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Sample records for referral and consultation

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

    PubMed

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

    2015-01-01

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

  2. Pacific Island Health Care Project: early experiences with a Web-based consultation and referral network.

    PubMed

    Person, D A

    2000-09-01

    The Pacific Island Health Care Project (PIHCP) has in the past provided definitive care at the Tripler Army Medical Center (TAMC) for nearly 3000 patients. To contain costs, increase access, and provide consultative and referral services to physicians in the Pacific Basin, a web-based network was established in 1997. Four sites in the Western Pacific were provided with a desktop computer, digital still and video cameras, flatbed scanners, and printers. Consultations with supporting imagery are submitted to TAMC where the consults are data-based and dynamically posted on a secure web server. TAMC consultants triage and comment on the cases and the educational significance. Unnecessary or inappropriate referrals are returned with instructions for local care. Cases are formatted to allow rapid response, image review, consultant/provider interaction, and peer review. More than 180 consults have been submitted from the island nations electronically (30 September 1998) and initial experience indicates that the Internet can be easily used as an inexpensive store and forward consultation format. There has been an overwhelming enthusiasm for this project by all participants and for the first time since the inception of the PIHCP, funding was available during the entire fiscal year, with tens of thousands of dollars saved.

  3. The rhetoric of patient voice: reported talk with patients in referral and consultation letters.

    PubMed

    Spafford, Marlee M; Schryer, Catherine F; Lingard, Lorelei

    2008-01-01

    Referral and consultation letters are written to enable the exchange of patient information and facilitate the trajectory of patients through the healthcare system. Yet, these letters, written about yet apart from patients, also sustain and constrain professional relationships and influence attitudes towards patients. We analysed 35 optometry referral letters and 35 corresponding ophthalmology consultation letters for reported 'patient voice' coded as 'experience' or 'agenda' and we interviewed 15 letter writers (eight optometry students, six optometrists, and one community ophthalmologist). There were 80 instances of reported 'patient voice' in 35 letters. The majority (68%) of the instances occurred in referral letters, likely due to differences in both 'letter function' and 'professional stance.' Reported 'patient voice' occurred predominantly as 'experience' (81%) rather than 'agenda' instances. Letters writers focused on their readers' needs, thus a biomedical voice dominated the letters and instances of reported 'patient voice' were recontextualized for the professional audience. While reporting 'patient voice' was not the norm in these letters, its inclusion appeared to accomplish specific work: to persuade reader action, to question patient credibility, and to highlight patient agency. These letter strategies reflect professional attitudes about patients and their care.

  4. Consultation, referral, and collaboration between midwives and obstetricians: lessons from New Zealand.

    PubMed

    Skinner, Joan P; Foureur, Maralyn

    2010-01-01

    There has been substantial growth in the provision of midwifery-led models of care, yet little is known about the obstetric consultation and referral practices of these midwives or the quality of the collaboration between midwives and obstetricians. This study aimed to describe these processes as they are practised in New Zealand, where midwifery-led maternity care is the dominant model. A total population postal survey was conducted that included 649 New Zealand midwives who provided midwifery-led care in 2001. There was a 56.5% response rate, describing care for 4251 women. Within this cohort, there was a 35% consultation rate and 43% of these women had their lead carer role transferred to an obstetrician. However, the midwives continued to provide care in collaboration with obstetricians for 74% of transferred women. Seventy-two percent of midwives felt that they were well supported by the obstetricians to continue care. Midwifery-led care is reasonable for the general population of childbearing women, and a 35% consultation rate can be seen as a benchmark for this population. Midwives can, when well supported, provide continuity of care for women who experience complexity during pregnancy and/or birth. Collaboration with obstetricians is possible, but there needs to be further work to describe what successful collaboration is and how it might be fostered.

  5. Preschool Parent-Pediatrician Consultations and Predictive Referral Patterns for Problematic Behaviors

    PubMed Central

    Fanton, John; MacDonald, Brittany; Harvey, Elizabeth

    2009-01-01

    Objective The present study examined parents’ reports of the frequency, nature, and outcome of pediatrician consultation and interventions about significant preschool behavior problems. Method Parents were asked whether they consulted or not with their pediatric providers about disruptive behavioral problems during a longitudinal study of preschool children. Results Eighty 4-year-old children had parents who had consulted with their pediatricians versus 90 children whose parents did not. Children who eventually met criteria for Attention Deficit/Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD) two years later, received different pediatric interventions at age 4 than children who did not have a diagnosis, χ2 (2) = 9.28, based on parent-report. Eighty-nine percent of children who were referred for evaluation or treatment by pediatricians later met criteria for ADHD or ODD. However, 56% of children who later met criteria for ADHD or ODD were not referred by age 4. Conclusion Pediatricians were able to differentiate between preschool children with transient versus persistent behavioral problems significantly better than chance, though a large number of children with behavioral problems were not provided with early assistance or referrals. Additional research is needed to obtain data directly from pediatricians about their interventions and resources for this vulnerable population. PMID:18941427

