for industrial customers. Any...

Ethics consultation and autonomy.

PubMed

Varelius, Jukka

2008-03-01

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist.

Characterization of Reaerosolization in an Effort to Improve Sampling of Airborne Viruses

DTIC Science & Technology

2008-04-01

financial support which helped me get through graduate school: Camp Dresser McKee for the CDM Fellowship; the UF Environmental Engineering Department...reservoir H um id ifi er /S at ur at or C ondenser THot TCold RH Figure A-1. BAU prototype schematic. A) Overview of system. B) Cross -sectional view of...degree in environmental engineering in August 2008 and entered the environmental engineering consulting industry with Camp Dresser McKee as an Engineer II in the Water/Wastewater Services Group.

3 CFR 13628 - Executive Order 13628 of October 9, 2012. Authorizing the Implementation of Certain Sanctions Set...

Code of Federal Regulations, 2013 CFR

2013-01-01

... specialized information or professional consulting, engineering, or support services, with respect to goods or... over the person.” (c) Subsection 1(d) is amended by inserting the words “agricultural commodities...

40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

Code of Federal Regulations, 2012 CFR

2012-07-01

... Consulting Engineering Agreements D Appendix D to Subpart E of Part 35 Protection of Environment... Transition Policy—Existing Consulting Engineering Agreements a. access to records—audit 1. Access clause... access clause is included in the consulting engineering subagreement. The clause contained in appendix C...

40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

Code of Federal Regulations, 2013 CFR

2013-07-01

... Consulting Engineering Agreements D Appendix D to Subpart E of Part 35 Protection of Environment... Transition Policy—Existing Consulting Engineering Agreements a. access to records—audit 1. Access clause... access clause is included in the consulting engineering subagreement. The clause contained in appendix C...

40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

Code of Federal Regulations, 2014 CFR

2014-07-01

... Consulting Engineering Agreements D Appendix D to Subpart E of Part 35 Protection of Environment... Transition Policy—Existing Consulting Engineering Agreements a. access to records—audit 1. Access clause... access clause is included in the consulting engineering subagreement. The clause contained in appendix C...

40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

Code of Federal Regulations, 2010 CFR

2010-07-01

... Consulting Engineering Agreements D Appendix D to Subpart E of Part 35 Protection of Environment... Transition Policy—Existing Consulting Engineering Agreements a. access to records—audit 1. Access clause... access clause is included in the consulting engineering subagreement. The clause contained in appendix C...

40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

Code of Federal Regulations, 2011 CFR

2011-07-01

... Consulting Engineering Agreements D Appendix D to Subpart E of Part 35 Protection of Environment... Transition Policy—Existing Consulting Engineering Agreements a. access to records—audit 1. Access clause... access clause is included in the consulting engineering subagreement. The clause contained in appendix C...

Proceedings of the REAPS Technical Symposium held in Philadelphia, Pennsylvania on 14-16 October, 1980 (The National Shipbuilding Research Program)

DTIC Science & Technology

1980-10-01

service sponsored by the Maritime Administration and operated by the Transportation Research Board of the National Research Council. Information...Engineering Specialist INTERCAN LOGISTICAL SERVICES LIMITED 751 Victoria Sq. Montreal, Quebec H26 2J3 Canada John J. Dougherty VP INTERSHIPPING CONSULTANTS...this burden, to Washington Headquarters Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204

48 CFR 15.408 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... inventory, provide a separate cost breakdown, if priced based on cost. For interorganizational transfers..., travel, computer and consultant services, preservation, packaging and packing, spoilage and rework, and... records as of the cutoff date. These include such costs as preproduction engineering, special plant...

Engineering for Deep Sea Drilling for Scientific Purposes

DTIC Science & Technology

1980-01-01

Clyde Consultants JOSEPH E. BEALL, Triton Engineering Services Company DOUWE DE VRIES, N L Industries, Incorporated TERRY N. GARDNER, Exxon...estimate: $1 million additional cost for each site drilled and 25 to 35 wells to be drilled over the period. __ U 20 inclusion in a request for proposal...26 of a positively buoyant system would allow a nearly conventional rise tensioning system. However, the latter approach would require de - .aping a

Breaking out of the biomed box: an audit assessment and recommendations for an in-house biomedical engineering program.

PubMed

Dickey, David M; Jagiela, Steven; Fetters, Dennis

2003-01-01

In order to assess the current performance and to identify future growth opportunities of an in-house biomedical engineering (BME) program, senior management of Lehigh Valley Hospital (Allentown, Penn) engaged (in July 2001) the services of a clinical engineering consultant. Although the current in-house program was both functionally and financially sound, an independent audit had not been performed in over 4 years, and there were growing concerns by the BME staff related to the department's future leadership and long-term support from senior management. After an initial 2-month audit of the existing program, the consultant presented 41 separate recommendations for management's consideration. In order to refine and implement these recommendations, 5 separate committees were established to further evaluate a consolidated version of them, with the consultant acting as the facilitator for each group. Outcomes from each of the committees were used in the development of a formal business plan, which, upon full implementation, would not only strengthen and refine the current in-house service model but could also result in a substantial 3-year cost savings for the organization ($1,100,000 from existing operations, $500,000 in cost avoidance by in-sourcing postwarranty support of future capital equipment acquisitions). Another key outcome of the project was related to the development of a new master policy, titled the "Medical Equipment Management Program," complete with a newly defined state-of-the-art equipment scheduled inspection frequency model.

Artificial Intelligence: The Bumpy Path Through Defense Acquisition

DTIC Science & Technology

2017-12-01

products through Amazon’s suite of services , or can be trained using the Alexa application to interact and control other smart products in your house...software, and capitalizing on the opportunities for customization and consultation. NVIDIA’s approach to AI hardware, offers opportunities for garage...have teamed up to provide licensing, training , and development services for a product called Unreal Engine 4, aimed at government and military

Ethics education in the consulting engineering environment: where do we start?

PubMed

Elder, Keith E

2004-04-01

As a result of in-house discussions stimulated by previous Gonzaga engineering ethics conferences, Coffman Engineers began the implementation of what is to be a company-wide ethics training program. While preparing a curriculum aimed at consulting engineers, we found very little guidance as to how to proceed with most available literature being oriented towards the academic environment. We consulted a number of resources that address the teaching of engineering ethics in higher education, but questioned their applicability for the Consulting Engineering environment. This lack of guidance led us to informal research into the ethical knowledge and attitudes of both consulting engineers and engineering students. Some of our findings were unexpected, and suggest that a simpler approach to teaching ethics to working professionals might be preferred to that typically promoted in higher education.

77 FR 43368 - Navistar Truck Development and Technology Center, a Subsidiary of Navistar International...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

..., Alpha Personnel, Inc., and PPP Careers, Inc., Fort Wayne, Indiana; Amended Certification Regarding... workers were engaged in engineering and technical consulting services. The company reports that workers leased from PPP Careers, Inc. were employed on-site at the 2911 Meyer Road, Fort Wayne, Indiana location...

Espey, Huston & Associates Technical Library. A Proposal.

ERIC Educational Resources Information Center

Fortine, Suellen

This proposal for the establishment of a library or information center for an environmental and engineering consulting firm in Texas is divided into two phases--current problems, and future expansion of library service. Major considerations include informational problems of the existing small library facility, i.e., locational and subject access,…

7 CFR Appendix D to Subpart E of... - Alcohol Production Facilities Planning, Performing, Development and Project Control

Code of Federal Regulations, 2013 CFR

2013-01-01

... impacts. (2) Applicable engineering, design/build, construction management, inspection and plant start-up... imposed by construction, equipment, material or service contracts, penalty payments, damage claims, awards... consultants with suitable experience, training and professional competence in the design and construction of...

7 CFR Appendix D to Subpart E of... - Alcohol Production Facilities Planning, Performing, Development and Project Control

Code of Federal Regulations, 2010 CFR

2010-01-01

... impacts. (2) Applicable engineering, design/build, construction management, inspection and plant start-up... imposed by construction, equipment, material or service contracts, penalty payments, damage claims, awards... consultants with suitable experience, training and professional competence in the design and construction of...

48 CFR 736.603 - Collecting data on and appraising firms' qualifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Collecting data on and... Architect-Engineer Services 736.603 Collecting data on and appraising firms' qualifications. An USAID Consultant Registry Information System (ACRIS) is maintained in Washington by the USAID Office of Small and...

48 CFR 736.603 - Collecting data on and appraising firms' qualifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Collecting data on and... Architect-Engineer Services 736.603 Collecting data on and appraising firms' qualifications. An USAID Consultant Registry Information System (ACRIS) is maintained in Washington by the USAID Office of Small and...

48 CFR 736.603 - Collecting data on and appraising firms' qualifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Collecting data on and... Architect-Engineer Services 736.603 Collecting data on and appraising firms' qualifications. An USAID Consultant Registry Information System (ACRIS) is maintained in Washington by the USAID Office of Small and...

48 CFR 736.603 - Collecting data on and appraising firms' qualifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Collecting data on and... Architect-Engineer Services 736.603 Collecting data on and appraising firms' qualifications. An USAID Consultant Registry Information System (ACRIS) is maintained in Washington by the USAID Office of Small and...

48 CFR 736.603 - Collecting data on and appraising firms' qualifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Collecting data on and... Architect-Engineer Services 736.603 Collecting data on and appraising firms' qualifications. An USAID Consultant Registry Information System (ACRIS) is maintained in Washington by the USAID Office of Small and...

23 CFR 172.1 - Purpose and applicability.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Purpose and applicability. 172.1 Section 172.1 Highways... policies and procedures for the administration of engineering and design related service contracts under 23... provisions of 23 U.S.C. 112(a) and are issued to ensure that a qualified consultant is obtained through an...

23 CFR 172.1 - Purpose and applicability.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Purpose and applicability. 172.1 Section 172.1 Highways... policies and procedures for the administration of engineering and design related service contracts under 23... provisions of 23 U.S.C. 112(a) and are issued to ensure that a qualified consultant is obtained through an...

23 CFR 172.1 - Purpose and applicability.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Purpose and applicability. 172.1 Section 172.1 Highways... policies and procedures for the administration of engineering and design related service contracts under 23... provisions of 23 U.S.C. 112(a) and are issued to ensure that a qualified consultant is obtained through an...

Explorations of roundwood technology in buildings

Treesearch

Jeffrey Cook

2001-01-01

A report and critical commentary is presented on the use of small diameter roundwood in building construction in the United States and England. Examples are discussed of roundwood joinery being evaluated at the USDA Forest Service's Forest Products Laboratory, and joinery developed by the British engineering consulting firm Buro Happold, working over 15 years in...

78 FR 8588 - Rg Steel Sparrows Point LLC, Formerly Known as Severstal Sparrows Point LLC, a Subsidiary of RG...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

..., Alliance Engineering, Inc., Washington Group International, Javan & Walter, Inc., Kinetic Technical... Consulting, Crown Security, Eastern Automation, EDS(HP), Teksystems, URS Corporation, and B More Industrial... from B More Industrial Services LLC were employed on-site at the Sparrows Point, Maryland location of...

Gap analysis: assessing the value perception of consultant pharmacist services and the performance of consultant pharmacists.

PubMed

Clark, Thomas R

2008-09-01

To understand the importance of services provided by consultant pharmacists and to assess perception of their performance of services. Cross-sectional; nursing facility team. Random e-mail survey of consultant pharmacists; phone survey of team members. 233 consultant pharmacists (practicing in a nursing facility); 540 team members (practicing in a nursing facility, interacting with > or = 1 consultant pharmacist): 120 medical directors, 210 directors of nursing, 210 administrators. Consultant pharmacists, directors of nursing, medical directors, and administrators rating importance/performance of 21 services. Gap between teams' ratings of importance and consultant pharmacists' performance is assessed to categorize services. Importance/performance ranked on five-point scale. Mean scores used for gap analysis to cluster services into four categories. Per combined group, six services categorized as "Keep It Up" (important, good performance), consensus with individual groups, except discrepancy with medical directors, for one service. Six services each categorized as "Improve" (important, large gap) and "Improve Second" (lower importance, large gap), with varied responses by individual groups. Three different services were categorized into "Don't Worry," with consensus within individual groups. Consensus from all groups found 5 of 21 services are important and performed well by consultant pharmacists, indicating to maintain performance of services. For three services, consultant pharmacists do not need to worry about their performance. Thirteen services require improvement in consultant pharmacists' performance; various groups differ on extent of improvement needed. Results can serve as benchmark comparisons with results obtained by consultant pharmacists in their own facilities.

Communication strategies for a successful inpatient dermatology consultative service: a narrative review.

PubMed

Afifi, Ladan; Shinkai, Kanade

2017-03-01

Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service. ©2017 Frontline Medical Communications.

48 CFR 1552.211-78 - Management consulting services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Management consulting... 1552.211-78 Management consulting services. As prescribed in 1511.011-78, insert the following contract clause in all contracts for management consulting services. Management Consulting Services (APR 1985) All...

Bioenvironmental Engineering Guide to Beryllium

DTIC Science & Technology

2017-07-26

Health Dept Consultative Services Division 2510 Fifth St., Bldg. 840 Wright-Patterson AFB, OH 45433-7913 DISTRIBUTION STATEMENT A. Approved for...Environ Health Dept Chair, Occup & Environ Health Dept This report is published in the interest of scientific and technical...UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) USAF School of Aerospace Medicine Occupational & Environmental Health Dept

Analyzing Company Economics Using the Leontief Open Production Model

ERIC Educational Resources Information Center

Laumakis, Paul J.

2008-01-01

This article details the application of an economic theory to the fiscal operation of a small engineering consulting firm. Nobel Prize-winning economist Wassily Leontief developed his general input-output economic theory in the mid-twentieth century to describe the flow of goods and services in the U.S. economy. We use one mathematical model that…

Initiation of a medical toxicology consult service at a tertiary care children's hospital.

PubMed

Wang, George Sam; Monte, Andrew; Hatten, Benjamin; Brent, Jeffrey; Buchanan, Jennie; Heard, Kennon J

2015-05-01

Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children < 6 years, poisoning continues to be a common pediatric diagnosis and bedside toxicology consultation is not common at children's hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children's hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8-16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship.

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

ERIC Educational Resources Information Center

Amara, Nabil; Landry, Rejean; Halilem, Norrin

2013-01-01

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

40 CFR Appendix C-1 to Subpart E... - Required Provisions-Consulting Engineering Agreements

Code of Federal Regulations, 2014 CFR

2014-07-01

... Engineering Agreements C Appendix C-1 to Subpart E of Part 35 Protection of Environment ENVIRONMENTAL... Provisions—Consulting Engineering Agreements 1. General 2. Responsibility of the Engineer 3. Scope of Work 4... drawings, designs, specifications, reports, and incidental engineering work or materials furnished...

40 CFR Appendix C-1 to Subpart E... - Required Provisions-Consulting Engineering Agreements

Code of Federal Regulations, 2013 CFR

2013-07-01

... Engineering Agreements C Appendix C-1 to Subpart E of Part 35 Protection of Environment ENVIRONMENTAL... Provisions—Consulting Engineering Agreements 1. General 2. Responsibility of the Engineer 3. Scope of Work 4... drawings, designs, specifications, reports, and incidental engineering work or materials furnished...

40 CFR Appendix C-1 to Subpart E... - Required Provisions-Consulting Engineering Agreements

Code of Federal Regulations, 2011 CFR

2011-07-01

... Engineering Agreements C Appendix C-1 to Subpart E of Part 35 Protection of Environment ENVIRONMENTAL... Provisions—Consulting Engineering Agreements 1. General 2. Responsibility of the Engineer 3. Scope of Work 4... drawings, designs, specifications, reports, and incidental engineering work or materials furnished...

40 CFR Appendix C-1 to Subpart E... - Required Provisions-Consulting Engineering Agreements

Code of Federal Regulations, 2012 CFR

2012-07-01

... Engineering Agreements C Appendix C-1 to Subpart E of Part 35 Protection of Environment ENVIRONMENTAL... Provisions—Consulting Engineering Agreements 1. General 2. Responsibility of the Engineer 3. Scope of Work 4... drawings, designs, specifications, reports, and incidental engineering work or materials furnished...

Implementing a comprehensive cost information system in rural health facilities: the case of Nouna health district, Burkina Faso.

PubMed

Flessa, Steffen; Kouyaté, Bocar

2006-09-01

To present first findings of a cost-of-illness (COI) information system implemented in Nouna health district, Burkina Faso. The entire project will include household and provider tangible COI, whereas this article concentrates on the development of a provider cost information system in rural first-line health facilities. Special forms and reports are prepared to routinely collect capital and recurrent costs of first-line facilities. Inventory lists are designed, and buildings and equipment are assessed by engineers. Total, fixed, variable and average costs are calculated for 15 rural health centres with five cost centres: general outpatient consultation, ambulatory nursing care, deliveries, immunization and other services (neonatal consultation, child care and family planning). In 2003, the average costs per service unit were 1.34 US$ for a general consultation, 0.51 US$ for ambulatory nursing care, 6.73 US$ per delivery, 3.64 US$ per vaccination and 1.11 US$ per service unit of other care. On average, a health centre consumes 29,900 US$ per year for a catchment population of 10,000 inhabitants. The major share of costs is fixed and does not depend on the workload of the health centre. Consequently, the costs of first-line facilities will hardly increase if the demand for health services rises. These findings can be used to improve the health financing in Nouna health district, Burkina Faso.

Why and When do Patients Use e-Consultation Services? The Trust and Resource Supplementary Perspectives.

PubMed

Li, Jia; Liu, Minghui; Liu, Xuan; Ma, Ling

2018-01-01

e-Consultation provides a new way to deliver healthcare services online. With the help of e-Consultation services, patients can gain access to nationwide medical expertise that otherwise would not be available to them. As an online delivery approach, e-Consultation also provides a choice for patients to receive medical advice from online doctors immediately, no matter how far away from the hospital they may be or how late in the day it is. However, the adoption and usage of e-Consultation is still far from satisfactory. Therefore, understanding why and when patients use e-Consultation services are important research questions. Considering that the choice of a healthcare provider is a serious decision, this research uses the trust perspective to explain the e-Consultation service adoption phenomenon. Specifically, trust is conceptualized as a second-order construct consisting of two dimensions: competence and integrity. In addition, e-Consultation is viewed as a supplementary resource to traditional off-line consultation services, and disease type as a contextual factor is hypothesized to focus the context where e-Consultation services are more suitable. A scenario-based survey was conducted to test the proposed research model. We obtained a total of 190 valid questionnaires. Our results indicated that trust (p < 0.01) had a positive effect on the intention to use an e-Consultation service. Meanwhile, our results also indicated that the higher the disease is in rarity (p < 0.05), severity (p < 0.01), or urgency (p < 0.05), the lesser the positive effect of trust is on the intention to use an e-Consultation service. Trust is the major driving force of an e-Consultation service adoption. When the disease is high in rarity, severity, or urgency, an off-line healthcare provider is less capable of providing meaningful, qualified, and immediate service. Therefore, there is a decreased positive effect of trust on the intention to use an e-Consultation service for those diseases.

Consultant-based otolaryngology emergency service: a five-year experience.

PubMed

Barnes, M L; Hussain, S S M

2011-12-01

To present our experience of running a consultant-based otolaryngology emergency care service for more than five years. In 2003, we developed a system of consultant-based emergency service: consultants spent a week on-call providing a dedicated emergency service, with routine commitments cancelled. Our new system had advantages over traditional working practices in terms of consultant involvement, trainee education, continuity and efficiency. It also reduced disruption to elective commitments for both consultants and registrars. This system was fundamental to the successful review of all urgent (and in future elective) cases within target periods. Only 31 per cent of new referrals to the consultant emergency clinics required a further appointment. Good teamwork and flexibility in working arrangements have been essential to the success of this service. Given that health service changes have reduced junior trainee working hours and numbers, and that patients increasingly expect to be treated by trained doctors, our new consultant-based emergency service has merit. Although implementation in other units may differ, we recommend this new service, for the above reasons.

Bringing a military approach to teaching.

PubMed

Baillie, Jonathan

2015-03-01

Despite having only established the company nine years ago, the founders of Kidderminster-based Avensys Medical believe the company now offers not only one of the UK's most comprehensive maintenance, repair, consultancy, and equipment audit services for medical and dental equipment, but also one of the most tailored training portfolios for electro-biomedical (EBME) engineers working in healthcare settings to enable them to get the best out of such equipment, improve patient safety, optimise service life, and save both the NHS and private sector money. As HEJ editor, Jonathan Baillie, discovered on meeting one of the two co-founders, ex-Royal Electrical and Mechanical Engineers (REME) artificer sergeant-major (ASM) and MoD engineering trainer, Robert Strange, many of the company's key trainers have a strong military background, and it is the rigorous and disciplined approach this enables them to bring to their training that he believes singles the company out.

Electrical innovations, authority and consulting expertise in late Victorian Britain

PubMed Central

Arapostathis, Stathis

2013-01-01

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

Experience of a year of adult hospital dermatology consultations.

PubMed

Storan, Eoin R; McEvoy, Marian T; Wetter, David A; El-Azhary, Rokea A; Camilleri, Michael J; Bridges, Alina G; Davis, Mark D P

2015-10-01

Dermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important. We aim to describe the spectrum of skin diseases encountered and the health care subspecialties requesting dermatology hospital consultations. We performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses. Among dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft-versus-host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%). The majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services. © 2014 The International Society of Dermatology.

Development of an After-Sales Support Inter-Enterprise Collaboration System Using Information Technologies

NASA Astrophysics Data System (ADS)

Kimura, Toshiaki; Kasai, Fumio; Kamio, Yoichi; Kanda, Yuichi

This research paper discusses a manufacturing support system which supports not only maintenance services but also consulting services for manufacturing systems consisting of multi-vendor machine tools. In order to do this system enables inter-enterprise collaboration between engineering companies and machine tool vendors. The system is called "After-Sales Support Inter-enterprise collaboration System using information Technologies" (ASSIST). This paper describes the concept behind the planned ASSIST, the development of a prototype of the system, and discusses test operation results of the system.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Building Technologies Office

The Building Energy Asset Score is a national standardized tool for evaluating the physical and structural energy efficiency of commercial and multifamily residential buildings. The Asset Score generates a simple energy efficiency rating that enables comparison among buildings, and identifies opportunities for users to invest in energy efficiency upgrades. It is web-based and free to use. This fact sheet discusses the value of the score for energy services companies, engineers and green building consultants.

CrossTalk: The Journal of Defense Software Engineering. Volume 21, Number 3

DTIC Science & Technology

2008-03-01

describes essentials for requirements development and management. In addi- tion to providing training, eLearning and consulting services, she speaks at and...information, support sense- making, enable collaborative decision making, and effect changes in the physical environment. For example, the Global ...across layers, which enables effective use of resources and helps enforce security and confiden- tiality policies. Global Data Space DDS provides a

Procurement of Architectural and Engineering Services for Sustainable Buildings: A Guide for Federal Project Managers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

2004-06-01

This guide was prepared to be a resource for federal construction project managers and others who want to integrate the principles of sustainable design into the procurement of professional building design and consulting services. To economize on energy costs and improve the safety, comfort, and health of building occupants, building design teams can incorporate daylighting, energy efficiency, renewable energy, and passive solar design into all projects in which these elements are technically and economically feasible. The information presented here will help project leaders begin the process and manage the inclusion of sustainable design in the procurement process. The section onmore » establishing selection criteria contains key elements to consider before selecting an architectural and engineering (A/E) firm. The section on preparing the statement of work discusses the broad spectrum of sustainable design services that an A/E firm can provide. Several helpful checklists are included.« less

[Feasibility of consultation - liaison psychiatry in a large general hospital: quantitative description of services and personnel expenditure].

PubMed

Windhager, Elmar; Thaler, Katharina; Selberis-Vahl, Wilia Vasiliki; Friedl-Wörgetter, Petra; Windhager, Isabella; Zauner, Katharina

2015-01-01

The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution. A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013. There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved. A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

Career opportunities in clinical engineering.

PubMed

Morse, W A

1992-01-01

The varied career opportunities open to clinical engineers are described in this paper. Many of these opportunities are within the medical device industry in research, development, manufacturing design, regulatory activities, production, operations, sales, marketing, service, and management. Additional opportunities are available in hospitals, with the Veterans Administration, or working as an entrepreneur or a consultant. Each of these careers requires specific training and skills, and they all require a fundamental scientific knowledge of physical principles and mathematics. Research and management, however, require different educational preparation. The research emphasis should be on theoretical principles and creativity; the management emphasis should be on financial and labor problems. In all clinical engineering careers, the individual is a problem solver.

Perceiving integration of a complementary medicine service within a general surgery department through documentation of consultations: a thematic analysis.

PubMed

Schiff, Elad; Ben-Arye, Eran; Attias, Samuel; Sroka, Gideon; Matter, Ibrahim; Keshet, Yael

2012-12-01

This study aims to examine the meaning and practical implications of integration of a complementary medicine-based surgery service in a hospital setting (CISS--Complementary/Integrative Surgery Service) through analysis of consultation reports associated with this service. Thematic analysis was used to evaluate CISS consultation reports in a hospital electronic consultant charting system during the first half year of the service's activity. 304 consultation reports were analyzed. Nurses initiated significantly more consultations than physicians (55% vs 7%). Consultation requests were gradually more focused on specific symptoms, possibly manifesting a better understanding of the scope of complementary medicine in the surgery setting. CISS practitioners responded in more biomedical language over time, albeit offering a more holistic perspective regarding patients' needs as well as clarifications regarding the nature of the treatment they provided. Diverse communication patterns in consultations evolved over time representing dynamics in multiple levels of integration of the CISS. Documented communication through consultations can provide a window to the process of integration of complementary medicine-based services in health systems. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Outreach to Scientists and Engineers at the Hanford Technical Library

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buxton, Karen A.

Staff at the Hanford Technical Library has developed a suite of programs designed to help busy researchers at the Pacific Northwest National Laboratory (PNNL) make better use of library products and services. Programs include formal training classes, one-on-one consultations, and targeted email messages announcing new materials to researchers in specific fields. A staple of outreach has been to teach classes to library clients covering research tools in their fields. These classes started out in the library classroom and then expanded to other venues around PNNL. Class surveys indicated that many researchers desired a practical approach to learning rather than themore » traditional lecture format. The library instituted “Library Learning Day” and hosted classes in the PNNL computer training room to provide lab employees with a hands-on learning experience. Classes are generally offered at noon and lab staff attends classes on their lunch hour. Many just do not have time to spend a full hour in training. Library staff added some experimental half-hour mini classes in campus buildings geared to the projects and interests of researchers there to see if this format was more appealing. As other programs have developed librarians are teaching fewer classes but average attendance figures has remained fairly stable from 2005-2007. In summer of 2004 the library began the Traveling Librarian program. Librarians call-on groups and individuals in 24 buildings on the Richland Washington campus. Five full-time and two part-time librarians are involved in the program. Librarians usually send out email announcements prior to visits and encourage scientists and engineers to make appointments for a brief 15 minute consultation in the researcher’s own office. During the meeting lab staff learn about products or product features that can help them work more productively. Librarians also make cold calls to staff that do not request a consultation and may not be making full use of the library. Scientists and engineers who require longer sessions can arrange half-hour training appointments in the researcher’s own office or at the library. Since the program was implemented staff made 165 visits to 1249 laboratory staff including some repeat consultation requests. New acquisitions lists are sent to individuals and groups that would be interested in recent journal, database, and books purchases. These lists are topic specific and targeted to groups and individuals with an interest in the field. For example newly acquired engineering resources are targeted at engineering groups. The new acquisitions list for engineering began mid year in 2005. An analysis of circulation statistics for engineering books in fiscal year 2005, 2006, and 2007 show that circulation increased each year with 2007 circulation nearly double that of 2005. This took place when overall circulation rose in FY06 but fell slightly in FY07. Outreach strategies tailored and individualized can be effective. Offering multiple outreach options offers researchers different ways to interact with library staff and services.« less

[Differences between patients in consultation psychiatry and psychiatric inpatients].

PubMed

Unterecker, Stefan; Maloney, Julia; Pfuhlmann, Bruno; Deckert, Jürgen; Warrings, Bodo

2014-05-01

To optimize psychiatric consultation service epidemiological information is needed. We compared data on gender, age and diagnoses of patients in the consultation service to psychiatric inpatients. In psychiatric consultation service patients are older (56.6 vs. 44.9 years, p < 0.05) and males are older than females (58.8 vs. 54.4 years, p < 0.05). For male patients, the psychiatric consultation service is contacted more often in cases of organic disorders, for females in adjustment disorders (p < 0.05). The diagnostic spectrum in psychiatric consultation service is different for males and females with relevance for diagnostic and therapeutic procedures. © Georg Thieme Verlag KG Stuttgart · New York.

The feasibility of using UML to compare the impact of different brands of computer system on the clinical consultation.

PubMed

Kumarapeli, Pushpa; de Lusignan, Simon; Koczan, Phil; Jones, Beryl; Sheeler, Ian

2007-01-01

UK general practice is universally computerised, with computers used in the consulting room at the point of care. Practices use a range of different brands of computer system, which have developed organically to meet the needs of general practitioners and health service managers. Unified Modelling Language (UML) is a standard modelling and specification notation widely used in software engineering. To examine the feasibility of UML notation to compare the impact of different brands of general practice computer system on the clinical consultation. Multi-channel video recordings of simulated consultation sessions were recorded on three different clinical computer systems in common use (EMIS, iSOFT Synergy and IPS Vision). User action recorder software recorded time logs of keyboard and mouse use, and pattern recognition software captured non-verbal communication. The outputs of these were used to create UML class and sequence diagrams for each consultation. We compared 'definition of the presenting problem' and 'prescribing', as these tasks were present in all the consultations analysed. Class diagrams identified the entities involved in the clinical consultation. Sequence diagrams identified common elements of the consultation (such as prescribing) and enabled comparisons to be made between the different brands of computer system. The clinician and computer system interaction varied greatly between the different brands. UML sequence diagrams are useful in identifying common tasks in the clinical consultation, and for contrasting the impact of the different brands of computer system on the clinical consultation. Further research is needed to see if patterns demonstrated in this pilot study are consistently displayed.

Consultant management estimating tool.

DOT National Transportation Integrated Search

2012-04-01

The New York State Department of Transportation (NYSDOT) Consultant Management Bureaus primary responsibilities are to negotiate staffing hours/resources with : engineering design consultants, and to monitor the consultant's costs. Currently the C...

Implementation of a nationwide health economic consultation service to assist substance use researchers: Lessons learned.

PubMed

Murphy, Sean M; Leff, Jared A; Linas, Benjamin P; Morgan, Jake R; McCollister, Kathryn; Schackman, Bruce R

2018-03-20

Health economic evaluation findings assist stakeholders in improving the quality, availability, scalability, and sustainability of evidence-based services, and in maximizing the efficiency of service delivery. The Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV, and HIV (CHERISH) is a NIDA-funded multi-institutional center of excellence whose mission is to develop and disseminate health-economic research on healthcare utilization, health outcomes, and health-related behaviors that informs substance use disorder treatment policy, and HCV and HIV care of people who use substances. We designed a consultation service that is free to researchers whose work aligns with CHERISH's mission. The service includes up to six hours of consulting time. After prospective consultees submit their request online, they receive a screening call from the consultation service director, who connects them with a consultant with relevant expertise. Consultees and consultants complete web-based evaluations following the consultation; consultees also complete a six-month follow-up. We report on the status of the service from its inception in July 2015 through June 2017. We have received 28 consultation requests (54% Early Stage Investigators, 57% MD or equivalent, 28% PhD, 61% women) on projects typically related to planning a study or grant application (93%); 71% were HIV/AIDS-related. Leading topics included cost-effectiveness (43%), statistical-analysis/econometrics (36%), cost (32%), cost-benefit (21%), and quality-of-life (18%). All consultees were satisfied with their overall experience, and felt that consultation expectations and objectives were clearly defined and the consultant's expertise was matched appropriately with their needs. Results were similar for consultants, who spent a median of 3 hours on consultations. There is a need for health-economic methodological guidance among substance use, HCV, and HIV researchers. Lessons learned pertain to the feasibility of service provision, the need to implement systems to measure and improve service value, and strategies for service promotion.

A Pharmaceutical Bioethics Consultation Service: Six-Year Descriptive Characteristics and Results of a Feedback Survey.

PubMed

Van Campen, Luann E; Allen, Albert J; Watson, Susan B; Therasse, Donald G

2015-04-03

Background : Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods : Data on the descriptive characteristics of bioethics consultations were collected from 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results : Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions : Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service raises awareness about bioethics, empowers employees to raise bioethical concerns, and helps them reason through challenging issues.

A Pharmaceutical Bioethics Consultation Service: Six-Year Descriptive Characteristics and Results of a Feedback Survey

PubMed Central

Van Campen, Luann E.; Allen, Albert J.; Watson, Susan B.; Therasse, Donald G.

2015-01-01

Background: Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods: Data on the descriptive characteristics of bioethics consultations were collected from 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results: Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions: Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service raises awareness about bioethics, empowers employees to raise bioethical concerns, and helps them reason through challenging issues. PMID:26740962

Consulting a trained physician when considering a request for euthanasia: an evaluation of the process in flanders and the Netherlands.

PubMed

Van Wesemael, Yanna; Cohen, Joachim; Bilsen, Johan; Onwuteaka-Philipsen, Bregje D; Distelmans, Wim; Deliens, Luc

2010-12-01

In Belgium and the Netherlands, consultation of a second independent physician by the attending physician is mandatory in euthanasia cases. In both countries, specialized consultation services have been established to provide physicians trained for that purpose. This retrospective study describes and compares the quality of consultation of both services based on surveys of attending physicians and those providing the consultation (consultants). While Dutch consultants discussed certain subjects, for example, alternative curative or palliative treatment more often with the attending physician than Belgian consultants, both usually discussed those subjects considered necessary for a quality consultation and were independent from patient and attending physician. Over 90% of attending physicians in both countries evaluated the consultant's knowledge of palliative care, patient's disease, and judicial procedure, and their communication skills, as sufficient. Consultation with specialized consultation services seems to promote quality of euthanasia consultations.

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting.

PubMed

DiPiro, Pamela J; Krajewski, Katherine M; Giardino, Angela A; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H

2017-01-01

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Variable Geometry and Multicycle Engines

DTIC Science & Technology

1977-03-01

Panels which are composed of experts appointed by the National Delegates, the Consultant and Exchange Program and the Aerospace Applications Studies ...concerned with the improving possibilities available fromt various variable geometry comlpo- nents both in service and under study and test now. Hi-gh...avanitages -t les expoSt .6 traitalit Lie cette Lquestioni onit suscitrý un vii’ int~r~t. ALL coors des discus’dons qui suivirent Ia presentationl Lie

A Comparison of General Medical and Clinical Ethics Consultations: What Can We Learn From Each Other?

PubMed Central

Geppert, Cynthia M.A.; Shelton, Wayne N.

2012-01-01

Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed. PMID:22469350

Improving engineering effectiveness

NASA Technical Reports Server (NTRS)

Fiero, J. D.

1985-01-01

Methodologies to improve engineering productivity were investigated. The rocky road to improving engineering effectiveness is reviewed utilizing a specific semiconductor engineering organization as a case study. The organization had a performance problem regarding new product introductions. With the help of this consultant as a change agent the engineering team used a systems approach to through variables that were effecting their output significantly. Critical factors for improving this engineering organization's effectiveness and the roles/responsibilities of management, the individual engineers and the internal consultant are discussed.

Development and Evaluation of a Novel Survey Tool Assessing Inpatient Consult Service Performance.

PubMed

Miloslavsky, Eli M; Chang, Yuchiao

2017-12-01

Subspecialty consultation in inpatient medicine is increasing, and enhancing performance of consultation services may have a broad-reaching impact. Multisource feedback is an important tool in assessing competence and improving performance. A mechanism for primary team resident feedback on performance of consult services has not been described. We developed and evaluated an instrument designed to assess internal medicine (IM) subspecialty inpatient consult service performance. We hypothesized that the instrument would be feasible to administer and provide important information to fellowship directors. The instrument was administered in 2015 and 2016 at a single academic center. All IM residents were invited to evaluate 10 IM subspecialty consult services on 4 items and an overall satisfaction rating. The instrument allowed for free-text feedback to fellows. Program directors completed another survey assessing the impact of the consult service evaluation. A total of 113 residents responded (47 in 2015 and 66 in 2016, for a combined response rate of 35%). Each of the 4 items measured (communication, professionalism, teaching, and pushback) correlated significantly with the overall satisfaction rating in univariate and multivariate analyses. There were no differences in ratings across postgraduate year or year of administration. There was considerable variation in ratings among the services evaluated. The 7 program directors who provided feedback found the survey useful and made programmatic changes following evaluation implementation. A primary team resident evaluation of inpatient medicine subspecialty consult services is feasible, provides valuable information, and is associated with changes in consult service structure and curricula.

Development and Preliminary Application of Multi-channel Agricultural Science and Technology Consulting Service U Disk

NASA Astrophysics Data System (ADS)

Yu, W. S.; Luo, C. S.; Wei, Q. F.; Zheng, Y. M.; Cao, C. Z.

2017-12-01

To deal with the “last kilometer” problem during the agricultural science and technology information service, the USB flash disk “Zixuntong”, which integrated five major consulting channels, i.e., telephone consultation, mutual video, message consultation, online customer service and QQ group was developed on the bases of capital experts and date resources. Since the products have the computer and telephone USB interface and are combined with localized information resources, users can obtain useful information on any terminal without the restriction of network. Meanwhile, the cartoon appearance make it friendly and attractive to people. The USB flash disk was used to provide agricultural expert consulting services and obtained a good preliminary application achievement. Finally, we concluded the creative application of USB flash disk in agricultural consulting services and prospected the future development direction of agricultural mobile consultation.

There is no place like @home!: The value of home consultations in paediatric rehabilitation.

PubMed

van Maren-Suir, I; Ketelaar, M; Brouns, B; van der Sanden, K; Verhoef, M

2018-07-01

Family-centred services (FCS) is widely regarded as the best practice approach in early interventions. Creating a therapeutic environment, which also stimulates collaboration between parents and service professionals, is a way to conform to the principles of FCS. The present paper describes the project entitled @home, involving the implementation of home consultations by a specialized team working with children aged 0-5 years at our rehabilitation centre in the Netherlands. The objectives of this article are to (a) describe the development and implementation of home consultations as part of regular care and (b) share the experiences of parents and service providers with home consultations. The implementation process was divided into 3 steps: (1) interviewing experts, (2) adjusting current rehabilitation trajectories, and (3) service providers offering consultations to children at home. The experiences with the home consultations were immediately incorporated in the system, making the implementation an iterative process. In 82% of the 133 home conducted consultations, the service professionals reported that it was more valuable to offer home consultations than seeing the child at the rehabilitation centre. The semistructured interviews revealed that parents and service providers found that they received and provided more tailored advice, perceived a more equal partnership between service professionals and parents, and reported that the home consultations provided a good natural therapeutic environment where a child can be itself and where the child performs best. By using the @home system based on the 3 service models, home consultations are now part of the regular paediatric rehabilitation system at our rehabilitation centre. © 2018 John Wiley & Sons Ltd.

Internet Hospitals in China: Cross-Sectional Survey

PubMed Central

Lin, Lingyan; Fan, Si; Lin, Fen; Wang, Long; Guo, Tongjun; Ma, Chuyang; Zhang, Jingkun; Chen, Yixin

2017-01-01

Background The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Internet hospitals have not been systematically investigated. Objective The aim of this study was to describe the characteristics of China’s Internet hospitals, and to assess their health service capacity. Methods We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as “Internet hospital,” “web hospital,” or “cloud hospital.” All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. Results We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Conclusions Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China’s Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done. PMID:28676472

The Application of Statistical Process Control in Non-Manufacturing Activities

DTIC Science & Technology

1988-01-01

food and lodging, legal, medical, fin- ancial, communication, engineering, architecture, and consultation. Also included would be education...sequence of pro- duction events and an output that is a product or the completion of a 9 service. A good example of this is a fast food restaurant. A...of quality improvement, and how they relate to each other. In discussing the definition of quality, the character- istics of both good and bad

Characteristics of Phase-Correcting Fresnel Zone Plates and Elliptical Waveguides

DTIC Science & Technology

1994-02-01

elektronika, No. 9, pp. 1681-1688, 1985) B. K. Goto and H. Banjo, "Angle Eikonals of Plane and Spherical Zone Plates," Journal of the Optical Society o...CARLuncover, NTIS (technical reports), and MATHSCI on DIALOG information services. The INSPec and ENGIneering databases were readily available to the...authors via the Georgia Institute of3 Technology electronic library system, while the remaining databases were consulted by library personnel. Ultimately, a

An integrated approach to infrastructure.

PubMed

Hayes, Stewart

2010-02-01

In an edited version of a paper presented at the IHEA (Institute of Hospital Engineering Australia) 60th National Conference 2009, Stewart Hayes, principal consultant at Jakeman Business Solutions, argues that, with "traditional" means of purchasing and maintaining critical hospital infrastructure systems "becoming less viable", a more integrated, strategic approach to procuring and providing essential hospital services that looks not just to the present, but equally to the facility's anticipated future needs, is becoming ever more important.

Two steps forward, one step back: changes in palliative care consultation services in California hospitals from 2007 to 2011.

PubMed

Pantilat, Steven Z; O'Riordan, David L; Bruno, Kelly A

2014-11-01

The number of palliative care consultation services is growing, yet little is known about how program characteristics change over time. Compare changes in the characteristics of palliative care programs and palliative care consultation services in 2007 and 2011. We surveyed all hospitals in California in 2011 and compared palliative care program and palliative care consultation service characteristics with survey results from 2007. There were 41 new palliative care programs since 2007; 17 programs closed between 2007 and 2011. Hospital characteristics associated with the closure of a palliative care program included a hospital size of 1-149 beds versus 150 or more (p=0.03), for-profit status (p=0.001), and having no system affiliation (p=0.0001). The prevalence of palliative care consultation services was 33% in 2007 and 37% in 2011 (p=0.3). At both time periods nearly all palliative care consultation services (98%) were available onsite during weekday business hours and only half were available at other times (p=0.4). There was an increase (p=0.002) in nurse/physician full-time equivalent (FTE; 2007, mean=1.5; 95% confidence interval [CI]=1.3-1.7; 2011, mean=1.9; 95% CI=1.6-2.2) but fewer teams reported having social workers (58% versus 80%, p=0.002) and chaplains (58% versus 77%, p=0.0001) in 2011. Over half of the palliative care consultation services reported seeing less than 50% of patients who would benefit from a consultation (2007: 59%, 2011=50%, p=0.2), yet most also reported struggling to cope with patient volume (2007: 62%; 2011: 66%, p=0.5). Fewer than half of hospitals in California offer a palliative care program and many close over time. Making palliative care consultation services a condition of participation by insurers could make hospital palliative care consultation services universal. Mechanisms need to be established to improve staffing levels, maintain the interdisciplinary nature of palliative care consultation services, and accommodate demand for services.

77 FR 18258 - Government-to-Government Telephonic Consultation Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

... DEPARTMENT OF THE INTERIOR National Park Service [NPS-WASO-NRNHL-0212-9515; 2280-665] Government-to-Government Telephonic Consultation Meetings AGENCY: National Park Service, Interior. SUMMARY: The National Park Service announces two telephonic government- to-government consultation meetings with Indian...

77 FR 2732 - Tribal Consultation; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-19

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation; Notice of Meeting AGENCY: Administration for Children and Families, Department of Health and... Services (HHS), Administration for Children and Families (ACF) will host a Tribal Consultation to consult...

A cost minimisation analysis of a telepaediatric otolaryngology service.

PubMed

Xu, Cathy Q; Smith, Anthony C; Scuffham, Paul A; Wootton, Richard

2008-02-04

Paediatric ENT services in regional areas can be provided through telemedicine (tele-ENT) using videoconferencing or with a conventional outpatient department ENT service (OPD-ENT) in which patients travel to see the specialist. The objective of this study was to identify the least-cost approach to providing ENT services for paediatric outpatients. A cost-minimisation analysis was conducted comparing the annual costs of the two modes of service provided by the Royal Children's Hospital (RCH) in Brisbane. Activity records were reviewed to analyse volume of activity during a 12 month period in 2005, i.e. number of clinics, duration of clinics, number of consultations via telemedicine and in outpatient clinics, diagnoses, and travel related information. A sensitivity analysis was conducted using factors where there was some uncertainty or potential future variation. During the study period, 88 ENT consultations were conducted via videoconference for 70 patients at Bundaberg Base Hospital. 177 ENT consultations were conducted at the RCH for 117 patients who had travelled from the Bundaberg region to Brisbane. The variable cost of providing the tele-ENT service was A$108 per consultation, compared with A$155 per consultation for the conventional outpatient service. Telemedicine was cheaper when the workload exceeded 100 consultations per year. If all 265 consultations were conducted as tele-ENT consultations, the cost-savings would be $7,621. The cost-minimisation analysis demonstrated that under the circumstances described in this paper, the tele-ENT service was a more economical method for the health department of providing specialist ENT services.

The Process of Psychological Consultation

ERIC Educational Resources Information Center

Nolan, Anna; Moreland, Neil

2014-01-01

Consultation is a key means of service delivery in many psychological services. However, the "process" of consultation is little explored in Educational Psychology literature, particularly in the United Kingdom (UK). This paper focuses on a small-scale qualitative research study of psychological consultation provided by educational…

48 CFR 31.205-33 - Professional and consultant service costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Professional and consultant service costs. 31.205-33 Section 31.205-33 Federal Acquisition Regulations System FEDERAL... Commercial Organizations 31.205-33 Professional and consultant service costs. (a) Definition. Professional...

Development and Implementation of an Inpatient Otolaryngology Consultation Service at an Academic Medical Center.

PubMed

Huddle, Matthew G; London, Nyall R; Stewart, C Matthew

2018-02-01

To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014. Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward). Billing data were collected for incidences of new patient and subsequent consultation charges. The 2-year preimplementation period (July 2005-June 2007) was compared with the postimplementation periods, divided into 2-year blocks (July 2007-June 2013). Outcome measures of patient encounters and work relative value units were compared between pre- and postimplementation blocks. Total encounters increased from 321 preimplementation to 1211, 1347, and 1073 in postimplementation groups ( P < 0.001). Total work relative value units increased from 515 preimplementation to 2090, 1934, and 1273 in postimplementation groups ( P < 0.001). A formal inpatient consultation service was designed with supervisory oversight by non-Accreditation Council for Graduate Medical Education fellows and then expanded to include intermittent hospitalist management, followed by the addition of a dedicated physician assistant. These additions have led to the formation of a sustainable consultation service that supports the mission of high-quality care and service to consulting teams.

Strangers at the Benchside: Research Ethics Consultation

PubMed Central

Cho, Mildred K.; Tobin, Sara L.; Greely, Henry T.; McCormick, Jennifer; Boyce, Angie; Magnus, David

2008-01-01

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. PMID:18570086

48 CFR 3452.237-71 - Services of consultants.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Services of consultants. 3452.237-71 Section 3452.237-71 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION... set forth, $150, exclusive of travel costs, or if the services of any consultant under this contract...

A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

PubMed

Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

2018-03-01

Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

Ask the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system.

PubMed

Fogel, Adam; Khamisa, Karima; Afkham, Amir; Liddy, Clare; Keely, Erin

2017-04-01

Introduction The Champlain BASE (Building Access to Specialists through eConsultation) eConsultation service was designed to address the limited access to specialist care in Canada, which can lead to long waiting times and, subsequently, negative patient outcomes. Our primary objective was to perform an in-depth analysis of the use, content, and perceived value of haematology electronic consults (eConsults) submitted by primary care providers (PCPs) to the eConsult service. Methods We conducted a cross-sectional study using descriptive statistics to examine post-eConsult surveys for PCPs and other collected data including PCP designation, time for specialist to complete the eConsult, specialist response time, perceived value of the eConsult by the PCP, and the need for a face-to-face referral following the eConsult. A medically-trained author reviewed all haematology eConsults from April 2011 to January 2015, and categorized them by clinical topic and question type using validated taxonomies. Results Haematology accounted for 436 out of 5601 (7.8%) total eConsults, making it the third most popular service utilized. In 66% of haematology eConsults, a face-to-face consultation was not needed. Anaemia, neutropenia, and hyperferritinemia were the most common clinical queries. Most eConsult question types concerned the management of haematological disorders or the interpretation of laboratory tests. Most eConsults were answered within three days, using less than 15 minutes of the specialists' time. PCPs highly valued the service. Discussion This initiative increases access to haematology care and has the potential to reduce the long waiting times for non-urgent traditional consultation, along with the benefit of cost savings to the healthcare system.

Sustainability of a Primary Care-Driven eConsult Service.

PubMed

Liddy, Clare; Moroz, Isabella; Afkham, Amir; Keely, Erin

2018-03-01

Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability. We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician's course of action, and rate of avoidance of face-to-face visits. A total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month. This study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems. © 2018 Annals of Family Medicine, Inc.

Identification of general characteristics, motivation, and satisfaction of internet-based medical consultation service users in Croatia

PubMed Central

Klinar, Ivana; Balažin, Ana; Baršić, Bruno; Tiljak, Hrvoje

2011-01-01

Aim To identify users’ reasons to look for physician consultation on the internet instead of visiting a physician and to explore their general characteristics, motivation, and satisfaction with internet medical consultation service ‘Your Questions.’ Methods Users of a free internet medical consultation service ‘Your Questions’ (www.plivazdravlje.hr) were invited to participate in a web-based survey designed to explore their general characteristics (age, sex, etc), reasons for using the service, the nature of their health problem or question, and their satisfaction with the service. Respondents were divided into two groups: users who consulted an internet physician only (Group I) and users who used internet consulting before or after visiting a physician (Group II). Results The response rate was 38% (1036/2747), with 79% female respondents. A fifth of the respondents (21%) consulted an internet physician only (Group I). Multivariate analysis revealed that the respondents in Group I were younger (median 24 vs 28 years in Group II), more interested into questions about pregnancy (odds ratio [OR], 1.984; 95% confidence interval [CI], 1.203-3.272), more often embarrassed to talk to a physician in person (OR, 1.828; 95% CI, 1.119-2.989), and more motivated to protect their privacy (OR, 1.727; 95% CI, 1.252-2.380). They also had greater satisfaction with the service (77% vs 60%, P < 0.001). Conclusion The factors associated with the use of internet-based medical consultation services were younger age, need for privacy protection, avoidance of embarrassment at the physician’s office, and having a question related to pregnancy. This reveals the internet medical consultation service as a useful health promotion supplement that is particularly applicable for the population of young adults. PMID:21853551

Identification of general characteristics, motivation, and satisfaction of internet-based medical consultation service users in Croatia.

PubMed

Klinar, Ivana; Balazin, Ana; Barsić, Bruno; Tiljak, Hrvoje

2011-08-15

To identify users' reasons to look for physician consultation on the internet instead of visiting a physician and to explore their general characteristics, motivation, and satisfaction with internet medical consultation service 'Your Questions.' Users of a free internet medical consultation service 'Your Questions' (www.plivazdravlje.hr) were invited to participate in a web-based survey designed to explore their general characteristics (age, sex, etc), reasons for using the service, the nature of their health problem or question, and their satisfaction with the service. Respondents were divided into two groups: users who consulted an internet physician only (Group I) and users who used internet consulting before or after visiting a physician (Group II). The response rate was 38% (1036/2747), with 79% female respondents. A fifth of the respondents (21%) consulted an internet physician only (Group I). Multivariate analysis revealed that the respondents in Group I were younger (median 24 vs 28 years in Group II), more interested into questions about pregnancy (odds ratio [OR], 1.984; 95% confidence interval [CI], 1.203-3.272), more often embarrassed to talk to a physician in person (OR, 1.828; 95% CI, 1.119-2.989), and more motivated to protect their privacy (OR, 1.727; 95% CI, 1.252-2.380). They also had greater satisfaction with the service (77% vs 60%, P<0.001). The factors associated with the use of internet-based medical consultation services were younger age, need for privacy protection, avoidance of embarrassment at the physician's office, and having a question related to pregnancy. This reveals the internet medical consultation service as a useful health promotion supplement that is particularly applicable for the population of young adults.

48 CFR 931.205-33 - Professional and consultant service costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Professional and consultant service costs. 931.205-33 Section 931.205-33 Federal Acquisition Regulations System DEPARTMENT OF... Organizations 931.205-33 Professional and consultant service costs. (g)(1) Reasonable litigation and other legal...

Production, Service and Trade Enterprise EKOREX Co. Ltd.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wlodkowski, A.

1995-12-31

In the first period of its activity the business employed skilled and experienced specialists from the ex-Military College for Army Chemical Engineers in Cracow; therefore, the enterprise dealt chiefly with the elimination of environmental contamination. Nowadays, the enterprise`s operational range comprises: consulting and training services related with ecology; study on environmental contamination; participation in the US program of low emission elimination in Cracow; designing, consulting in the realization of projects {open_quotes}GEF{close_quotes} (Global Environmental Facility); designing, construction, servicing, operating the sewerage and water treatment plants, boiler-houses, incinerators etc.; and designing of heat networks, exchanger junctions, central heating and household hot watermore » installations. Since 1991 employees have individually participated in making the program and in testing boilers and fuels verified in the boiler houses covered by the Polish - US program of reduction of low emission sources in Cracow. We have actively joined the program of elimination of heating network boiler houses (industrial and local) by designing (for the Cracow cogeneration plant and MPEC) new connections among some structures and the municiple thermal distribution network and exchangers stations. In 1994, 47 such designs were made and have been working on successive projects to be carried out in Cracow.« less

Consultation performance of general practitioners when supported by an asthma/COPDC-service

PubMed Central

2012-01-01

Background General practitioners (GPs) can refer patients to an asthma/COPD service (AC-service) for diagnostic assessment of spirometry and medical history and for asthma or COPD monitoring. The AC-service reports diagnostic results and additional information about disease burden (BORG-score for complaints, MRC-dyspnoea score, exacerbation rate), life style, medication and compliance, to the patient’s GP. This study explores how GPs use this additional information when discussing the patient’s disease burden and how this influences GPs’ information and education provision during consultations with asthma/COPD patients. Method Patients with (a suspicion of) asthma or COPD were referred to an AC-service and consulted their GPs after they had received a report from the AC-service. Retrospectively patients answered questions about their GPs’ performance during these consultations. Performances were compared with performances of the same GPs during consultations without support of the AC-service (usual care), earlier that year. Results Of consultations not initiated by an AC-service check-up, 91% focussed on complaints, the initial reason for the consultation. In AC-service supported follow-up consultations, GPs explored disease burden when the (BORG-)score for complaints was high - as reported by the AC-service - even when patients themselves thought it was irrelevant. GPs put significantly less effort in exploring disease burden when the Borg-score was low (BORG 3–4: 69%; BORG1-2: 51%, p = 0,01). GPs mostly ignored MRC-dyspnoea scores: attention to dyspnoea was 18% for MRC-score <3 and 25% for MRC-score ≥3 (p = 0,63). GPs encouraged physical fitness in 13% of patients. Smoking behaviour was discussed with 66% of the actual smokers but only 14% remembered a stop smoking advice. Furthermore, pharmacotherapeutic management education in AC-service supported consultations did not differ from performance in usual care according to patient evaluations. Conclusion Other than taking into account the severity of complaints, there was no difference between GPs’ performance in AC-service supported and in usual care consultations. AC-service reports are thus not effective by themselves. GPs should be encouraged to use the information better and systematically check all relevant aspects that characterize the disease burden of their patients. PMID:22824247

Damage Tolerance Assessment Branch

NASA Technical Reports Server (NTRS)

Walker, James L.

2013-01-01

The Damage Tolerance Assessment Branch evaluates the ability of a structure to perform reliably throughout its service life in the presence of a defect, crack, or other form of damage. Such assessment is fundamental to the use of structural materials and requires an integral blend of materials engineering, fracture testing and analysis, and nondestructive evaluation. The vision of the Branch is to increase the safety of manned space flight by improving the fracture control and the associated nondestructive evaluation processes through development and application of standards, guidelines, advanced test and analytical methods. The Branch also strives to assist and solve non-aerospace related NDE and damage tolerance problems, providing consultation, prototyping and inspection services.

Student-Run Clinics: A Novel Approach to Integrated Care, Teaching and Recruitment.

PubMed

Mishan, Liza I; Dragatsi, Dianna

2017-05-01

The purpose of this study is to assess the educational impact of incorporating a psychiatry consult service into a medical student-run clinic. In November 2014, a psychiatry consult service was introduced at the Columbia-Harlem Homeless Medical Partnership (CHHMP), a student-run clinic located in Harlem, New York. From September 2015 to January 2016, surveys (Qualtrics) were then distributed to student members of the clinic. Surveys assessed how the psychiatric consult service impacted students' knowledge, skills and attitudes about psychiatry. According to survey results (83.8% response rate, n = 31), 100% of students at CHHMP agreed that the psychiatry consult service is a useful addition to the clinic, and 94% agreed that the service helped increase their perceived knowledge of psychiatry. Survey results suggest that having a psychiatry consult service at a student-run clinic is a beneficial educational model in increasing medical students' perceived knowledge and comfort with psychiatry.

UPEC `94 review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hammons, T.J.

1995-02-01

The twenty-ninth Universities Power Engineering Conference (UPEC `94), held September 14--16, 1994, at University College, Galway, Ireland, surpassed all previous meetings in respect of number and quality of technical content of the papers and number of delegates attending. As in the past, it had a broad theme, covering all aspects of electrical power engineering, and was attended by academics, research workers, and members of the power service and manufacturing organizations. During the sessions, 265 papers from more than 30 countries were debated. There were 27 technical sessions, 3 poster sessions, and an opening and a closing session, 160 papers beingmore » presented orally in four groups of parallel sessions, the remainder being presented in poster sessions. The high standard of the papers, presentations, and technical discussions was particularly gratifying. The Universities Power Engineering Conference, held annually, provides a forum for the exchange of ideas among practicing engineers from the universities, consultants, and in the manufacturing and supply industries.« less

Clinical Assessment at College Counseling Centers: The Consultant-on-Duty Model

ERIC Educational Resources Information Center

Schoen, Eva; McKelley, Ryan

2012-01-01

The consultant-on-duty (COD) clinical consultation model maximizes efficient use of services, is distinct from other university counseling center (UCC) services, and precedes therapy. This model enables clinicians to ensure optimal fit between client need and type of UCC services provided, including brief therapy. The 4 objectives of the COD model…

Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital's intercultural consultation.

PubMed

Sturm, Gesine; Guerraoui, Zohra; Bonnet, Sylvie; Gouzvinski, Françoise; Raynaud, Jean-Philippe

2017-08-01

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study.

PubMed

Gillis, R M E; van Litsenburg, W; van Balkom, R H; Muris, J W; Smeenk, F W

2017-05-19

Previous studies showed that general practitioners have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support general practitioners in their diagnostic process, an asthma diagnostic consultation service was set up. We evaluated the performance of this asthma diagnostic consultation service by analysing the (dis)concordance between the general practitioners working hypotheses and the asthma diagnostic consultation service diagnoses and possible consequences this had on the patients' pharmacotherapy. In total 659 patients were included in this study. At this service the patients' medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the general practitioners working hypotheses with the asthma diagnostic consultation service diagnoses and the change in medication that was incurred. In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their general practitioner. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The 'one-stop-shop' principle was met with 53% of patients and 91% (n = 599) were referred back to their general practitioner, mostly within 6 months. Only 6% (n = 41) remained under control of the asthma diagnostic consultation service because of severe unstable asthma. In conclusion, the asthma diagnostic consultation service helped general practitioners significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens. SERVICE HELPS GENERAL PRACTITIONERS MAKE ACCURATE DIAGNOSES: A consultation service can help general practitioners more accurately diagnose asthma and select the appropriate treatments for their patients. Researchers in The Netherlands, led by Frank Smeenk from Catharina Hospital in Eindhoven, describe an asthma diagnostic consultation service they created to support GPs in their diagnostic process for patients suspected of having asthma. Over a four-year period, the service received a total of 659 referrals and only confirmed the diagnosis of asthma in 275 cases. Another 20 patients had asthma overlapping with chronic obstructive pulmonary syndrome. The service also picked up other diseases, such as rhinitis, that general practitioners had missed. Overall, because of the consultation service and its revised diagnoses, more than half of all patients adjusted their medications. Most patients required only a single consultation and could then be referred back to their physicians.

The association between question type and the outcomes of a Dermatology eConsult service.

PubMed

O'Toole, Ashley; Joo, Jiyeh; DesGroseilliers, Jean-Pierre; Liddy, Clare; Glassman, Steven; Afkham, Amir; Keely, Erin

2017-08-01

eConsult is a web based service that facilitates communication between primary care providers (PCPs) and specialists, which can reduce the need for face-to-face consultations with specialists. One example is the Champlain BASE (Building Access to Specialist through eConsultation) service with dermatology being the largest specialty consulted. Dermatology eConsults submitted from July 2011 to January 2015 were reviewed. Post eConsult surveys for PCPs were analyzed to determine the number of traditional consults avoided and perceived value of eConsults. The time it took the PCP to receive a reply and the amount of time reported by the specialist to answer eConsult were proactively recorded and analyzed. A subset of 154 most recent eConsults was categorized for dermatology content and question type (e.g. diagnosis or management) using a validated taxonomy. A total of 965 eConsults were directed to dermatology from 217 unique PCPs. The majority of eConsults (64%) took the specialist between 10 and 15 minutes to answer. The overall value of this service to the provider was rated as very good or excellent in 95% of cases. In 49%, traditional in-person assessments were avoided. In the subset of the most recent cases, diagnosis was the most common question type asked (65.2%) followed by management (29%) and drug treatment (10.6%). The top five subject areas (40%) were: Dermatitis, Infections, Neoplasm, Nevi, and Pruritus. eConsults was feasible and well received by PCPs, which improves access to dermatology care with a potential to reduce wait times for traditional consultation. © 2017 The International Society of Dermatology.

Supplemental Enviromnentul Assessment for Control of Common Reed (Phragmites australis) at Joint Base Langley-Eustis, Fort Eustis, Virginia

DTIC Science & Technology

2012-09-01

lo prevent new nests lium that area and a programmutic permit is being discussed with US Fish und Wildlite Service. n1ese nests also have designated...mgular mail lo : Timothy P, Christensen 733 Mission Snpport Group Civil Engineer Division 1407 Washington Blvd Fort Eustis, VA 23604 Timothy .p...have consulted with city .~taff rcgan.llng this project. Based on this review, the proposal appears lo be consistent with local and rogional plans

A Guide to Cultural and Environmental Interpretation in the U.S. Army Corps of Engineers.

DTIC Science & Technology

1981-08-01

34 (Veverka 1978a, Blahna and Roggenbuck 1979). Although this belongingness or affilia- tion motive appears to be a strong one, these same researchers note that...with only one park or recreation area and to rarely see a Corps employee . In these cases, it may be necessary to use such per- sonal services as roving...more of the specifics of conducting guided tours, Corps interpreters are urged to consult: "Conducted Trips - A Training Bul- letin for Field Employees

Forensic applications of metallurgy - Failure analysis of metal screw and bolt products

NASA Astrophysics Data System (ADS)

Tiner, Nathan A.

1993-03-01

It is often necessary for engineering consultants in liability lawsuits to consider whether a component has a manufacturing and/or design defect, as judged by industry standards, as well as whether the component was strong enough to resist service loads. Attention is presently given to the principles that must be appealed to in order to clarify these two issues in the cases of metal screw and bolt failures, which are subject to fatigue and brittle fractures and ductile dimple rupture.

11. Photographic copy of photograph, photographer unknown, 2 July 1938 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. Photographic copy of photograph, photographer unknown, 2 July 1938 (original print located at U.S. Bureau of Reclamation Upper Columbia Area Office, Yakima, Washington). "Inspecting concrete on upstream face of Keechelus Dam spillway. Joseph Jacobs, consulting engineer; M.B. Lemon, Gatetender; Paul Taylor, assistant engineer; and C.H. Paul, consulting engineer." - Keechelus Dam, Spillway, Yakim River, 10 miles northwest of Easton, Easton, Kittitas County, WA

Impact of integration of sexual and reproductive health services on consultation duration times: results from the Integra Initiative.

PubMed

Siapka, Mariana; Obure, Carol Dayo; Mayhew, Susannah H; Sweeney, Sedona; Fenty, Justin; Vassall, Anna

2017-11-01

The lack of human resources is a key challenge in scaling up of HIV services in Africa's health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients' consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8-112.0) and 43.9% lower (95% CIs -55.4 to - 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and procedures during the process of integrating HIV and FP services. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Impact of integration of sexual and reproductive health services on consultation duration times: results from the Integra Initiative

PubMed Central

Siapka, Mariana; Obure, Carol Dayo; Mayhew, Susannah H; Fenty, Justin; Initiative, Integra; Vassall, Anna

2017-01-01

Abstract The lack of human resources is a key challenge in scaling up of HIV services in Africa’s health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients’ consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8–112.0) and 43.9% lower (95% CIs −55.4 to − 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and procedures during the process of integrating HIV and FP services. PMID:29194545

7 CFR 1789.151 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... an unfair competitive advantage. Retainer Contract means a Consultant Contract providing for a... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) USE OF CONSULTANTS FUNDED BY BORROWERS Policy and Procedures With Respect to Consultant Services...

Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.

PubMed

Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith

2014-01-01

Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide.

PubMed

Liddy, Clare; Moroz, Isabella; Mihan, Ariana; Nawar, Nikhat; Keely, Erin

2018-06-21

Electronic consultation (eConsult) is an asynchronous electronic communication tool allowing primary care providers to obtain a specialist consultant's expert opinion in a timely manner, thereby offering a potential solution to excessive wait times for specialist care, which remain a serious concern in many countries. Our 2014 review of eConsult services demonstrated feasibility and high acceptability among patients and providers. However, gaps remain in knowledge regarding eConsult's impact on system costs and patient outcomes. Following the PRISMA guidelines, we conducted a systematic review in May 2017 of English and French literature on OVID Medline, EMBASE, ERIC, and CINAHL databases, examining all studies on eConsult services published since our previous review. The Quadruple Aim Framework was used to synthesize outcomes. Articles reporting on the impact of eConsult on access, patient safety and satisfaction, utilization rates, clinical workflow, and continuing medical education were analyzed using a narrative synthesis approach. The initial search yielded 1,021 results, 50 of which were included on abstract and received a quality assessment and full text review. Of these, 43 were included in our final analysis. Results demonstrated the worldwide presence of eConsult services in North America and countries beyond, including Brazil, Australia, Spain, and The Netherlands. The breadth of specialty services offered has greatly expanded beyond dermatology and includes cardiology, nephrology, and hematology among others. Overall impact on access measures, acceptability, cost, and provider satisfaction remain positive. There is limited research on population health outcomes of morbidity and mortality. The availability of eConsult services has spread both geographically and in terms of specialty services offered. By allowing for a greater population to be served, access to care is being improved; however, long-term impact should continue to be assessed with a focus on patient safety, morbidity, mortality, and cost effectiveness metrics.

Internet Hospitals in China: Cross-Sectional Survey.

PubMed

Xie, Xiaoxu; Zhou, Weimin; Lin, Lingyan; Fan, Si; Lin, Fen; Wang, Long; Guo, Tongjun; Ma, Chuyang; Zhang, Jingkun; He, Yuan; Chen, Yixin

2017-07-04

The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China's Internet hospitals have not been systematically investigated. The aim of this study was to describe the characteristics of China's Internet hospitals, and to assess their health service capacity. We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as "Internet hospital," "web hospital," or "cloud hospital." All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China's Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done. ©Xiaoxu Xie, Weimin Zhou, Lingyan Lin, Si Fan, Fen Lin, Long Wang, Tongjun Guo, Chuyang Ma, Jingkun Zhang, Yuan He, Yixin Chen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.07.2017.

Acoustical consulting-Reflections on a challenging career

NASA Astrophysics Data System (ADS)

Braslau, David

2004-05-01

The acoustical consulting profession can be entered in a number of ways. The most direct approach is to obtain a degree in acoustics and join a large consulting firm immediately after graduation. Acoustical consulting can also be entered indirectly from various fields of engineering or physics which can provide a somewhat broader background. These disciplines might include, for example, structural engineering and structural dynamics, mechanics of materials, dynamic behavior of solids or geophysics. Acoustical consulting specialization can be very broad or very narrow as seen from the National Council of Acoustical Consultants capability listing. As an acoustical consultant, one must address a wide range of problems which provides both the challenges and joys of this profession. Technical capabilities and professional judgment are constantly developed from exposure to these problems and through interaction with other members of the profession. Selected case studies including sound isolation in buildings, noise and vibration from blasting, control of noise from environmental sources, acoustical design of classrooms and performing spaces, and product design demonstrate the variety of challenges faced by an acoustical consultant.

[Inpatient pain consultation service at a university hospital: a retrospective analysis of patient characteristics and the rate of the implementation of recommendations].

PubMed

Lassen, C L; Sommer, M; Meyer, N; Klier, T W; Graf, B M; Pawlik, M T; Wiese, C H R

2012-08-01

The aim of this study was to conduct an audit of a university inpatient pain consultation service and to examine the quality and the implementation of the recommended therapeutic measures. Factors that influenced the implementation should be identified. All inpatients treated by the consultation service in the years 2009 and 2010 were analyzed retrospectively. Demographic patient characteristics as well as quality parameters of the consultation service and pharmacological and non-pharmacological recommendations and their implementation were analyzed. In total 1,048 requests for the consultation service were processed of which 39.7% of the requests were for patients with acute pain, 33.8% with chronic and 19.9% with tumor-associated pain. Measures recommended most were medication, physiotherapy and psychological treatment. Recommended medications were actually prescribed in more than 80%, physiotherapy recommended in about 75% and psychological treatment recommended in 47% of the cases. Only a few influencing factors for the implementation of the recommended measures could be identified. Many different pain states are seen in an inpatient pain consultation service. The recommendations given are implemented in most cases especially concerning the medication.

Improving access to specialists in remote communities: a cross-sectional study and cost analysis of the use of eConsult in Nunavut.

PubMed

Liddy, Clare; McKellips, Fanny; Armstrong, Catherine Deri; Afkham, Amir; Fraser-Roberts, Leigh; Keely, Erin

2017-01-01

Residents of remote communities face inequities in access to specialists, excessive wait times, and poorly coordinated care. The Champlain BASE TM (Building Access to Specialists through eConsultation) service facilitates asynchronous communication between primary care providers (PCP) and specialists. The service was extended to several PCPs in Nunavut in 2014. To (1) describe the use of eConsult services in Nunavut, and (2) conduct a costing evaluation. A cross-sectional study and cost analysis of all eConsult cases submitted between August 2014 and April 2016. PCPs from Nunavut submitted 165 eConsult cases. The most popular specialties were dermatology (16%), cardiology (8%), endocrinology (7%), otolaryngology (7%), and obstetrics/gynaecology (7%). Specialists provided a response in a median of 0.9 days (IQR=0.3-3.0, range=0.01-15.02). In 35% of cases, PCPs were able to avoid the face-to-face specialist visits they had originally planned for their patients. Total savings associated with eConsult in Nunavut are estimated at $180,552.73 or $1,100.93 per eConsult. The eConsult service provided patients in Nunavut's remote communities with prompt access to specialist advice. The service's chief advantage in Canada's northern communities is its ability to offer electronic access to a breadth of specialties far greater than could be supported locally. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings.

Improving access to urologists through an electronic consultation service

PubMed Central

Witherspoon, Luke; Liddy, Clare; Afkham, Amir; Keely, Erin; Mahoney, John

2017-01-01

Introduction Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. Methods Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. Results Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. Conclusions Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists. PMID:28798830

Paediatric palliative care by video consultation at home: a cost minimisation analysis.

PubMed

Bradford, Natalie K; Armfield, Nigel R; Young, Jeanine; Smith, Anthony C

2014-07-28

In the vast state of Queensland, Australia, access to specialist paediatric services are only available in the capital city of Brisbane, and are limited in regional and remote locations. During home-based palliative care, it is not always desirable or practical to move a patient to attend appointments, and so access to care may be even further limited. To address these problems, at the Royal Children's Hospital (RCH) in Brisbane, a Home Telehealth Program (HTP) has been successfully established to provide palliative care consultations to families throughout Queensland. A cost minimisation analysis was undertaken to compare the actual costs of the HTP consultations, with the estimated potential costs associated with face-to face-consultations occurring by either i) hospital based consultations in the outpatients department at the RCH, or ii) home visits from the Paediatric Palliative Care Service. The analysis was undertaken from the perspective of the Children's Health Service. The analysis was based on data from 95 home video consultations which occurred over a two year period, and included costs associated with projected: clinician time and travel; costs reimbursed to families for travel through the Patients Travel Subsidy (PTS) scheme; hospital outpatient clinic costs, project co-ordination and equipment and infrastructure costs. The mean costs per consultation were calculated for each approach. Air travel (n = 24) significantly affected the results. The mean cost of the HTP intervention was $294 and required no travel. The estimated mean cost per consultation in the hospital outpatient department was $748. The mean cost of home visits per consultation was $1214. Video consultation in the home is the most economical method of providing a consultation. The largest costs avoided to the health service are those associated with clinician time required for travel and the PTS scheme. While face-to-face consultations are the gold standard of care, for families located at a distance from the hospital, video consultation in the home presents an effective and cost efficient method to deliver a consultation. Additionally video consultation in the home ensures equity of access to services and minimum disruption to hospital based palliative care teams.

Health visitor views on consultation using the Solihull approach: a grounded theory study.

PubMed

Stefanopoulou, Evgenia; Coker, Sian; Greenshields, Maria; Pratt, Richard

2011-07-01

Consultation is integral to maintaining competence for health professionals and involves a collaborative relationship between specialist and primary care services. Although consultation aims to support them in their work, existing literature exploring health visitors' experiences of consultation is limited. This study explored health visitors' experiences of consultation in relation to their clinical practice, their experience of their work and its impact on the wider service. In all, 10 health visitors were interviewed using a semi-structured guide and analysis was subjected to a grounded theory framework. Participants' views were influenced by a combination of factors--consultants' training specific to their role, their communication and engagement, consultation's support of joint-working and/or transitions, and its relevance to and impact upon practice. Findings suggest that such interface activities require effective co-ordination, communication and structuring strategies, highlighting the importance of future initiatives in developing health visitors' mental health role further. Given the comparative lack of evaluation of such activities, these findings may inform policy-making and service development to ensure high quality of service delivery.

A technology-based patient and family engagement consult service for the pediatric hospital setting.

PubMed

Jackson, Gretchen P; Robinson, Jamie R; Ingram, Ebone; Masterman, Mary; Ivory, Catherine; Holloway, Diane; Anders, Shilo; Cronin, Robert M

2018-02-01

The Vanderbilt Children's Hospital launched an innovative Technology-Based Patient and Family Engagement Consult Service in 2014. This paper describes our initial experience with this service, characterizes health-related needs of families of hospitalized children, and details the technologies recommended to promote engagement and meet needs. We retrospectively reviewed consult service documentation for patient characteristics, health-related needs, and consultation team recommendations. Needs were categorized using a consumer health needs taxonomy. Recommendations were classified by technology type. Twenty-two consultations were conducted with families of patients ranging in age from newborn to 15 years, most with new diagnoses or chronic illnesses. The consultation team identified 99 health-related needs (4.5 per consultation) and made 166 recommendations (7.5 per consultation, 1.7 per need). Need categories included 38 informational needs, 26 medical needs, 23 logistical needs, and 12 social needs. The most common recommendations were websites (50, 30%) and mobile applications (30, 18%). The most frequent recommendations by need category were websites for informational needs (39, 50%), mobile applications for medical needs (15, 40%), patient portals for logistical needs (12, 44%), and disease-specific support groups for social needs (19, 56%). Families of hospitalized pediatric patients have a variety of health-related needs, many of which could be addressed by technology recommendations from an engagement consult service. This service is the first of its kind, offering a potentially generalizable and scalable approach to assessing health-related needs, meeting them with technologies, and promoting patient and family engagement in the inpatient setting. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Views regarding the training of ethics consultants: a survey of physicians caring for patients in ICU

PubMed Central

Chwang, Eric; Landy, David C; Sharp, Richard R

2007-01-01

Background Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services. Objective To describe physicians' expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit (ICU). Design Mailed survey. Participants Physicians responsible for the care of at least 10 patients in ICU over a 6‐month period at a 921‐bed private teaching hospital with an established ethics consultation service. 69 of 92 (75%) eligible physicians responded. Measurements Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal‐training programmes for ethics consultants. Results Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law (p<0.03), religious traditions (p<0.001), medicine (p<0.001) and conflict‐mediation techniques (p<0.001). When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important. Conclusions Although many physicians caring for patients in ICU believe ethics consultants must possess non‐medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a “medicine plus one” view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established. PMID:17526680

42 CFR 431.105 - Consultation to medical facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... 42 Public Health 4 2010-10-01 2010-10-01 false Consultation to medical facilities. 431.105 Section 431.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

Establishing specialized health services for professional consultation in euthanasia: experiences in the Netherlands and Belgium

PubMed Central

2009-01-01

Background The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN) and Life End Information Forum (LEIF) in Belgium. The aim of this study is to describe and compare these initiatives. Methods We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols). Results In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions. Conclusion In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a consultation provision could also be considered in order to safeguard the practice of euthanasia (as it can provide safeguards to adequate performance of euthanasia and assisted suicide). PMID:19961568

Evaluating the uptake, acceptability, and effectiveness of Uliza! clinicians' HIV hotline: a telephone consultation service in Kenya.