  6. Behavior Analytic Consultation for Academic Referral Concerns

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

    2016-01-01

    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  7. Referral for cancer genetics consultation: a review and compilation of risk assessment criteria

    PubMed Central

    Hampel, H; Sweet, K; Westman, J; Offit, K; Eng, C

    2004-01-01

    Methods: The criteria were based on a comprehensive review of publications describing diagnostic criteria for hereditary cancer syndromes and risk to first degree relatives of cancer patients. Priority was given to diagnostic criteria from consensus statements (for example, those from the National Comprehensive Cancer Network). Expert opinion from study personnel was then used to adopt a single set of criteria from other publications whenever guidelines differed. Results: Based on family history, a set of criteria was developed to identify patients at risk for a hereditary cancer susceptibility syndrome, patients with moderate risk who might benefit from increased cancer surveillance, and patients who are at average risk. The criteria were applied to 4360 individuals who provided their cancer family history between July 1999 and April 2002, using a touch screen computer system in the lobby of a comprehensive cancer centre. They categorised an acceptable number of users into each risk level: 14.9% high risk, 13.7% moderate risk, and 59.6% average risk; 11.8% provided insufficient information for risk assessment. Conclusions: These criteria should improve ease of referral and promote consistency across centres when evaluating patients for referral to cancer genetics specialists. PMID:14757853

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

    PubMed

    Keely, Erin; Traczyk, Lara; Liddy, Clare

    2015-08-01

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

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

    PubMed

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

    2009-12-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2005-05-01

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

  12. Acute Interventions and Referral of Patients With Bipolar Disorder by the Psychiatric Consultation Liaison Service in a General Hospital in Germany: A Retrospective Analysis

    PubMed Central

    Anderson, Christina

    2014-01-01

    Objective: To investigate the population of bipolar patients in a general hospital in Germany who required treatment by a consultant psychiatrist. Method: A retrospective analysis was conducted of the clinical records of 47 patients diagnosed with bipolar disorder (DSM-IV-TR criteria) who were treated by a consultant psychiatrist between 2009 and 2012 in one of the general hospitals of Charité Berlin, Campus Benjamin Franklin, Berlin, Germany. We investigated the sections of the hospital that requested psychiatric consultations for bipolar patients, the status of these patients, and their primary cause of treatment, as well as the intervention (including pharmacotherapy) recommended by the consultant psychiatrist. Results: For more than half of the patients, their psychiatric illness was either directly or indirectly the reason they presented to the hospital. The remaining bipolar patients were treated for various somatic illnesses unrelated to their bipolar disorder throughout the hospital, with a relative overrepresentation of patients in the neurology department. More than half of the patients were referred to a psychiatric hospital by the consultant psychiatrist. Benzodiazepines were the most commonly administered drugs for acute pharmacologic intervention. Conclusions: Psychiatric consultations are not frequently requested for bipolar patients compared to those with other psychiatric disorders. However, more than half of the bipolar patients needed further psychiatric treatment in a psychiatric hospital. This finding emphasizes the importance of psychiatric consultations in a general hospital for bipolar patients. The administration of benzodiazepines as an acute treatment seems to be the standard pharmacologic procedure, not a specific pharmacotherapy like mood stabilizers. PMID:25133062

  13. A comparison of patients with major depressive disorder recruited through newspaper advertising versus consultation referrals for clinical drug trials.

    PubMed

    Miller, C A; Hooper, C L; Bakish, D

    1997-01-01

    Difficulties in recruiting patients for clinical trials have plagued investigators for many years. One concern is the generalizability of clinical trial results to community practice, that is, whether volunteers recruited through advertising are homogeneous with those seeking treatment in a clinical setting. This article retrospectively compares the baseline characteristics of patients recruited through newspaper advertisements with those recruited through consultation referrals by reviewing the charts of 54 patients enrolled in two clinical trials for major depressive disorder (MDD). We examined demographic data, background information, clinical histories, and baseline status. Results indicated homogeneity for most variables. The consultation group was significantly more likely to have had previous treatment for the current episode of depression. These results suggest that, although the advertisement and consultation groups were very similar, the drug naivety of the advertisement group may make them a preferred source in terms of generalizability to community practice.

  14. A comparison of placebo response with major depressive disorder in patients recruited through newspaper advertising versus consultation referrals.