PubMed

Karari, Charles; Tittle, Robin; Penner, Jeremy; Kulzer, Jayne; Bukusi, Elizabeth A; Marima, Reson; Cohen, Craig R

2011-01-01

Many clinical sites that serve patients who are HIV positive face challenges of insufficient staffing levels and staff training and have limited access to consultation resources including specialists on site. Uliza! (Swahili for "ask") Clinicians' HIV Hotline was launched in April 2006 in Nyanza province in Kenya as a HIV telephone consultation service for healthcare providers. Hotline users called an Uliza! consultant who discussed the patients' problems and helped the caller work through a solution, as well as reinforced national guidelines. This objective of this study was to evaluate the uptake, acceptability, and effectiveness of Uliza! Consultants completed a form with details of each call, and healthcare workers completed satisfaction surveys during site visits. All available medical records were audited to determine whether the advice given by the consultant was implemented. After a year of service, Uliza! responded to 296 calls. Clinical officers (64%) followed by nurses (21%) most frequently used the service. Most callers had questions regarding antiretroviral therapy (36%) or tuberculosis (18%). Thirty-six percent of all consults were pediatric questions. Ninety-four percent of users rated the service as useful. Advice given to providers was implemented and documented in the medical records in 72% of the charts audited. Healthcare providers in HIV clinics will use a telephone consultation service when easily accessible. Clinicians using Uliza! found it useful, and advice given was usually implemented. Uliza! increased access to current information for quality care in a rural and resource limited setting and has potential for scale-up to a national level.

75 FR 28298 - Avaya Inc., Worldwide Services Group, Global Support Services (GSS) Organization, Including On...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-20

...., Worldwide Services Group, Global Support Services (GSS) Organization, Including On-Site Leased Workers From Kelly Services Inc., P/S Partner Solutions Ltd., Exceed Resources Inc., Real Soft, InfoQuest Consulting Group, Ccsi Inc., ICONMA LLC, MGD Consulting, Inc., Case Interactive LLC., Sapphire Technologies...

Consultation on the Libyan health systems: towards patient-centred services

PubMed Central

El Oakley, Reida M.; Ghrew, Murad H.; Aboutwerat, Ali A.; Alageli, Nabil A.; Neami, Khaldon A.; Kerwat, Rajab M.; Elfituri, Abdulbaset A.; Ziglam, Hisham M.; Saifenasser, Aymen M.; Bahron, Ali M.; Aburawi, Elhadi H.; Sagar, Samir A.; Tajoury, Adel E.; Benamer, Hani T.S.

2013-01-01

The extra demand imposed upon the Libyan health services during and after the Libyan revolution in 2011 led the ailing health systems to collapse. To start the planning process to re-engineer the health sector, the Libyan Ministry of Health in collaboration with the World Health Organisation (WHO) and other international experts in the field sponsored the National Health Systems Conference in Tripoli, Libya, between the 26th and the 30th of August 2012. The aim of this conference was to study how health systems function at the international arena and to facilitate a consultative process between 500 Libyan health experts in order to identify the problems within the Libyan health system and propose potential solutions. The scientific programme adopted the WHO health care system framework and used its six system building blocks: i) Health Governance; ii) Health Care Finance; iii) Health Service Delivery; iv) Human Resources for Health; v) Pharmaceuticals and Health Technology; and vi) Health Information System. The experts used a structured approach starting with clarifying the concepts, evaluating the current status of that health system block in Libya, thereby identifying the strengths, weaknesses, and major deficiencies. This article summarises the 500 health expert recommendations that seized the opportunity to map a modern health systems to take the Libyan health sector into the 21st century. PMID:23359277

Hirsch Index Value and Variability Related to General Surgery in a UK Deanery.

PubMed

Abdelrahman, Tarig; Brown, Josephine; Wheat, Jenny; Thomas, Charlotte; Lewis, Wyn

2016-01-01

The Hirsch Index (h-index) is often used to assess research impact, and on average a social science senior lecturer will have an h-index of 2.29, yet its validity within the context of UK General Surgery (GS) is unknown. The aim of this study was to calculate the h-indices of a cohort of GS consultants in a UK Deanery to assess its relative validity. Individual h-indices and total publication (TP) counts were obtained for GS consultants via the Scopus and Web of Science (WoS) Internet search engines. Assessment of construct validity and reliability of these 2 measures of the h-index was undertaken. All hospitals in a single UK National Health Service Deanery were included (14 general hospitals). All 136 GS consultants from the Deanery were included. Median h-index (Scopus) was 5 (0-52) and TP 15 (0-369), and strong correlation was found between h-index and TP (ρ = 0.932, p < 0.001), with the intraclass correlation between Scopus and WoS h-index also significant (intraclass correlation coefficient = 0.973 [95% CI: 0.962-0.981], p < 0.001). Academic GS consultants had higher h-indices than nonacademic University Hospital and District General Hospital consultants (Scopus 12 vs 7 vs 4 [p < 0.001] and WoS 10.5 vs 7 vs 4 [p < 0.001]). h-Index was >2.29 in 57.4% of consultants. No subspecialty differences were apparent in median h-indices (p = 0.792) and TP (p = 0.903). h-Index is a valid GS research productivity metric with over half of consultants performing at levels equivalent to social science Senior Lecturers. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Growing an ethics consultation service: A longitudinal study examining two decades of practice.

PubMed

Gorka, Christine; Craig, Jana M; Spielman, Bethany J

2017-01-01

Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time. This study examines data collected from a busy ethics consultation service over a period of more than two decades. We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity. We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores.

Implementing a resident acute care surgery service: Improving resident education and patient care.

PubMed

Kantor, Olga; Schneider, Andrew B; Rojnica, Marko; Benjamin, Andrew J; Schindler, Nancy; Posner, Mitchell C; Matthews, Jeffrey B; Roggin, Kevin K

2017-03-01

To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P < .01). Of 323 operative cases, the residents performed an average of 82% of the case independently. There was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, P < .01 on a 6-point Likert scale) and complexity of cases (mean 5.35 vs 4.94, P < .01) on service evaluations of resident acute care surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution. Copyright © 2016 Elsevier Inc. All rights reserved.

Service Learning In Physics: The Consultant Model

NASA Astrophysics Data System (ADS)

Guerra, David

2005-04-01

Each year thousands of students across the country and across the academic disciplines participate in service learning. Unfortunately, with no clear model for integrating community service into the physics curriculum, there are very few physics students engaged in service learning. To overcome this shortfall, a consultant based service-learning program has been developed and successfully implemented at Saint Anselm College (SAC). As consultants, students in upper level physics courses apply their problem solving skills in the service of others. Most recently, SAC students provided technical and managerial support to a group from Girl's Inc., a national empowerment program for girls in high-risk, underserved areas, who were participating in the national FIRST Lego League Robotics competition. In their role as consultants the SAC students provided technical information through brainstorming sessions and helped the girls stay on task with project management techniques, like milestone charting. This consultant model of service-learning, provides technical support to groups that may not have a great deal of resources and gives physics students a way to improve their interpersonal skills, test their technical expertise, and better define the marketable skill set they are developing through the physics curriculum.

Young people's views on the potential use of telemedicine consultations for sexual health: results of a national survey.

PubMed

Garrett, Cameryn C; Hocking, Jane; Chen, Marcus Y; Fairley, Christopher K; Kirkman, Maggie

2011-10-25

Young people are disproportionately affected by sexually transmissible infections in Australia but face barriers to accessing sexual health services, including concerns over confidentiality and, for some, geographic remoteness. A possible innovation to increase access to services is the use of telemedicine. Young people's (aged 16-24) pre-use views on telephone and webcam consultations for sexual health were investigated through a widely-advertised national online survey in Australia. Descriptive statistics were used to describe the study sample and chi-square, Mann-Whitney U test, or t-tests were used to assess associations. Multinomial logistic regression was used to explore the association between the three-level outcome variable (first preference in person, telephone or webcam, and demographic and behavioural variables); odds ratios and 95%CI were calculated using in person as the reference category. Free text responses were analysed thematically. A total of 662 people completed the questionnaire. Overall, 85% of the sample indicated they would be willing to have an in-person consultation with a doctor, 63% a telephone consultation, and 29% a webcam consultation. Men, respondents with same-sex partners, and respondents reporting three or more partners in the previous year were more willing to have a webcam consultation. Imagining they lived 20 minutes from a doctor, 83% of respondents reported that their first preference would be an in-person consultation with a doctor; if imagining they lived two hours from a doctor, 51% preferred a telephone consultation. The main objections to webcam consultations in the free text responses were privacy and security concerns relating to the possibility of the webcam consultation being recorded, saved, and potentially searchable and retrievable online. This study is the first we are aware of that seeks the views of young people on telemedicine and access to sexual health services. Although only 29% of respondents were willing to have a webcam consultation, such a service may benefit youth who may not otherwise access a sexual health service. The acceptability of webcam consultations may be increased if medical clinics provide clear and accessible privacy policies ensuring that consultations will not be recorded or saved.

Young people's views on the potential use of telemedicine consultations for sexual health: results of a national survey

PubMed Central

2011-01-01

Background Young people are disproportionately affected by sexually transmissible infections in Australia but face barriers to accessing sexual health services, including concerns over confidentiality and, for some, geographic remoteness. A possible innovation to increase access to services is the use of telemedicine. Methods Young people's (aged 16-24) pre-use views on telephone and webcam consultations for sexual health were investigated through a widely-advertised national online survey in Australia. Descriptive statistics were used to describe the study sample and chi-square, Mann-Whitney U test, or t-tests were used to assess associations. Multinomial logistic regression was used to explore the association between the three-level outcome variable (first preference in person, telephone or webcam, and demographic and behavioural variables); odds ratios and 95%CI were calculated using in person as the reference category. Free text responses were analysed thematically. Results A total of 662 people completed the questionnaire. Overall, 85% of the sample indicated they would be willing to have an in-person consultation with a doctor, 63% a telephone consultation, and 29% a webcam consultation. Men, respondents with same-sex partners, and respondents reporting three or more partners in the previous year were more willing to have a webcam consultation. Imagining they lived 20 minutes from a doctor, 83% of respondents reported that their first preference would be an in-person consultation with a doctor; if imagining they lived two hours from a doctor, 51% preferred a telephone consultation. The main objections to webcam consultations in the free text responses were privacy and security concerns relating to the possibility of the webcam consultation being recorded, saved, and potentially searchable and retrievable online. Conclusions This study is the first we are aware of that seeks the views of young people on telemedicine and access to sexual health services. Although only 29% of respondents were willing to have a webcam consultation, such a service may benefit youth who may not otherwise access a sexual health service. The acceptability of webcam consultations may be increased if medical clinics provide clear and accessible privacy policies ensuring that consultations will not be recorded or saved. PMID:22026640

Service on demand for ISS users

NASA Astrophysics Data System (ADS)

Hüser, Detlev; Berg, Marco; Körtge, Nicole; Mildner, Wolfgang; Salmen, Frank; Strauch, Karsten

2002-07-01

Since the ISS started its operational phase, the need of logistics scenarios and solutions, supporting the utilisation of the station and its facilities, becomes increasingly important. Our contribution to this challenge is a SERVICE On DEMAND for ISS users, which offers a business friendly engineering and logistics support for the resupply of the station. Especially the utilisation by commercial and industrial users is supported and simplified by this service. Our industrial team, consisting of OHB-System and BEOS, provides experience and development support for space dedicated hard- and software elements, their transportation and operation. Furthermore, we operate as the interface between customer and the envisaged space authorities. Due to a variety of tailored service elements and the ongoing servicing, customers can concentrate on their payload content or mission objectives and don't have to deal with space-specific techniques and regulations. The SERVICE On DEMAND includes the following elements: ITR is our in-orbit platform service. ITR is a transport rack, used in the SPACEHAB logistics double module, for active and passive payloads on subrack- and drawer level of different standards. Due to its unique late access and early retrieval capability, ITR increases the flexibility concerning transport capabilities to and from the ISS. RIST is our multi-functional test facility for ISPR-based experiment drawer and locker payloads. The test program concentrates on physical and functional interface and performance testing at the payload developers site prior to the shipment to the integration and launch. The RIST service program comprises consulting, planning and engineering as well. The RIST test suitcase is planned to be available for lease or rent to users, too. AMTSS is an advanced multimedia terminal consulting service for communication with the space station scientific facilities, as part of the user home-base. This unique ISS multimedia kit combines communication technologies, software tools and hardware to provide a simple and cost-efficient access to data from the station, using the interconnection ground subnetwork. BEOLOG is our efficient ground logistics service for the transportation of payload hardware and support equipment from the user location to the launch/landing sites for the ISS service flights and back home. The main function of this service is the planning and organisation of all packaging, handling, storage & transportation tasks according to international rules. In conclusion, we offer novel service elements for logistics ground- and flight-infrastructure, dedicated for ISS users. These services can be easily adapted to the needs of users and are suitable for other μg- platforms as well.

Ten Steps to Establishing an e-Consultation Service to Improve Access to Specialist Care

PubMed Central

Maranger, Julie; Afkham, Amir; Keely, Erin

2013-01-01

Abstract There is dissatisfaction among primary care physicians, specialists, and patients with respect to the consultation process. Excessive wait times for receiving specialist services and inefficient communication between practitioners result in decreased access to care and jeopardize patient safety. We created and implemented an electronic consultation (e-consultation) system in Eastern Ontario to address these problems and improve the consultation process. The e-consultation system has passed through the proof-of-concept and pilot study stages and has effectively reduced unnecessary referrals while receiving resoundingly positive feedback from physician-users. Using our experience, we have outlined the 10 steps to developing an e-consultation service. We detail the technical, administrative, and strategic considerations with respect to (1) identifying your partners, (2) choosing your platform, (3) starting as a pilot project, (4) designing your product, (5) ensuring patient privacy, (6) thinking through the process, (7) fostering relationships with your participants, (8) being prepared to provide physician payment, (9) providing feedback, and (10) planning the transition from pilot to permanency. In following these 10 steps, we believe that the e-consultation system and its associated improvements on the consultation process can be effectively implemented in other healthcare settings. PMID:24073898

Health care ethics consultation: an update on core competencies and emerging standards from the American Society For Bioethics and Humanities' core competencies update task force.

PubMed

Tarzian, Anita J

2013-01-01

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report.

Anxious Applicants to Top Colleges Seek an Edge by Hiring Consultants.

ERIC Educational Resources Information Center

Gose, Ben

1997-01-01

College applicants' increasing use of consultant services to help ensure admission to elite colleges is criticized by college admissions officers, concerned that the services assist only the wealthy, and by high school counselors who feel consultants may be dispensing bad advice or may not be committed to student needs. Some feel college…

Impact of the role of nurse, midwife and health visitor consultant.

PubMed

Coster, Samantha; Redfern, Sally; Wilson-Barnett, Jenifer; Evans, Amanda; Peccei, Riccardo; Guest, David

2006-08-01

This paper describes the findings from one aspect of an evaluation study of the role of the nurse, midwife and health visitor consultant and the consultants' perceived impact of their role on services and patient care. The nurse, midwife and health visitor consultant role was established in 2000 in England to improve patient care, strengthen leadership and provide a clinical career opportunity for nurses, midwives and health visitors. An evaluative study was commissioned to report on the role 4 years after the new consultant posts were first established. A multimethod evaluation was undertaken in 2002-2003 combining focus groups, telephone interviews and a comprehensive questionnaire survey of all the consultants in England. Four hundred and nineteen consultants responded to the questionnaire, 22 volunteered for the focus groups and 32 participated in the interviews. Nearly half (44%) the consultants who responded to the survey reported having a substantial impact on their service and 55% reported having some positive impact. High reported impact increased to 71% for those who had been in post for 2 years or longer. Consultants felt that they had been most successful in providing better support to staff, but only 10% said that they had a major impact on reducing unnecessary expenditure within the service. Factors associated with high levels of reported impact included engagement in a wide range of activities, perceived competence in the role and strong medical support. Those reporting most impact also reported the greatest dissatisfaction with salary. As consultants become more established in their posts, they are able to identify improvements in practice, service reconfiguration and educational advantages for staff. Our findings suggest that the true influence of these posts will become clearer over time as the impact of consultants on long-term organizational change becomes more apparent.

What Chemistry To Teach Engineers?

ERIC Educational Resources Information Center

Hawkes, Stephen J.

2000-01-01

Examines possible general chemistry topics that would be most relevant and practical for engineering majors. Consults the Accreditation Board for Engineering and Technology (ABET), engineering textbooks, texts from other required subjects, and practicing engineers for recommendations. (Contains 24 references.) (WRM)

A Home-Based Palliative Care Consult Service for Veterans.

PubMed

Golden, Adam G; Antoni, Charles; Gammonley, Denise

2016-11-01

We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

On the Fifth Day: The Pay Equals the Work.

ERIC Educational Resources Information Center

Sissom, Leighton E.

1986-01-01

Addresses the guidelines most institutions of higher learning use in determining to what extent their faculty can be involved in outside consulting. Reports on a study detailing the amount of time engineering faculty spent doing consulting. Outlines a set of pros and cons concerning faculty consulting. (TW)

Locum tenens consultant doctors in a rural general hospital - an essential part of the medical workforce or an expensive stopgap?

PubMed

Sim, Andrew Jw

2011-01-01

Maintaining hospital consultant staffing levels often requires the employment of locum tenens to meet service needs. This is particularly so in hospitals where core clinical services are run by a small number of permanently appointed consultants. The problems associated with locum employment are underestimated and little attention has been directed towards addressing the issue in the rural general hospitals of Scotland. This study looked at the permanent and short- and long-term locum consultant usage over an 8 year period in one Scottish rural general hospital, the Western Isles Hospital in Stornoway. Data were extracted from the Human Resources Department of NHS Western Isles' list of locum consultants for most weeks from the beginning of January 2002 to the end of December 2009. The Western Isles Hospital in Stornoway has an establishment of 17 permanent consultants. During the 8 year study period 239 different consultants were employed, 20 held substantive permanent positions, 31 were long-term locums (employed >3 months) and 188 were short-term locums. The short-term locums worked for 535 different locum episodes. The pattern of usage varied according to service configuration. Study data revealed the alarming scope of the locum tenens issue, which will increase unless action is taken. For sustainable medical services to continue in the rural general hospitals of Scotland, staffing models must minimise the need to employ locum consultants.

Point of care use of a personal digital assistant for patient consultation management: experience of an intravenous resource nurse team in a major Canadian teaching hospital.

PubMed

Bosma, Laine; Balen, Robert M; Davidson, Erin; Jewesson, Peter J

2003-01-01

The development and integration of a personal digital assistant (PDA)-based point-of-care database into an intravenous resource nurse (IVRN) consultation service for the purposes of consultation management and service characterization are described. The IVRN team provides a consultation service 7 days a week in this 1000-bed tertiary adult care teaching hospital. No simple, reliable method for documenting IVRN patient care activity and facilitating IVRN-initiated patient follow-up evaluation was available. Implementation of a PDA database with exportability of data to statistical analysis software was undertaken in July 2001. A Palm IIIXE PDA was purchased and a three-table, 13-field database was developed using HanDBase software. During the 7-month period of data collection, the IVRN team recorded 4868 consultations for 40 patient care areas. Full analysis of service characteristics was conducted using SPSS 10.0 software. Team members adopted the new technology with few problems, and the authors now can efficiently track and analyze the services provided by their IVRN team.

Analyzing the Effect of Consultation Training on the Development of Consultation Competence

ERIC Educational Resources Information Center

Newell, Markeda L.; Newell, Terrance

2018-01-01

The purpose of this study was to examine the effectiveness of one consultation course on the development of pre-service school psychologists' consultation knowledge, confidence, and skills. Computer-simulation was used as a means to replicate the school environment and capture consultants' engagement throughout the consultation process without…

Quality of psychiatric care in the general hospital: referrer perceptions of an inpatient liaison psychiatry service.

PubMed

Solomons, Luke C; Thachil, Ajoy; Burgess, Caroline; Hopper, Adrian; Glen-Day, Vicky; Ranjith, Gopinath; Hodgkiss, Andrew

2011-01-01

To explore the experience of senior staff on acute medical wards using an established inpatient liaison psychiatry service and obtain their views on clinically relevant performance measures. Semistructured face-to-face interviews with consultants and senior nurses were taped, transcribed and analyzed manually using the framework method of analysis. Twenty-five referrers were interviewed. Four key themes were identified - benefits of the liaison service, potential areas of improvement, indices of service performance such as speed and quality of response and expanded substance misuse service. Respondents felt the liaison service benefited patients, staff and service delivery in the general hospital. Medical consultants wanted stepped management plans devised by consultant liaison psychiatrists. Senior nurses, who perceived themselves as frontline crisis managers, valued on-the-spot input on patient management. Consultants and senior nurses differed in their expectations of liaison psychiatry. Referrers valued speed of response and regarded time from referral to definitive management plan as a key performance indicator for benchmarking services. Copyright © 2011 Elsevier Inc. All rights reserved.

Collaborative Course Syllabus Construction: Impact on Consultative Competency of Graduate Students in School Psychology

ERIC Educational Resources Information Center

Camilli, Andrea Lauren

2009-01-01

Consultation has emerged as an effective alternative to traditional methods of service delivery in schools. Additionally, current research and recent changes in legislation (e.g., reauthorization of IDEA) indicate that not only is consultation an effective approach to service delivery, but it is a preferred activity of school psychologists and an…

Teleconsultation for Clinicians Who Provide Human Immunodeficiency Virus Care: Experience of the National HIV Telephone Consultation Service

PubMed Central

Neff, Sarah; Goldschmidt, Ronald H.

2011-01-01

Abstract Objective To examine the infrastructure, successes, and challenges of a teleconsultation service for human immunodeficiency virus (HIV) clinicians. Materials and Methods The HIV Warmline is a telephone consultation service providing free, live HIV/AIDS management advice to U.S. clinicians. We present descriptive data about callers, patients, and consultation topics gathered by electronic query of the HIV Warmline database for 2009. Caller satisfaction survey results for 2009 are also presented. Results The HIV Warmline has provided more than 37,000 consultations since its inception in 1992. The service provides consultations to clinicians from all 50 states, from a variety of professional backgrounds, and with a wide range of HIV experience levels. The majority of call topics concern antiretroviral therapy. Callers are generally pleased with the service, giving a mean Likert scale rating of 4.7 on satisfaction survey questions. Conclusion The experience of the HIV Warmline can serve as a model for other programs planning to develop remote consultation systems. HIV teleconsultation has been relatively simple to implement and can be useful for many types of clinicians. HIV teleconsultation should continue to be evaluated as a way to improve HIV care, especially in areas without easy access to HIV expertise. PMID:21612517

15 CFR 200.103 - Consulting and advisory services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... competence, NIST offers consulting and advisory services on various problems related to measurement, e.g... enhance the competence of standards laboratory personnel, NIST conducts at irregular intervals several...

Feasibility and cost of a medical student proxy-based mobile teledermatology consult service with Kisoro, Uganda, and Lake Atitlán, Guatemala.

PubMed

Greisman, Laura; Nguyen, Tan M; Mann, Ranon E; Baganizi, Michael; Jacobson, Mark; Paccione, Gerald A; Friedman, Adam J; Lipoff, Jules B

2015-06-01

The expansion of mobile technology and coverage has unveiled new means for delivering medical care to isolated and resource-poor communities. Teledermatology, or dermatology consultation from a distance using technology, is gaining greater acceptance among physicians and patients. To evaluate feasibility and cost of a smartphone-based teledermatology consult service utilizing a designated medical student proxy to facilitate all consults on site, and to evaluate the service's effect upon diagnosis and management. An IRB-approved smartphone-based teledermatology consult service was established to serve two rural communities in the developing world: Kisoro, Uganda, and Lake Atitlán, Guatemala. Fourth-year medical students were recruited as proxies for each site, responding to consults by local doctors and transmitting photographs and clinical information via a smartphone application to a dermatology resident and attending in the USA over an encrypted website. At the Ugandan site, when indicated, the medical student performed skin biopsies under supervision, and rotating Montefiore residents transported specimens back to the USA. From October 2011 to August 2012, 93 cases were evaluated by the consult service (57 from Uganda and 36 from Guatemala). Initial diagnoses changed completely in 55.9% (52 of 93) of cases, and management changes were recommended in 89.2% (83 of 93) of cases. The estimated total cost of supplies and technology was 42.01 USD per consult and 64.24 USD per biopsy (including processing). Given fixed upfront costs, the cost per consult decreased with each additional case. Smartphone-based systems for teledermatology consultation using a medical student proxy are feasible for delivery of care in the developing world at relatively little cost. Optimization and sustainability of this system requires and deserves further investigation in larger studies. © 2014 The International Society of Dermatology.

The West Virginia Occupational Safety and Health Initiative: practicum training for a new marketplace.

PubMed

Meyer, J D; Becker, P E; Stockdale, T; Ducatman, A M

1999-05-01

Occupational medicine practice has experienced a shift from larger corporate medical departments to organizations providing services for a variety of industries. Specific training needs will accompany this shift in practice patterns; these may differ from those developed in the traditional industrial or corporate medical department setting. The West Virginia Occupational Health and Safety Initiative involves occupational medicine residents in consultation to a variety of small industries and businesses. It uses the expertise of occupational physicians, health and safety extension faculty, and faculty in engineering and industrial hygiene. Residents participate in multidisciplinary evaluations of worksites, and develop competencies in team-building, workplace health and safety evaluation, and occupational medical consulting. Specific competencies that address requirements for practicum training are used to measure the trainee's acquisition of knowledge and skills. Particular attention is paid to the acquisition of group problem-solving expertise, skills relevant to the current market in practice opportunities, and the specific career interests of the resident physician. Preliminary evaluation indicates the usefulness of training in evaluation of diverse industries and worksites. We offer this program as a training model that can prepare residents for the challenges of a changing marketplace for occupational health and safety services.

Characterization of Complementary and Alternative Medicine-Related Consultations in an Academic Drug Information Service.

PubMed

Gregory, Philip J; Jalloh, Mohamed A; Abe, Andrew M; Hu, James; Hein, Darren J

2016-12-01

To characterize requests received through an academic drug information consultation service related to complementary and alternative medicines. A retrospective review and descriptive analysis of drug information consultations was conducted. A total of 195 consultations related to complementary and alternative medicine were evaluated. All consultation requests involved questions about dietary supplements. The most common request types were related to safety and tolerability (39%), effectiveness (38%), and therapeutic use (34%). Sixty-eight percent of the requests were from pharmacists. The most frequent consultation requests from pharmacists were questions related to drug interactions (37%), therapeutic use (37%), or stability/compatibility/storage (34%). Nearly 60% of complementary and alternative medicine-related consultation requests were able to be completely addressed using available resources. Among review sources, Natural Medicines Comprehensive Database, Clinical Pharmacology, Micromedex, and Pharmacist's Letter were the most common resources used to address consultations. Utilization of a drug information service may be a viable option for health care professionals to help answer a complementary and alternative medicine-related question. Additionally, pharmacists and other health care professionals may consider acquiring resources identified to consistently answering these questions. © The Author(s) 2015.

Improving referral to psychological support unit at Saudi Red Crescent Authority in Riyadh Region.

PubMed

Alzahrani, Ahmad Yousif; Mahmod, Sabri Abd Allah; Bakhamis, Thamer Mohammad; Al-Surimi, Khaled

2017-01-01

The Psychological Support Unit (PSU) performance in Saudi Red Crescent Authority (SRCA) showed that only a small number of case referred seeking psychological advice and management from PSU among all SRCA employees. However, research shows that between 28% and 52% of emergency medical services (EMS) providers usually seek psychological help in various EMS cultures, where 86% of them usually suffer from critical stress. Thus, we decided to design a quality improvement project that aims to improve the referral process by increasing cases referred to the PSU at SRCA in Riyadh Region by 75% in 2 months. A multidisciplinary team has been formed to analyse the problem using quality tools including, brainstorming, fishbone diagram and flow chart of the PSU processes. Several possible reasons have been identified, such as lack of awareness among the SRCA's employees about PSU and its services, and the concern about privacy and confidentiality during psychological consultations in the PSU, in addition to the long referring process to PSU. The team decided to test the following change ideas: increasing the awareness of employees about the PSU services, improving the privacy and confidentiality during the consultation using electronic channels, and finally re-engineering the referral process to make it lean and remove all the unnecessary steps. Several improvement interventions have been tested sequentially in three consecutive Plan-Do-Study-Act cycles on a weekly basis. The project findings demonstrated that the first change idea was successful but not reaching the target while the second change had led to huge impact exceeding our target but with short effect. On the other hand, although the third change idea of re-engineering the PSU referral process had led to negative result initially, over the following weeks of measurement the results turned to be positive and meeting our expectations. We concluded that re-engineering referral process is most effective improvement intervention among other change ideas in term of magnitude and sustainability of the effect on increasing the number of referral cases to the PSU. We recommend conducting further testing and measuring of these change ideas in other PSU across the SRCA to understand the diffident context in other regions of SRCA.

An Exploratory Study in School Counselor Consultation Engagement

ERIC Educational Resources Information Center

Perera-Diltz, Dilani M.; Moe, Jeffry L.; Mason, Kimberly L.

2011-01-01

Consultation, an indirect school counselor service, is provided by 79% (n = 998) school counselor currently. Most frequently consultation occurs with teachers, parents, and principals. MANOVA and post hoc analysis indicate differences in consultation practices across academic levels. Choosing a consultation model based on the type of service…

Integrating ergonomics in design processes: a case study within an engineering consultancy firm.

PubMed

Sørensen, Lene Bjerg; Broberg, Ole

2012-01-01

This paper reports on a case study within an engineering consultancy firm, where engineering designers and ergonomists were working together on the design of a new hospital sterile processing plant. The objective of the paper is to gain a better understanding of the premises for integrating ergonomics into engineering design processes and how different factors either promote or limit the integration. Based on a grounded theory approach a model illustrating these factors is developed and different hypotheses about how these factors either promote and/or limit the integration of ergonomics into design processes is presented along with the model.

Breast cancer patients' satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service.

PubMed

Hack, Carolin C; Antoniadis, Sophia; Hackl, Janina; Langemann, Hanna; Schwitulla, Judith; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-07-01

Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine. Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals. 72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%). Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.

The composing process of technical writers: A preliminary study

NASA Technical Reports Server (NTRS)

Mair, D.; Roundy, N.

1981-01-01

The assumption that technical writers compose as do other writers is tested. The literature on the composing process, not limited to the pure or applied sciences, was reviewed, yielding three areas of general agreement. The composing process (1) consists of several stages, (2) is reflexive, and (3) may be mastered by means of strategies. Data on the ways technical writers compose were collected, and findings were related to the three areas of agreement. Questionnaires and interviews surveying 70 writers were used. The disciplines represented by these writers included civil, chemical, agricultural, geological, mechanical, electrical, and petroleum engineering, chemistry, hydrology, geology, and biology. Those providing consulting services, or performing research. No technical editors or professional writers were surveyed, only technicians, engineers, and researchers whose jobs involved composing reports. Three pedagogical implications are included.

An Exploratory Study of Informal Learning and Team Performance in the Pre-Consulting Phase

ERIC Educational Resources Information Center

Sibarani, Roza Marsaulina

2014-01-01

This paper reports the process of informal learning in the pre-consulting phase in management-consulting firms in Indonesia. As the consulting industry significantly grows in Indonesia, more organisations use consultant services to improve their business. Pre-consulting is an important phase to define the right solutions, which involves a lot of…

Effects of Collaborative Consultative Services for Students Who Are Deaf and Hard of Hearing

ERIC Educational Resources Information Center

Kiske, Katie

2017-01-01

The purpose of this research was to determine the perception of consultative services as well as the self-efficacy of both teachers of the deaf and general education teachers that work with students who are D/HH. This study investigated current perceptions and attitudes as well as identified trends in current consultative practice between teachers…

Services in the Community for Adults with Psychosis and Intellectual Disabilities: A Delphi Consultation of Professionals' Views

ERIC Educational Resources Information Center

Hemmings, C. P.; Underwood, L. A.; Bouras, N.

2009-01-01

Background: There remains a severe lack of evidence on the effectiveness of community services for adults with psychosis and intellectual disabilities (ID). There has been little consensus even of what services should provide for this service user group. Method: A consultation of multidisciplinary professionals was carried out by using a…

Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience.

PubMed

Volpe, Tiziana; Boydell, Katherine M; Pignatiello, Antonio

2013-01-01

Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study's qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners.

Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience

PubMed Central

Boydell, Katherine M.; Pignatiello, Antonio

2013-01-01

Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study's qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners. PMID:23864854

78 FR 26781 - Administration for Native Americans Tribal Consultation; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Administration... Families, Department of Health and Human Services. ACTION: Notice of tribal consultation. SUMMARY: The Department of Health and Human Services (HHS), Administration for Children and Families (ACF) will host a...

Investigation of the mediating effects of IT governance-value delivery on service quality and ERP performance

NASA Astrophysics Data System (ADS)

Tsai, Wen-Hsien; Chou, Yu-Wei; Leu, Jun-Der; Chao Chen, Der; Tsaur, Tsen-Shu

2015-02-01

This study aimed to explore the mediating effects of IT governance (ITG)-value delivery in the relationships among the quality of vendor service, the quality of consultant services, ITG-value delivery and enterprise resource planning (ERP) performance. The sampling of this research was acquired from a questionnaire survey concerning ERP implementations in Taiwan. In this survey, 4366 questionnaires were sent to manufacturing and service companies listed in the TOP 5000: The Largest Corporations in Taiwan 2009. The results showed that an ERP system will exhibit a decreased error rate and improved performance if ERP system vendors and consultants provide good service quality. The results also demonstrated that significant relationships exist among the quality of vendor service, the quality of consultant services and value delivery. The contribution of this article is twofold. First, it found that value delivery provides an effective measure of ERP performance under an ITG framework. Second, it provides evidence of the partial mediating effects of value delivery between service quality and ERP performance. In other words, if enterprises want to improve ERP performance, they need to consider factors such as value delivery and the quality of a vendor/consultant's service.

Rapid Response Team activation for pediatric patients on the acute pain service.

PubMed

Teets, Maxwell; Tumin, Dmitry; Walia, Hina; Stevens, Jenna; Wrona, Sharon; Martin, David; Bhalla, Tarun; Tobias, Joseph D

2017-11-01

Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team. Two independent practitioners reviewed electronic medical records to determine which events were likely associated with pain management interventions. Over a 4-year period, 4872 patients were admitted to the acute pain service of whom 135 unique patients required Rapid Response Team consults. There were 159 unique Rapid Response Team activations among 6538 unique acute pain service consults. A subset of 27 pain management-related Rapid Response Team consultations was identified. The largest percentage of patients on the acute pain service were adolescents aged 12-17 (36%). Compared to this age group, the odds of Rapid Response Team activation were higher among infants <1 year old (odds ratio = 2.85; 95% confidence interval: 1.59, 5.10; P < .001) and adults over 18 years (odds ratio = 1.68; 95% confidence interval: 1.01, 2.80; P = .046). Identifying demographics and etiologies of acute pain service patients requiring Rapid Response Team consultations may help to identify patients at risk for clinical decompensation. © 2017 John Wiley & Sons Ltd.

School Food Service -- Three Points of View.

ERIC Educational Resources Information Center

Flambert, Richard

A food-systems consultant and designer advises school districts that want prosperous food service programs to adopt big-business methods. Successful commercial operations hire top food-service consultants and designers to get the most from their space, equipment, and labor. Commercial enterprises are concerned with efficient utilization of plant…

Online health consultation: examining uses of an interactive cancer communication tool by low-income women with breast cancer.

PubMed

Lu, Hsueh-Yi; Shaw, Bret R; Gustafson, David H

2011-07-01

To examine how psychosocial variables predicted use of an online health consultation service among low-income breast cancer patients and in turn how using this service affected these same psychosocial outcomes. This retrospective study included 231 recently diagnosed, low-income (at or below 250% of the federal poverty level) breast cancer patients provided a free computer with 16 weeks of access to the Internet-based 'Ask an Expert' service offered as part of the Comprehensive Health Enhancement Support System (CHESS) "Living with Breast Cancer" program. The use activity included a total of 502 messages submitted to the online health consultation service. The data included five psychosocial variables: information seeking, social support, health self efficacy, participation in health care, and doctor-patient relationship, were collected at both the pre-test and 16-week post-test after using the service. Correlation tests were conducted to examine the relationship between pre- and post-test, and use activity. A multiple regression model was formed for each of five psychosocial variables to examine how use activity of the consultation service was associated with various psychosocial measurements. In total, 865 distinct consulting queries from 502 messages were identified as measurement of patients' use activities (3.74 consulting queries per participant). Use activity had significant negative relationships with pre-test scores across all five psychosocial variables. The regression models found significant positive main effects (use activity) associated with three of these psychosocial variables: health self efficacy, participation in health care and doctor-patient relationship. Use activity of the online consultation service did not have significant relationships with the dependent variables of information seeking and perceived social support. Low-income breast cancer patients sought out information from an online cancer information expert. Patients with more negative perceptions at pre-test tended to use the service more. Greater use of the service was associated with improvement in patients' perception of health self-efficacy, participation in health care and doctor-patient relationship. Moreover, use of online health consultation appears to level the differences, narrowing the gaps between those who were worse and better off at pre-test. These findings suggest that online health consultation can serve as an effective complement to other resources, which help low-income, breast cancer patients feel more confident to participate more actively in their health care, become more actively involved in making decisions about their treatments and enhance the relationship with their doctors. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Immigrants' use of primary health care services for mental health problems.

PubMed

Straiton, Melanie; Reneflot, Anne; Diaz, Esperanza

2014-08-13

Equity in health care across all social groups is a major goal in health care policy. Immigrants may experience more mental health problems than natives, but we do not know the extent to which they seek help from primary health care services. This study aimed to determine a) the rate immigrants use primary health care services for mental health problems compared with Norwegians and b) the association between length of stay, reason for immigration and service use among immigrants. National register data covering all residents in Norway and all consultations with primary health care services were used. We conducted logistic regression analyses to compare Norwegians' with Polish, Swedish, German, Pakistani and Iraqi immigrants' odds of having had a consultation for a mental health problem (P-consultation). After accounting for background variables, all immigrants groups, except Iraqi men had lower odds of a P-consultation than their Norwegian counterparts. A shorter length of stay was associated with lower odds of a P-consultation. Service use varies by country of origin and patterns are different for men and women. There was some evidence of a possible 'healthy migrant worker' effect among the European groups. Together with previous research, our findings however, suggest that Iraqi women and Pakistanis in particular, may experience barriers in accessing care for mental health problems.

Mental health services for Nunavut children and youth: evaluating a telepsychiatry pilot project.

PubMed

Volpe, T; Boydell, K M; Pignatiello, A

2014-01-01

This study examines the delivery of psychiatric consultation services using videoconferencing technology to health and mental health workers in the Nunavut territory of Canada. The research provides insights into the TeleLink Mental Health Program and the delivery of professional-to-professional program consultations and continuing education seminars. Participant observation of 12 program consultations and four continuing education sessions was conducted. Individual interviews were conducted with the consulting psychiatrist and the lead program coordinator in Nunavut. As well, a focus group was held with Nunavut workers who participated in the televideo sessions. The study found a number of factors that facilitated or hindered the process and content of a consultation-based telepsychiatry program and its effect on building capacity among frontline staff. Four main themes emerged related to the delivery of psychiatric services via televideo: gaining access, ensuring culturally appropriate services, providing relevant continuing education, and offering stable and confidential technology. Live interactive videoconferencing technology is an innovative and effective way of delivering specialized mental health services to professionals working in remote areas of Nunavut. Study results provide important strategies for expanding this approach to other jurisdictions in Nunavut and other Inuit regions.

The Educational Needs of Graduate Mechanical Engineers in New Zealand.

ERIC Educational Resources Information Center

Deans, J.

1999-01-01

Surveys graduate and undergraduate mechanical engineering students at the University of Auckland. Shows that the dominant work activities of New Zealand mechanical engineers include design and consultancy and that graduate engineers rapidly migrate into management. (Author/CCM)

Harvard Catalyst | The Clinical Translational Science Center IND/IDE Consult Service: providing an IND/IDE consult service in a decentralized network of academic healthcare centers.

PubMed

Kim, Min J; Winkler, Sabune J; Bierer, Barbara E; Wolf, Delia

2014-04-01

The Food and Drug Administration (FDA) regulations require sponsors of clinical investigations involving an investigational drug or device to submit an Investigational New Drug (IND) or Investigational Device Exemption (IDE) application. Strict adherence to applicable regulations is vital to the success of clinical research. Unlike most major pharmaceutical sponsors, investigator sponsors often do not fully appreciate their regulatory obligations nor have resources to ensure compliance. As a result they can place themselves and their institutions at risk. Nevertheless, investigator-initiated clinical trials are vital to the further development of innovative drugs, biologics, and medical devices. The IND/IDE Subcommittee under the Regulatory Knowledge and Support Program at Harvard Catalyst, The Harvard Clinical and Translational Science Center worked in collaboration with Harvard and Harvard affiliated institutions to create and launch an IND/IDE Consult Service in a decentralized network of collaborating Academic Healthcare Centers (AHC). The IND/IDE Consult Service offers expertise, resources, and shared experiences to assist sponsor-investigators and IRBs in meeting regulatory requirements for conducting and reviewing investigator-initiated IND/IDE studies. The scope of the services provided by the Harvard Catalyst IND/IDE Consult Service are described, including the specifics of the service, lessons learned, and challenges faced, in a scalable model that builds inter-institutional capacity. © 2014 Wiley Periodicals, Inc.

Harvard Catalyst | The Clinical Translational Science Center IND/IDE Consult Service: Providing an IND/IDE Consult Service in a Decentralized Network of Academic Healthcare Centers

PubMed Central

Winkler, Sabune J.; Bierer, Barbara E.; Wolf, Delia

2014-01-01

Abstract The Food and Drug Administration (FDA) regulations require sponsors of clinical investigations involving an investigational drug or device to submit an Investigational New Drug (IND) or Investigational Device Exemption (IDE) application. Strict adherence to applicable regulations is vital to the success of clinical research. Unlike most major pharmaceutical sponsors, investigator sponsors often do not fully appreciate their regulatory obligations nor have resources to ensure compliance. As a result they can place themselves and their institutions at risk. Nevertheless, investigator‐initiated clinical trials are vital to the further development of innovative drugs, biologics, and medical devices. The IND/IDE Subcommittee under the Regulatory Knowledge and Support Program at Harvard Catalyst, The Harvard Clinical and Translational Science Center worked in collaboration with Harvard and Harvard affiliated institutions to create and launch an IND/IDE Consult Service in a decentralized network of collaborating Academic Healthcare Centers (AHC). The IND/IDE Consult Service offers expertise, resources, and shared experiences to assist sponsor‐investigators and IRBs in meeting regulatory requirements for conducting and reviewing investigator‐initiated IND/IDE studies. The scope of the services provided by the Harvard Catalyst IND/IDE Consult Service are described, including the specifics of the service, lessons learned, and challenges faced, in a scalable model that builds inter‐institutional capacity. PMID:24455986

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Consultants, Consultancy and Consultocracy in Education Policymaking in England

ERIC Educational Resources Information Center

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

2015-01-01

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

Economic Outcomes Associated with a Pharmacist-Adjudicated Formulary Consult Service in a Veterans Affairs Medical Center.

PubMed

Britt, Rachel B; Hashem, Mohamed G; Bryan, William E; Kothapalli, Radhika; Brown, Jamie N

2016-09-01

Several cost analysis studies have been conducted looking at clinical and economic outcomes associated with clinical pharmacist services in a variety of health care settings. However, there is a paucity of data regarding the economic impact of clinical pharmacist involvement in formulary management at the hospital level. To evaluate economic outcomes of a pharmacist-adjudicated formulary management consult service in a Veterans Affairs (VA) medical center offering outpatient and inpatient services. This VA medical center uses a pharmacist-adjudicated formulary management system for review of restricted drug consults. A retrospective review of electronic medical records was conducted to identify restricted drug consults at this institution between January 1, 2014, and March 31, 2014. Only restricted drug consults that were not approved were included for evaluation in order to best characterize the effects of formulary interventions by pharmacists. Economic outcomes were determined as direct cost savings by comparing the cost of requested drug with the recommended drug and accounting for the cost of pharmacist review. Characteristics of consults that were not approved and pharmacist rationale were also evaluated. Of 1,802 restricted drug consults adjudicated by a pharmacist during the study period, 198 consults in 190 individual patients met criteria for inclusion and were evaluated. The most commonly requested indications were dyslipidemia, pain, and diabetes, while the most commonly requested drugs were rosuvastatin, insulin pens, tamsulosin, varenicline, ezetimibe, and rivaroxaban. The majority of consults were requested for outpatient use. Total cost savings among 195 evaluable consults was $420,324.05, while mean cost savings per consult was $2,229.43 (range: -$3,009.27-$65,982.36). The highest cost savings were seen with outpatient use. A pharmacist-adjudicated formulary consult service in a VA medical center was associated with a substantial cost savings after adjustment for cost of pharmacist review. Future research should assess clinical outcomes associated with a restrictive formulary management system. No outside funding supported this study. None of the authors report any financial interests or potential conflict of interest with regard to this work. Study concept and design were created by all authors. Data were collected and interpreted by Britt, with input from all authors. The manuscript was written by Britt and revised by all authors.

[Online-consulting for eating disorders--analysis of users and contents].

PubMed

Grunwald, Martin; Wesemann, Dorette

2006-04-01

Since 1998, the online information and consulting server for patients with eating disorders and their relatives (www.ab-server.de) offers an online consulting service. 2176 e-mails were qualitatively and quantitatively analysed. The symptom descriptions refer mostly to bulimia nervosa (63.1%). People mainly asked for behaviour patterns in dealing with the illness or with an affected person (33.3%) as well as for information about the illness (18.7%). The low threshold and professional online consulting service is highly accepted by the target group.

42 CFR 137.401 - What role does Tribal consultation play in the IHS annual budget request process?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false What role does Tribal consultation play in the IHS annual budget request process? 137.401 Section 137.401 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF...

Data collection in consultation-liaison psychiatry: an evaluation of Casemix.

PubMed

Ellen, Steven; Lacey, Cameron; Kouzma, Nadya; Sauvey, Nick; Carroll, Rhonda

2006-03-01

To evaluate the usefulness of Casemix as a data collection system for consultation-liaison psychiatry services. Health information staff were requested to code psychiatric assessments and diagnosis prospectively for admissions to the Alfred Hospital, Melbourne, between July 2002 and June 2004 using Casemix. Psychiatric assessments were requested on 2.5% of all hospital admissions (n = 2575). Casemix provided extensive demographic and hospital unit data for referred patients, is easy to set up, and is cost-free for the psychiatry service. Casemix can provide extensive meaningful data for consultation-liaison psychiatry services that could assist in the argument for greater funding of these services.

Interdependence in decision-making by medical consultants: implications for improving the efficiency of inpatient physician services.

PubMed

Wilk, Adam S; Chen, Lena M

2017-12-01

Hospital administrators are seeking to improve efficiency in medical consultation services, yet whether consultants make decisions to provide more or less care is unknown. We examined how medical consultants account for prior consultants' care when determining whether to provide intensive consulting care or sign off in the treatment of complex surgical inpatients. We applied three distinct theoretical frameworks in the interpretation of our results. We performed a retrospective cohort study of consultants' care intensity, measured alternately using a dummy variable for providing two or more days consulting (versus one) and a continuous measure of total days consulting, with 100% Medicare claims data from 2007-2010. Our analytic samples included consults for beneficiaries undergoing coronary artery bypass grafting (n = 61,785) or colectomy (n = 33,460) in general acute care hospitals. We compared the care intensity of consultants who observed different patterns of consulting care before their initial consults using ordinary least squares regression models at the patient-physician dyad level, controlling for patient comorbidity and many other patient- and physician-level factors as well as hospital region and year fixed effects. Consultants were less likely to provide intensive consulting care with each additional prior consultant on the case (1.2-1.7 percent) or if a prior consultant rendered intensive consulting care (20.6-21.5 percent) but more likely when prior consults were more concentrated across consultants (2.9-3.1 percent). Effects on consultants' total days consulting were similar. On average, consultants appeared to calibrate their care intensity for individual patients to maximize their value to all patients. Interventions for improving consulting care efficiency should seek to facilitate (not constrain) consultants' decision-making processes.

[Study of efficiancy of teleconsultation: the Telepathology Consultation Service of the Professional Assoziation of German Pathologists for the screening program of breast carcinoma].

PubMed

Schrader, T; Hufnagl, P; Schlake, W; Dietel, M

2005-01-01

In the autumn a German screening program was started for detecting breast cancer in the population of women fifty and above. For the first time in this program, quality assurance rules were established: All statements of the radiologists and pathologists have to be confirmed by a second opinion. This improvement in quality is combined with a delay in time and additional expence. A new Telepathology Consultation Service was developed based on the experiences of the Telepathology Consultation Center of the UICC to speed up the second opinion process. The complete web-based service is operated under MS Windows 2003 Server, as web server the Internet Information Server, and the SQL-Server (both Microsoft) as the database. The websites, forms and control mechanism have been coded in by ASP scripts and JavaScript. A study to evaluate the effectiveness of telepathological consultation in comparison to conventional consultation has been carried out. Pathologists of the Professional Association of German Pathologists took part as well as requesting pathologists and as consultants for other participants. The quality of telepathological diagnosis was comparable to the conventional diagnosis. Telepathology allows a faster respond of 1 to 2 day (conventional postal delay). The time to prepare a telepathology request is about twice as conventional. This ratio may be inverted by an interface between the Pathology Information System and the Telepathology Server and the use of virtual microscopy. The Telepathology Consultation Service of the Professional Association of German Pathologists is a fast and effective German-language, internet-based service for obtaining a second opinion.

The Impact of the Internet on Health Consultation Market Concentration: An Econometric Analysis of Secondary Data

PubMed Central

2016-01-01

Background Many markets have traditionally been dominated by a few best-selling products, and this is also the case for the health care industry. However, we do not know whether the market will be more or less concentrated when health care services are delivered online (known as E-consultation), nor do we know how to reduce the concentration of the E-consultation market. Objective The aim of this study was to investigate the concentration of the E-consultation market and how to reduce its concentration through information disclosure mechanisms (online reputation and self-representation). Methods We employed a secondary data econometric analysis using transaction data obtained from an E-consultation Website (haodf.com) for three diseases (infantile pneumonia, diabetes, and pancreatic cancer) from 2008 to 2015. We included 2439 doctors in the analysis. Results The E-consultation market largely follows the 20/80 principle, namely that approximately 80% of orders are fulfilled by nearly 20% of doctors. This is much higher than the offline health care market. Meanwhile, the market served by doctors with strong online reputations (beta=0.207, P<.001) or strong online self-representation (beta=0.386, P<.001) is less concentrated. Conclusions When health care services are delivered online, the market will be more concentrated (known as the “Superstar” effect), indicating poor service efficiency for society as a whole. To reduce market concentration, E-consultation websites should provide important design elements such as ratings of doctors (user feedback), articles contributed by doctors, and free consultation services (online representation). A possible and important way to reduce the market concentration of the E-consultation market is to accumulate enough highly rated or highly self-represented doctors. PMID:27793793

Mental health consultant to law enforcement: Secret Service development of a Mental Health Liaison Program.

PubMed

Coggins, M H; Pynchon, M R

1998-01-01

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants--psychologists and psychiatrists--with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions.

Characteristics of patients seen by visiting psychiatrists through Medicare in a rural community mental health service with an established telemedicine service.

PubMed

Bidargaddi, Niranjan; Schrader, Geoffrey; Smith, David; Carson, Dean; Strobel, Jörg

2017-06-01

We aimed to determine characteristics of patients receiving Medicare-funded face-to-face consultations by psychiatrists in a rural service with an established telemedicine service. For this study, 55 case-managed patients from four rural community mental health teams in South Australia provided information through questionnaires regarding psychological symptoms, quality of life, body mass index (BMI) and gave access to their Medicare data. In a logistic regression, it was found that being younger was more likely associated with a Medicare psychiatric consultation ( p<0.05). Participants with at least one recorded visit to a Medicare psychiatrist consultation also tended to have lower levels of psychological distress at the end of the 4-year period, have a higher BMI, and more general practitioner consultations. The study provides clinicians and policy makers with preliminary information on the subtle differences in clinical profile of patients seen by Medicare-funded psychiatrists within an established state-managed telepsychiatry service.

Price elasticity of demand for psychiatric consultation in a Nigerian psychiatric service.

PubMed

Esan, Oluyomi

2016-12-01

This paper addresses price elasticity of demand (PED) in a region where most patients make payments for consultations out of pocket. PED is a measure of the responsiveness of the quantity demanded of goods or services to changes in price. The study was done in the context of an outpatient psychiatric clinic in a sub -Saharan African country. The study was performed at the University College Hospital (UCH), Ibadan, Nigeria. Aggregate data were collected on weekly clinic attendance over a 24-month period October 2008 - September 2010 representing 12 months before, to 12months after a 67% increase in price of outpatient psychiatric consultation. The average weekly clinic attendance prior to the increase was compared to the average clinic attendance after the price increase. Arc-PED for consultation was also estimated. Clinic attendance dropped immediately and significantly in the weeks following the price increase. There was a 34.4% reduction in average weekly clinic attendance. Arc-PED for psychiatric consultation was -0.85. In comparison to reported PED on health care goods and services, this study finds a relatively high PED in psychiatric consultation following an increase in price of user fees of psychiatric consultation.

The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study.

PubMed

Lai, Lillian; Liddy, Clare; Keely, Erin; Afkham, Amir; Kurzawa, Julia; Abdeen, Nishard; Audcent, Tobey; Bromwich, Matthew; Brophy, Jason; Carsen, Sasha; Fournier, Annick; Fraser-Roberts, Leigh; Gandy, Hazen; Hui, Charles; Johnston, Donna; Keely, Kathryn; Kontio, Ken; Lamontagne, Christine; Major, Nathalie; O'Connor, Michael; Radhakrishnan, Dhenuka; Reisman, Joe; Robb, Marjorie; Samson, Lindy; Sell, Erick; Splinter, William; van Stralen, Judy; Venkateswaran, Sunita; Murto, Kimmo

2018-01-01

Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit "elective" clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction. To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults. Prospective observational cohort study. Single Canadian tertiary-care academic pediatric hospital (June 2014-16) servicing 1.2 million people. 1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions. Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected. 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9-1.2) compared with a face-to-face referral (132 days; 95%CI:127-136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service. Similar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes.

Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services.

PubMed

Adams, Traci N; Bonsall, Joanna; Hunt, Daniel; Puig, Alberto; Richards, Jeremy B; Yu, Liyang; McSparron, Jakob I; Shah, Nainesh; Weissler, Jonathan; Miloslavsky, Eli M

2018-05-01

Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

Options for change in the NHS consultant contract.

PubMed

Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

Options for change in the NHS consultant contract.

PubMed Central

Clarke, R. W.; Gray, C.

1994-01-01

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

Live Cases: Service-Learning Consulting Projects in Business Courses.

ERIC Educational Resources Information Center

Godar, Susan Hayes

2000-01-01

Offers suggestions to community service coordinators on how to encourage the use of service learning projects among business faculty in the form of consulting for non-profit organizations. Provides examples of projects in marketing and management courses and discusses how to implement this type of activity in a business course. (EV)

77 FR 47671 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... Project Service Center, 05-- Business Consulting Services, Tele- Workers. 81,633B International Research... sales of the workers' firm; or (B) A loss of business by the workers' firm with the firm described in... Orlando, FL May 15, 2011. Business Machines (IBM), The Project Service Center, 05-- Business Consulting...

Community Consultation and Intervention: Supporting Students Who Do Not Access Counseling Services

ERIC Educational Resources Information Center

Mier, Sharon; Boone, Matthew; Shropshire, Sonya

2009-01-01

Although the severity of psychological problems among college students and the demand for campus counseling services has increased, many students who could benefit from mental health services still do not access them. This article describes Community Consultation and Intervention, a program designed to support students who are unlikely to access…

Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study

PubMed Central

Wherton, Joseph; Vijayaraghavan, Shanti; Morris, Joanne; Bhattacharya, Satya; Hanson, Philippa; Campbell-Richards, Desirée; Ramoutar, Seendy; Collard, Anna; Hodkinson, Isabel

2018-01-01

Background There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. Objective The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. Methods A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). Results When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2% and 22% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Conclusions Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. PMID:29625956

Consultant selection guidebook : procedures for selecting consultants for FHWA federal-aid projects and state funded projects. [Rev. 2002

DOT National Transportation Integrated Search

2002-01-01

This Guidebook provides an overview of procedures for consultant selection. The local agencies that intend to request federal and state funds for reimbursement of consultant services should follow specific selection and contracting procedures. These ...

21 CFR 211.34 - Consultants.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Consultants. 211.34 Section 211.34 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... Consultants. Consultants advising on the manufacture, processing, packing, or holding of drug products shall...

21 CFR 211.34 - Consultants.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Consultants. 211.34 Section 211.34 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... Consultants. Consultants advising on the manufacture, processing, packing, or holding of drug products shall...

21 CFR 211.34 - Consultants.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Consultants. 211.34 Section 211.34 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... Consultants. Consultants advising on the manufacture, processing, packing, or holding of drug products shall...

21 CFR 211.34 - Consultants.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Consultants. 211.34 Section 211.34 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... Consultants. Consultants advising on the manufacture, processing, packing, or holding of drug products shall...

21 CFR 211.34 - Consultants.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Consultants. 211.34 Section 211.34 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... Consultants. Consultants advising on the manufacture, processing, packing, or holding of drug products shall...

40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Purpose. When the EPA requires the services of consultants with expertise in environmental sciences or... Consultants for Environmental Protection. 18.10 Section 18.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL ENVIRONMENTAL PROTECTION RESEARCH FELLOWSHIPS AND SPECIAL RESEARCH CONSULTANTS FOR...

40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Purpose. When the EPA requires the services of consultants with expertise in environmental sciences or... Consultants for Environmental Protection. 18.10 Section 18.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL ENVIRONMENTAL PROTECTION RESEARCH FELLOWSHIPS AND SPECIAL RESEARCH CONSULTANTS FOR...

40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Purpose. When the EPA requires the services of consultants with expertise in environmental sciences or... Consultants for Environmental Protection. 18.10 Section 18.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL ENVIRONMENTAL PROTECTION RESEARCH FELLOWSHIPS AND SPECIAL RESEARCH CONSULTANTS FOR...

Court finds ambiguity in denial of off-label AIDS drug.

PubMed

1998-03-06

A home intravenous drug therapy provider and an insurance company operated by the American Consulting Engineers Council have gone to court over disputed medical claims. An AIDS patient being treated with ganciclovir for CMV retinitis had a decrease in his white blood cell count, neutropenia, that endangered his life. The physicians prescribed neupogen, approved by the Food and Drug Administration (FDA) for cancer treatment, to counteract the neutropenia. The health care provider, I.V. Services of America, continued the neupogen treatment; the treatments were covered as an inpatient but denied after discharge. I.V. Services sued, alleging that the cause of the neutropenia should not bar coverage. The New York judge found in favor of the health care provider, calling the insurance company's position self serving and the denial of the claim arbitrary.

Rolla West master plan : task 2, I-44 interchange--sub consultant services to HNTB.

DOT National Transportation Integrated Search

2008-08-01

Provide support to HNTB as they complete the following tasks: data collection, alternatives workshop, identification of funding : sources, final plan preparation. A full sub consultant scope of service is attached to this application.

76 FR 12967 - Tribal Consultation Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meetings AGENCY: Administration for Children and Families' Office of Head Start (OHS), HHS. ACTION... Services, Administration for Children and Families, OHS leadership, and the leadership of Tribal...

77 FR 5027 - Tribal Consultation Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meetings AGENCY: Administration for Children and Families' Office of Head Start (OHS). ACTION... the Department of Health and Human Services, Administration for Children and Families, Office of Head...

76 FR 20674 - Tribal Consultation Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-13

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meetings AGENCY: Administration for Children and Families' Office of Head Start (OHS), HHS. ACTION... of Health and Human Services, Administration for Children and Families, Office of Head Start...

77 FR 44677 - RG Steel Sparrows Point LLC, Formerly Known as Severstal Sparrows Point LLC, a Subsidiary of RG...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

... Leased Workers From Echelon Service Company, Sun Associated Industries, Inc., MPI Consultants LLC...-site leased workers from Echelon Service Company, Sun Associated Industries, Inc., MPI Consultants LLC...

Core Competencies for Training Effective School Consultants

ERIC Educational Resources Information Center

Burkhouse, Katie Lynn Sutton

2012-01-01

The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

The Department of Defense Human factors standardization program.

PubMed

Chaikin, G

1984-09-01

The Department of Defense (DoD) Human Factors Standardization Program is the most far-reaching standardization programme in the USA. It is an integrated component of the overall DoD Standardization Program. While only ten major documents are contained in the human factors standardization area, their effects on human factors engineering programmes are profound and wide-ranging. Preparation and updating of the human engineering standardisation documents have grown out of the efforts of several military agencies, contractors, consultants, universities and individuals. New documents, engineering practice studies and revision efforts are continuously planned by the Tri-Service (Army, Navy, Air Force) Human Factors Standardization Steering Committee in collaboration with industry groups and technical societies. The present five-year plan and other standardisation documents are readily available for review and input by anyone with relevant interests. Human factors specialists and other readers of this journal may therefore influence the direction of the human factors standardisation programme and the content of its military specifications, standards and handbooks.

Insertion of Foreign Bodies (polyembolokoilamania): Underpinnings and Management Strategies

PubMed Central

Unruh, Brandon T.; Nejad, Shamim H.; Stern, Thomas W.

2012-01-01

LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article. PMID:22690353

[Implementation of telemedicine services in the earthquake disaster relief: the best medical experts provide direct medical service to the affected people].

PubMed

Li, Tan-shi; Chai, Jia-ke

2013-05-01

To sum up the experience and significance of the remote medical consultation system used by the PLA General Hospital in 4/20 Sichuan Lushan earthquake medical rescue in 2013. After the Lushan earthquake in April 20, 2013, the expert medical rescue team of the PLA General Hospital immediately took the wireless portable telemedicine system to the converge hospital which had received many wounds in earthquake and had been connected with other hospitals, medical rescue teams and rescue ambulances to open the remote medical consultation system for disaster services including intensive care, emergency treatment, orthopedics, cerebral surgery, hepatobiliary surgery, obstetrics, gynecology and other related professional remote assistance services. The experts put forward the diagnosis and treatment for victims and had a benign interaction between the experts in disaster site and rear experts, as a result improved the ability of treatment of the disaster expert medical team. The PLA General Hospital treated more than 110 patients by remote medical consultation system in the Lushan earthquake and achieved real-time HD consultation and on-site operation guide. The using of remote medical consultation system achieved the connection between multimedia communication system and medical information system of the hospital and the interconnection of video, audio, data and medical services among each united hospitals, which can provide the significant experience of using remote medical consultation system in our disaster medical rescue activities.

Sport psychology group consultation using social networking web sites.

PubMed

Dietrich, Frederick; Shipherd, Amber M; Gershgoren, Lael; Filho, Edson Medeiros; Basevitch, Itay

2012-08-01

A social networking Web site, Facebook, was used to deliver long-term sport psychology consultation services to student-athletes (i.e., soccer players) in 30- to 60-min weekly sessions. Additional short-term team building, group cohesion, communication, anger management, injury rehabilitation, mental toughness, commitment, and leadership workshops were provided. Cohesion and overall relationships between both the student-athletes and the sport psychology consultants benefited from this process. Social networking Web sites offer a practical way of providing sport psychology consulting services that does not require use of major resources. (c) 2012 APA, all rights reserved.

A Prospective Multicenter Evaluation of the Value of the On-Call Orthopedic Resident.

PubMed

Jackson, J Benjamin; Vincent, Scott; Davies, James; Phelps, Kevin; Cornett, Chris; Grabowski, Greg; Scannell, Brian; Stotts, Alan; Bice, Miranda

2018-02-01

Funding for graduate medical education is at risk despite the services provided by residents. We quantified the potential monetary value of services provided by on-call orthopedic surgery residents. We conducted a prospective, cross-sectional, multicenter cohort study design. Over a 90-day period in 2014, we collected data on consults by on-call orthopedic surgery residents at 4 tertiary academic medical centers in the United States. All inpatient and emergency department consults evaluated by first-call residents during the study period were eligible for inclusion. Based on their current procedural terminology codes, procedures and evaluations for each consult were assigned a relative value unit and converted into a monetary value to determine the value of services provided by residents. The primary outcome measures were the total dollar value of each consult and the percentage of resident salaries that could be funded by the generated value of the resident consult services. In total, 2644 consults seen by 33 residents from the 4 institutions were included for analysis. These yielded an average value of $81,868 per center for the 90-day study period, that is, $327,471 annually. With a median resident stipend of $53,992, the extrapolated average percentage of resident stipends that could be funded by these consult revenues was 73% of the stipends of the residents who took call or 36% of the stipends of the overall resident cohort. The potential monetary value generated by on-call orthopedic surgery residents is substantial.

How Can Air Force Civil Engineers Use Expert Systems?

DTIC Science & Technology

1988-09-01

Acknowledgements On this academic path called "thesis", many individuals have befriended me along the way. I would like to express my thanks to Maj James R...that provided their insight into civil engineering throughout the interviews: Col James G. Zody, Col Thomas E. Lollis, Col Joe L. Hicks, Col Nicholas A...training role" ( Basden , 1984: 63-64). Consultant. Using an expert system as a consultant, the non- specialist can obtain counsel, guidance, or information

Medicaid Reimbursement for School Nursing Services: A Position Paper of the National Association of State School Nurse Consultants.

ERIC Educational Resources Information Center

Journal of School Health, 1996

1996-01-01

This statement of the National Association of State School Nurse Consultants lists those school nursing services and procedures the organization believes should be reimbursable by Medicaid to school districts. Identified services are in the areas of case finding, nursing care procedures, care coordination, patient/student counseling, and emergency…

78 FR 57858 - Tribal Consultation Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meeting AGENCY: Administration for Children and Families' Office of Head Start (OHS), HHS. ACTION... Department of Health and Human Services, Administration for Children and Families, Office of Head Start...

77 FR 13338 - Tribal Consultation Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meetings AGENCY: Office of Head Start (OHS), Administration for Children and Families, HHS. ACTION... Department of Health and Human Services, Administration for Children and Families, Office of Head Start...

78 FR 20658 - Tribal Consultation Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-05

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meeting AGENCY: Administration for Children and Families' Office of Head Start (OHS), HHS. ACTION... Department of Health and Human Services, Administration for Children and Families, Office of Head Start...

Multicultural development in human services agencies: challenges and solutions.

PubMed

Hyde, Cheryl A

2004-01-01

Comprehensive multicultural organizational development (MCOD) is increasingly necessary in human services agencies. This article presents results from an exploratory study that identified challenges and solutions to MCOD, against the backdrop of daily realities of agency life. The author conducted interviews with 20 consultants and 20 practitioners experienced in MCOD. Qualitative analysis revealed four challenges--socioeconomic environment, organizational dynamics, conceptualization of the change effort, and consultant competence; and four solutions--collaborative environmental relations, leadership development, assessment and planning, and consultant selection. Results suggest the complexities of MCOD and ways that human services agencies can sustain such efforts.

1970-1971 Yearly Report: Consulting Teacher Program; Chittenden South School District.

ERIC Educational Resources Information Center

Vermont Univ., Burlington. Coll. of Education.

Reported are service and research projects which consultants from Vermont's 1970-71 Consulting Teacher Program (Chittenden South) helped teachers to implement to improve the social and academic behaviors of 269 handicapped learners in regular elementary classes. Such program aspects as inservice education, consulting activities, parent…

Optimizing education on the inpatient dermatology consultative service.

PubMed

Afifi, Ladan; Shinkai, Kanade

2017-03-01

A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge and an opportunity for dermatology consultation teams. There is an emergence of new information about how dermatology can best be taught in the hospital, much of which relies on principles of workplace learning as well as the science of how learning and teaching best happen in work settings. These best practices are summarized in this narrative review with integrated discussion of concepts from outpatient dermatology education and lessons learned from other inpatient teaching models. In addition, consultative dermatology curricula should utilize a blended curriculum model comprised of patient care and active learning and self-study modalities. Specific educational methods will discuss 2 strategies: (1) direct patient-care activities (ie, bedside teaching rounds) and (2) nonpatient care activities (ie, case presentations, didactic sessions, online modules, and reading lists). ©2017 Frontline Medical Communications.

Consulting in an Insurance Company: What We as Academics Can Learn.

ERIC Educational Resources Information Center

Timmons, Theresa Cullen

1988-01-01

Describes a technical writing teacher's experience consulting at a large insurance company. Suggests that consulting provides teachers valuable insight into the real-life writing concerns of writers in service occupations. (ARH)

Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation Services.

PubMed

Barclay, Rebecca P; Penfold, Robert B; Sullivan, Donna; Boydston, Lauren; Wignall, Julia; Hilt, Robert J

2017-04-01

To learn if a quality of care Medicaid child psychiatric consultation service implemented in three different steps was linked to changes in statewide child antipsychotic utilization. Washington State child psychiatry consultation program primary data and Medicaid pharmacy division antipsychotic utilization secondary data from July 1, 2006, through December 31, 2013. Observational study in which consult program data were analyzed with a time series analysis of statewide antipsychotic utilization. All consultation program database information involving antipsychotics was compared to Medicaid pharmacy division database information involving antipsychotic utilization. Washington State's total child Medicaid antipsychotic utilization fell from 0.51 to 0.25 percent. The monthly prevalence of use fell by a mean of 0.022 per thousand per month following the initiation of elective consults (p = .004), by 0.065 following the initiation of age/dose triggered mandatory reviews (p < .001), then by another 0.022 following the initiation of two or more concurrent antipsychotic mandatory reviews (p = .001). High-dose antipsychotic use fell by 57.8 percent in children 6- to 12-year old and fell by 52.1 percent in teens. Statewide antipsychotic prescribing for Medicaid clients fell significantly at different rates following each implementation step of a multilevel consultation and best-practice education service. © Health Research and Educational Trust.

Evaluation of a Digital Consultation and Self-Care Advice Tool in Primary Care: A Multi-Methods Study

PubMed Central

Bowers, Gillian; Bowers, John

2018-01-01

Digital services are often regarded as a solution to the growing demands on primary care services. Provision of a tool offering advice to support self-management as well as the ability to digitally consult with a General Practitioner (GP) has the potential to alleviate some of the pressure on primary care. This paper reports on a Phase II, 6-month evaluation of eConsult, a web-based triage and consultation system that was piloted across 11 GP practices across Scotland. Through a multi-method approach the evaluation explored eConsult use across practices, exposing both barriers and facilitators to its adoption. Findings suggest that expectations that eConsult would offer an additional and alternative method of accessing GP services were largely met. However, there is less certainty that it has fulfilled expectations of promoting self-help. In addition, low uptake meant that evaluation of current effectiveness was difficult for practices to quantify. The presence of an eConsult champion(s) within the practice was seen to be a significant factor in ensuring successful integration of the tool. A lack of patient and staff engagement, insufficient support and lack of protocols around processes were seen as barriers to its success. PMID:29724040

12 CFR 225.28 - List of permissible nonbanking activities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... management official of the client institution, except where such interlocking relationship is permitted... conducting management consulting activities may provide management consulting services to customers not... customers in payment for goods and services, and purchasing from the merchant validly authorized checks that...

48 CFR 209.571-7 - Systems engineering and technical assistance contracts.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Systems engineering and... Organizational and Consultant Conflicts of Interest 209.571-7 Systems engineering and technical assistance contracts. (a) Agencies shall obtain advice on systems architecture and systems engineering matters with...

48 CFR 209.571-7 - Systems engineering and technical assistance contracts.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Systems engineering and... Organizational and Consultant Conflicts of Interest 209.571-7 Systems engineering and technical assistance contracts. (a) Agencies shall obtain advice on systems architecture and systems engineering matters with...

48 CFR 209.571-7 - Systems engineering and technical assistance contracts.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Systems engineering and... Organizational and Consultant Conflicts of Interest 209.571-7 Systems engineering and technical assistance contracts. (a) Agencies shall obtain advice on systems architecture and systems engineering matters with...

48 CFR 209.571-7 - Systems engineering and technical assistance contracts.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Systems engineering and... Organizational and Consultant Conflicts of Interest 209.571-7 Systems engineering and technical assistance contracts. (a) Agencies shall obtain advice on systems architecture and systems engineering matters with...

Community voices: barriers and opportunities for programmes to successfully prevent vertical transmission of HIV identified through consultations among people living with HIV

PubMed Central

Anderson, Ginna; Caswell, Georgina; Edwards, Olive; Hsieh, Amy; Hull, Beri; Mallouris, Christoforos; Mason, Naisiadet; Nöstlinger, Christiana

2012-01-01

Introduction In 2010, two global networks of people living with HIV, the International Community of Women Living with HIV (ICW Global) and the Global Network of People living with HIV (GNP + ) were invited to review a draft strategic framework for the global scale up of prevention of vertical transmission (PVT) through the primary prevention of HIV and the prevention of unintended pregnancies among women living with HIV. In order to ensure recommendations were based on expressed needs of people living with HIV, GNP+ and ICW Global undertook a consultation amongst people living with HIV which highlighted both facilitators and barriers to prevention services. This commentary summarizes the results of that consultation. Discussion The consultation was comprised of an online consultation (moderated chat-forum with 36 participants from 16 countries), an anonymous online e-survey (601 respondents from 58 countries), and focus-group discussions with people living with HIV in Jamaica (27 participants). The consultation highlighted the discrepancies across regions with respect to access to essential packages of PVT services. However, the consultation participants also identified common barriers to access, including a lack of trustworthy sources of information, service providers’ attitudes, and gender-based violence. In addition, participant responses revealed common facilitators of access, including quality counselling on reproductive choices, male involvement, and decentralized services. Conclusions The consultation provided some understanding and insight into the participants’ experiences with and recommendations for PVT strategies. Participants agreed that successful, comprehensive PVT programming require greater efforts to both prevent primary HIV infection among young women and girls and, in particular, targeted efforts to ensure that women living with HIV and their partners are supported to avoid unintended pregnancies and to have safe, healthy pregnancies instead. In addition to providing the insights into prevention services discussed above, the consultation served as a valuable example of the meaningful involvement of people living with HIV in programming and implementation to ensure that programs are tailored to individuals’ needs and to circumvent rights abuses within those settings. PMID:22789649

Community voices: barriers and opportunities for programmes to successfully prevent vertical transmission of HIV identified through consultations among people living with HIV.

PubMed

Anderson, Ginna; Caswell, Georgina; Edwards, Olive; Hsieh, Amy; Hull, Beri; Mallouris, Christoforos; Mason, Naisiadet; Nöstlinger, Christiana

2012-07-11

In 2010, two global networks of people living with HIV, the International Community of Women Living with HIV (ICW Global) and the Global Network of People living with HIV (GNP+) were invited to review a draft strategic framework for the global scale up of prevention of vertical transmission (PVT) through the primary prevention of HIV and the prevention of unintended pregnancies among women living with HIV. In order to ensure recommendations were based on expressed needs of people living with HIV, GNP+ and ICW Global undertook a consultation amongst people living with HIV which highlighted both facilitators and barriers to prevention services. This commentary summarizes the results of that consultation. The consultation was comprised of an online consultation (moderated chat-forum with 36 participants from 16 countries), an anonymous online e-survey (601 respondents from 58 countries), and focus-group discussions with people living with HIV in Jamaica (27 participants). The consultation highlighted the discrepancies across regions with respect to access to essential packages of PVT services. However, the consultation participants also identified common barriers to access, including a lack of trustworthy sources of information, service providers' attitudes, and gender-based violence. In addition, participant responses revealed common facilitators of access, including quality counselling on reproductive choices, male involvement, and decentralized services. The consultation provided some understanding and insight into the participants' experiences with and recommendations for PVT strategies. Participants agreed that successful, comprehensive PVT programming require greater efforts to both prevent primary HIV infection among young women and girls and, in particular, targeted efforts to ensure that women living with HIV and their partners are supported to avoid unintended pregnancies and to have safe, healthy pregnancies instead. In addition to providing the insights into prevention services discussed above, the consultation served as a valuable example of the meaningful involvement of people living with HIV in programming and implementation to ensure that programs are tailored to individuals' needs and to circumvent rights abuses within those settings.