    PubMed

    Miller, C A; Hooper, C L; Bakish, D

    1997-01-01

    Recent evidence indicates few differences between patients recruited through advertising and by consultation referral, and there is some suggestion that those recruited through advertising are more representative of the target community population. However little has been reported on differences in placebo response and compliance in these two patient groups. We conducted a retrospective chart review of 49 patients with major depressive disorder (MDD), recruited through advertising or consultation, randomized to placebo in five clinical trials. Variables included demographics, clinical history, efficacy, compliance, and completion data. Homogeneity was demonstrated for most variables. Differences in placebo groups included significantly lower Hamilton Rating Scale for Depression (HAM-D) scores for the advertisement group throughout the trials. Advertisement patients were also more likely to be early placebo responders and in remission at Days 14 and 28. No differences were found in completion rates or reasons for early termination. Compliance was excellent for both groups. Early placebo response of the advertisement group reinforces the need for trials of at least 8 weeks. In addition, consultation patients may have a more severe illness and be treatment resistant, suggesting they are less generalizable to community practice populations.

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

    PubMed Central

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

    2017-01-01

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

  16. The inpatient neurology consultation service: value and cost.

    PubMed

    Douglas, M R; Peake, D; Sturman, S G; Sivaguru, A; Clarke, C E; Nicholl, D J

    2011-06-01

    Neurological conditions comprise a significant proportion of patient admissions to hospital but, in the majority of cases, are admitted under the care of non-neurological physicians. As a consequence, neurological ward consultations are commonly requested by the admitting medical teams to review diagnoses and management plans. The outcomes of neurological ward consultations were examined and the time required for the referral process recorded by performing a detailed prospective three-month audit of inpatient referrals to the neurology service. The consultations of 120 patients were recorded, categorised and analysed. These consultations were beneficial in the vast majority of cases, with a clear impact on patient diagnoses or management plans. The consultation process was time consuming, however, both in respect of the initial review, but also with follow-up visits. This audit highlights the importance of neurological input in the diagnosis and management of hospital inpatients. The time taken for this process should be resourced appropriately.

  17. GPs' payment contracts and their referral practice.

    PubMed

    Mariñoso, Begoña Garcia; Jelovac, Izabela

    2003-07-01

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

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

    PubMed Central

    Naseriasl, Mansour; Adham, Davoud; Janati, Ali

    2015-01-01

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

  19. 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…

  20. Developmental Counseling and Therapy as a Model for School Counselor Consultation with Teachers

    ERIC Educational Resources Information Center

    Clemens, Elysia

    2007-01-01

    Referral requests for individual counseling pose a threat to the implementation of comprehensive school counseling programs (Jackson & White, 2000). Consulting with teachers is one way that school counselors can efficiently respond to some referrals while also providing system support. Using a developmental counseling and therapy-based…

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

    PubMed

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

    1996-07-01

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

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

    PubMed

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

    2008-08-01

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

  3. USAR Nurse Referral and Retention Program.

    PubMed

    Foley, J E; Foley, B J

    1992-09-01

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

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

    PubMed

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

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

  5. Information and Referral Service, District Office Training.

    ERIC Educational Resources Information Center

    Health and Welfare Council of Central Maryland, Inc., Baltimore.

    Within a standard format the details of instruction and training in various areas (units) of information and referral (I and R) services are given for Social Security Administration workers. Each unit is specified by the following categories: objective, special consideration, background, presentation, participation, review, and examples. There are…

  6. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. [Structured electronic consultation letter for shoulder disorders].

    PubMed

    Paloneva, Juha; Oikari, Marjo; Ylinen, Jari; Ingalsuo, Minna; Ilkka, Kunnamo; Ilkka, Kiviranta

    2012-01-01

    Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. Expectations considering the purpose, contents, and timing of the referral of the consulting physician and the consultant do not always meet. A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.

  8. [Teledermatological consultation].

    PubMed

    Knol, A; Damstra, R J; van den Akker, Th W; de Haan, J

    2004-02-14

    Teledermatological consultation can be effected in two ways. One is 'store-and-forward' which involves storing photographic digital images and sending them to a consultant dermatologist who then replies by e-mail, and the other is by videoconferencing using a real time interactive audiovisual link. In daily general practice the first method is the easiest to implement. In 76-90% of cases, a diagnosis or differential diagnosis made in this way corresponds with the diagnosis made at the more usual face-to-face examination. The advantage of teledermatological consultation is that diagnosis and therapy take place faster than after regular referral and it is better than no referral at all. The referring physician should deliver data on the patient's history and physical examination in a standardized format. The same is true for the encoded personal data, the working diagnosis, and referral request. One overview and 2 detailed photos from two angles are normally taken. The overview shows the extent and localization of the skin abnormality. The patient has to consent to a teledermatological consultation. The responsibility for the treatment lies with the doctor who sees the patient face-to-face. The data that is transmitted must be encrypted or coded in such a way that it cannot be traced back to one particular person.

  9. Trust and the Client-Consultant Relationship

    ERIC Educational Resources Information Center

    Solomonson, William L.

    2012-01-01

    This study seeks to improve the contributions of performance consultants, instructional design consultants, and training consultants by explaining the effect that several variables have on trust as a mediator to relationship commitment within the context of the client-consultant relationship. The participants were 228 college students from two…

  10. Depression in older adults: screening and referral.

    PubMed

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

    2014-01-01

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

  11. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees.

    PubMed

    Shannon, Patricia J; Vinson, Gregory A; Cook, Tonya L; Lennon, Evelyn

    2016-07-01

    In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed.

  12. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  13. Idiopathic pulmonary fibrosis: Early detection and referral

    PubMed Central

    Oldham, Justin M.; Noth, Imre

    2016-01-01

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

  14. Narrative and Structure in Consultation

    ERIC Educational Resources Information Center

    Hadley, David

    2012-01-01

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

  15. Consultative Instructor Supervision and Evaluation

    ERIC Educational Resources Information Center

    Lee, William W.

    2010-01-01

    Organizations vary greatly in how they monitor training instructors. The methods used in monitoring vary greatly. This article presents a systematic process for improving instructor skills that result in better teaching and better learning, which results in better-prepared employees for the workforce. The consultative supervision and evaluation…

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

    PubMed

    2017-02-01

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

  17. Requirements and characteristics of 500 consecutive patients consulting an ophthalmic medical practitioner.

    PubMed Central

    Claoué, C M

    1988-01-01

    This paper reports the results of a prospective survey on 500 consecutive patients consulting an ophthalmic medical practitioner. The reason for consultation, and results of refraction and examination were analysed. The majority required only a refraction. One in 8 visits was for primary ophthalmic health care other than refraction. An abnormality of the visual system (other than refractive error) was present in 19% of patients. Five per cent required referral to their general practitioner. PMID:3411589

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

    PubMed

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

    1998-01-01

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

  19. General Education Teachers' Knowledge and Self-Reported Use of Classroom Interventions for Working with Difficult-To-Teach Students: Implications for Consultation, Prereferral Intervention and Inclusive Services.

    ERIC Educational Resources Information Center

    Wilson, Caryll Palmer; Gutkin, Terry B.; Hagen, Kenneth M.; Oats, Robert G.

    1998-01-01

    Teachers (N=20) described problems, goals, interventions, data collection, and consultation practices employed across prereferral, prereferral intervention, referral, and postreferral phases of service delivery for mildly handicapped students. Findings highlight teachers' difficulties with data collection and intervention practices. Implications…

  20. Observed Consultation: Confidence and Accuracy of Assessors

    ERIC Educational Resources Information Center

    Tweed, Mike; Ingham, Christopher

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Thornberg, Robert

    2014-01-01

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

  2. Delivering palliative care in an acute hospital setting: views of referrers and specialist providers.

    PubMed

    Ewing, Gail; Farquhar, Morag; Booth, Sara

    2009-09-01

    There has been a steady expansion of hospital-based palliative care in the United Kingdom but limited published research on health professionals' views of hospital multidisciplinary specialist palliative care services (SPCS). The aim of the study was to describe referrer (SPCS user) and provider (SPCS staff) perspectives on delivery of specialist palliative care in hospital. Interviews were conducted with referrers, including five junior doctors, 13 consultants, and six clinical nurse specialists, to investigate the reasons for referral, beneficial aspects, and barriers to use. Focus groups were conducted with providers, six medical and five nursing, to identify their perspective on delivering the specialist service in hospital. Discussions were tape recorded and transcribed verbatim. Data were analyzed thematically using a framework analysis approach. The study found large areas of agreement between referrers and providers on what hospital palliative care teams should be providing for patients, that is, expertise in managing difficult symptoms and complex psychosocial problems, and this was being achieved locally. Access to the specialist team was also important: visibility on the wards, informal routes of access to advice and a timely response by specialists. However, discordance in views of providing palliative care was also identified; in particular, whether specialists should be providing generalist palliative care (such as basic psychological support) neglected by ward teams and implementation of specialist advice by referrers. Such perspectives on the interface of generalist and specialist provision provide insights into improving care for palliative patients in the acute hospital setting.

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

    ERIC Educational Resources Information Center

    Jennings, Danielle J.; Hanline, Mary Frances

    2013-01-01

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

  4. Outpatient clinic referrals and their outcome.

    PubMed

    Sullivan, F M; Hoare, T; Gilmour, H

    1992-03-01

    A cohort of 392 patients referred to six outpatient clinics by general practitioners during 1987 with diagnoses of rheumatoid arthritis, osteoarthritis, peripheral vascular disease, psoriasis or eczema, were studied from the time of their first attendance until up to two years later. Six consultant clinics were studied in the three specialties: rheumatology, vascular surgery and dermatology. For each specialty a clinic in both a teaching hospital and a district general hospital were included. The cohort members were predominantly middle-aged or elderly people, with a greater proportion of women, except at the vascular surgery clinic where 65% of patients were men. The 392 patients made a total of 936 visits (median two, range one-eight) during the study period; 91 patients were still attending up to two years after the first visit. Patients referred by their general practitioner for therapy were less likely to be discharged than those referred for other reasons. The principal reason for continuing attendance as perceived by patients, general practitioners and hospital doctors was the necessity for consultant supervision, although agreement was far from complete in individual cases. Junior staff tended to see a higher proportion of patients at follow-up visits than did consultants, and were found to have lower discharge rates than consultants. Analyses of data showed that at the first visit, diagnosis, disease severity and the grade of doctor seeing the patient in the clinic was significantly associated with patient discharge at the P < 0.05 level of significance. Patients considered that their visits had produced improvement in their condition in 38% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed

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

    2012-05-01

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

  6. Patient referral by telemedicine: effectiveness and cost analysis of an Intranet system.

    PubMed

    Harno, K; Paavola, T; Carlson, C; Viikinkoski, P

    2000-01-01

    The clinical effectiveness and costs of telemedicine in improving the referral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medicine outpatient clinics of two Finnish district hospitals were compared--Peijas Hospital (PH) with telemedicine and Hyvinkää Hospital (HH) without it. The three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/1000) from primary-care centres was twice that to HH (3.8/1000). Thirty-seven per cent of referrals to PH included requests from general practitioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patients receiving a teleconsultation ended up in the outpatient department of PH within one year. These visits were mainly due to progression of chronic disease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic visit in internal medicine (EU211) were seven times greater per patient than for an e-mail consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU7876 in favour of the teleconsultation process. General practitioners sought an outpatient visit for 130 of their patients, and advice only for another 77. On-line advice was nonetheless given in 108 cases, and only 88 patient visits were arranged. Eleven referrals were declined. The cost difference between giving on-line medical advice for the 108 cases and a visit to the outpatient clinic for the other 88 was less costly (by EU4140) than investigating the 124 patients whose original clinic referrals to the PH were

  7. 77 FR 23283 - Tribal Consultation Policy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-18

    ... things, internal communications on the development of proposed legislation, enforcement policy, and other...- Determination B. Open Communications and Respect for Cultural Values and Traditions C. Ensuring Consultation Is... subcontractors through linkages, referrals, training, regular communication, and sharing of information...

  8. [Systemic consultation--about possibilities and limitations].

    PubMed

    Rostworowska, Maria; Opoczyńska, Małgorzata; de Barbaro, Bogdan

    2002-01-01

    The paper presents the role of systemic consultation in the diagnostic and therapeutic process of the people hospitalised for the first time because of a psychotic episode. The following questions are going to be put: What is the role of systemic family consultation in the diagnostic and therapeutic process on the inpatient ward? What are the differences between systemic consultation and others forms of family interventions f.e. family interviews, psycho--education, systemic therapy? What are possibilities and limitations of consultation? What does it invite to? These are only some of those questions, which are typical for daily clinical practice, in which the family consultation takes an important part. In this paper according to our clinical experience, we would like to share some of our thoughts on the questions put. In spite of difficulties the family consultation confronts us with, we are deeply convinced that it has an important part in therapeutic and diagnostic process.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  10. Development and implementation of a proactive geriatrics consultation model in collaboration with hospitalists.

    PubMed

    Sennour, Youcef; Counsell, Steven R; Jones, Jerrlyn; Weiner, Michael

    2009-11-01

    Acutely ill hospitalized older adults often experience a decline in function that may be preventable using a proactive, interdisciplinary, patient-centered approach. Hospitalists are treating an increasing number of these patients. A collaborative geriatrics consultation model to prevent functional decline and improve care for older patients with geriatrics syndromes was developed and implemented in partnership with a large hospitalist group in a community teaching hospital. A team of a geriatrician and a geriatrics nurse practitioner led the new consultation service. The team assisted with identifying cases, provided consultation early in the hospital stay, focused its evaluation on functional and psychosocial issues, and assisted in clinical management to optimize implementation of recommendations. In the first 4 years, the consultation service conducted 1,538 consultations in patients with a mean age of 81 (range 56-103). The most frequent geriatrics diagnoses were gait instability, delirium, and depression; recommendations usually included consulting physical therapy, increasing activity, and changing medications. The number of referrals and referring physicians grew steadily each year. Twenty-eight of 34 (82%) of the referring hospitalists completed a Web-based satisfaction questionnaire. All responding hospitalists agreed that proactive geriatrics consultation helped them provide better care; 96% rated the service as excellent. Analysis of hospital administrative data revealed a lower length of stay index and lower hospital costs in patients receiving a geriatrics consultation. The Proactive Geriatrics Consultation Service represents a promising model of collaboration between hospitalists and geriatricians for improving care of hospitalized older adults.

  11. Consultant/Linker Knowledge and Skills Inventory.

    ERIC Educational Resources Information Center

    Smink, Jay

    The Consultant/Linker Knowledge and Skills Inventory is used to assess both existing and needed levels of knowledge and skills for consulting with school staff. The inventory is self-administered, and requires 20 to 30 minutes to complete. For each item, knowledge and skill are rated low, medium, or high; and need for improvement is rated none,…

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

    ERIC Educational Resources Information Center

    Spencer, Gregory P.