Positive Clinical Outcomes Are Synergistic With Positive Educational Outcomes When Using Telehealth Consulting in General Practice: A Mixed-Methods Study.

PubMed

Knight, Patricia; Bonney, Andrew; Teuss, Grigorijs; Guppy, Michelle; Lafferre, Danielle; Mullan, Judy; Barnett, Stephen

2016-02-08

The use of telehealth technology to enable real-time consultations between patients and specialist services (to whom travel may be an impediment to the patient's care) has recently been encouraged in Australia through financial incentives. However, the uptake has been both fragmented and inconsistent. The potential benefits for patients include access to a broader range of specialist referral services, cost and time saving, and more rapid access to specialist services and a continuum of care through the triangulation of interaction between patient, primary health care providers (general practitioners and nurses), and specialists. Enhanced broadband connectivity and higher-grade encryption present an opportunity to trial the use of telehealth consulting as an intrinsic element of medical education for both medical students and doctors-in-training within rural practices and Aboriginal Medical Services. This paper discusses the reported, and varied, benefits of telehealth consulting arising from a multisite trial in New South Wales, Australia. The purpose of this study is to encourage the use of selected telehealth consultations between patients in a primary care setting with a specialist service as an integral aspect of medical education. The trial closely followed the protocol developed for this complex and multiaspect intervention. This paper discusses one aspect of the research protocol--using telehealth consultations for medical education--in detail. Qualitative and quantitative analyses were conducted. In the quantitative analysis, free-text comments were made on aspects of Telehealth Consulting for the patient, concerning the quality of the interactions, and the time and cost saving, and also on the leaning opportunities. Students commented that their involvement enhanced their learning. All respondents agreed or strongly agreed that that the interpersonal aspects were satisfactory, with some brief comments supporting their views. In the analysis of the qualitative data, five themes emerged from the analyses concerning the educational benefits of Telehealth Consulting for different levels of learners, while three themes were identified concerning clinical benefits. The results demonstrated strong synergies between the learning derived from the telehealth consulting and the clinical benefits to the patient and clinicians involved.

Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study.

PubMed

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

2018-04-17

There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2% and 22% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. ©Trisha Greenhalgh, Sara Shaw, Joseph Wherton, Shanti Vijayaraghavan, Joanne Morris, Satya Bhattacharya, Philippa Hanson, Desirée Campbell-Richards, Seendy Ramoutar, Anna Collard, Isabel Hodkinson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.04.2018.

18 CFR 50.5 - Pre-filing procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ELECTRIC TRANSMISSION FACILITIES § 50.5 Pre-filing procedures. (a) Introduction. Any applicant seeking a... consultations, project engineering, route planning, environmental and engineering contractor engagement... proceeding. This description also must include the identification of the environmental and engineering firms...

Estimated sediment deposition in Lake Corpus Christi, Texas, 1972-85

USGS Publications Warehouse

Leibbrand, Norman F.

1987-01-01

Some difference was found in comparison of the results of the U.S. Geological Survey (Water Resources Division) study and the McCaughan and Etheridge Consulting Engineers study. Total sediment outflow from Lake Corpus Christi was estimated at 177 acre-feet (dry) by the Geological Survey and 1,070 acre-feet (dry) by McCaughan and Etheridge Consulting Engineers. This difference may be due to construction of a new dam, completed in 1958, that is higher and inundated the old dam.

Differences in lifetime use of services for mental health problems in six European countries.

PubMed

Kovess-Masfety, Viviane; Alonso, Jordi; Brugha, Traolach S; Angermeyer, Matthias C; Haro, Josep Maria; Sevilla-Dedieu, Christine

2007-02-01

In Europe mental health services vary somewhat in the level of resources available and in their organization. The purpose of this study was to describe lifetime use of mental health services in six European countries, especially by individuals with a DSM-IV-defined psychiatric disorder (psychotic disorders were excluded), and to assess differences between countries as a function of resource availability. Data were obtained from 8,796 noninstitutionalized adults of six European countries by computer-assisted interviews with the Composite International Diagnostic Interview, version 3.0. Lifetime consultation rates varied between countries and according to mental health status. For depression, lifetime consultation rates ranged from 37.0% in Italy to 71.0% in the Netherlands. Among users of services, general practitioners were the professionals most frequently consulted in all countries (64.2% on average), followed by psychiatrists (consultation ranged from 25.5% in the Netherlands to 43.8% in Spain) and psychologists (consultation ranged from 23.3% in France to 64.8% in the Netherlands). The lowest rates were in the countries with the lowest availability of professionals, but the countries with the highest density of professionals did not necessarily have the highest consultation rates. Although there are important differences in mental health care between European countries, they seem to be only partially related to differences in overall health care provision.

Ethics consultants and ethics committees.

PubMed

La Puma, J; Toulmin, S E

1989-05-01

To address moral questions in patient care, hospitals and health care systems have enlisted the help of hospital ethicists, ethics committees, and ethics consultation services. Most physicians have not been trained in the concepts, skills, or language of clinical ethics, and few ethicists have been trained in clinical medicine, so neither group can fully identify, analyze, and resolve clinical ethical problems. Some ethics committees have undertaken clinical consultations themselves, but liability concerns and variable standards for membership hinder their efforts. An ethics consultation service comprising both physician-ethicists and nonphysician-ethicists brings complementary viewpoints to the management of particular cases. If they are to be effective consultants, however, nonphysician-ethicists need to be "clinicians": professionals who understand an individual patient's medical condition and personal situation well enough to help in managing the case. Ethics consultants and ethics committees may work together, but they have separate identities and distinct objectives: ethics consultants are responsible for patient care, while ethics committees are administrative bodies whose primary task is to advise in creating institutional policy.

The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study

PubMed Central

Liddy, Clare; Keely, Erin; Afkham, Amir; Kurzawa, Julia; Abdeen, Nishard; Audcent, Tobey; Bromwich, Matthew; Brophy, Jason; Carsen, Sasha; Fournier, Annick; Fraser-Roberts, Leigh; Gandy, Hazen; Hui, Charles; Johnston, Donna; Keely, Kathryn; Kontio, Ken; Lamontagne, Christine; Major, Nathalie; O’Connor, Michael; Radhakrishnan, Dhenuka; Reisman, Joe; Robb, Marjorie; Samson, Lindy; Sell, Erick; Splinter, William; van Stralen, Judy; Venkateswaran, Sunita; Murto, Kimmo

2018-01-01

Background Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit “elective” clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction. Objective To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults. Design Prospective observational cohort study. Setting Single Canadian tertiary-care academic pediatric hospital (June 2014–16) servicing 1.2 million people. Participants 1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions. Main outcomes and measures Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected. Results 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9–1.2) compared with a face-to-face referral (132 days; 95%CI:127–136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service. Conclusions and relevance Similar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes. PMID:29320539

Consultation for Parents of Young Gifted Children.

ERIC Educational Resources Information Center

Wolf, Joan S.

1989-01-01

The article describes private evaluation and consultation services provided to parents of young gifted children, and discusses the benefits of private consultation and the potential role of school personnel in meeting the needs of this population. (Author/JDD)

Consultation sequencing of a hospital with multiple service points using genetic programming

NASA Astrophysics Data System (ADS)

Morikawa, Katsumi; Takahashi, Katsuhiko; Nagasawa, Keisuke

2018-07-01

A hospital with one consultation room operated by a physician and several examination rooms is investigated. Scheduled patients and walk-ins arrive at the hospital, each patient goes to the consultation room first, and some of them visit other service points before consulting the physician again. The objective function consists of the sum of three weighted average waiting times. The problem of sequencing patients for consultation is focused. To alleviate the stress of waiting, the consultation sequence is displayed. A dispatching rule is used to decide the sequence, and best rules are explored by genetic programming (GP). The simulation experiments indicate that the rules produced by GP can be reduced to simple permutations of queues, and the best permutation depends on the weight used in the objective function. This implies that a balanced allocation of waiting times can be achieved by ordering the priority among three queues.

Managing outpatient consultations: from referral to discharge.

PubMed

Mitchell, Rachael; Jacob, Hannah; Morrissey, Benita; Macaulay, Chloe; Gomez, Kumudini; Fertleman, Caroline

2017-08-01

Although a great deal of paediatric consultations are not urgent, doctors in training spend so much time providing service for acute conditions that they spend little time focusing on outpatient work before they become a consultant. Engaging clinicians in the managerial aspects of providing clinical care is a key to improving outcomes, and this article addresses these aspects of the outpatient consultation from referral to discharge. We aim to provide doctors in training with a tool to use during their training and their first few years as a consultant, to think about how outpatient work is organised and how it can be improved to maximise patient experience. The non-urgent consultation varies across the world; this article is aimed to be relevant to an international audience. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Developing a Consulting Practice. Survival Skills for Scholars. Volume 3.

ERIC Educational Resources Information Center

Metzger, Robert O.

This book discusses the content consultation process as undertaken by scholars (professors or advanced graduate students) in all fields to be performed as a regular activity and run as a business. Chapter 1 offers an overview and description of consultation practice. Chapter 2 discusses indirect marketing of consultation services for scholars.…

Improving Methods of Consulting with Young People: Piloting a New Model of Consultation

ERIC Educational Resources Information Center

Woolfson, Richard C.; Bryce, Donna; Mooney, Lindsay; Harker, Michael; Lowe, Dorothy; Ferguson, Ellen

2008-01-01

National and international legislation has increasingly placed a duty on professionals to consult with young people about matters affecting their lives. Consequently, conducting consultation exercises with young people in order to improve the quality of services available is becoming established practice in many areas. Following on from previous…

42 CFR 493.1409 - Condition: Laboratories performing moderate complexity testing; technical consultant.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing moderate complexity testing; technical consultant. 493.1409 Section 493.1409 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION...

42 CFR 493.1409 - Condition: Laboratories performing moderate complexity testing; technical consultant.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Laboratories performing moderate complexity testing; technical consultant. 493.1409 Section 493.1409 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION...

42 CFR 493.1415 - Condition: Laboratories performing moderate complexity testing; clinical consultant.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Laboratories performing moderate complexity testing; clinical consultant. 493.1415 Section 493.1415 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION...

7 CFR 1789.153 - Borrower funding.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 12 2014-01-01 2013-01-01 true Borrower funding. 1789.153 Section 1789.153... Consultant Services Funded by Borrowers-General § 1789.153 Borrower funding. Borrowers shall use their general funds for the purposes of funding consultant services hereunder. Borrowers may not use the...

7 CFR 1789.153 - Borrower funding.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 12 2012-01-01 2012-01-01 false Borrower funding. 1789.153 Section 1789.153... Consultant Services Funded by Borrowers-General § 1789.153 Borrower funding. Borrowers shall use their general funds for the purposes of funding consultant services hereunder. Borrowers may not use the...

7 CFR 1789.153 - Borrower funding.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 12 2011-01-01 2011-01-01 false Borrower funding. 1789.153 Section 1789.153... Consultant Services Funded by Borrowers-General § 1789.153 Borrower funding. Borrowers shall use their general funds for the purposes of funding consultant services hereunder. Borrowers may not use the...

7 CFR 1789.153 - Borrower funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Borrower funding. 1789.153 Section 1789.153... Consultant Services Funded by Borrowers-General § 1789.153 Borrower funding. Borrowers shall use their general funds for the purposes of funding consultant services hereunder. Borrowers may not use the...

7 CFR 1789.153 - Borrower funding.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 12 2013-01-01 2013-01-01 false Borrower funding. 1789.153 Section 1789.153... Consultant Services Funded by Borrowers-General § 1789.153 Borrower funding. Borrowers shall use their general funds for the purposes of funding consultant services hereunder. Borrowers may not use the...

Psychiatric Consultation in the Federal Government

ERIC Educational Resources Information Center

Hagen, Duane; Weiland, Gustave J.

1973-01-01

The roles of direct service, training and education of physicians and nurses, direct consultation, and administrative mental health training are discussed as they relate to mental health services to Federal employees in the Washington area subject to stresses resulting from individuality loss, responsibility diffusion, frequent reorganizations,…

WTP (willingness to pay) for tele-health consultation service in Hokkaido, Japan.

PubMed

Ogasawara, Katsuhiko; Abe, Tamotsu

2013-01-01

We developed a tele-health consultation system that combines a sphygmomanometer with a tele-conference system. These were placed in pharmacies and the University. We selected five pharmacies to set up a consultation room; one in a local area, two in a suburban area, and the remaining two in an urban area. Nurses with more than 5 years of clinical experience were assigned as consultants. These consultants offer health consultation but do not practice medicine. Some researchers have indicated the economic viability of at-home health management systems, but nothing has been researched on the economic viability of tele-health consultation. The objective of present study was estimated Willingness to Payment (WTP) of Tele-health consultation service. The WTP was estimated by Double-Bounded Dichotomous-Choice model. We performed logistic-regression analysis to confirm factors to affect WTP. The number of the respondent was 480. Mean WTP was calculated 495 yen and the median was 367 yen. There was significant difference for factor of "annual income", "have a willingness to use this system", and "have a child/children".

Why do Chinese Canadians not consult mental health services: health status, language or culture?

PubMed

Chen, Alice W; Kazanjian, Arminée; Wong, Hubert

2009-12-01

Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.

The Impact of the Internet on Health Consultation Market Concentration: An Econometric Analysis of Secondary Data.

PubMed

Li, Jia; Zhang, Ya; Ma, Ling; Liu, Xuan

2016-10-28

Many markets have traditionally been dominated by a few best-selling products, and this is also the case for the health care industry. However, we do not know whether the market will be more or less concentrated when health care services are delivered online (known as E-consultation), nor do we know how to reduce the concentration of the E-consultation market. The aim of this study was to investigate the concentration of the E-consultation market and how to reduce its concentration through information disclosure mechanisms (online reputation and self-representation). We employed a secondary data econometric analysis using transaction data obtained from an E-consultation Website (haodf.com) for three diseases (infantile pneumonia, diabetes, and pancreatic cancer) from 2008 to 2015. We included 2439 doctors in the analysis. The E-consultation market largely follows the 20/80 principle, namely that approximately 80% of orders are fulfilled by nearly 20% of doctors. This is much higher than the offline health care market. Meanwhile, the market served by doctors with strong online reputations (beta=0.207, P<.001) or strong online self-representation (beta=0.386, P<.001) is less concentrated. When health care services are delivered online, the market will be more concentrated (known as the "Superstar" effect), indicating poor service efficiency for society as a whole. To reduce market concentration, E-consultation websites should provide important design elements such as ratings of doctors (user feedback), articles contributed by doctors, and free consultation services (online representation). A possible and important way to reduce the market concentration of the E-consultation market is to accumulate enough highly rated or highly self-represented doctors. ©Jia Li, Ya Zhang, Ling Ma, Xuan Liu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.10.2016.

Characteristics of palliative care consultation services in California hospitals.

PubMed

Pantilat, Steven Z; Kerr, Kathleen M; Billings, J Andrew; Bruno, Kelly A; O'Riordan, David L

2012-05-01

Although hospital palliative care consultation services (PCCS) can improve a variety of clinical and nonclinical outcomes, little is known about how these services are structured. We surveyed all 351 acute care hospitals in California to examine the structure and characteristics of those hospitals with PCCS. We achieved a 92% response rate. Thirty-one percent (n=107) of hospitals reported having a PCCS. Teams commonly included physicians (87%), social workers (80%), spiritual care professionals (77%), and registered nurses (71%). Nearly all PCCS were available on-site during weekday business hours; 50% were available on-site or by phone in the weekday evenings and 54% were available during weekend daytime hours. The PCCS saw an average of 347 patients annually (median=310, standard deviation [SD]=217), or 258 patients per clinical full-time equivalent (FTE; median=250, SD=150.3). Overall, 60% of consultation services reported they are struggling to cope with the workload. On average, patients were in the hospital 5.9 days (median=5.5, SD=3.3) prior to referral to PCCS, and remained in the hospital for 6 days (median=4, SD=7.9) following the initial consultation. Patient and family meetings were an aspect of the consultation in 74% of cases. Overall, 21% of consultation patients were discharged home with hospice services and 25% died in the hospital. There is variation in how PCCS in California hospitals are structured and in the ways they engage with patients. Ultimately, linking PCCS characteristics and practices to patient and family outcomes will identify best practices that PCCS can use to maximize quality.

Who Uses eConsult? Investigating Physician Characteristics Associated with Usage (and Nonusage).

PubMed

Bilodeau, Howard; Deri Armstrong, Catherine; Keely, Erin; Liddy, Clare

2017-12-18

The Champlain BASE™ eConsult Service was developed in a Local Health Integration Network (LHIN) in Ontario, Canada in 2010 to reduce wait times and improve access to specialist care. The service allows primary care providers to receive advice from specialists via a secure electronic platform without necessarily requiring a face-to-face consultation. As of 2015, over half of the LHIN's family physicians were registered and trained to use the service. However, 24% of registrants never went on to submit a case. The purpose of this study is to examine the demographic characteristics associated with usage. Usage data for the pool of physicians registered between January 1, 2011 and September 30, 2015 were linked to physician characteristics retrieved from the College of Physicians and Surgeons of Ontario database. Probit regressions were estimated to determine characteristics associated with usage. Neither sex, being an international medical school graduate-documented predictors of electronic medical records adoption-nor proximity to specialists were found to explain usage. Only length of time in practice was found to be predictive. Being out of medical school an additional 10 years was estimated to decrease the probability of ever using eConsult by five percentage points (p < 0.01). Lower use by veteran physicians may reflect their lower need for services like eConsult given their well-established specialist networks, or their greater confidence in practicing medicine. Future work should explore the reasons and barriers for not registering, or not using eConsult, with an aim toward increasing the appropriate use of this cost-effective and innovative service.

32 CFR 634.24 - Traffic planning and codes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... enforcement officer, engineer, safety officer, and other concerned staff agencies. Highway engineering representatives from adjacent civil communities must be consulted to ensure the installation plan is compatible... and minor routes, location of traffic control devices, and conditions requiring engineering or...

US-USSR telemedicine consultation spacebridge to Armenia and Ufa

NASA Technical Reports Server (NTRS)

1991-01-01

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

Education and the improvement of clinical ethics services

PubMed Central

2013-01-01

The proliferation of clinical ethics in health care institutions around the world has raised the question about the qualifications of those who serve on ethics committees and ethics consultation services. This paper discusses some of weaknesses associated with the most common educational responses to this concern and proposes a complementary approach. Since the majority of those involved in clinical ethics are practicing health professionals, the question of qualification is especially challenging as the role of ethics committees and, increasingly, ethics consultation services are becoming increasingly important to the functioning of health care institutions. Since the challenging nature of health care finances often leads institutions to rely on voluntary participation of committed health professional with only token administrative or clerical support to provide the needed ethics services, significant challenges are created for attaining competence and functional effectiveness. The article suggests that a complementary approach should be adopted for sustaining and building capacity in clinical ethics. Ethics committees and consultation services should systematically adopt quality improvement techniques to effect designed changes in clinical ethics performance and to build ethical capacity within targeted clinical units and services. Demonstrating improvements in functioning can go a long way to build confidence and capacity for clinical ethics and can help in justifying the need for support. To do so, however, requires that ethics committees and consultation services first shift attention to those areas that demonstrate weak or questionable ethical performance, including the established practices of the ethics committee and consultation service, and second seek collaboration with the involved health care providers to pursue demonstrable change. Such an approach has a much better chance of improving the capacity for clinical ethics in health care institutions than relying on educational approaches alone. PMID:23517735

42 CFR 493.1453 - Condition: Laboratories performing high complexity testing; clinical consultant.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Laboratories performing high complexity testing; clinical consultant. 493.1453 Section 493.1453 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY...

76 FR 43349 - General Motors Corporation, Renaissance Center, including On-Site Leased Workers From Accretive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

..., Global Technology Associates, LTD, JDM Systems Consultants, Inc., Kelly Service, Inc., Populus Group, TEK Systems, Compuware Corporation, and Nexus Business Solutions, Detroit, MI; Amended Certification Regarding..., Global Technology Associates, Ltd., JDM Systems Consultants, Inc., Kelly Service, Inc., Populus Group...

Improving referral to psychological support unit at Saudi Red Crescent Authority in Riyadh Region

PubMed Central

Alzahrani, Ahmad Yousif; Mahmod, Sabri abd Allah; Bakhamis, Thamer Mohammad; Al-Surimi, Khaled

2017-01-01

The Psychological Support Unit (PSU) performance in Saudi Red Crescent Authority (SRCA) showed that only a small number of case referred seeking psychological advice and management from PSU among all SRCA employees. However, research shows that between 28% and 52% of emergency medical services (EMS) providers usually seek psychological help in various EMS cultures, where 86% of them usually suffer from critical stress. Thus, we decided to design a quality improvement project that aims to improve the referral process by increasing cases referred to the PSU at SRCA in Riyadh Region by 75% in 2 months. A multidisciplinary team has been formed to analyse the problem using quality tools including, brainstorming, fishbone diagram and flow chart of the PSU processes. Several possible reasons have been identified, such as lack of awareness among the SRCA’s employees about PSU and its services, and the concern about privacy and confidentiality during psychological consultations in the PSU, in addition to the long referring process to PSU. The team decided to test the following change ideas: increasing the awareness of employees about the PSU services, improving the privacy and confidentiality during the consultation using electronic channels, and finally re-engineering the referral process to make it lean and remove all the unnecessary steps. Several improvement interventions have been tested sequentially in three consecutive Plan-Do-Study-Act cycles on a weekly basis. The project findings demonstrated that the first change idea was successful but not reaching the target while the second change had led to huge impact exceeding our target but with short effect. On the other hand, although the third change idea of re-engineering the PSU referral process had led to negative result initially, over the following weeks of measurement the results turned to be positive and meeting our expectations. We concluded that re-engineering referral process is most effective improvement intervention among other change ideas in term of magnitude and sustainability of the effect on increasing the number of referral cases to the PSU. We recommend conducting further testing and measuring of these change ideas in other PSU across the SRCA to understand the diffident context in other regions of SRCA. PMID:29450278

Conjoint Behavioral Consultation: Application to the School-Based Treatment of Anxiety Disorders

ERIC Educational Resources Information Center

Auster, Elana R.; Feeney-Kettler, Kelly A.; Kratochwill, Thomas R.

2006-01-01

In the current paper we discuss the treatment of childhood anxiety disorders using a problem-solving consultation framework. The role of consultation as a service delivery model in a school setting is elaborated on, as well as the contribution that consultation has in the movement towards evidence-based practices in school psychology.…

Relationships among Relational Communication Processes and Consultation Outcomes for Students with Attention Deficit Hyperactivity Disorder

ERIC Educational Resources Information Center

Erchul, William P.; DuPaul, George J.; Grissom, Priscilla F.; Junod, Rosemary E. Vile; Jitendra, Asha K.; Mannella, Mark C.; Tresco, Katy E.; Flammer-Rivera, Lizette M.; Volpe, Robert J.

2007-01-01

Consultation has been shown to be an effective means to deliver school-based psychological services. The purpose of this study was to link patterns of consultant and teacher verbal interactions to consultation outcomes. Relational communication (Rogers & Escudero, 2004) was the research perspective taken, and the source of the consultation…

Consultancy to dairy farmers relating to animal health and herd health management on small- and medium-sized farms.

PubMed

Pothmann, H; Nechanitzky, K; Sturmlechner, F; Drillich, M

2014-02-01

The objectives of this study were to obtain information about animal health challenges for dairy farmers of small- and medium-sized herds and about the fields in which consultancy services should be improved. The hyperlink to an internet-based survey was sent to 9,021 farmers in Austria. The survey included questions about the participants and their farms, about who is consulting with the farmers with regard to animal health, feeding, sire selection, construction of barns and animal husbandry, about animal health issues farmers find most challenging, and about their demands for improved consultancy services. The questionnaire was completed anonymously. Analyses were stratified by milk yield (categorized) and whether farmers worked full-time or part-time. The overall response rate was 11.3% (n=1,018). The majority of farms kept less than 20 cows (54.0%) or 20 to 50 cows (40.1%). With regard to animal health, the veterinarian was the most important consultant for the majority of farmers (84.6%). On issues related to feeding, sire selection, and stable construction, the veterinarian was seen as a less important consultant than specialists in these fields (20.4, 11.6, and 7.9% suggested the veterinarian as an important consultant in these areas). The survey indicated that reproductive disorders, udder disease, poor conception rate, lameness, and calf diarrhea represent the most important challenges to farmers. Of these, concerns about calf diarrhea were affected by milk yield of the herds and management. More high- than low-yielding farms (11.7 vs. 6.4%) and more full-time than part-time managed herds (9.6 vs.4.3%) regarded calf diarrhea as an important problem. Farmers would welcome improved consultancy with regard to fertility, feeding, and sire selection. The results indicated which animal health issues farmers find particularly challenging and displayed which areas farmers require improved consultancy services. Veterinarians and organizations offering consultancy should take the results into consideration in improving or adapting their advisory services. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

38 CFR 51.180 - Pharmacy services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... consultation. The facility management must employ or obtain the services of a pharmacist licensed in a State in which the facility is located or a VA pharmacist under VA contract who— (1) Provides consultation on all... be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any...

38 CFR 51.180 - Pharmacy services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... consultation. The facility management must employ or obtain the services of a pharmacist licensed in a State in which the facility is located or a VA pharmacist under VA contract who— (1) Provides consultation on all... be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any...

38 CFR 51.180 - Pharmacy services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... consultation. The facility management must employ or obtain the services of a pharmacist licensed in a State in which the facility is located or a VA pharmacist under VA contract who— (1) Provides consultation on all... be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any...

38 CFR 51.180 - Pharmacy services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... consultation. The facility management must employ or obtain the services of a pharmacist licensed in a State in which the facility is located or a VA pharmacist under VA contract who— (1) Provides consultation on all... be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any...

38 CFR 51.180 - Pharmacy services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... consultation. The facility management must employ or obtain the services of a pharmacist licensed in a State in which the facility is located or a VA pharmacist under VA contract who— (1) Provides consultation on all... be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any...

Technical Assistance Information Centers and Consultants.

ERIC Educational Resources Information Center

National Arts and the Handicapped Information Service, New York, NY.

Three types of resources for planners of programs for the arts and/or the handicapped are indicated in this directory: technical assistance, information services, and consultants. In this context, technical assistance is defined as free or low cost professional advisory service provided by telephone, mail, or personal visits. Resources listed…

Data Management Consulting at the Johns Hopkins University

ERIC Educational Resources Information Center

Varvel, Virgil E., Jr.; Shen, Yi

2013-01-01

As research data complexity and quantity grows and funding agency requirements for data management are articulated, there is a growing need for data management services (DMS). Within these services, one important role emerging is that of data management consultant (DMC). Roles were analyzed that these professionals play through case study analysis…

Two Approaches to Using Client Projects in the College Classroom

ERIC Educational Resources Information Center

Cooke, Lynne; Williams, Sean

2004-01-01

Client projects are an opportunity for universities to create long-lasting, mutually beneficial relationships with businesses through an academic consultancy service. This article discusses the rationale and logistics of two models for conducting such projects. One model, used at Clemson University, is a formal academic consultancy service in…

77 FR 67380 - Submission for OMB Review; Comment Request: Ethical Dilemmas in Surgery and Utilization of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

...; Comment Request: Ethical Dilemmas in Surgery and Utilization of Hospital Ethics Consultation Service: A..., unless it displays a currently valid OMB control number. Proposed Collection: Title: Ethical Dilemmas in Surgery and Utilization of Hospital Ethics Consultation Service: A Survey. Type of Information Collection...

Being a Food Service Worker; Student Manual.

ERIC Educational Resources Information Center

Hospital Research and Educational Trust, Chicago, IL.

Instructional materials for student use in training or retraining for the occupation of food service worker at the vocational high school or community college level were developed by professional consultants. They were tested in a nationwide on-the-job training program and revised according to instructor evaluation and consultant suggestions. A…

Training the Food Service Worker; Instructor's Guide.

ERIC Educational Resources Information Center

Hospital Research and Educational Trust, Chicago, IL.

Curriculum materials for instructor use in planning lessons to train or retrain food service workers at the vocational high school or community college level were developed by professional consultants. They were tested in a nation-wide on-the-job training program and revised according to instructor evaluation and consultant suggestions. A minimum…

40 CFR 160.10 - Applicability to studies performed under grants and contracts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AGENCY (CONTINUED) PESTICIDE PROGRAMS GOOD LABORATORY PRACTICE STANDARDS General Provisions § 160.10... services of a consulting laboratory, contractor, or grantee to perform all or a part of a study to which this part applies, it shall notify the consulting laboratory, contractor, or grantee that the service...

Resources and the Quality of Life

ERIC Educational Resources Information Center

Jemian, Wartan A.

1975-01-01

Describes the speakers involved and presents the issues addressed at the Plenary Session of the American Society of Engineering Education in 1974. Speakers included a historian, a representative of the Army Corps of Engineers, a practicing engineer, and a consultant on national materials policy. (GS)

Research on the development and preliminary application of Beijing agricultural sci-tech service hotline WebApp in agricultural consulting services

NASA Astrophysics Data System (ADS)

Yu, Weishui; Luo, Changshou; Zheng, Yaming; Wei, Qingfeng; Cao, Chengzhong

2017-09-01

To deal with the “last kilometer” problem during the agricultural science and technology information service, we analyzed the feasibility, necessity and advantages of WebApp applied to agricultural information service and discussed the modes of WebApp used in agricultural information service based on the requirements analysis and the function of WebApp. To overcome the existing App’s defects of difficult installation and weak compatibility between the mobile operating systems, the Beijing Agricultural Sci-tech Service Hotline WebApp was developed based on the HTML and JAVA technology. The WebApp has greater compatibility and simpler operation than the Native App, what’s more, it can be linked to the WeChat public platform making it spread easily and run directly without setup process. The WebApp was used to provide agricultural expert consulting services and agriculture information push, obtained a good preliminary application achievement. Finally, we concluded the creative application of WebApp in agricultural consulting services and prospected the development of WebApp in agricultural information service.

Telepsychiatry with child welfare families referred to a family service agency.

PubMed

Keilman, Peggy

2005-02-01

A telepsychology and telepsychiatry service, using ISDN interactive video H.320, providing psychological consultations for the Family Resource Center in Farmington, New Mexico, was evaluated. During the first year of service, 56 individuals participated including University of New Mexico staff, Family Resource Center staff and clients. Consultations involved children from families referred by the Children, Youth and Family Department (CYFD) in New Mexico. Telemedicine was used in some child abuse cases. This study investigated whether the quality and acceptance of telemedicine consultations were comparable to face-to-face interactions in a group referred by a state child welfare agency. Participants received formal written consultation reports after the video conferencing sessions, which included a number of recommendations. Participants were asked to complete an anonymous questionnaire to rate various aspects of videoconferencing. The participants rated the university staff as involved, enjoyed the Family Resource Center staff's presence, felt the procedure was useful for evaluation purposes, found the format allowed for discussions of problems, and felt that the format was useful when compared to face-to-face consultations. The participants also said they had followed up on many of the recommendations. Videoconferencing appears to be a viable approach for providing consultation for families referred by a state child welfare agency. Several participants rated the session as both educational and consultative compared to simply therapeutic.

Parent satisfaction with neuropsychological consultation after pediatric mild traumatic brain injury.

PubMed

Kirkwood, Michael W; Peterson, Robin L; Baker, David A; Connery, Amy K

2017-04-01

Few studies have focused on consumer satisfaction following neuropsychological evaluation. We sought to examine parent satisfaction with neuropsychological consultation following a mild traumatic brain injury (TBI) in school-age children. We surveyed 71 parents of 8- to 17-year-olds participating in a prospective longitudinal study examining neuropsychological consultation as an intervention for persistent postconcussive symptoms. Children had sustained injuries between 2 and 12 months prior to enrollment. Neuropsychological consultation occurred on average 5 months post-injury. Parent satisfaction data were collected via telephone approximately 4 months after the neuropsychological consultation. The vast majority of parents were quite satisfied with the service (e.g., 94% overall satisfaction rate; 96% rated the service as good or excellent). Satisfaction rates were associated positively with time since injury and negatively with parental education. No other child, parent, or provider variable correlated with satisfaction. The results add to the relatively sparse literature on parent satisfaction with neuropsychological evaluation. A pressing future need in pediatric neuropsychology is to examine the satisfaction of other consumers of the service, including healthcare personnel, educators, and the child patients themselves.

Dermatology hospitalists: a multicenter survey study characterizing the infrastructure of consultative dermatology in select American hospitals.

PubMed

Ko, Lauren N; Kroshinsky, Daniela

2018-05-01

Although considered an outpatient specialty, dermatology plays an important role in inpatient medicine. We characterized the activity and structure of dermatology consultation services in select U.S. hospitals. In this cross sectional study, a 31-question survey was distributed in person to 32 board-certified dermatologists at the 2017 Society of Dermatology Hospitalists meeting. Thirty participants completed the survey (yield 93.8%). Most dermatology hospitalists spend 41-52 weeks on service (50%), with 37% spending between 11 and 30 weeks. Coverage was organized by continuous weeks (68%) or months (21%). While on service, hospitalists staffed an average of 4 outpatient clinics per week. Consultative teams also included internal medicine residents (43%), medical students (47%), pediatric residents (10%), and fellows from other specialties (27%). Consultation services saw approximately 3.7 new inpatients and 4.2 follow-up inpatients per day, with daily rounds lasting approximately 2.6 hours. The results suggest that hospital dermatologists in the U.S. consider inpatient care their niche and devote a majority of their time staffing consults over clinic. The diverse composition of inpatient teams and the number of academic duties held by these physicians suggests they play an important role in medical education. © 2018 The International Society of Dermatology.

42 CFR 493.1455 - Standard; Clinical consultant qualifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Clinical consultant qualifications. 493.1455 Section 493.1455 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Testing Laboratories Performing High Complexity Testing § 493.1455 Standard; Clinical consultant...

42 CFR 493.1417 - Standard; Clinical consultant qualifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Clinical consultant qualifications. 493.1417 Section 493.1417 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Testing Laboratories Performing Moderate Complexity Testing § 493.1417 Standard; Clinical consultant...

42 CFR 493.1457 - Standard; Clinical consultant responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Clinical consultant responsibilities. 493.1457 Section 493.1457 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Testing Laboratories Performing High Complexity Testing § 493.1457 Standard; Clinical consultant...

42 CFR 493.1419 - Standard; Clinical consultant responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Clinical consultant responsibilities. 493.1419 Section 493.1419 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Testing Laboratories Performing Moderate Complexity Testing § 493.1419 Standard; Clinical consultant...

42 CFR 431.105 - Consultation to medical facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

42 CFR 431.105 - Consultation to medical facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

42 CFR 431.105 - Consultation to medical facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

76 FR 48865 - Tribal Consultation Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Tribal Consultation Meetings AGENCY: Administration for Children and Families' Office of Head Start (OHS). ACTION..., Public Law 110-134, notice is hereby given of one-day Tribal Consultation Sessions to be held between the...

42 CFR 431.105 - Consultation to medical facilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

Sharing the load: parents and carers talk to consumer consultants at a child and youth mental health inpatient unit.

PubMed

Geraghty, Kerry; McCann, Karen; King, Robert; Eichmann, Kathryn

2011-08-01

Caring for a child or adolescent affected by mental illness has been identified as imposing stresses and burdens in excess of those usually associated with child rearing. Peer support has been identified as one means by which these stresses and burdens can be reduced. This study investigated the work of a peer support service provided by Mater Child and Youth Mental Health Service in Brisbane, Australia. The study took the form of a content analysis of records of consultations between consumer consultants and 50 families/carers of children admitted into the acute inpatient unit during the period May 2006-April 2008. The content analysis identified four key themes or domains: experience of service provision, emotions and feelings associated with the admission, need for information, and coping with challenges. The findings from the study affirm the role of consumer consultants in child and adolescent inpatient services. Some families value a peer perspective and the opportunity to seek advice and information around a wide variety of topics from people not directly involved in the treatment of their child. © 2011 Mater Health Services. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Special online consulting for patients with eating disorders and their relatives: analysis of user characteristics and E-mail content.

PubMed

Grunwald, Martin; Wesemann, Dorette

2007-02-01

In the treatment of chronic diseases, programs that use the internet as a medium are becoming more and more important as a complement to classical intervention techniques. Since 1998, a non-profit information and online consulting service for patients with eating disorders and their friends and relatives (www.ab-server.de) has existed. This was established by members of the Deutsche Forschungsinitiative Essstörungen e.V. (DFE) [German Research Initiative for Eating Disorders] and members of the Clinic of Psychiatry, University of Leipzig, Germany. For the present study, 2,176 e-mail requests from users of the online consultation service were analyzed qualitatively and quantitatively in order to better understand the differences between different types and groups of users. The analysis was related to the social field of the person requesting the consultation, the type of disorder reported, and the content of the e-mail request. Three main user groups could be identified: people who described themselves as having an eating disorder (57.2%), people who were related socially to the affected person (32.4%), and interested persons (9.8%). The consulting service was predominantly used by persons suffering from bulimia nervosa or their families and friends (63.1%). One third (33.3%) of the posted e-mails were related to behavioral patterns in dealing with the illness and the affected person. They were followed by inquiries for information about the disease (18.7%) and by those seeking help in finding specialized clinics/therapists and places in therapies. The increasing use of the online consulting service indicates that there is a substantial need for information and help in persons with eating disorders and in their relatives, who are able to easily contact professionals using this online service. Online consulting has a high potential for complementary care of affected people.

Job Prospects in HVAC Engineering.

ERIC Educational Resources Information Center

Basta, Nicholas

1985-01-01

Although heating, ventilation, and air conditioning (HVAC) engineering degrees are not offered, there is a serious need for specialists and consultants in this area (since most have been trained as mechanical engineers). Opportunities exist for individuals possessing a customer-oriented attitude, with knowledge in computerized controls, innovative…

Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: A retrospective analysis.

PubMed

Zern, Emily K; Young, Michael N; Triana, Taylor; Xu, Meng; Holmes, Benjamin; Borges, Nyal; McPherson, John A; Karlekar, Mohana B

2017-03-01

Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH). We conducted a retrospective study of 317 consecutive patients undergoing TH after cardiac arrest. We compared intensive care unit (ICU) characteristics and clinical outcomes of subjects who received PC consultation (n=125) to those who did not (n=192). The proportion of TH patients with PC consultations increased to greater than 60% by 2013, corresponding to our institution's expansion of PC services, development of a dedicated PC unit, and integration of this service into our published TH protocol. In the TH population, time to return of spontaneous circulation (ROSC) was associated with higher inpatient mortality (p<0.001) and placement of a PC consult (p=0.011). TH patients who received PC consultation had longer ICU stays (p=0.034), more ventilator days (p<0.001), and higher inpatient mortality (p<0.001). When these measures were analyzed cohort-wide comparing all TH patients pre- and post-2013, at which time the frequency of PC consultation had dramatically increased, there were no statistically significant differences in ICU care or outcomes. In our population of cardiac arrest patients undergoing TH, the utilization of PC services has increased over time, particularly for those patients with high morbidity and mortality. Future randomized studies may further delineate optimal patient selection for PC consultation to better facilitate goals of care discussions and timely medical decision-making. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

PubMed

Fennelly, Orna; Blake, Catherine; FitzGerald, Oliver; Breen, Roisin; Ashton, Jennifer; Brennan, Aisling; Caffrey, Aoife; Desmeules, François; Cunningham, Caitriona

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs. In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study

PubMed Central

de Bont, Eefje G P M; Lepot, Julie M M; Hendrix, Dagmar A S; Loonen, Nicole; Guldemond-Hecker, Yvonne; Dinant, Geert-Jan; Cals, Jochen W L

2015-01-01

Objective Even though childhood fever is mostly self-limiting, children with fever constitute a considerable workload in primary care. Little is known about the number of contacts and management during general practitioners’ (GPs) out-of-hours care. We investigated all fever related telephone contacts, consultations, antibiotic prescriptions and paediatric referrals of children during GP out-of-hours care within 1 year. Design Observational cohort study. Setting and patients We performed an observational cohort study at a large Dutch GP out-of-hours service. Children (<12 years) whose parents contacted the GP out-of-hours service for a fever related illness in 2012 were included. Main outcome measures Number of contacts and consultations, antibiotic prescription rates and paediatric referral rates. Results We observed an average of 14.6 fever related contacts for children per day at GP out-of-hours services, with peaks during winter months. Of 17 170 contacts in 2012, 5343 (31.1%) were fever related and 70.0% resulted in a GP consultation. One in four consultations resulted in an antibiotic prescription. Prescriptions increased by age and referrals to secondary care decreased by age (p<0.001). The majority of parents (89.5%) contacted the out-of-hours service only once during a fever episode (89.5%) and 7.6% of children were referred to secondary care. Conclusions This study shows that childhood fever does account for a large workload at GP out-of-hours services. One in three contacts is fever related and 70% of those febrile children are called in to be assessed by a GP. One in four consultations for childhood fever results in antibiotic prescribing and most consultations are managed in primary care without referral. PMID:25991452

[Use of services and treatment adequacy of major depressive episodes in France].

PubMed

Briffault, X; Morvan, Y; Rouillon, F; Dardennes, R; Lamboy, B

2010-06-01

Though depressive disorders are major problems of public health, general population data about use of services and treatment adequacy are scarce in France. The literature suggests that the percentage of people suffering from mental disorders who are adequately treated is low. The objective of this study was to estimate the 12-month use of services in the French general population suffering from major depressive episodes (MDE) and levels of treatment adequacy. This analysis was conducted on data from the Health barometer 2005, an epidemiological survey concerning several health topics. Thirty thousand five hundred and fourteen individuals from 12 to 75 years old were interviewed by telephone from October 2004 to February 2005. Depressive disorders were assessed by a standardized tool, the CIDI-SF, according to DSM-IV classification. The mental health questions were answered by 16,883 individuals; i.e. by 60% of individuals aged 15 or older. One year prevalence of MDE was 7.8%. In this group, 58.2% used services in a 12-month period, though only 21% of the service users received adequate treatment. Amongst those who used services, 2/3 consulted health care professionals (i.e. 1/3 of people presenting a MDE). The remaining percentage - 21.4% - of people presenting a MDE used psychotropic drugs without mentioning any use of services for mental health problems. The vast majority of individuals with MDE who used services (34.6% of those with MDE) consulted a professional trained to treat depression (general practitioner, psychiatrist, psychologist and psychotherapist). Only a small proportion (19.9%) of those consulting a professional went to a non-specialist professional as well; and even less (6%) consulted only a non-specialist professional. Amongst trained professionals, most consultations (61%, or 21.1% of the MDE group) concern general practitioners; another 38.4% (13.3% of the MDE group) involved psychiatrists; and 27.8% (9.6% of the MDE group) went to psychologists or psychotherapists. Amongst the psychologists and psychotherapists, most consultations were with psychologists (74.1%). The proportion with adequate treatment differed according to the type of professional. Consulting a general practitioner is associated with the lowest levels of adequate treatment (37.2%, and for general practitioners only, 21.5%). Consulting a psychiatrist is associated with higher proportions of adequate treatment (65.1%, and for consulting a psychiatrist only, 60.7%). Consulting both a general practitioner and a psychiatrist is associated with the highest levels of adequate treatment (79.7%). Antidepressants (ATD) are used far more frequently than psychotherapy (PT): 33.4% of individuals with MDE used ATD, and among the latter, 58.4% had also used anxiolytic drugs (AXL). Finally, 26.9% of the MDE group used AXL, 7.5% without any use of ATD. For PT, 10.8% used PT, and 8.1% used PT and ATD. Improving use of professionals and treatment adequacy are two primary objectives from a public health perspective. Since most adequately treated people used an antidepressant therapy (90%), and only 30% a PT, use of psychotherapeutic approaches might be improved. Moreover, levels of treatment adequacy are very low in people presenting an MDE who did not consult for "mental health reasons". Improving the recognition of symptoms of depression might contribute to better treatment adequacy. Copyright (c) 2009 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Coevolution in management fashion: an agent-based model of consultant-driven innovation.

PubMed

Strang, David; David, Robert J; Akhlaghpour, Saeed

2014-07-01

The rise of management consultancy has been accompanied by increasingly marked faddish cycles in management techniques, but the mechanisms that underlie this relationship are not well understood. The authors develop a simple agent-based framework that models innovation adoption and abandonment on both the supply and demand sides. In opposition to conceptions of consultants as rhetorical wizards who engineer waves of management fashion, firms and consultants are treated as boundedly rational actors who chase the secrets of success by mimicking their highest-performing peers. Computational experiments demonstrate that consultant-driven versions of this dynamic in which the outcomes of firms are strongly conditioned by their choice of consultant are robustly faddish. The invasion of boom markets by low-quality consultants undercuts popular innovations while simultaneously restarting the fashion cycle by prompting the flight of high-quality consultants into less densely occupied niches. Computational experiments also indicate conditions involving consultant mobility, aspiration levels, mimic probabilities, and client-provider matching that attenuate faddishness.

Open access to Water Indicators for Climate Change Adaptation: proof-of-concept for the Copernicus Climate Change Service (C3S)

NASA Astrophysics Data System (ADS)

Lottle, Lorna; Arheimer, Berit; Gyllensvärd, Frida; Dejong, Fokke; Ludwig, Fulco; Hutjes, Ronald; Martinez, Bernat

2017-04-01

Copernicus Climate Change Service (C3S) is still in the development phase and will combine observations of the climate system with the latest science to develop authoritative, quality-assured information about the past, current and future states of the climate and climate dependent sectors in Europe and worldwide. C3S will provide key indicators on climate change drivers and selected sectorial impacts. The aim of these indicators will be to support adaptation and mitigation. This presentation will show one service already operational as a proof-of-concept of this future climate service. The project "Service for Water Indicators in Climate Change Adaptation" (SWICCA) has developed a sectorial information service for water management. It offers readily available climate-impact data, for open access from the web-site http://swicca.climate.copernicus.eu/. The development is user-driven with the overall goal to speed up the workflow in climate-change adaptation of water management across Europe. The service is co-designed by consultant engineers and agencies in 15 case-studies spread out over the continent. SWICCA has an interactive user-interface, which shows maps and graphs, and facilitates data download in user-friendly formats. In total, more than 900 open dataset are given for various hydrometeorological (and a few socioeconomical) variables, model ensembles, resolutions, time-periods and RCPs. The service offers more than 40 precomputed climate impact indicators (CIIs) and transient time-series of 4 essential climate variables ECVs) with high spatial and temporal resolution. To facilitate both near future and far future assessments, SWICCA provides the indicators for different time ranges; normally, absolute values are given for a reference period (e.g. 1971-2000) and the expected future changes for different 30-year periods, such as early century (2011-2040), mid-century (2041-2070) and end-century (2071-2100). An ensemble of model results is always given to indicate confidence in the estimates. The SWICCA demonstrator also includes user guidance, information sheets, tutorials, and links to other relevant websites. The aim of this service is to provide research data and guidance for climate impact assessments in the water sector. The main target group is consulting engineers (so called Purveyors) working with climate change adaptation in the water sector. By using indicators, climate impact assessments can be done without having to run a full production chain from raw climate model results - instead the indicators can be included in the local workflow with local methods applied, to facilitate decision-making and strategies to meet the future. Working with real users will ensure that useful data is inserted into the C3S Climate Data Store (CDS).

Directory of Environmental Consultants.

ERIC Educational Resources Information Center

Cate, Bill, Ed.

Over 400 inter-field professionals are named as environmental consultants in this 1972 annual directory. Primarily, they are faculty members at colleges and universities in Canada, Puerto Rico, and the United States who will provide free environmental consulting services to interested government, industry, and citizen organizations, but are not…

Access to Cancer Services for Rural Colorectal Cancer Patients

ERIC Educational Resources Information Center

Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary

2008-01-01

Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…

Improving the Quality of Services in Residential Treatment Facilities: A Strength-Based Consultative Review Process

ERIC Educational Resources Information Center

Pavkov, Thomas W.; Lourie, Ira S.; Hug, Richard W.; Negash, Sesen

2010-01-01

This descriptive case study reports on the positive impact of a consultative review methodology used to conduct quality assurance reviews as part of the Residential Treatment Center Evaluation Project. The study details improvement in the quality of services provided to youth in unmonitored residential treatment facilities. Improvements were…

Guidelines for conducting TMDL consultations on selenium

Treesearch

Dennis A. Lemly

2000-01-01

This report was prepared to provide Environmental Contaminants Specialists in the U.S. Fish and Wildlife Service (Service) with a step-by-step procedure for consultations involving Total Maximum Daily Loads (TMDL's) for selenium. The need for this information stems from recent actions taken by the U.S. Environmental Protection Agency (EPA) that will involve the...

Developments in rheumatology consultant manpower provision: the BSR/arc Workforce Register 2003-05.

PubMed

Harrison, M J; Morley, K D; Symmons, D P M

2006-11-01

To summarize the changes and continuing inequalities in rheumatology service provision in the UK between 2001 and 2005. Questionnaires about demographics and workload were sent to all consultants on the BSR/arc Workforce Register in January 2003 and 2005. A total of 94% of 506 consultants responded in 2003 and 89% of 542 in 2005. About 19% of the consultants practice rheumatology with acute medicine. Levels of optimal provision exceed 60% in England and Wales, but are below 50% in Scotland and Northern Ireland. The levels of provision in London are substantially higher than anywhere else. The median number of hours worked per week has increased from 35.2 in 2003 to 41 in 2005. Rheumatology continues to expand. There is inequality with better provision in England (especially London) and Wales than Scotland and Northern Ireland. Patterns of nurse and Senior House Officer (SHO) provision correlate with consultant numbers. Thus, the catalyst for improved service is consultant expansion.

Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service.

PubMed

Bierenbaum, Melanie L; Katsikas, Steven; Furr, Allen; Carter, Bryan D

2013-12-01

The aim of this study was to identify factors contributing to clinician time spent in non-reimbursable activity on an inpatient pediatric consultation-liaison (C-L) service. A retrospective study was conducted using inpatient C-L service data on 1,246 consecutive referrals. For this patient population, the strongest predictor of level of non-reimbursable clinical activity was illness chronicity and the number of contacts with C-L service clinicians during their hospital stay. Patients with acute life-threatening illnesses required the highest mean amount of non-reimbursable service activity. On average, 28 % of total clinician time in completing a hospital consultation was spent in non-reimbursable activity. Effective C-L services require a proportion of time spent in non-reimbursable clinical activity, such as liaison and coordinating care with other providers. Identifying referral and systemic factors contributing to non-reimbursable activity can provide insight into budgeting/negotiating for institutional support for essential clinical and non-clinical functions in providing competent quality patient care.

Facilitation of University Technology Transfer through a Cooperative Army-University-Industry Program,

DTIC Science & Technology

1995-01-01

through Army technology transfer centers for applied engineering training and consulting, and second in assisting and expanding university technology...industry with an applied engineering program and the training for new engineers and researchers, serve as an information resource for both the Army and

Advancing the practice of systems engineering at JPL

NASA Technical Reports Server (NTRS)

Jansma, Patti A.; Jones, Ross M.

2006-01-01

In FY 2004, JPL launched an initiative to improve the way it practices systems engineering. The Lab's senior management formed the Systems Engineering Advancement (SEA) Project in order to "significantly advance the practice and organizational capabilities of systems engineering at JPL on flight projects and ground support tasks." The scope of the SEA Project includes the systems engineering work performed in all three dimensions of a program, project, or task: 1. the full life-cycle, i.e., concept through end of operations 2. the full depth, i.e., Program, Project, System, Subsystem, Element (SE Levels 1 to 5) 3. the full technical scope, e.g., the flight, ground and launch systems, avionics, power, propulsion, telecommunications, thermal, etc. The initial focus of their efforts defined the following basic systems engineering functions at JPL: systems architecture, requirements management, interface definition, technical resource management, system design and analysis, system verification and validation, risk management, technical peer reviews, design process management and systems engineering task management, They also developed a list of highly valued personal behaviors of systems engineers, and are working to inculcate those behaviors into members of their systems engineering community. The SEA Project is developing products, services, and training to support managers and practitioners throughout the entire system lifecycle. As these are developed, each one needs to be systematically deployed. Hence, the SEA Project developed a deployment process that includes four aspects: infrastructure and operations, communication and outreach, education and training, and consulting support. In addition, the SEA Project has taken a proactive approach to organizational change management and customer relationship management - both concepts and approaches not usually invoked in an engineering environment. This paper'3 describes JPL's approach to advancing the practice of systems engineering at the Lab. It describes the general approach used and how they addressed the three key aspects of change: people, process and technology. It highlights a list of highly valued personal behaviors of systems engineers, discusses the various products, services and training that were developed, describes the deployment approach used, and concludes with several lessons learned.

18 CFR 12.34 - Approval of independent consultant.

Code of Federal Regulations, 2014 CFR

2014-04-01

... consultant. 12.34 Section 12.34 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND... Director of the Office of Energy Projects Licensing for approval, with a copy to the Regional Engineer, a...

18 CFR 12.34 - Approval of independent consultant.

Code of Federal Regulations, 2012 CFR

2012-04-01

... consultant. 12.34 Section 12.34 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND... Director of the Office of Energy Projects Licensing for approval, with a copy to the Regional Engineer, a...

18 CFR 12.34 - Approval of independent consultant.

Code of Federal Regulations, 2011 CFR

2011-04-01

... consultant. 12.34 Section 12.34 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND... Director of the Office of Energy Projects Licensing for approval, with a copy to the Regional Engineer, a...

18 CFR 12.34 - Approval of independent consultant.

Code of Federal Regulations, 2010 CFR

2010-04-01

... consultant. 12.34 Section 12.34 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND... Director of the Office of Energy Projects Licensing for approval, with a copy to the Regional Engineer, a...

18 CFR 12.34 - Approval of independent consultant.

Code of Federal Regulations, 2013 CFR

2013-04-01

... consultant. 12.34 Section 12.34 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND... Director of the Office of Energy Projects Licensing for approval, with a copy to the Regional Engineer, a...

Pathfinder Technologies Specialist, X-37

NASA Technical Reports Server (NTRS)

French, James R.

2001-01-01

The X-37 is a technology demonstrator sponsored by NASA. It includes a number of experiments both imbedded (i.e., essential aspects of the vehicle) and separate. The technologies demonstrated will be useful in future operational versions as well as having broad applications to other programs. Mr. James R. French, of JRF Engineering Services and as a consultant to SAIC, has provided technical support to the X-37 NASA Program office since the beginning of the program. In providing this service, Mr. French has maintained close contact with the Boeing Seal Beach and Rocketdyne technical teams via telephone, e-mail, and periodic visits. His interfaces were primarily with the working engineers in order to provide NASA sponsors with a different view than that achieved through management channels. Mr. French's periodic and highly detailed technical reports were submitted to NASA and SAIC (Science Applications International Corporation) on a weekly/monthly basis. These reports addressed a wide spectrum of programmatic and technical interests related to the X-37 Program including vehicle design, flight sciences, propulsion, thermal protection, Guidance Navigation & Control (GN&C), structures, and operations. This deliverable is presented as a consolidation of the twelve monthly reports submitted during the Contract's Option Year,

Protective clothing, re-engineering

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lorenz, S.M.

1995-11-01

In 1993, Commonwealth Edison spent 5.1 Million dollars for protective clothing materials and services for six power plants. Therefore, it was necessary for ComEd to evaluate their protective clothing programs while also considering the rapid escalation in disposal costs and the potential for on-site storage of waste. Today, I will be discussing the preliminary planning and the outcome of one year`s worth of investigating, reviewing, and calculating for an operation that will save Commonwealth Edison millions of dollars. A Process Engineering Reevaluation Team composed of corporate and power plant personnel was formed to evaluate all aspects of protective clothing materialsmore » and services. Throughout the year, the nine member team consulted clothing manufacturers, commercial laundry operators, and laundry equipment specialists. Faced with a wide range of garment design, types, sizes, materials, and disposal options, we were faced with a considerable challenge. In addition, we had to develop a product that all six sites would agree on. Three areas in particular that the team sought to improve were the material of the clothing, design of the garment, and the ability to share the protective clothing with all six of our nuclear sites.« less

Federal Consulting: Strategies and Tools for the Career Development Professional.

ERIC Educational Resources Information Center

Kahnweiler, Jennifer B.; Pressman, Sue

The Federal Government is America's largest employer and is expanding consulting opportunities for career development professionals. Increased Federal mandates for outsourcing have opened wide doors for the entrepreneurial-spirited career counselors and created new challenges for traditional methods of offering career services. As consultants who…

78 FR 24469 - Proposed Information Collection (Ethics Consultation Feedback Tool (ECFT)) Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-25

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0750] Proposed Information Collection (Ethics... ethics consultation service. DATES: Written comments and recommendations on the proposed collection of... information technology. Title: Ethics Consultation Feedback Tool (ECFT), VA Form 10-0502. OMB Control Number...

Prevention of delayed referrals through the Champlain BASE eConsult service.

PubMed

Liddy, Clare; Drosinis, Paul; Fogel, Adam; Keely, Erin

2017-08-01

To identify the proportion and evaluate the content of eConsults (electronic consultations) in which the Champlain BASE (Building Access to Specialists through eConsultation) eConsult process prompted a referral to a specialist that was not originally contemplated by the primary care provider (PCP). Cross-sectional study of all eConsults submitted between April 15, 2011, and January 31, 2015. Champlain Local Health Integration Network, a large health region in eastern Ontario. Primary care providers registered to use the Champlain BASE eConsult service. Answers from a close-out survey-completed by PCPs at the conclusion of each eConsult-stating that specialist referral was not originally contemplated but that the eConsult process had prompted referral. The logs containing the communication exchanged between the PCPs and the specialists were reviewed, and each prompted referral case was categorized by the type of question asked, if pharmaceutical advice was given, if the referral was redirected to a different specialty group, and if the referral was urgent. A total of 188 (3.4%) of 5601 eConsults completed during the study period were cases in which PCPs stated that they had originally not contemplated referring the patient to a specialist but that the Champlain BASE eConsult process had prompted referral. Prompted referrals were most often directed to cardiologists (10.6%), dermatologists (10.6%), infectious disease specialists (9.0%), hematologists (9.0%), and urologists (8.5%). The most common questions were about diagnosis (34.0%), drug treatment (18.0%), and management (15.0%). Pharmaceutical advice was given in 28.0% of prompted referral cases, and in 26.0% of cases, the face-to-face referral was redirected to another specialty group. In 5.0% of cases, the specialist stated the referral was urgent. The median specialist response time was 0.96 days (interquartile range 0.17 to 3.80 days). By providing PCPs with increased access to specialists, the Champlain BASE eConsult service serves an important role in identifying and preventing the potential detrimental consequences of delayed medical referrals across specialty groups. Copyright© the College of Family Physicians of Canada.

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation.

PubMed

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-06-23

This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Champlain health region in Eastern Ontario, Canada. Primary care providers and specialists registered to use the eConsult service. Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Asset management in theory and practice.

PubMed

Mace, J D

1998-01-01

Managing capital-intensive imaging environments continues to be a challenge for nearly all administrators. Asset management, the strategic management of equipment inventory, must include planning, assessment, procurement, utilization review, maintenance, repair and disposal of equipment to reduce costs and improve efficiency. It must involve some shared risk between the facility and the provider, whether an original equipment manufacturer (OEM) or independent service organization (ISO). An absence of risk in the arrangement implies the provider is offering service management or consulting. A case study reports on three hospitals in the OhioHealth system. Their immediate goal, as they began to investigate asset management: cut costs immediately. A cross-functional team from the three hospitals began its investigation of various options, including working with ISOs, OEMs and development of inhouse clinical engineering. After developing a process to evaluate vendors, the team was able to score each against their cost-reduction potential, quality and implementation skills. The team narrowed its selection quickly to two multivendor service providers. An initial contract guaranteed savings of 20 percent of the annual budget, with a projected two to five percent additional savings. OEM relationships were moved to a time-and-materials basis, and ISOs were used in selected areas. In addition, the internal inhouse clinical engineering services group was moved into a "first call" approach in some areas. That expanded role resulted in savings and improved response time. The process, although not without its problems, was viewed favorably overall.

Experiences with the DSM-III in a psychiatric consultation/liaison service.

PubMed

Larsen, F

1986-01-01

375 patients referred to consultation/liaison service at a general hospital from the neurological and internal medical department were diagnosed according to the DSM-III criteria for axis I and II. The sample represents all the patients referred from the two departments in a two year period. The phenomenological approach of the DSM-III and its reliability, is an advantage over older classification systems in the psychiatric consultation/liaison work. The system was easily applicable in this setting, leaving only 4 percent with "Diagnoses deferred" on both axes. From the consultation/liaison psychiatrist's point of view, special problems seemed to exist concerning the categories "Somatoform disorders" and "Psychological factors affecting physical condition", and the concepts of the axis II.

A comparison of white-collar jobs in regard to mental health consultation rates in a health care center operated by a Japanese company.

PubMed

Soeda, Shuji; Hayashi, Takeshi; Sugawara, Yoichi; Takano, Tomoki; Terao, Takeshi; Nakamura, Jun

2003-04-01

The aim of this study was to compare the consultation rates (CR) of workers performing several types of white-collar jobs. We collected data from the database inputted at the first consultation to a health care center from April 1996 to March 1999. We found that the CR of engineer group was 2.3 times higher than that of employees involved in research and development group. We speculate that this is partially due to the portion, which is not small, of computer systems engineer (SE) comprising this group; SE has previously been mentioned as a particularly stressful occupation in Japan. Since the result of this study is preliminary, we need to conduct a further study taking into account that multiple factors affect CR.

Portfolio careers for medical graduates: implications for postgraduate training and workforce planning.

PubMed

Eyre, Harris A; Mitchell, Rob D; Milford, Will; Vaswani, Nitin; Moylan, Steven

2014-06-01

Portfolio careers in medicine can be defined as significant involvement in one or more portfolios of activity beyond a practitioner's primary clinical role, either concurrently or in sequence. Portfolio occupations may include medical education, research, administration, legal medicine, the arts, engineering, business and consulting, leadership, politics and entrepreneurship. Despite significant interest among junior doctors, portfolios are poorly integrated with prevocational and speciality training programs in Australia. The present paper seeks to explore this issue. More formal systems for portfolio careers in Australia have the potential to increase job satisfaction, flexibility and retention, as well as diversify trainee skill sets. Although there are numerous benefits from involvement in portfolio careers, there are also risks to the trainee, employing health service and workforce modelling. Formalising pathways to portfolio careers relies on assessing stakeholder interest, enhancing flexibility in training programs, developing support programs, mentorship and coaching schemes and improving support structures in health services.

The NASA Engineering and Safety Center (NESC) GN and C Technical Discipline Team (TDT): Its Purpose, Practices and Experiences

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.

2008-01-01

This paper will briefly define the vision, mission, and purpose of the NESC organization. The role of the GN&C TDT will then be described in detail along with an overview of how this team operates and engages in its objective engineering and safety assessments of critical NASA projects. This paper will then describe key issues and findings from several of the recent GN&C-related independent assessments and consultations performed and/or supported by the NESC GN&C TDT. Among the examples of the GN&C TDT s work that will be addressed in this paper are the following: the Space Shuttle Orbiter Repair Maneuver (ORM) assessment, the ISS CMG failure root cause assessment, the Demonstration of Autonomous Rendezvous Technologies (DART) spacecraft mishap consultation, the Phoenix Mars lander thruster-based controllability consultation, the NASA in-house Crew Exploration Vehicle (CEV) Smart Buyer assessment and the assessment of key engineering considerations for the Design, Development, Test & Evaluation (DDT&E) of robust and reliable GN&C systems for human-rated spacecraft.

Management of infectious diseases in remote northwestern Ontario with telemedicine videoconference consultations.

PubMed

Mashru, Jai; Kirlew, Michael; Saginur, Raphael; Schreiber, Yoko S

2017-01-01

Northwestern Ontario in Canada provides a unique clinical challenge for providing optimal medical care. It is a large geographic area (385,000 km 2 ) and is home to 32 remote First Nations communities, most without road access. These communities suffer a heavy burden of infectious disease and specialist consultations are difficult to obtain. The Division of Infectious Diseases at the Ottawa Hospital and the Sioux Lookout Meno Ya Win Health Centre established a telemedicine-based infectious disease consultation service in July 2014. We describe the implementation of this service, types of cases seen and patient satisfaction, as well as some of the challenges encountered. Information on visits was prospectively collected through an administrative database, and patient satisfaction surveys were administered after each initial consultation. During our first year of operation, 191 teleconsultations occurred: 76 initial consultations, 82 follow-up appointments and 33 case conferences. The scope of cases has been broad, mostly involving musculoskeletal infections (26%), followed by skin and soft tissue infections (23%). HCV, acute rheumatic fever, and respiratory infections (including pulmonary tuberculosis) were other diagnoses. Patient satisfaction has been very high and 28 telemedicine patient visits have occurred in their remote home communities, minimizing travel. The infectious disease consulting service and local clinicians have succeeded in addressing needs for care in infectious diseases in northwestern Ontario, where important gaps in service to First Nations' communities continue to exist. Regular scheduled available access to an infectious disease specialist is a well-received advancement of care in this remote region of Canada.

Billing and reimbursement for a bedside toxicology service at a tertiary care academic center during its first fiscal year.

PubMed

Wiegand, Timothy J; Crane, Peter W; Kamali, Michael; Reif, Marilynn; Wratni, Rose; Montante, Ronald; Loveland, Tracey

2015-03-01

A bedside toxicology consult service may improve clinical care, facilitate patient clearance and disposition, and result in potential cost savings for poisoning exposures. Despite this, there is scant data regarding economic feasibility for such a service. Previously published information suggests low hourly reimbursement at approximately $26.00/h at the bedside for toxicology consultations. A bedside toxicology consultant service was initiated in 2011. Coverage was available 24 h a day for 50 out of 52 weeks. Bedside rounding on toxicology consult patients was available 6/7 days per week. The practice is associated with >800 bed teaching institution in a large upstate NY region with elements of urban and suburban practice. Demographic and billing data was collected for all patients consulted upon from July 1, 2011 to June 31, 2012. In charges of $514,941 were generated during the period of data collection. Monthly average was $42,912. Net reimbursement of charges was 29 % of overall charges at $147,792. In terms of total encounters, net collection rate in which something was reimbursed or "paid" against charges for that encounter was 82.6 % of all encounters at 999/1,210. Average encounter time for inpatients, including critical care, was 1.05 h, and the average time spent for outpatients was 1.18 h. Reimbursement rates appear higher than previously reported. Revenue generated from reimbursement from toxicology consultation can result in recouping a substantial portion of a toxicologist's salary or potentially fund fellowship positions and salaries or toxicology division infrastructure.

A Mental Health Consultation Program for Project Head Start.

ERIC Educational Resources Information Center

Kawin, Marjorie R.

The Psychological Center provided a family oriented mental health consultation service to 17 delegate agencies who had contracts with Head Start programs in 1966-67. This paper presents an overview of the services which an interdisciplinary staff of 52 professionals provided to 6,780 families and 1,500 agency staff members. Gerald Caplan's (1964)…

30 CFR 243.201 - How will MMS determine if I am financially solvent?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section by one of the methods in § 243.200(a): (1) A written request asking us to consult a business... active appeals. (d) If you request that we consult a business-information or credit-reporting service or... solvent? 243.201 Section 243.201 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR...

The Future of the Digital Library: An Interview with Tom Peters

ERIC Educational Resources Information Center

Morrison, James L.; Peters, Tom

2005-01-01

This article presents an interview with Tom Peters, an academic librarian and founder of TAP Information Services, a firm that provides consulting services to libraries and other organizations in the information industry. Peters also serves as a consultant to LibraryCity, an ambitious project that seeks to make thousands of e-books in easy-to-use…

76 FR 30639 - Final Environmental Assessment and Mitigated Finding of No Significant Impact; Giant Miscanthus...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-26

... received on the draft and in consultation with NRCS and ARS, FSA developed and included a finalized... from the Natural Resources Conservation Service (NRCS) and the Agricultural Research Service (ARS) in... included as an appendix to the Final EA. The comments, as well as consultation with NRCS and ARS, provided...

Integrated delivery systems focus on service delivery after capitation efforts stall.

PubMed

2005-03-01

Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver.

Experiences of Two Multidisciplinary Team Members of Systemic Consultations in a Community Learning Disability Service

ERIC Educational Resources Information Center

Johnson, Clair; Viljoen, Nina

2017-01-01

Background: Systemic approaches can be useful in working with people with learning disabilities and their network. The evidence base for these approaches within the field of learning disabilities, however, is currently limited. Materials and Methods: This article presents part of a service evaluation of systemic consultations in a Community…

Special Education Program for Severely and Profoundly Handicapped Individuals: A Directory of State Education Agency Services.

ERIC Educational Resources Information Center

National Association of State Directors of Special Education, Washington, DC.

The report presents information based on a 1978 survey on programs in 46 state education agencies for severely and profoundly handicapped (SPH) individuals. The principal section of the report discusses summary data on state consultants responsible for services to SPH students, definitions, percentage of consultant time spent on programs, child…

Performance Learning Roadmap A Network-Centric Approach for Engaged Learners

DTIC Science & Technology

2005-01-01

Insurance Corporation Target Corporation Unilever Corporation United Nations Development Programme University of Wisconsin (UWSA)–Madison U.S. Coast Guard...performance support services, including consulting, coaching, mentoring, rapid 14 deployment training, targeted training, analysis , facilitation, and team...services include consulting, coaching, mentoring, rapid deployment training, targeted train- ing, analysis , facilitation, and team collaboration support

78 FR 66779 - United States Enrichment Corporation, Paducah Gaseous Diffusion Plant, Including On-Site Leased...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

..., KB Consultants, Henry, Meisenheimer, & Grende, SR Martin Group And CDI Corporation, Paducah, Kentucky.... Petter Supply, KB Consultants, Henry, Meisenheimer & Grende, SR Martin Group and CDI Corporation were... Services, Henry A. Petter Supply, KB Consultants, Henry, Meisenheimer & Grende, SR Martin Group and CDI...

An Investigation of the Acceptability of Videoconferencing within a School-Based Behavioral Consultation Framework

ERIC Educational Resources Information Center

Fischer, Aaron J.; Dart, Evan H.; Leblanc, Hannah; Hartman, Kelsey L.; Steeves, Rachel O.; Gresham, Frank M.

2016-01-01

School-based behavioral consultation with classroom teachers is one of the primary ways school psychologists deliver intervention services to students. The present study aimed to evaluate the acceptability of videoconferencing (VC) with teachers as an alternative medium of consultative communication. Specifically, problem identification interviews…

Rural versus Suburban Primary Care Needs, Utilization, and Satisfaction with Telepsychiatric Consultation

ERIC Educational Resources Information Center

Hilty, Donald M.; Nesbitt, Thomas S.; Kuenneth, Christina A.; Cruz, Grace M.; Hales, Robert E.

2007-01-01

Context and Purpose: Rural and suburban populations remain underserved in terms of psychiatric services but have not been compared directly in terms of using telepsychiatry. Methods: Patient demographics, reasons for consultation, diagnosis, and alternatives to telepsychiatric consultation were collected for 200 consecutive, first-time…

Advancing Knowledge in Schools through Consultative Knowledge Linking.

ERIC Educational Resources Information Center

Kratochwill, Thomas R.

Consultation services have been considered an essential and important role for school psychologists throughout the history of the field. Traditionally consultation has been cast as a problem-solving process, nevertheless, it can be thought of as a knowledge-linking process in which psychologists advance knowledge in schools to various mediators…

78 FR 49335 - Agency Information Collection (Ethics Consultation Feedback Tool (ECFT)) Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0750] Agency Information Collection (Ethics...-0750''. SUPPLEMENTARY INFORMATION: Title: Ethics Consultation Feedback Tool (ECFT), VA Form 10-10065... experience during the Ethics Consultation Service. VA will be used the data to improve the process of ethics...

Partnerships for Change: Maximizing Consultative Services

ERIC Educational Resources Information Center

Reinhardt, Patricia

2011-01-01

Consultation offers a cost-effective option that can develop into a satisfying, collaborative relationship that is highly productive, given the right ingredients: content and process knowledge on the part of the consultant, a systemic approach to change, and a foundation of professional and ethical standards on which to build a trustworthy…

Consultation and the TADS Experience. Occasional Paper Number 1.

ERIC Educational Resources Information Center

Trohanis, Pascal L.; And Others

During the past 10 years, the Technical Assistance Development System's (TADS) staff and advisory board members along with 500 other people have provided consultation services to model demonstration programs and state education agencies that help young handicapped children and their families. Consultants are usually located through a sponsor or…

Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.

PubMed

Chambers, Georgina M; Randall, Sean; Mihalopoulos, Cathrine; Reilly, Nicole; Sullivan, Elizabeth A; Highet, Nicole; Morgan, Vera A; Croft, Maxine L; Chatterton, Mary Lou; Austin, Marie-Paule

2017-12-05

Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.

An exploration of the role and scope of the clinical nurse consultant (CNC) in a metropolitan health service.

PubMed

Bloomer, Melissa J; Cross, Wendy M

2011-01-01

Clinical nurse consultants have been a part of the nursing workforce for some time however a lack of clarity regarding this role has led to significant variations in health service expectations, workloads and scope for the Clinical nurse consultants working within this metropolitan health service. The aim of this study was to explore the role of the CNC as it is perceived by them, in the context of this health service. A qualitative approach was used for this study. Following ethics approval a single audio-taped focus group was undertaken to gather data. Guiding questions were used to elicit responses from the group, moderated by the co-investigators. The focus group was transcribed verbatim. Each researcher independently analysed the narrative data, using coding and clustering the data to develop primary and sub-themes. Whilst each participant experiences their role individually, there were four themes derived from comments expressed by the participants: 'Diversity and conflict', 'Leaders but powerless', 'Support systems' and 'The portfolio holder role'. The role of the Clinical nurse consultant is complex and diverse. The variability in the role suggests that organisational consensus of the role, scope and purpose of the CNC position has not been actualised, resulting in a lack of support systems, and an underutilisation of the Clinical nurse consultants as leaders, where they can challenge existing practice and guide future directions in care delivery.

[Change in service provision and availability under the list patient system reform].

PubMed

Grytten, Jostein; Skau, Irene; Sørensen, Rune; Aasland, Olaf G

2004-02-05

In this article, we analyse the relationship between length of patient lists and general practitioners' (GPs') service provision in order to investigate whether the list patient system reform has led to reduced accessibility and/or supplier inducement. The data were collected from a comprehensive questionnaire survey among GPs in the list patient system in 2002 (2306 GPs) and from the National Insurance Administration in 2001 (1637 GPs). The relationship between length of patient lists and service provision was analysed using regression analysis. The relationship between length of patient lists and number of consultations per GP was almost proportional, as was the relationship between length of patient list and number of consultations initiated by GPs. GPs who wanted more patients on their list had fewer consultations than those who were satisfied with the length of their lists and they did not compensate by taking more laboratory tests per consultation. Analysis of the two independent sets of data gave almost identical results. Patients' access to their GPs is independent of the length of his or her patient list. Even GPs with long lists do not ration consultations. This probably reflects efficient organisation of the practice. Our results do not support the theory that GPs induce demand for their services; one explanation is that GPs with short lists have chosen to have precisely that and have no need to induce demand.

Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland.

PubMed

Keogh, Kandice; Clark, Paul; Valery, Patricia C; McPhail, Steven M; Bradshaw, Candise; Day, Melany; Smith, Anthony C

2016-12-01

For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p < 0.001). The failure to attend rate decreased (13.0% vs 6.5%, pre vs post-expansion respectively; p = 0.030), suggesting engagement with the service increased. Staff cited nurse-conducted primary assessment prior to specialist consultation and personalised patient treatment packs as key contributors to increased patient flow and engagement. This expanded team approach appears effective in delivering specialised treatment to an underserved area in regional Central Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders. © The Author(s) 2016.

‘Why does it happen like this?’ Consulting with users and providers prior to an evaluation of services for children with life limiting conditions and their families

PubMed Central

Brown, Erica; Coad, Jane; Staniszewska, Sophie; Hacking, Suzanne; Chesworth, Brigit; Chambers, Lizzie

2015-01-01

Children with life limiting conditions and their families have complex needs. Evaluations must consider their views and perspectives to ensure care is relevant, appropriate and acceptable. We consulted with children, young people, their parents and local professionals to gain a more informed picture of issues affecting them prior to preparing a bid to evaluate services in the area. Multiple methods included focus groups, face-to-face and telephone interviews and participatory activities. Recordings and products from activities were analysed for content to identify areas of relevance and concern. An overarching theme from parents was ‘Why does it happen like this?’ Services did not seem designed to meet their needs. Whilst children and young people expressed ideas related to quality of environment, services and social life, professionals focused on ways of meeting the families’ needs. The theme that linked families’ concerns with those of professionals was ‘assessing individual needs’. Two questions to be addressed by the evaluation are (1) to what extent are services designed to meet the needs of children and families and (2) to what extent are children, young people and their families consulted about what they need? Consultations with families and service providers encouraged us to continue their involvement as partners in the evaluation. PMID:24270996

Starting a business as a nurse consultant: practical considerations.