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

  13. Faculty Consulting and Supplemental Income. ERIC Digest.

    ERIC Educational Resources Information Center

    Boyer, Carol M.; Lewis, Darrell R.

    Although consulting has long been recognized as a legitimate faculty role in most colleges, concern has arisen about the appropriateness of "double dipping," and particularly whether consulting and other supplemental income activities result in shirking other university responsibilities. The debate centers on six basic issues: who…

  14. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Buono, Anthony F., Ed.

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

  16. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  18. Finalizing the Consultant Effectiveness Scale: An Analysis and Validation of the Characteristics of Effective Consultants.

    ERIC Educational Resources Information Center

    Knoff, Howard M.; Hines, Constance V.; Kromrey, Jeffrey D.

    1995-01-01

    Proposes that as consultation becomes a larger part of the school psychologist's role and function, the need to empirically identify characteristics of effective consultants is increasingly important. Describes the Consultant Effectiveness Scale (CES) and reexamines it with a national sample of school psychologists. Evaluates discriminate validity…

  19. Postpartum consultation: Occurrence, requirements and expectations

    PubMed Central

    Carlgren, Ingrid; Berg, Marie

    2008-01-01

    Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84) had a postpartum consultation of which 61.9% (n = 52) had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care. PMID:18651967

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  2. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  3. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  4. Pediatric neurocritical care: a neurology consultation model and implication for education and training.

    PubMed

    LaRovere, Kerri L; Graham, Robert J; Tasker, Robert C

    2013-03-01

    Pediatric neurocritical care is developing specialization within pediatric intensive care and pediatric neurology practice, and the evolving clinical expertise has relevance to training and education in both fields. We describe a model of service using a Neurology Consulting Team in the intensive care unit setting. Medical records were reviewed from a 32-month cohort of Neurology Consulting Team referrals. Six hundred eighty-nine (19%) of 3719 patients admitted to the intensive care unit were assessed by the team. The most common diagnostic categories were seizures, neurosurgical, cerebrovascular, or central nervous system infection. Fifty-seven percent (350 of 615 patients) required mechanical ventilation. Cohort mortality was 7% vs 2% for the general intensive care population (P < 0.01). The team provided 4592 initial and subsequent consultations; on average there were five to six new consultations per week. Each patient had a median of two (interquartile range, 1 to 6) consultations during admission. Three quarters of the cohort required neurodiagnostic investigation (1625 tests), with each patient undergoing a median of two (range, 0 to 3) studies. Taken together, the subset of pediatric intensive care unit patients undergoing neurology consultation, investigation, and management represents a significant practice experience for trainees, which has implications for future curriculum development in both pediatric critical care medicine and pediatric neurology.

  5. Consultation: Enhancing Leisure Service Delivery to Handicapped Children and Youth.

    ERIC Educational Resources Information Center

    Goldstein, Judith E., Ed.

    The document provides guidelines for consultants in the area of consultation in delivery of leisure services for handicapped children and youth. Included are chapters with the following titles and authors: "The Consultant-Consultee Relationship" (G. O'Morrow), "A Special Education Viewpoint: Consultation in the Public Schools" (S. Brannan),…

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

    ERIC Educational Resources Information Center

    Childers, Thomas; Krauser, Cheri

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

  7. Childhood adversity and frequent medical consultations.

    PubMed

    Fiddler, Maggie; Jackson, Judy; Kapur, Navneet; Wells, Adrian; Creed, Francis

    2004-01-01

    We assessed possible psychological mediators of the relationship between childhood adversity and frequent medical consultations among new outpatients at neurology, cardiology, and gastroenterology clinics. We assessed whether these differed in patients with and without organic disease that explained their symptoms. At first clinic visit we recorded Hospital Anxiety and Depression scale (HADS--anxiety and depression subscale scores), Illness Perception Questionnaire (IPQ--four subscales: consequences, cure, identity, timeline), Health Anxiety Questionnaire (total score), and Symptom Amplification Scale (total score). Subjects were divided into two groups according to whether they had experienced any type of childhood adversity using the Childhood Experience of Care and Abuse Schedule. Outcome was the (log) number of medical consultations for 12 months before and 6 months after the index clinic visits. Multiple regression analysis was used to determine mediators; this was performed separately for patients with symptoms explained and not explained by organic disease. One-hundred and twenty-nine patients (61% response) were interviewed. Fifty-two (40.3%) had experienced childhood adversity; they made a median of 16 doctor visits compared with 10 for those without adversity (adjusted P=.026). IPQ identity score (number of symptoms attributed to the illness) and HAD depression scores were significantly associated with both childhood adversity and number of medical consultations and these variables acted as mediators between childhood adversity and frequency of consultation in the multiple regression analyses. This association was limited to patients with medically unexplained symptoms and was mediated by IPQ Identity Score (number of symptoms attributed to the patient's illness) and HAD depression score. Sexual abuse and overt neglect were the adversities most closely associated with frequent consultations. In patients with medically unexplained symptoms the association

  8. School Consultation Research: Methodological Critique and Future Research Directions.

    ERIC Educational Resources Information Center

    Gresham, Frank M.; Kendell, Ginger K.

    1987-01-01

    This article reviews the current status of school consultation research and critiques the research methodologies used in consultation research. Major theoretical models in which consultation research has been conducted are briefly described. Consultation research is reviewed in three primary areas of investigation: (1) outcome research; (2)…

  9. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  10. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Gallagher, Barbara

    1984-01-01

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

  13. Underdiagnosis and Referral Bias of Autism in Ethnic Minorities

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  14. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda

    1991-01-01

    Fifty referrals from family physicians in Ontario were examined by interviewing the patients, referring physicians, consultants, and others involved at various points in the process. This, the second in a series of six articles, introduces the participants and describes how grounded theory methodology was used to analyze the approximately 3000 pages of field notes. PMID:21229052

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  17. Science Consultants, Fictional Films, and Scientific Practice.

    ERIC Educational Resources Information Center

    Kirby, David A.

    2003-01-01

    Proposes films to be successful communicative devices within the scientific community by showing that other scientists respond to depictions in films and how they respond. Demonstrates that science consultants use fictional films as promotional devices for their research fields. (Author/NB)

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Smith, Clagett G.

    1970-01-01

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

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

    PubMed

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

    2014-05-01

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

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

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

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

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

    PubMed

    Becker, Janet E

    2004-02-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

    Glass, Graeme E; Tzafetta, Kallirroi

    2014-12-01

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

  5. Assessment and Policy for Commercial Driver License Referrals

    PubMed Central

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

    2007-01-01

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

  6. Developing satisfied and talented consultants

    SciTech Connect

    Greenwood, Sarah; Higgs, Helen

    2007-07-01

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

  7. Consulting and Communication in Organizations.

    ERIC Educational Resources Information Center

    Garrison, John P.

    This paper describes a recent program of organizational awareness and development (OAD) initiated for a university program council. It describes the nature, purposes, and objectives of OAD and its role as a third party. It also provides an example of applied communication research, divided into four phases: (1) diagnostic, (2) feedback, (3)…

  8. NICU consultants and support staff

    MedlinePlus

    ... nurses with extra experience in the care of newborn infants in addition to completing master's or doctoral level ... doctor with special training in the care of infants and children. This type ... for a healthy newborn. A pediatrician also provides primary care for most ...

  9. 20 CFR 416.919g - Who we will select to perform a consultative examination.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Who we will select to perform a consultative... Type of Referral and for Report Content § 416.919g Who we will select to perform a consultative... support staff to help perform the consultative examination. Any such support staff (e.g., X-ray...

  10. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Planning and consultation process. 400.57 Section... Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish a public/private RCA program must engage in a planning and consultation process with the local...

  11. Negotiating Post-Consultation "Homework" Tasks between Counselors and Clients

    ERIC Educational Resources Information Center

    Strong, Tom; Massfeller, Helen F.

    2010-01-01

    Counselors frequently conclude consultations with clients with suggestions or prescriptions for clients to follow up on, post-consultation. In this paper, we conceptualize the discussion regarding such post-consultation tasks as negotiations between counselor and client, focusing in particular on what observably occurs and is "talked into being"…

  12. Quantum Leap--A Teacher and a Consultant Exchange Jobs.

    ERIC Educational Resources Information Center

    Lier, Jacquie; Bufe, Bruce

    1993-01-01

    To gain appreciation for each others' perspectives, a Mississippi language arts consultant and a third-grade teacher from Iowa traded jobs for a year. As a consultant, the teacher found that classroom teachers were more interested in whole-language instruction practicalities than in theory. As a teacher, the consultant learned that classroom…

  13. TCARE: Tailored Caregiver Assessment and Referral

    ERIC Educational Resources Information Center

    Montgomery, Rhonda; Kwak, Jung

    2008-01-01

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

  14. [Teacher Referral Information and Statistical Information Forms.

    ERIC Educational Resources Information Center

    Short, N. J.

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

  15. 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.

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

    ERIC Educational Resources Information Center

    Mueller, Michael M.; Nkosi, Ajamu

    2007-01-01

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

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

    PubMed Central

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

    1995-01-01

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

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

    PubMed

    Larsson, Laura S; Kuster, Emilie

    2013-01-01

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

  19. Topic analysis: an objective measure of the consultation and its application to computer assisted consultations.

    PubMed

    Pringle, M; Robins, S; Brown, G

    1985-06-15

    A simple method has been developed to classify the verbal interaction during medical consultations in terms of the relative proportions of medical and social content and the initiator of conversational topics discussed. The method has been applied to video tape recordings of three doctors' consultations with and without a computer present to classify and compare the items discussed. Actual computer use has been shown to have a medical effect on the consultations (p less than 0.05) and to increase the proportion of topics initiated by the doctor (p less than 0.001). Although this was largely accounted for by the massive increase in doctor initiated medical items resulting directly from computer use, there was evidence that, for two of the doctors, these topics were replacing some of the normal social and patient initiated medical exchanges.