PubMed

Papp, E M

2000-03-01

Nursing experience translates well to self employment in the occupational and environmental health field. However, nurses must conduct a self assessment to determine whether owning a business is a good fit for their personality and work style. Exploring which services to offer is the next step in starting a business and consists of determining not only which service to offer (e.g., writing policies or protocols, providing clinical services) but also which type of consultation model to use (i.e., purchase of expertise, doctor/client, process consultation). Every business must have a plan. A business plan is essential to starting a business. It solidifies the entrepreneur's focus, lays the foundation for the business, provides a tool for evaluating success, and is a strong tool for soliciting financial support. The name of the business is an important consideration because it is often the first contact the customers have with the occupational health nurse consultant. The name must be descriptive, appropriate, and memorable.

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

PubMed

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

2015-05-01

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

Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

PubMed Central

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

2015-01-01

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

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

PubMed

Edmunds, Julie M; Brodman, Douglas M; Ringle, Vanesa A; Read, Kendra L; Kendall, Philip C; Beidas, Rinad S

2017-02-01

The present study examined 115 service providers' adherence to components of cognitive-behavioral therapy (CBT) for youth anxiety prior to training, post workshop training, and after three months of weekly consultation. Adherence was measured using a role-play with a trained actor. We examined differences in individual adherence to CBT components across time and the relationship between number of consultation sessions attended and adherence ratings following consultation. Findings indicated that somatic arousal identification and relaxation were the most used treatment components prior to training. Adherence to all components of CBT increased following workshop training, except the usage of problem-solving. Adherence to problem-solving, positive reinforcement, the identification of anxious self-talk, and the creation of coping thoughts increased following consultation but usage of problem-solving remained low compared to other treatment components. Overall adherence remained less than optimal at the final measurement point. Number of consultation sessions attended predicted post-consultation adherence to identification of somatic arousal, identification of anxious self-talk, and positive reinforcement. Implications include tailoring future training based on baseline levels of adherence and spending more time during training and consultation on underutilized CBT components, such as problem-solving. Limitations of the present study, including how adherence was measured, are discussed. This study adds to the implementation science literature by providing more nuanced information on changes in adherence over the course of training and consultation of service providers.

eConsultations to Infectious Disease Specialists: Questions Asked and Impact on Primary Care Providers' Behavior.

PubMed

Murthy, Ruchi; Rose, Gregory; Liddy, Clare; Afkham, Amir; Keely, Erin

2017-01-01

Since 2010, the Champlain BASE (Building Access to Specialist Advice through eConsultation) has allowed primary care providers (PCPs) to submit clinical questions to specialists through a secure web service. The study objectives are to describe questions asked to Infectious Diseases specialists through eConsultation and assess impact on physician behaviors. eConsults completed through the Champlain BASE service from April 15, 2013 to January 29, 2015 were characterized by the type of question asked and infectious disease content. Usage data and PCP responses to a closeout survey were analyzed to determine eConsult response time, change in referral plans, and change in planned course of action. Of the 224 infectious diseases eConsults, the most common question types were as follows: interpretation of a clinical test 18.0% (41), general management 16.5 % (37), and indications/goals of treating a particular condition 16.5% (37). The most frequently consulted infectious diseases were as follows: tuberculosis 14.3% (32), Lyme disease 14.3% (32), and parasitology 12.9% (29). Within 24 hours, 63% of cases responded to the questions, and 82% of cases took under 15 minutes to complete. In 32% of cases, a face-to-face referral was originally planned by the PCP but was no longer needed. In 8% of cases, the PCP referred the patient despite originally not planning to make a referral. In 55% of cases, the PCP either received new information or changed their course of action. An eConsult service provides PCPs with timely access to infectious disease specialists' advice that often results in a change in plans for a face-to-face referral. © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

STS-114 Engine Cut-off Sensor Anomaly Technical Consultation Report

NASA Technical Reports Server (NTRS)

Wilson, Timmy R.; Kichak, Robert A.; Ungar, Eugene K.; Cherney, Robert; Rickman, Steve L.

2009-01-01

The NESC consultation team participated in real-time troubleshooting of the Main Propulsion System (MPS) Engine Cutoff (ECO) sensor system failures during STS-114 launch countdown. The team assisted with External Tank (ET) thermal and ECO Point Sensor Box (PSB) circuit analyses, and made real-time inputs to the Space Shuttle Program (SSP) problem resolution teams. Several long-term recommendations resulted. One recommendation was to conduct cryogenic tests of the ECO sensors to validate, or disprove, the theory that variations in circuit impedance due to cryogenic effects on swaged connections within the sensor were the root cause of STS-114 failures.

Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models.

PubMed

Bourgeois, James A; Hilty, Donald M; Klein, Sally C; Koike, Alan K; Servis, Mark E; Hales, Robert E

2003-01-01

The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

Peer-to-Peer Consultations: Ancillary Services Peer Exchange with India: Experience from South Africa, Europe & the United States (Fact Sheet)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

In support of national and subnational decision makers, the 21st Century Power Partnership regularly works with country partners to organize peer-to-peer consultations on critical issues. In March 2014, 21CPP collaborated with the Regulatory Assistance Project - India to host two peer-to-peer exchanges among experts from India, South Africa, Europe, and the United States to discuss the provision of ancillary services, particularly in the context of added variability and uncertainty from renewable energy. This factsheet provides a high level summary of the peer-to-peer consultation.

Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases

PubMed Central

Jordan, Kelvin; Clarke, Alexandra M; Symmons, Deborah PM; Fleming, Douglas; Porcheret, Mark; Kadam, Umesh T; Croft, Peter

2007-01-01

Background Primary care consultation data are an important source of information on morbidity prevalence. It is not known how reliable such figures are. Aim To compare annual consultation prevalence estimates for musculoskeletal conditions derived from four general practice consultation databases. Design of study Retrospective study of general practice consultation records. Setting Three national general practice consultation databases: i) Fourth Morbidity Statistics from General Practice (MSGP4, 1991/92), ii) Royal College of General Practitioners Weekly Returns Service (RCGP WRS, 2001), and iii) General Practice Research Database (GPRD, 1991 and 2001); and one regional database (Consultations in Primary Care Archive, 2001). Method Age-sex standardised persons consulting annual prevalence rates for musculoskeletal conditions overall, rheumatoid arthritis, osteoarthritis and arthralgia were derived for patients aged 15 years and over. Results GPRD prevalence of any musculoskeletal condition, rheumatoid arthritis and osteoarthritis was lower than that of the other databases. This is likely to be due to GPs not needing to record every consultation made for a chronic condition. MSGP4 gave the highest prevalence for osteoarthritis but low prevalence of arthralgia which reflects encouragement for GPs to use diagnostic rather than symptom codes. Conclusion Considerable variation exists in consultation prevalence estimates for musculoskeletal conditions. Researchers and health service planners should be aware that estimates of disease occurrence based on consultation will be influenced by choice of database. This is likely to be true for other chronic diseases and where alternative symptom labels exist for a disease. RCGP WRS may give the most reliable prevalence figures for musculoskeletal and other chronic diseases. PMID:17244418

Initial development of the recovery-oriented services assessment: A collaboration with peer-provider consultants.

PubMed

Lodge, Amy C; Kuhn, Wendy; Earley, Juli; Stevens Manser, Stacey

2018-06-01

The Recovery Self-Assessment (RSA) is a reliable and valid tool used to measure recovery-oriented services. Recent studies, however, suggest that the length and reading level of the RSA makes its routine use in service settings difficult. Recognizing the importance of including people with lived experience of a mental health challenge in research processes and the need to enhance the utility of tools that measure recovery-oriented services, this paper describes an innovative researcher-peer provider consultant multistep process used to revise the provider version of the RSA to create a new instrument-the Recovery-Oriented Services Assessment (ROSA). The authors conducted an exploratory factor analysis (EFA) with principal axis factoring extraction and direct oblimin rotation to evaluate the underlying structure of the provider RSA using data from mental health employees (n = 323). To triangulate the findings of the EFA, quantitative and qualitative data were collected from peer provider consultants (n = 9) on the importance of and language of RSA items. EFA results indicated that a 1-factor solution provided the best fit and explained 48% of the total variance. Consultants triangulated EFA results and recommended the addition of 2 items and language revisions. These results were used to develop the ROSA-a 15-item instrument measuring recovery-oriented services with accessible language. Two versions of the ROSA were developed: a staff version and a people-in-services version. The ROSA may provide organizations with a more accessible way to measure the extent to which their services are recovery oriented. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Route to Success: A Leader School's Youth Consultant Program. Linking Learning with Life.

ERIC Educational Resources Information Center

Kelley, Jennifer; Specter, Joanna; Young, Jamaal

This booklet explains how high schools can replicate the service learning youth consultant program that was originally formed at Spring Valley High School (SVHS) in Columbia, South Carolina, in 1996 to assume governance of SVHS's service learning program, which is called VikingServe. The booklet begins with an overview of VikingServe and a listing…

Towards an Understanding of Factors Influencing Early Years Professionals' Practice of Consultation with Young Children

ERIC Educational Resources Information Center

Davies, Sarah; Artaraz, Kepa

2009-01-01

Recent Government agendas in England highlight a need to involve children in policy and service design, provision and evaluation of services they use or which affect them. While consultation with older children has become more common, this is not the case for younger children. This article reports on a study exploring the current practice and…

An Exploratory Trial of the Effectiveness of an Enhanced Consultative Approach to Delivering Speech and Language Intervention in Schools

ERIC Educational Resources Information Center

Mecrow, Carol; Beckwith, Jennie; Klee, Thomas

2010-01-01

Background: Increased demand for access to specialist services for providing support to children with speech, language and communication needs prompted a local service review of how best to allocate limited resources. This study arose as a consequence of a wish to evaluate the effectiveness of an enhanced consultative approach to delivering speech…

Addressing Pediatric Health Concerns through School-Based Consultation

ERIC Educational Resources Information Center

Truscott, Stephen D.; Albritton, Kizzy

2011-01-01

In schools, the term "consultation" has multiple meanings. Often it is used to describe a quick, informal process of advice giving between teachers and/or school specialists. As a formal discipline, School-Based Consultation (SBC) is an indirect service delivery model that involves two or more parties working together to benefit students. Most…

Changing Residential Child Care: A Systems Approach to Consultation Training and Development

ERIC Educational Resources Information Center

Gibson, Johnnie; Leonard, Marcella; Wilson, Mena

2004-01-01

In this article, the authors describe and illustrate their approach to consultancy, development and training in residential child care. When working together the authors form the MOSAIC Consortium and provide training and consultancy to residential child care services. The article draws on systems theory, systems thinking and the politics of child…

Consulting Careers: A Profile of Three Occupations

ERIC Educational Resources Information Center

Mullins, John

2011-01-01

Choosing an industry in which to work is often as important as choosing an occupation. And over the next several years, the best advice for some workers may be to choose an industry that sells advice: consulting. The management, scientific, and technical consulting services industry comprises businesses that offer specialized advice to other…

The Consulting Challenge: A Case Competition

ERIC Educational Resources Information Center

Sachau, Daniel A.; Naas, Patricia A.

2010-01-01

The Consulting Challenge is a yearly case competition in which teams of graduate students respond to a request for proposals (RFP) for consulting services. The case and RFP are based on a problem that a host organization has experienced. Over 3 days, students meet with representatives of the host organization, analyze data, prepare a proposal for…

Using Consultee-Centered Consultation with Teachers in a Contemporary School Setting to Inform Culturally Responsive Practice

ERIC Educational Resources Information Center

Castro-Villarreal, Felicia; Rodriguez, Billie Jo

2017-01-01

The National Association of School Psychologists (NASP) describes consultation as a practice that permeates all aspects of school psychological service delivery, and school consultation is increasingly recognized as a central and essential feature of practice in school-based problem-solving paradigms. This research examined teachers' experiences…

'What makes an excellent mental health doctor?' A response integrating the experiences and views of service users with critical reflections of psychiatrists.

PubMed

Gunasekara, Imani; Patterson, Sue; Scott, James G

2017-11-01

While therapeutic relationships are appropriately recognised as the foundation of mental health service, service users commonly report suboptimal experiences. With shared understanding critical to improvement in practice, we explored service users' experiences and expectations of psychiatrists and consultations, engaging psychiatrists throughout the process. Using an iterative qualitative approach we co-produced a response to the question 'what makes an excellent mental health doctor?' Experiences and expectations of psychiatrists were explored in interviews with 22 service users. Data collection, analysis and interpretation were informed by consultation with peer workers. Findings were contextualised in formal consultations with psychiatrists. As 'masters of their craft', excellent mental health doctors engage authentically with service users as people (not diagnoses). They listen, validate experiences and empathise affectively and cognitively. They demonstrate phronesis, applying clinical knowledge compassionately. Psychiatrists share service users' aspiration of equitable partnership but competing demands and 'professional boundaries' constrain engagement. Consistent delivery of the person-centred, recovery-oriented care promoted by policy and sought by service users will require substantial revision of the structure and priorities of mental health services. The insights and experiences of service users must be integral to medical education, and systems must provide robust support to psychiatrists. © 2017 John Wiley & Sons Ltd.

75 FR 71097 - Commission Information Collection Activities (FERC-919); Comment Request; Submitted for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... professions including consultant economists, lawyers, and electrical engineers. The costs of engaging these... economist, lawyer, and electrical engineer according to Salary.com data. (See http://salary.com ). Public... electrical engineer according to Salary.com data, for the hours required in 18 CFR 35.37(a) for market power...

A Hierarchical Model and Analysis of Factors Affecting the Adoption of Timber as a Bridge

Treesearch

Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

1995-01-01

The Analytical Hierarchy Process was used to characterize the bridge material selection decisions of highway engineers and local highway officials across the United States. State Department of Transportation engineers, private consulting engineers, and local highway officials were personally interviewed in Mississippi, Virginia, Washington, and Wisconsin to identify...

Consultant paediatric outreach clinics--a practical step in integration.

PubMed

Spencer, N J

1993-04-01

Ten years' experience of paediatric outreach clinics is reviewed and evaluated. The advantages and disadvantages of paediatric outreach and its possible place in the new era of contracting and more developed community paediatric services are discussed. It is concluded that paediatric outreach increases parental and professional choice and access to paediatric consultant services, increases service flexibility, reduces unnecessary hospital visits, and enables more rational and relevant clinical decision making. Outreach is particularly relevant in areas of deprivation where paediatric needs are greatest.

Consultant paediatric outreach clinics--a practical step in integration.

PubMed Central

Spencer, N J

1993-01-01

Ten years' experience of paediatric outreach clinics is reviewed and evaluated. The advantages and disadvantages of paediatric outreach and its possible place in the new era of contracting and more developed community paediatric services are discussed. It is concluded that paediatric outreach increases parental and professional choice and access to paediatric consultant services, increases service flexibility, reduces unnecessary hospital visits, and enables more rational and relevant clinical decision making. Outreach is particularly relevant in areas of deprivation where paediatric needs are greatest. PMID:8503675

Optimizing BMP Placement at Watershed-Scale Using SUSTAIN. A presentation

EPA Science Inventory

SUSTAIN is intended to support local and county government engineers/planners, federal/state regulatory reviewers, private consulting engineers, concerned citizens, stakeholders, and academicians in the development of watershed-based management plans. The users are expec...

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

PubMed

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

2016-01-29

Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel--audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel--interviews, ethnographic observations and analysis of documents within the trust; macrolevel--key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: 'what to expect in your virtual consultation'. The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We anticipate that this study will contribute to a balanced assessment of when, how and in what circumstances this model might be introduced. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Evaluation of the Implementation of a New Nurse-Led Express "Test-And-Go" Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Service for Men Who Have Sex With Men at a Sexual Health Center in Melbourne, Australia.

PubMed

Chow, Eric P F; Fortune, Ria; Dobinson, Sheranne; Wakefield, Trish; Read, Tim R H; Chen, Marcus Y; Bradshaw, Catriona S; Fehler, Glenda; Fairley, Christopher K

2018-06-01

In August 2015, a nurse-led express human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing service "Test-And-Go" (TAG) for asymptomatic men who have sex with men (MSM) was implemented in a large public sexual health center in Melbourne, Australia. We aimed to compare the clients' characteristics between the TAG and routine walk-in service among asymptomatic MSM. This study was conducted at the Melbourne Sexual Health Centre, Australia, between August 5, 2015, and June 1, 2016. General estimating equation logistic regression models were constructed to examine the association between the use of TAG service and clients' demographic characteristics, sexual behaviors, and HIV/STI positivity. Clients' consultation and waiting times for both services were calculated. Of the 3520 consultations, 784 (22.3%) were TAG services and 2736 (77.7%) were routine walk-in services for asymptomatic MSM. Asymptomatic MSM were more likely to use the TAG service if they were born in Australia (adjusted odds ratio, 1.29; 95% confidence interval, 1.07-1.56), and had more than 6 male partners in the last 12 months (adjusted odds ratio, 1.13; 95% confidence interval, 1.08-1.58). Age, HIV status, condomless anal sex and HIV/STI positivity did not differ between the two services. The TAG service had a shorter median waiting time (8.4 minutes vs 52.9 minutes; p < 0.001) and consultation time (8.9 minutes vs 17.6 minutes; p < 0.001) than the routine walk-in service. Although country of birth and sexual behaviors differed between clients attending the 2 services, there were no differences in HIV and STI positivity. Importantly, the TAG service required less waiting and consultation time and hence created additional clinic capacity at the general clinic to see clients who are at higher risk.

Implementing Routine Palliative Care Consultation Before LVAD Implantation: A Single Center Experience.

PubMed

Salomon, Say; Frankel, Hilary; Chuang, Elizabeth; Eti, Serife; Selwyn, Peter

2018-05-01

Left ventricular assist devices (LVADs) are increasingly used to improve quality of life for end-stage heart failure patients. The Joint Commission now requires preimplantation palliative care assessment; however, many palliative care teams have little experience providing this service. To describe the integration of palliative services at one Center of Excellence for Heart and Vascular Care. This is a retrospective chart review of all patients receiving LVADs at a single urban academic medical center from January 2015 to September 2016. Palliative care needs and services provided are described. Two case presentations illustrate the collaboration between the cardiothoracic and palliative care teams. Fifty one patients were included. Of those, 28 received a palliative care consultation during this roll-out period. The rate of consultation rose from 35% to 71% as workflows improved with institutional commitment. Symptom assessment, psychosocial assessment, and advance care planning (ACP) were always performed (n = 28; 100%). More than half of the patients were evaluated for dyspnea (n = 20; 71%), fatigue (n = 18; 64%), and pain (n = 16; 57%). Consults centered around ACP, and very few patients (n = 7; 25%) required palliative care follow-up. Palliative consultation did not delay LVAD placement. Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

First contact: acute stress reactions and experiences of emergency department consultations following an incident of intimate partner violence.

PubMed

Olive, Philippa

2017-08-01

The aim of this research was to explore women's emotional and affective responses following an incident of intimate partner violence experienced during emergency department attendances. A growing body of research has explored women's experiences of emergency departments following intimate partner violence still little remains known about the experience and impact of emotional and affective responses during these attendances. A descriptive qualitative design was used, underpinned theoretically by critical realism and postmodern complexity theory to attend to multiple, intersecting mechanisms that lie behind events and experiences. Semistructured interviews with six women who had attended an emergency department directly following an incident of intimate partner violence. Interview data were transcribed and thematically analysed in nvivo9 using a coding framework. There were three interconnected key findings. First, was the commonality of acute stress experiences among women attending an emergency department following partner violence, second was that these acute stress reactions negatively impacted women's consultations, and third was the need for specialist domestic violence services at the point of first contact to assist service users navigate an effective consultation. Acute stress reactions were an important feature of women's experiences of emergency department consultations following intimate partner violence. Attending to psychological first aid; providing a safe and quiet space; and affording access to specialist violence advocacy services at the point of first contact will limit harm and improve health consultation outcomes for this population. This research provides an account of emotional and affective responses experienced by women attending emergency departments following intimate partner violence and explicates how these acute stress reactions impacted their consultation. This research has relevance for practitioners in many first contact health services, such as urgent and emergency care, general practice, community public health and mental health. © 2016 John Wiley & Sons Ltd.

A survey of direct-to-consumer teledermatology services available to US patients: Explosive growth, opportunities and controversy.

PubMed

Fogel, Alexander L; Sarin, Kavita Y

2017-01-01

Introduction Direct-to-consumer (DTC) teledermatology is radically changing the way patients obtain dermatological care. Now, with a few clicks, patients can obtain dermatological consultations and prescription medications without a prior physician-patient relationship. To analyse all DTC teledermatology services available to US patients. Methods We performed Internet searches to identify DTC teledermatology services available through Internet webpages or through smartphone applications. For each service, the scope of care provided, cost, wait times, prescription policies and other relevant information were recorded. Results Twenty-two DTC teledermatology services are available to US patients in 45 states. Six (27%) services offer care from international physicians. Sixteen (73%) services allow patients to seek care for any reason, while six (27%) limit care to acne or anti-aging. The median reported response time for DTC teledermatology services is 48 hours from the time of patient request. The median consultation fee for companies providing care from US board-certified physicians is US$59. Across all services, consultation fees range from US$1.59 to US$250. Conclusions DTC teledermatology services are readily available to patients in most states. These services may reduce the cost of patient visits, expand access to care and increase patient convenience. However, the presence of services staffed by physicians who are not US board-certified, as well as the use of incautious language regarding prescription medications, is concerning.

Using Genre Analysis To Teach Writing in Engineering. Report on a Pilot Video-Teleconference for Engineering Teaching Assistants and Writing Center Consultants.

ERIC Educational Resources Information Center

Alford, Elisabeth; And Others

A pilot project tested and evaluated teleconferencing as a medium for training engineering teaching assistants in technical writing. The teleconference, which linked 15 participants in the engineering departments and writing centers of the University of South Carolina and Ohio State University, also included a training session on the use of genre…

Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya

PubMed Central

Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

2017-01-01

Abstract The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client–provider consultation sessions. The cross-sectional study observed 366 client–provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63–0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07–14.21), adequate infrastructure (5.29; 95% CI: 2.89–7.69) and reagents (1.48; 95% CI: 1.02–1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92–4.36), job satisfaction (2.02; 95% CI: 1.21–2.83) and supervision (1.01; 95% CI: 0.35–1.68), while workload (−0.88; 95% CI: −1.75 to − 0.01) was negatively associated. Technical quality of the client–provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client–provider consultation sessions as measured by both health facility structural and provider factors. PMID:29194543

Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya.

PubMed

Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

2017-11-01

The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility structural and provider factors. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Impact of a radio frequency management information system on the process and timing of providing respiratory care services.

PubMed

Stoller, James K; Kester, Lucy; Orens, Douglas K; McCarthy, Kevin

2002-08-01

Although radio frequency (RF) systems have proliferated and are designed to simplify care delivery in many clinical settings, little information is available on the impact of such RF systems on the delivery of patient care. Having used a hand-held-device-based management information system in our Respiratory Therapy Section for 16 years, we assessed the impact of an RF system on the delivery of respiratory therapy (RT) services. A single nursing unit dedicated to pulmonary and ear, nose, and throat care was selected for the RF system trial. Baseline (pre-RF) data were collected over 2 separate 1-month intervals (February 1999 and February 2000). The main outcome measures were (1) the amount of time needed at the beginning of the shift to organize and assign orders for RT services, (2) the time interval between notification of an RT consult order and completion of the RT consult, and (3) the time interval between notification of an RT treatment order and completion of the RT treatment. The activities required for organizing and assigning the orders were manually timed. Starting 6 weeks after therapists were trained to use the RF system, similar data were collected while using the RF system for two 1-month intervals (February and March 2001). The mean +/- SD time interval between receiving an RT consult order and completing the consult was reduced from 7.8 +/- 18.9 h to 2.8 +/- 2.4 h (p = 0.002). The percentage of patients who waited longer than 8 hours between receipt of a consult order and completion of the consult decreased from 18% to 4.7% (p = 0.026). The total time required for organizing and assigning RT work was reduced from 81.6 min to 43.6 min. The RF system had several advantages over the hand-held-device-based system: (1) shorter interval between the order for and completion of an RT consult, (2) lower percentage of patients for whom the interval between the order and the consult exceeded 8 hours, and (3) less time required to make shift assignments. These results invite assessment of whether accelerated delivery of RT services confers clinical benefits.

Effect of loss control service on reported injury incidence.

PubMed

Nave, Michael E; Veltri, Anthony

2004-01-01

A retrospective analysis evaluated the effectiveness of an insurance carrier's flexible loss control service strategy in reducing workers' compensation policyholders' reported injury and illness claims. To assess the effects of a loss control service strategy on workers' compensation claim frequency rates, on medical-only claim rates, on severity-claim rates, and on claim cost among a group of California employers. Eighty-two small- and medium-sized companies with workers' compensation policies expiring in 1999 were randomly selected from a population of policyholders assigned to loss control consultants for two or more years. Claim performance data were obtained for each company's first expired in-force policy year and its 1999 expired policy year. The retrospective design was combined with a control component based on a randomly selected comparison group of 45 companies whose first policy year with the insurer expired in 1999 and who received safety services from the loss control staff. The flexible loss control consultation service strategy was associated with lower average claim rates and costs. Companies assigned to a loss control consultant for two or more years (the "outcome group") had an average claim rate of 1.24 per $10,000 premium, compared with a rate of 1.62 in the "initial group" and a rate of 1.60 in the "comparison group." The average severity-claim rate of the outcome group was 0.32, compared with the initial-year and comparison-group means of 0.48 and 0.46, respectively. The average medical-only claim rate was 0.92, compared with the initial- and comparison-group means of 1.14 and 1.14. The outcome group's average loss ratio was over 10% lower than that of the initial and comparison groups. Statistical analysis indicated that differences among the groups' claim rates and severity-claim rates were [F=(2,206) 4.938, P=0.008] and [F=(2,206) 8.208, P<0.001], respectively. A loss control service strategy that provides service flexibility and develops partnership between employer and consultant can help reduce the frequency and severity of workers' compensation claims. Barriers to consultation service flexibility, both internal and external, should be identified and removed to enhance service efficacy.

Learning together for effective collaboration in school-based occupational therapy practice.

PubMed

Villeneuve, Michelle A; Shulha, Lyn M

2012-12-01

School-based occupational therapy (SBOT) practice takes place within a complex system that includes service recipients, service providers, and program decision makers across health and education sectors. Despite the promotion of collaborative consultation at a policy level, there is little practical guidance about how to coordinate multi-agency service and interprofessional collaboration among these stakeholders. This paper reports on a process used to engage program administrators in an examination of SBOT collaborative consultation practice in one region of Ontario to provide an evidence-informed foundation for decision making about implementation of these services. Within an appreciative inquiry framework (Cooperrider, Whitney, & Stavros, 2008), Developmental Work Research methods (Engeström, 2000) were used to facilitate shared learning for improved SBOT collaborative consultation. Program administrators participated alongside program providers and service recipients in a series of facilitated workshops to develop principles that will guide future planning and decision making about the delivery of SBOT services. Facilitated discussion among stakeholders led to the articulation of 12 principles for effective collaborative practice. Program administrators used their shared understanding to propose a new model for delivering SBOT services. Horizontal and vertical learning across agency and professional boundaries led to the development of powerful solutions for program improvement.

Use of specialty OB consults during high-risk pregnancies in a Medicaid-covered population: initial impact of the Arkansas ANGELS intervention.

PubMed

Bronstein, Janet M; Ounpraseuth, Songthip; Jonkman, Jeffrey; Fletcher, David; Nugent, Richard R; McGhee, Judith; Lowery, Curtis L

2012-12-01

This study examines the impact of a Medicaid-supported intervention (Antenatal and Neonatal Guidelines, Education and Learning System) to expand a high-risk obstetrics consulting service on the use of specialty consults between 2001 and 2006. Using a Medicaid claims-birth certificate data set, we find a decline over time in use of specialty consults for lower risk diagnoses and a shift to remote modalities for contact. Local physician participation in grand rounds via teleconference was associated both with specialty contact and use of remote modalities. Local physician use of a Call Center service was also associated with patient specialty contact. Expansion of telemedicine remote sites did not increase the likelihood of contact but was associated with the shift toward remote modalities. Specialty consult use and modality were influenced by the care context of the patient, particularly level of pregnancy risk, the specialty of the primary prenatal care provider, the timing of her prenatal care, and her ethnicity and education level.

42 CFR 86.13 - Project requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

...), a school of nursing, a school of public health or its equivalent, and a school of engineering or its... career categories, e.g., industrial toxicology, biostatistics, epidemiology, and ergonomics. Training... engineering, among others, by providing curriculum materials and consultation for curriculum/course...

33 CFR 385.31 - Adaptive management program.

Code of Federal Regulations, 2013 CFR

2013-07-01

....31 Section 385.31 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE PROGRAMMATIC REGULATIONS FOR THE COMPREHENSIVE EVERGLADES RESTORATION PLAN... Engineers and the South Florida Water Management District shall, in consultation with the Department of the...

33 CFR 385.31 - Adaptive management program.

Code of Federal Regulations, 2012 CFR

2012-07-01

....31 Section 385.31 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE PROGRAMMATIC REGULATIONS FOR THE COMPREHENSIVE EVERGLADES RESTORATION PLAN... Engineers and the South Florida Water Management District shall, in consultation with the Department of the...

33 CFR 385.31 - Adaptive management program.

Code of Federal Regulations, 2014 CFR

2014-07-01

....31 Section 385.31 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE PROGRAMMATIC REGULATIONS FOR THE COMPREHENSIVE EVERGLADES RESTORATION PLAN... Engineers and the South Florida Water Management District shall, in consultation with the Department of the...

33 CFR 385.31 - Adaptive management program.

Code of Federal Regulations, 2011 CFR

2011-07-01

....31 Section 385.31 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE PROGRAMMATIC REGULATIONS FOR THE COMPREHENSIVE EVERGLADES RESTORATION PLAN... Engineers and the South Florida Water Management District shall, in consultation with the Department of the...

Revenue Potential for Inpatient IR Consultation Services: A Financial Model.

PubMed

Misono, Alexander S; Mueller, Peter R; Hirsch, Joshua A; Sheridan, Robert M; Siddiqi, Assad U; Liu, Raymond W

2016-05-01

Interventional radiology (IR) has historically failed to fully capture the value of evaluation and management services in the inpatient setting. Understanding financial benefits of a formally incorporated billing discipline may yield meaningful insights for interventional practices. A revenue modeling tool was created deploying standard financial modeling techniques, including sensitivity and scenario analyses. Sensitivity analysis calculates revenue fluctuation related to dynamic adjustment of discrete variables. In scenario analysis, possible future scenarios as well as revenue potential of different-size clinical practices are modeled. Assuming a hypothetical inpatient IR consultation service with a daily patient census of 35 patients and two new consults per day, the model estimates annual charges of $2.3 million and collected revenue of $390,000. Revenues are most sensitive to provider billing documentation rates and patient volume. A range of realistic scenarios-from cautious to optimistic-results in a range of annual charges of $1.8 million to $2.7 million and a collected revenue range of $241,000 to $601,000. Even a small practice with a daily patient census of 5 and 0.20 new consults per day may expect annual charges of $320,000 and collected revenue of $55,000. A financial revenue modeling tool is a powerful adjunct in understanding economics of an inpatient IR consultation service. Sensitivity and scenario analyses demonstrate a wide range of revenue potential and uncover levers for financial optimization. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Final Nellis Air Force Base Capital Improvements Program Environmental Assessment

DTIC Science & Technology

2013-08-01

USCB United States Census Bureau USFWS United States Fish and Wildlife Service VOC Volatile Organic Compound WINDO Wing Infrastructure and...desert tortoise, consultation with the United States (U.S.) Fish and Wildlife Service would be initiated. Consultation with the U.S. Army Corps of...and decrease energy consumption on military installations. The projects described in the CIP are derived from the Base Comprehensive Asset Management

Supporting self and others: from staff nurse to nurse consultant. Part 1: chocolate and Marmite!

PubMed

Fowler, John

This series of articles explores various ways of supporting staff who work in the fast-moving and ever-changing health service. In this first article, John Fowler, an experienced nursing lecturer, author and consultant, examines the importance of developing an informal working culture of support from both the individual's perspective and from the perspective of the health service management.

Factors Affecting the Transportability of the State Consultant Model to Another Region: The Mutual Adaptation of the State Consultant Model and of the Structure of AEL's Educational Services Office.

ERIC Educational Resources Information Center

Sanders, Jack

The Educational Services Office (ESO) of the Appalachia Educational Laboratory (AEL) sought an organizational strategy that would improve its ability to meet client demand without sacrificing the integrity of its programs or the fulfillment of its institutional responsibilities. Three alternative organizational strategies were identified:…

Monitoring Treatment Integrity: An Alternative to the "Consult and Hope" Strategy in School-Based Behavioural Consultation

ERIC Educational Resources Information Center

Wilkinson, Lee A.

2006-01-01

An international trend in school psychology services is a shift from an emphasis on assessment-based activities to a paradigm of consultation problem-solving and behavioural intervention. As the profession experiences an expansion of roles and functions, school psychologists should have an understanding of a critical aspect of behaviour change:…

A Fish out of Water? Management Consultants in Academia

ERIC Educational Resources Information Center

Serrano-Velarde, Kathia

2010-01-01

What happens when management consultants enter the academic arena and offer their services to universities? In the following article, we examine this question by drawing on findings from a qualitative study based on a series of 30 interviews with senior management consultants and academic managers in Germany. The aim of this explorative study is,…

77 FR 9883 - Tribal Consultation Meetings Regarding Requirements Applicable to Title IV-B Child and Family...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-21

... Tribal Consultation Meetings Regarding Requirements Applicable to Title IV-B Child and Family Services...: Notice of tribal consultation. SUMMARY: The title IV-B regulations regarding the title IV-B plan and... title IV-B, subpart 1 and/or title IV-B, subpart 2 program and any other interested party. We provide...

The Role of Agricultural Consultants in New Zealand in Environmental Extension

ERIC Educational Resources Information Center

Botha, Neels; Coutts, Jeff; Roth, Hein

2008-01-01

The aim of this study was to understand the role that agricultural consultants in New Zealand were undertaking in the Research, Development and Extension (RD&E) system--and in particular in relation to environmental extension. New Zealand does not have a public extension service and hence there is a strong reliance on consultants and regional…

Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008.

PubMed

Menz, Hylton B

2009-10-30

In 2004, as an extension of the Enhanced Primary Care (EPC) program, the Australian Government introduced a policy of providing Medicare rebates for allied health services provided to patients with chronic or complex health conditions. The objective of this study was to evaluate the utilisation of podiatry services provided under this scheme between 2004 and 2008. Data pertaining to the Medicare item 10962 for the calendar years 2004-2008 were extracted from the Australian Medicare Benefits Schedule (MBS) database and cross-tabulated by sex and age. Descriptive analyses were undertaken to assess sex and age differences in the number of consultations provided and to assess for temporal trends over the five-year assessment period. The total cost to Medicare over this period was also determined. During the 2004-2008 period, a total of 1,338,044 EPC consultations were provided by podiatrists in Australia. Females exhibited higher utilisation than males (63 versus 37%), and those aged over 65 years accounted for 75% of consultations. There was a marked increase in the number of consultations provided from 2004 to 2008, and the total cost of providing EPC podiatry services during this period was $62.9 M. Podiatry services have been extensively utilised under the EPC program by primary care patients, particularly older women, and the number of services provided has increased dramatically between 2004 and 2008. Further research is required to determine whether the EPC program enhances clinical outcomes compared to standard practice.

eCONSULTS TO ENDOCRINOLOGISTS IMPROVE ACCESS AND CHANGE PRIMARY CARE PROVIDER BEHAVIOR.

PubMed

Tran, Christopher S; Liddy, Clare E; Liu, Dora M; Afkham, Amir; Keely, Erin J

2016-10-01

To describe the impact of an eConsult service on access to endocrinologists along with its influence on changing primary care provider (PCP) course of action and referral behaviors. Established in 2011, the Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to endocrinologists by PCPs between April 15, 2011 and January 31, 2015. Usage data and PCP responses to a mandatory closeout survey were analyzed to determine eConsult response times, PCP practice behavior, referral outcomes, and provider satisfaction. Each eConsult was coded according to clinical topic and question type based on established taxonomies. A total of 180 PCPs submitted 464 eConsults to endocrinology during the study period. Specialist median response time was 7 hours, with 90% of responses occurring within 3 days. PCPs received a new or additional course of action in 62% of submitted cases. An unnecessary face-to-face referral was avoided in 44% of all eConsults and in 67% of cases where the PCP initially contemplated requesting a referral. Over 95% of cases were rated at least 4 out of 5 in value for PCPs and their patients. The use of eConsult improves access to endocrinologists by providing timely, highly rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits. BASE = Building Access to Specialist Advice through eConsult PCP = primary care physician UCSF = University of California San Francisco.

Nationwide Interdisciplinary E-Consultation on Transgender Care in the Veterans Health Administration.

PubMed

Shipherd, Jillian C; Kauth, Michael R; Matza, Alexis

2016-12-01

Veteran's Health Administration (VHA) requires the provision of quality transgender care for the relatively large number of transgender veterans using VHA services. The Office of Patient Care Services has taken a multimethod approach to improving provider knowledge and skill for transgender veteran care. However, unique patient-specific questions can arise. Thus, VHA implemented a 3-year feasibility program to determine if nationwide interdisciplinary e-consultation can offer veteran-specific consultation to providers who treat transgender veterans in VHA. Launch of this program is described along with use to date, types of questions submitted by providers, and length of time to complete a response in the veteran's electronic medical record. In 17 months, the program responded to 303 e-consults, with consultation provided on the care of 230 unique veterans. Nationwide coverage was achieved 1 year after the launch of the program. Common consult questions have been about medications, including hormones (n = 125); primary care concerns (n = 97); mental health evaluations (n = 63); and psychotherapy (n = 18). Consistent with the interdisciplinary model, multiple disciplines typically responded to each consult (x = 2.27). Average time to completion of a consult was 5.9 calendar days (range = 2.4-7.7 days). VHA has established a nationwide interdisciplinary e-consultation program. Additional outreach about the program will be needed if funding is continued. E-consultation on transgender health within VHA is feasible and complements the suite of trainings offered within VHA. Other healthcare organizations may benefit from a similar program.

Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges.

PubMed

Bujoreanu, Simona; White, Matthew T; Gerber, Bradley; Ibeziako, Patricia

2015-05-01

The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals. Copyright © 2015 by the American Academy of Pediatrics.

The present and future role of the consultant physician with an interest in infection. Council of the British Society for the Study of Infection.

PubMed

1993-09-01

The Council of the British Society for the Study of Infection (BSSI) has considered the present and future role of the Consultant Physician with an interest in infection. The BSSI is anxious to set standards and improve the quality of care delivered to patients with infection; to give advice on the prevention and management of infection and to provide such services economically to assist Health Managers in the purchase of infection-related medical services appropriate to the needs of the community they serve. New approaches to the care of infected patients are reviewed where the Clinical Specialist, Microbiologist and Consultant in Communicable Disease Control (CCDC)--in Scotland, Consultant in Public Health Medicine (CPHM)--work together in a team. As the U.K. moves closer to its European partners in 1992, it seems timely for each specialty to make a clear statement about its training programme and the requirements expected of a fully trained Consultant in each discipline. Comparisons between the ratio of Consultants with a special interest in infection and the population are made, where known, between U.K. and other European countries. A model job description for the U.K. clinical specialist is therefore being made available, the present inadequate numbers of consultants are stated and recommendations made to expand urgently the number of Consultant Physicians with an interest in infection.

A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

PubMed

Kotecha, A; Brookes, J; Foster, P J

2017-06-01

PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.

The Five S’s: A Communication Tool for Child Psychiatric Access Projects

PubMed Central

Harrison, Joyce; Wasserman, Kate; Steinberg, Janna; Platt, Rheanna; Coble, Kelly; Bower, Kelly

2017-01-01

Given the gap in child psychiatric services available to meet existing pediatric behavioral health needs, children and families are increasingly seeking behavioral health services from their primary care clinicians (PCCs). However, many pediatricians report not feeling adequately trained to meet these needs. As a result, child psychiatric access projects (CPAPs) are being developed around the country to support the integration of care for children. Despite the promise and success of these programs, there are barriers, including the challenge of effective communication between PCCs and child psychiatrists. Consultants from the Maryland CPAP, the Behavioral Health Integration in Pediatric Primary Care (BHIPP) project, have developed a framework called the Five S’s. The Five S’s are Safety, Specific Behaviors, Setting, Scary Things, and Screening/Services. It is a tool that can be used to help PCCs and child psychiatrists communicate and collaborate to formulate pediatric behavioral health cases for consultation or referral requests. Each of these components and its importance to the case consultation are described. Two case studies are presented that illustrate how the Five S’s tool can be used in clinical consultation between PCC and child psychiatrist. We also describe the utility of the tool beyond its use in behavioral health consultation. PMID:27919566

Utilization of health care services in cancer patients with elevated fear of cancer recurrence.

PubMed

Champagne, Alexandra; Ivers, Hans; Savard, Josée

2018-05-02

Cancer patients commonly report experiencing fear of cancer recurrence (FCR), which may lead to several negative consequences. This study aimed at examining whether clinical levels of FCR are linked to a greater use of health care services. This is a secondary analysis of a longitudinal study of 962 cancer patients on the epidemiology of cancer-related insomnia. They completed the Fear of Cancer Recurrence Inventory-Short form (FCRI-SF) and reported information on their consultations (medical, psychosocial, and complementary and alternative medicine [CAM]) and medication usage (anxiolytics/hypnotics and antidepressants) at 6 time points over an 18-month period. Results indicated that clinical FCR at baseline was associated with greater consultation rates of medical and psychosocial professionals and a greater usage of anxiolytics/hypnotics and antidepressants. No significant association was found between the FCR level and use of CAM services. While consultation rates of medical and CAM professionals and usage of antidepressants generally increased over time, consultation rates of psychosocial professionals and usage of anxiolytics/hypnotics tended to decrease. Cancer patients with clinical levels of FCR are more likely to consult health care providers and to use psychotropic medications, which may translate into significant costs for society and the patients themselves. Copyright © 2018 John Wiley & Sons, Ltd.

Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team.

PubMed

Desan, Paul H; Zimbrean, Paula C; Weinstein, Andrea J; Bozzo, Janis E; Sledge, William H

2011-01-01

Some studies suggest intensive psychiatric consultation services facilitate medical care and reduce length of stay (LOS) in general hospitals. To compare LOS between a consultation-as-usual model and a proactive consultation model involving review of all admissions, rapid consultation, and close follow-up. LOS was compared in an ABA design between a 33-day intervention period and 10 similar control periods, 5 before and 5 after the intervention, on an internal medical unit. During the intervention period, a staff psychiatrist met with the medical team each weekday, reviewed all admissions, provided immediate consultation as needed, and followed all cases throughout their hospital stay. Time required for initial case review was brief, 2.9 ± 2.2 minutes per patient (mean ± S.D.). Over 50% of admissions had mental health needs: 20.3% were estimated to require specialist consultation to avoid potential delay of discharge. The consultation rate for the intervention sample was 22.6%, significantly greater than in the control sample, 10.7%. Mean LOS was significantly shorter in the intervention sample, 2.90 ± 2.12 versus 3.82 ± 3.30 days, and the fraction of cases with LOS > 4 days was significantly lower, 14.5% versus 27.9%. A rough cost benefit analysis was favorable with at least a 4.2 ratio of financial benefit to cost. Psychiatric review of all admissions is feasible, indicates a high incidence of mental health barriers to discharge, identifies more necessary consultations than typically requested, and results in earlier consultation. A proactive consultation model can reduce hospital LOS. Copyright © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Trends in extramural consultation: comparison between subspecialized and general surgical pathology service models.

PubMed

Liu, Yong-Jun; Kessler, Meghan; Zander, Dani S; Karamchandani, Dipti M

2016-10-01

Academic and community hospital pathology groups are increasingly adopting subspecialized service models for surgical pathology (SP) practice. Reasons cited include improvements in sign-out efficiency, quality and accuracy, enhancement of clinician-pathologist communications, and augmentation of resident training quality. However, there is a paucity of published quantitative data regarding the outcomes of transitioning from general to subspecialized SP service coverage. Retrospective assessment of the frequencies and outcomes of SP extramural consultations requested by faculty at our institution was performed, encompassing 2 consecutive years each of subspecialized and general SP service models. The frequencies of extramural consultations between the 2 practice models were not significantly different (0.25% vs 0.21%, P = .142). Although more pathology cases were sent out in gastrointestinal (0.29% vs 0.14%, P = .007), gynecologic (0.16% vs 0.02%, P = .009), and pulmonary (1.73% vs 0.28%, P = .008) services during the "subspecialization" era, fewer pediatric cases were sent out (0.48% vs 1.69%, P = .008). Importantly, the transition to the subspecialized model was associated with a marked reduction in the frequency of major disagreements between the original diagnosis and the consultant's diagnosis (1.8% vs 9.3%, P = .018). Our study supports the value of the subspecialized SP sign-out model for increasing diagnostic accuracy and enhancing the quality of patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

Effective Antimicrobial Stewardship in a Long-Term Care Facility through an Infectious Disease Consultation Service: Keeping a LID on Antibiotic Use

PubMed Central

Jump, Robin L. P.; Olds, Danielle M.; Seifi, Nasim; Kypriotakis, Georgios; Jury, Lucy A.; Peron, Emily P.; Hirsch, Amy A.; Drawz, Paul E.; Watts, Brook; Bonomo, Robert A.; Donskey, Curtis J.

2014-01-01

Design We introduced a long-term care facility (LTCF) Infectious Disease (ID) consult service (LID) that provides on-site consultations to residents of a VA LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. Setting A 160-bed Veterans Affairs (VA) LTCF. Methods Systemic antimicrobial use and the rate of positive C. difficile tests at the LTCF were compared for 36 months before and 18 months after the initiation of the ID consultation service using segmented regression analysis of an interrupted time-series. Results In contrast to the pre-intervention period, total systemic antibiotic administration decreased by 30% (P <.001) with a significant reduction in both oral (32%; P<.001) and intravenous agents (25%; P =.008). The greatest reductions were seen for tetracyclines (64%, P <.001), clindamycin (61%; P <.001), sulfamethoxazole/trimethoprim (38%; P <.001), fluoroquinolones (38%; P <.001) and beta-lactam/beta-lactamase inhibitor combinations (28%; P <.001). Rates of change for positive C. difficile tests at the LTCF declined in the post- vs. preintervention periods (P = .04). Conclusions Implementation of a LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with infectious disease expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship. PMID:23143354

Application of Telemedicine in Gansu Province of China.

PubMed

Cai, Hui; Wang, Hongjing; Guo, Tiankang; Bao, Guoxian

2016-01-01

Telemedicine has become an increasingly popular option for long-distance health care and continuing education. As information and communication technology is underdeveloped in China, telemedicine develops slowly. At present, telemedicine consultation centers are situated mainly in developed cities, such as Beijing, Shanghai, and Guangzhou. In many less developed regions, such as northwest China, the conditions or related facilities are not available for the application of a better medical service. Accordingly, the aim of this paper was to introduce the construction and application of a telemedicine consultation center in Gansu Province in the northwest of China. In addition, the function of Gansu Provincial Telemedicine Consultation Center on emergency public events was introduced. As a whole, there was a great demand for telemedicine service in the local medical institutions. In the telemedicine consultation center, the telemedicine equipments and regulations were needed to be improved. The function of telemedicine service was not fully used, there was a large space to be applied and the publicity of telemedicine service was important. What is important was that telemedicine played a significance role in promoting the medical policy reform, improving the medical environment and launching the remote rescue in the emergency public events. This paper emphasizes the health care challenges of poor regions, and indicates how to share the high-quality medical service of provincial hospitals effectively and how to help residents in resource-poor environments.

Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study

PubMed Central

Barratt, Helen; Harrison, David A.; Raine, Rosalind; Fulop, Naomi J.

2015-01-01

Objectives In England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process. Methods A documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n = 20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories. Results The commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners’ dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven. Discussion Government policy emphasises the importance of clinical leadership and ‘evidence’ in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care. PMID:25975768

Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study.

PubMed

Barratt, Helen; Harrison, David A; Raine, Rosalind; Fulop, Naomi J

2015-09-01

In England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process. A documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n=20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories. The commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners' dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven. Government policy emphasises the importance of clinical leadership and 'evidence' in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Application of Telemedicine in Gansu Province of China

PubMed Central

Cai, Hui; Wang, Hongjing

2016-01-01

Telemedicine has become an increasingly popular option for long-distance health care and continuing education. As information and communication technology is underdeveloped in China, telemedicine develops slowly. At present, telemedicine consultation centers are situated mainly in developed cities, such as Beijing, Shanghai, and Guangzhou. In many less developed regions, such as northwest China, the conditions or related facilities are not available for the application of a better medical service. Accordingly, the aim of this paper was to introduce the construction and application of a telemedicine consultation center in Gansu Province in the northwest of China. In addition, the function of Gansu Provincial Telemedicine Consultation Center on emergency public events was introduced. As a whole, there was a great demand for telemedicine service in the local medical institutions. In the telemedicine consultation center, the telemedicine equipments and regulations were needed to be improved. The function of telemedicine service was not fully used, there was a large space to be applied and the publicity of telemedicine service was important. What is important was that telemedicine played a significance role in promoting the medical policy reform, improving the medical environment and launching the remote rescue in the emergency public events. This paper emphasizes the health care challenges of poor regions, and indicates how to share the high-quality medical service of provincial hospitals effectively and how to help residents in resource-poor environments. PMID:27332894

A Hierarchical Analysis of Bridge Decision Makers ... The Role of New Technology Adoption in the Timber Bridge Market: Special Project

Treesearch

Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

1995-01-01

Bridge design engineers and local highway officials make bridge replacement decisions across the United States. The Analytical Hierarchy Process was used to characterize the bridge material selection decision of these individuals. State Department of Transportation engineers, private consulting engineers, and local highway officials were personally interviewed in...

48 CFR 3.1101 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... financial interest, personal activity, or relationship that could impair the employee's ability to act... the covered employee's household; (ii) Other employment or financial relationships (including seeking...) Consulting relationships (including commercial and professional consulting and service arrangements...

Client Perceptions of Occupational Health and Safety Management System Assistance Provided by OSHA On-Site Consultation: Results of a Survey of Colorado Small Business Consultation Clients.

PubMed

Autenrieth, Daniel A; Brazile, William J; Gilkey, David P; Reynolds, Stephen J; June, Cathy; Sandfort, Del

2015-01-01

The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing occupational health and safety management systems (OHSMS) to small businesses. The Safety and Health Program Assessment Worksheet (Revised OSHA Form 33) is the instrument used by consultants to assess an organization's OHSMS and provide feedback on how to improve a system. A survey was developed to determine the usefulness of the Revised OSHA Form 33 from the perspective of Colorado OSHA consultation clients. One hundred and seven clients who had received consultation services within a six-year period responded to the survey. The vast majority of respondents indicated that the Revised OSHA Form 33 accurately reflected their OHSMS and that information provided on the Revised OSHA Form 33 was helpful for improving their systems. Specific outcomes reported by the respondents included increased safety awareness, reduced injuries, and improved morale. The results indicate that the OHSMS assistance provided by OSHA consultation is beneficial for clients and that the Revised OSHA Form 33 can be an effective tool for assessing and communicating OHSMS results to business management. Detailed comments and suggestions provided on the Revised OSHA Form 33 are helpful for clients to improve their OHSMS.

Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor service.

PubMed

Umefjord, Göran; Petersson, Göran; Hamberg, Katarina

2003-10-22

In 1998 the Swedish noncommercial public health service Infomedica opened an Ask the Doctor service on its Internet portal. At no charge, anyone with Internet access can use this service to ask questions about personal health-related and disease-related matters. To study why individuals choose to consult previously-unknown doctors on the Internet. Between November 1, 2001, and January 31, 2002 a Web survey of the 3622 Ask the Doctor service users, 1036 men (29%) and 2586 (71%) women, was conducted. We excluded 186 queries from users. The results are based on quantitative and qualitative analysis of the answers to the question "Why did you choose to ask a question at Infomedica's 'Ask the Doctor' service?" 1223 surveys were completed (response rate 36 %). Of the participants in the survey 322 (26%) were male and 901 (74%) female. As major reasons for choosing to consult previously-unknown doctors on the Internet participants indicated: convenience (52%), anonymity (36%), "doctors too busy" (21%), difficult to find time to visit a doctor (16%), difficulty to get an appointment (13%), feeling uncomfortable when seeing a doctor (9%), and not being able to afford a doctors' visit (3%). Further motives elicited through a qualitative analysis of free-text answers were: seeking a second opinion, discontent with previous doctors and a wish for a primary evaluation of a medical problem, asking embarrassing or sensitive questions, seeking information on behalf of relatives, preferring written communication, and (from responses by expatriates, travelers, and others) living far away from regular health care. We found that that an Internet based Ask the Doctor service is primarily consulted because it is convenient, but it may also be of value for individuals with needs that regular health care services have not been able to meet.

Related factors in using a free breastfeeding hotline service in Taiwan.

PubMed

Wang, Shu-Fang; Chen, Chao-Huei; Chen, Chung-Hey

2008-04-01

This study aimed to examine the use of a free hotline service for breastfeeding mothers in Taiwan. Specific attention was given to the accumulated consultation time and to investigate the trends and reasons that prompted people to contact the service. Breastfeeding can be a difficult time for mothers, especially during the first two weeks after birth. It has been suggested that a telephone hotline service may be helpful for breastfeeding mothers. In this quantitative study data, including the demographic data and the problems of consultations, were gathered from callers during August 2003 to August 2005. Of the 2445 callers, 935 made subsequent calls (38.2%). Approximately 25.25 calls were answered each day by two specially-trained staff according to an answering book. The mean consultation time for single first-call was 21.82 minutes and for one subsequent-call was 15.87 minutes. Perceived insufficient milk supply (30%) and returning to work (21%) were the top two reasons for a first-call. If callers' problems were about babies' sickness, perceived insufficient milk supply, babies' body weight gain and supplement issues, the accumulated consultation time would last longer. More than half (53.3%; 1303/2445) of callers made the first-call during the first month after birth, followed by 23.2% (566/2445) during babies' age between one and three months old. The telephone hotline service for breastfeeding mothers in Taiwan was well used during the two year period of this study. Many mothers used the service repeatedly for a variety of reasons. Recommendations for breastfeeding support strategies for the professionals include category of common breastfeeding problems by different stages after birth. This study supports the establishment of free hotline services may encourage greater empowerment in breastfeeding mothers. Future studies are required to examine client satisfaction of the telephone service.

Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.

PubMed

Zennaro, Floriana; Grosso, Daniele; Fascetta, Riccardo; Marini, Marta; Odoni, Luca; Di Carlo, Valentina; Dibello, Daniela; Vittoria, Francesca; Lazzerini, Marzia

2014-07-28

The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures. Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10). Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88). Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

Philip T. Pienkos | NREL

Science.gov Websites

Valorization: Development of a Methane-to-Adipic Acid Bioprocess (consultant) Areas of Expertise Molecular engineering Enzyme and protein engineering Techno-economic analysis Education Ph.D., Molecular Biology Principal Research Supervisor, NREL, Aug. 2007-May 2011 Research Director, Molecular Logix, Inc., The

Quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia.

PubMed

Tafese, Fikru; Woldie, Mirkuzie; Megerssa, Berhane

2013-11-01

Good quality of care in family planning (FP) services help individuals and couples to meet their reproductive health needs safely and effectively. Therefore, assessment and improvement of the quality of family planning services could enhance family planning services utilization. This study was thus conducted to assess the quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia. A cross-sectional facility based study was conducted from March 1(st)-25(th), 2011 among family planning clients of government primary health care centers in southwest Ethiopia. Exit interview of 301 family planning clients identified through systematic random sampling technique was carried out using a pre-tested structured questionnaire. Availability of resources was checked using provider interview and inventory checklist. Moreover, a total of 150 consultation sessions were observed using checklist. Descriptive statistics and linear regression coefficients were generated to meet the objective of the study. There was a shortage of some medical equipment, trained staffs, and information education and communication materials (IEC) in all of the family planning clinics. The mean waiting time at the service delivery points and consultation duration were 16.4 and 10.5 minutes, respectively. The providers used at least one information education and communication material in 33.3% of the consultation sessions. The overall satisfaction score was 8.64. Clients' perception on adequacy of information during consultation (β=0.24; ( 95%CI=0.02-0.16) ease of getting the clinic site, short waiting time (β=0.17; 95%CI=0.15-029) and educational level (β=0.09; 95%CI =0.09-0.29) were significantly associated with overall satisfaction. The findings of this study showed that there was lack of critical resources for the provision of quality family planning services in all of the primary health care centers included in the study. This has affected important aspects of service provision including the use of IEC materials during consultations. Hence, it is advisable that health managers of the health facilities and the district health office ensure improved availability of trained personnel, IEC materials and other supplies at the clinics.

Ultraviolet spectrometer and polarimeter (UVSP) software development and hardware tests for the solar maximum mission

NASA Technical Reports Server (NTRS)

Bruner, M. E.; Haisch, B. M.

1986-01-01

The Ultraviolet Spectrometer/Polarimeter Instrument (UVSP) for the Solar Maximum Mission (SMM) was based on the re-use of the engineering model of the high resolution ultraviolet spectrometer developed for the OSO-8 mission. Lockheed assumed four distinct responsibilities in the UVSP program: technical evaluation of the OSO-8 engineering model; technical consulting on the electronic, optical, and mechanical modifications to the OSO-8 engineering model hardware; design and development of the UVSP software system; and scientific participation in the operations and analysis phase of the mission. Lockheed also provided technical consulting and assistance with instrument hardware performance anomalies encountered during the post launch operation of the SMM observatory. An index to the quarterly reports delivered under the contract are contained, and serves as a useful capsule history of the program activity.

42 CFR 137.320 - Is the Secretary required to consult with affected Indian Tribes concerning construction projects...

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Notification (prioritization Process, Planning, Development and Construction) § 137.320 Is the Secretary required to consult with affected Indian Tribes...

Supporting the Inclusion of a Student with Asperger Syndrome: A Case Study Using Conjoint Behavioural Consultation and Self-Management

ERIC Educational Resources Information Center

Wilkinson, Lee A.

2005-01-01

Conjoint behavioural consultation (CBC) is an indirect form of service delivery that combines the resources of home and school to meet the academic, social and behavioural needs of children. The purpose of this paper is to demonstrate the utility of CBC as a service delivery model for supporting the inclusion of a student with Asperger syndrome in…

Appropriate Targets for Search Advertising as Part of Online Gatekeeping for Suicide Prevention.

PubMed

Sueki, Hajime; Ito, Jiro

2018-05-01

Gatekeeper training is an effective suicide prevention strategy. However, the appropriate targets of online gatekeeping have not yet been clarified. We examined the association between the outcomes of online gatekeeping using the Internet and the characteristics of consultation service users. An advertisement to encourage the use of e-mail-based psychological consultation services among viewers was placed on web pages that showed the results of searches using suicide-related keywords. All e-mails received between October 2014 and December 2015 were replied to as part of gatekeeping, and the obtained data (responses to an online questionnaire and the content of the received e-mails) were analyzed. A total of 154 consultation service users were analyzed, 35.7% of whom were male. The median age range was 20-29 years. Online gatekeeping was significantly more likely to be successful when such users faced financial/daily life or workplace problems, or revealed their names (including online names). By contrast, the activity was more likely to be unsuccessful when it was impossible to assess the problems faced by consultation service users. It may be possible to increase the success rate of online gatekeeping by targeting individuals facing financial/daily life or workplace problems with marked tendencies for self-disclosure.

Email consultations in general practice.

PubMed

Neville, Ron G; Marsden, Wendy; McCowan, Colin; Pagliari, Claudia; Mullen, Helen; Fannin, Allison

2004-01-01

Email is an established method of communication in business, leisure and education but not yet health care. To evaluate an email service enabling communication between patients and their general practice regarding repeat prescriptions, appointment booking and clinical enquiries. Qualitative analysis of interactions and an electronic user survey. An urban practice in Dundee, Scotland. 150 patients aged 24 to 85. We set up a practice facility to allow our patients to use email to book appointments, order repeat prescriptions and consult their general practitioner (GP). Patient satisfaction with the service was very high. Patients specifically commended the practice for setting up a facility to allow communication outside standard working hours and for the ease of ordering repeat prescriptions. Patients were pleased to have a means of seeking their doctor's comment or opinion without bothering him or her by making and attending a formal face-to-face consultation. Email dialogue was polite, factual, but less formal than standard letters. Staff did not experience any perceptible rise in workload. Use of an email consultation facility worked well within an urban practice, was deemed helpful by patients, and resulted in no apparent increase in GP workload. Our results suggest that there may be an unmet need amongst patients for clinical email services, and that such services may have positive outcomes for patients and practices.

Analysis of Parent, Teacher, and Consultant Speech Exchanges and Educational Outcomes of Students with Autism during COMPASS Consultation

ERIC Educational Resources Information Center

Ruble, Lisa; Birdwhistell, Jessie; Toland, Michael D.; McGrew, John H.

2011-01-01

The significant increase in the numbers of students with autism combined with the need for better trained teachers (National Research Council, 2001) call for research on the effectiveness of alternative methods, such as consultation, that have the potential to improve service delivery. Data from 2 randomized controlled single-blind trials indicate…

[Health services utilization by the adult population in São Leopoldo, Rio Grande do Sul State, Brazil: a cross-sectional study].

PubMed

Dias-da-Costa, Juvenal Soares; Olinto, Maria Teresa Anselmo; Soares, Simoni Assunção; Nunes, Marcelo Felipe; Bagatini, Tatiane; Marques, Maximiliano das Chagas; Guimarães, Lisiane Kiefer; Müller, Letícia Possebon; Machado, Fátima Carina de Souza; Barcellos, Eduardo dos Santos; Pattussi, Marcos Pascoal

2011-05-01

The aim was to describe healthcare utilization by adults in a Brazilian city. The outcomes were medical appointments in the previous month and use of public (Unified National Health System - SUS) versus private healthcare services. A population-based cross-sectional study with 1,098 adults aged 20 years or over was carried out. No medical appointment in the previous month was reported by 623 persons (56.7%, 95%CI: 53.8-59.7). Of the 487 individuals who had consulted a physician, 51.2% used the public healthcare system, 26.9% private care, and 22% other services. Consultation was associated with female gender and older age. Individuals in the intermediate categories for income, schooling, and socioeconomic status consulted less than the corresponding high and low categories. The results suggest that the middle class in this city lacks the purchasing power to seek care in the private sector while also using public services less, thus generally seeking healthcare less frequently.

Careers and Emerging Opportunities in Visual Communication in Medicine: Medical photography in Norway.

PubMed

Kjersem, Bård

2015-06-01

The community of medical photographers in Norway is relatively small. Except for one they are all employed with titles such as research technicians, department engineers, senior consultants and skilled workers. At the present there is no formal education in medical photography. The most common educational attainment for photographers is the Journeyman's certificate. Until recently, the requirement for employment for photographers at Norwegian hospitals was the Journeyman's Certificate. However, the Institutt for Klinisk Medisin at University in Oslo recently advertised a vacancy for a departmental Engineer to run its photographic and video services. The post required that the candidates possess either a Bachelor's degree in a relevant subject. This is the first vacancy in medical photography in nine years. The Norwegian health services have been reformed in the direction of New Public Management (NPM). To utilise the resources effectively, tasks that normally would be performed by one health profession are shifted to another with a different or lower education and training. There are reasons to believe that the shift of medical photography from professional photographers to other health personnel without specialist training or qualifications is an attempt to utilise resources more effectively. During the next two years a mixed methods research will be carried out to explore the current situation for medical photography in Norway.

Diabetes services in the UK: third national survey confirms continuing deficiencies.

PubMed

Jefferson, I G; Swift, P G F; Skinner, T C; Hood, G K

2003-01-01

To determine the current level of diabetes services and to compare the results with previous national surveys. A questionnaire was mailed to all paediatricians in the UK identified as providing care for children with diabetes aged under 16 years. Information was sought on staffing, personnel, clinic size, facilities, and patterns of care. Responses were compared with results of two previous national surveys. Replies were received from 244 consultant paediatricians caring for an estimated 17 192 children. A further 2234 children were identified as being cared for by other consultants who did not contribute to the survey. Of 244 consultants, 78% expressed a special interest in diabetes and 91% saw children in a designated diabetic clinic. In 93% of the clinics there was a specialist nurse (44% were not trained to care for children; 47% had nurse:patient ratio >1:100), 65% a paediatric dietitian, and in 25% some form of specialist psychology or counselling available. Glycated haemoglobin was measured routinely at clinics in 88%, retinopathy screening was performed in 87%, and microalbuminuria measured in 66%. Only 34% consultants used a computer database. There were significant differences between the services provided by paediatricians expressing a special interest in diabetes compared with "non-specialists", the latter describing less frequent clinic attendance of dietitians or psychologists, less usage of glycated haemoglobin measurements, and less screening for vascular complications. Non-specialist clinics met significantly fewer of the recommendations of good practice described by Diabetes UK. The survey shows improvements in services provided for children with diabetes, but serious deficiencies remain. There is a shortage of diabetes specialist nurses trained to care for children and paediatric dietitians, and a major shortfall in the provision of psychology/counselling services. The services described confirm the need for more consultant paediatricians to receive specialist training and to develop expertise and experience in childhood diabetes.

Pharmacist consultations in general practice clinics: the Pharmacists in Practice Study (PIPS).

PubMed

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2014-01-01

Medication-related problems (MRPs) are a concern in primary care settings. Pharmacists based in the community or community pharmacies are able to identify, resolve and prevent MRPs; however, the lack of a formal partnership with physicians and poor access to patients' medical records are limitations. In Australia, delivery of pharmacist services within general practice clinics is rare. To evaluate the effectiveness of consultations by pharmacists based within primary care medical practices. A prospective, before-after intervention study was conducted at two primary health care (general practice) clinics in Melbourne, Australia. Participants were clinic patients who had risk-factors for MRPs (e.g. polypharmacy). Patients received a consultation with the pharmacist in a private consulting room at the clinic or in their home. The pharmacist reviewed the patient's medication regimen and adherence, with full access to their medical record, provided patient education, and produced a report for the general practitioner. The primary outcome was the number of MRPs identified by the pharmacist, and the number that remained unresolved 6 months after the pharmacist consultation. Secondary outcomes included medication adherence, health service use, and patient satisfaction. Eighty-two patients were recruited and 62 (75.6%) completed the study. The median number of MRPs per patient identified by the practice pharmacist was 2 (interquartile range [IQR] 1, 4). Six months after review, this fell to 0 (IQR 0, 1), P < 0.001. The proportion of patients who were adherent to their medications improved significantly, according to both the Morisky (44.1% versus 62.7%, P = 0.023) and the Tool for Adherence Behaviour Screening (TABS) (35.6% versus 57.6%, P = 0.019) scales. There was no significant effect on health service use. Patients were highly satisfied with the pharmacist consultations. Consultations undertaken by pharmacists located within primary health care clinics were effective in identifying and resolving MRPs. The consultations were well received by patients and were associated with improvements in medication adherence. Copyright © 2014 Elsevier Inc. All rights reserved.

Psychiatric Consultation and Substance Use Disorders

PubMed Central

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

2009-01-01

Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals with SUD were identified and potentially sent for appropriate treatment, the likelihood is that many patients with SUD remain unrecognized and do not receive necessary consultative and treatment services. PMID:24357934

Psychiatric consultation and substance use disorders.

PubMed

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

2009-01-01

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

National Program for Inspection of Non-Federal Dams. Millen Lake Dam (NH 00236), NHWRB Number 245.04, Connecticut River Basin, Washington, New Hampshire. Phase I Inspection Report.

DTIC Science & Technology

1980-03-01

Engineering Branch Engineering Division CARNEY M. TERZIAN, KENBER Design Branch Engineering Division RICHARD DIBKO CHIRA Water Control Branch...State of New Hampshire. Authorization and notice to proceed were issued to S E A Consultants Inc. under a letter of November 5, 1979 from William

Perceptions of self-defined memory problems vary in south Asian minority older people who consult a GP and those who do not: a mixed-method pilot study.

PubMed

Giebel, Clarissa; Challis, David; Worden, Angela; Jolley, David; Bhui, Kamaldeep Singh; Lambat, Ahmed; Purandare, Nitin

2016-04-01

South Asian older adults access services for mental health problems and dementia less than other older people in the UK, unlike for physical health problems. This pilot study investigated how South Asians with self-defined memory problems, with and without GP consultation, construe the symptoms, causes, consequences and treatment of the condition. Participants were recruited through community centres, their networks and memory clinics in Greater Manchester. The newly developed Barts Explanatory Model Inventory for Dementia (BEMI-D) was administered to 33 (18 M, 15 F) older South Asians aged 65 or above with memory problems in English, Gujarati or Urdu. Furthermore, cognition, executive function and depression were assessed. Perceptions of dementia varied by GP consultation for memory problems. A greater proportion of older adults without a consultation considered memory problems to be given by God, saw acceptance of fate as an alternative treatment and did not identify medical support as appropriate. Forgetfulness and loss of social meaning were identified as symptoms of dementia more by those with a consultation. Higher levels of diabetes, heart disease and depression were found in those without a consultation. Differences in perceptions may influence the decision about consulting a GP. Similarly, consultation for memory problems appears linked to extent physical health problems and mental health consultation (depression). These variations reported on a small scale in this pilot study suggest the need to explore the impact of perceptions on rates of GP consultation, so as to improve timely diagnosis and access to appropriate services. Copyright © 2015 John Wiley & Sons, Ltd.

User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns-Results from a Danish GP Patient Survey.

PubMed

Kronborg, Christian; Pedersen, Line Bjørnskov; Fournaise, Anders; Kronborg, Christel Nøhr

2017-10-01

Increases in public expenditures to general practitioner (GP) services and specialist care have spurred debate over whether to implement user fees for healthcare services such as GP consultations in Denmark. The objective of this study was to examine Danish patients' attitudes towards user fees and their willingness to pay (WTP) for a consultation, and to investigate how user charges may impact patients' behaviour. A questionnaire survey was conducted in a GP clinic. A total of 343 individual persons answered the questionnaire. One hundred and seventy (50%) persons were not willing to pay for a consultation. Among patients reporting positive WTP values, the mean WTP was 137 (standard deviation 140) Danish kroner (DKK). Patients who were 65 years old or older were more likely to be willing to pay for a GP consultation than patients under the age of 65 years. Furthermore, patients with a personal annual income of more than 200,000 DKK were more likely to be willing to pay for a consultation than other income groups. With respect to patients with a positive WTP value, their own assessment of the seriousness of the consultation and their self-assessed health influenced the amount they would be willing to pay. Finally, we observed a stated willingness to substitute GP consultations with alternatives that are free of charge. About half of the patients with an appointment for a GP consultation are willing to pay for the consultation. User charges may potentially influence the patients' behaviour. ClinicalTrials.gov NCT01784731.

45 CFR 1180.57 - Use of consultants.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES GRANTS REGULATIONS General Conditions Which Must Be Met... hires, uses, and pays a consultant as part of the staff. (b) The grantee may not use its grant to pay a...

45 CFR 1180.57 - Use of consultants.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES GRANTS REGULATIONS General Conditions Which Must Be Met... hires, uses, and pays a consultant as part of the staff. (b) The grantee may not use its grant to pay a...

45 CFR 1180.57 - Use of consultants.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES GRANTS REGULATIONS General Conditions Which Must Be Met... hires, uses, and pays a consultant as part of the staff. (b) The grantee may not use its grant to pay a...

45 CFR 1180.57 - Use of consultants.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES GRANTS REGULATIONS General Conditions Which Must Be Met... hires, uses, and pays a consultant as part of the staff. (b) The grantee may not use its grant to pay a...

45 CFR 1180.57 - Use of consultants.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES GRANTS REGULATIONS General Conditions Which Must Be Met... hires, uses, and pays a consultant as part of the staff. (b) The grantee may not use its grant to pay a...

Interprofessional student teams augmenting service provision in residential aged care.

PubMed

Kent, Fiona; Lai, Francis; Beovich, Bronwyn; Dodic, Miodrag

2016-09-01

The aim of this study was to determine the usefulness of student-led interprofessional consultations within residential aged care in augmenting patient care and enhancing student education. Volunteer fourth and final year health-care students conducted interprofessional consultations. In a mixed methods design, residents' health-care changes and perspectives were collected prospectively, and student and educator perceptions were measured by survey and interview. Sixteen aged care residents were consulted by interprofessional teams. Students identified two new health issues and proposed 17 recommendations for referrals and five changes to medication management. At six-weeks follow-up, two recommendations had been acted upon clinically, and two medication changes had been implemented. Reasons for the low uptake of recommendations were determined. Residents, students and educators reported high levels of satisfaction. Residential care facilities offer a useful interprofessional learning environment. Student consultations are positively regarded by patients, students and educators and may augment existing health services. © 2016 AJA Inc.

Ethics consultation on demand: concepts, practical experiences and a case study.

PubMed

Reiter-Theil, S

2000-06-01

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study.

Patterns in hospitals' use of a regional poison information center.

PubMed Central

Chafee-Bahamon, C; Caplan, D L; Lovejoy, F H

1983-01-01

A statewide poison center undertook a study to identify types of hospitals which used its information services. Initial trends in calls from hospitals to the center over the center's first two years and percentages of hospitals' patient caseloads for which the center consulted were analyzed for 104 acute care hospitals by hospitals' location, size, and emergency room staffing. After the center's establishment as a regional resource, emergency room staff in urban teaching hospitals showed the greatest increase in calls within a year (88 per cent) and the highest consultation rates for poison patients seen (57 per cent). Private physician emergency room staff, and staff in distant and rural hospitals, showed lower or no increases in calls and lower consultation rates. Findings suggest that private physician emergency room staff and staff in distant and rural hospitals be considered for poison center outreach. Marketing of consultation services for non-pediatric overdoses is also indicated. PMID:6829822

Inpatient rehabilitation diabetes consult service: a rehabilitation psychology approach to assessment and intervention.

PubMed

Schumann, Kristina P; Touradji, Pegah; Hill-Briggs, Felicia

2010-11-01

Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

PubMed Central

Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

2016-01-01

Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

76 FR 76029 - International Services Surveys: Amendments to the BE-120, Benchmark Survey of Transactions in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... services; (20) Legal services; (21) Management, consulting, and public relations services (includes... international investment and trade in services and publish for the use of the general public and United States...

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

PubMed Central

2012-01-01

Introduction Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. PMID:23020856

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities.

PubMed

Ascoli, Micol; Palinski, Andrea; Owiti, John Arianda; De Jongh, Bertine; Bhui, Kamaldeep S

2012-09-28

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes. Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

Exploring New Ways to Deliver Value to Healthcare Organizations: Algorithmic Testing, Data Integration, and Diagnostic E-consult Service.

PubMed

Risin, Semyon A; Chang, Brian N; Welsh, Kerry J; Kidd, Laura R; Moreno, Vanessa; Chen, Lei; Tholpady, Ashok; Wahed, Amer; Nguyen, Nghia; Kott, Marylee; Hunter, Robert L

2015-01-01

As the USA Health Care System undergoes transformation and transitions to value-based models it is critical for laboratory medicine/clinical pathology physicians to explore opportunities and find new ways to deliver value, become an integral part of the healthcare team. This is also essential for ensuring financial health and stability of the profession when the payment paradigm changes from fee-for-service to fee-for-performance. About 5 years ago we started searching for ways to achieve this goal. Among other approaches, the search included addressing the laboratory work-ups for specialists' referrals in the HarrisHealth System, a major safety net health care organization serving mostly indigent and underserved population of Harris County, TX. We present here our experience in improving the efficiency of laboratory testing for the referral process and in building a prototype of a diagnostic e-consult service using rheumatologic diseases as a starting point. The service incorporates algorithmic testing, integration of clinical, laboratory and imaging data, issuing structured comprehensive consultation reports, incorporating all the relevant information, and maintaining personal contacts and an e-line of communications with the primary providers and referral center personnel. Ongoing survey of providers affords testimony of service value in terms of facilitating their work and increasing productivity. Analysis of the cost effectiveness and of other value indicators is currently underway. We also discuss our pioneering experience in building pathology residents and fellows training in integrated diagnostic consulting service. © 2015 by the Association of Clinical Scientists, Inc.