  20. 76 FR 36579 - Onsite Consultation Agreements; Extension of the Office of Management and Budget's (OMB) Approval...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-22

    ... contained in the Consultation Agreement regulations (hereinafter, the Onsite Consultation Program regulations) (29 CFR part 1908). The Onsite Consultation Program regulations specify services to be provided, and practices and procedures to be followed, by the State Onsite Consultation Programs....

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Tanidir, Canan; Mukaddes, Nahit M.

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

    PubMed

    Kotecha, A; Brookes, J; Foster, P J

    2017-02-17

    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.Eye advance online publication, 17 February 2017; doi:10.1038/eye.2017.9.

  5. 20 CFR 416.919p - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Type of Referral and for Report Content § 416.919p Reviewing reports of consultative examinations. (a... evidence in the file (e.g., your blindness in one eye, amputations, pain, alcoholism, depression);...

  6. Critical consulting

    SciTech Connect

    Hocker, C.

    1993-02-01

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

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

    PubMed Central

    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. PMID:28096715

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

    ERIC Educational Resources Information Center

    Buchholz, William J., Ed.

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

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

    ERIC Educational Resources Information Center

    Shroder, Emelie J.; And Others

    1981-01-01

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

  10. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  11. 31 CFR 16.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  12. 14 CFR § 1264.110 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  13. 14 CFR 1264.110 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  14. Overcoming Barriers to Palliative Care Consultation.

    PubMed

    Perrin, Kathleen Ouimet; Kazanowski, Mary

    2015-10-01

    Palliative care consultations for patients with life-threatening illnesses provide benefits for the patients and their families as well as for the health care team. Patients have better quality of life and live longer but cost the health care system less. Still, many patients are not offered the opportunity to receive a palliative care consultation. Barriers to palliative care consultation for patients in critical care units include misunderstandings about palliative care and not having agreed upon criteria for referral. Critical care nurses can assist in overcoming these barriers.

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

    ERIC Educational Resources Information Center

    Stansfield, Jois

    2012-01-01

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

  16. 22 CFR 35.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    PubMed Central

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

    2008-01-01

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

  19. Surgical consultation and intervention during pediatric hematopoietic stem cell transplantation.

    PubMed

    Madenci, Arin L; Lehmann, Leslie E; Weldon, Christopher B

    2014-12-01

    Children undergoing HSCT are at risk for complications due to immune system impairment, toxicity from prior therapies and conditioning regimens, and long-term use of indwelling catheters. These problems may require assessment by the surgical team. We sought to characterize the role of surgical consultation during primary hospital stay for HSCT. We retrospectively reviewed the records of consecutive patients undergoing HSCT between September 2010 and September 2012. One hundred and seventy-three patients underwent 189 HSCTs. General surgery consultations occurred during 33% (n = 62) of primary hospitalizations for HSCT, with a total of 85 consults. Sixty-three (73%) consults resulted in an intervention in the operating room or at the bedside. The majority of consults were for CVL issues (59%, n = 50), followed by abdominal complaints (16%, n = 14). Patients requiring surgical consultation had significantly higher in-hospital mortality (16% vs. 2%, p < 0.01) and 100-day TRM (10% vs. 2%, p < 0.01), compared with those not requiring consultation. Patients undergoing HSCT often require surgical consultation, most commonly for line-related issues. Surgical consultation heralded an increased risk of in-hospital and 100-day TRM. Issues among this high-risk cohort of children who have undergone HSCT must be familiar to the general surgeon and oncologist alike.

  20. Ethics consultation and empathy : finding the balance in clinical settings.

    PubMed

    Bruns, Florian; Frewer, Andreas

    2011-12-01

    There is no doubt that emotions have an important effect on practices of moral reasoning such as clinical ethics consultation. Empathy is not only a basic human emotion but also an important and learnable skill for health care professionals. A basic amount of empathy is essential both in patient care and in clinical ethics consultation. This article debates the "adequate dose" of empathy in ethics consultations in clinical settings and tries to identify possible situations within the process of consultation in which this crucial feeling is at risk.

  1. [The Interdiscipilinary Orofacial Pain Consulting Service at the Center for Dental and Oral Medicine and Cranio-Maxillofacial Surgery, University of Zurich, Switzerland].

    PubMed

    Ettlin, Dominik; Galli, Ursula; Palla, Sandro

    2007-01-01

    At the Center for Dental and Oral Medicine and Cranio-Maxillofacial Surgery of the University of Zurich, a new interdisciplinary pain consulting service was established in early 2005 due to the increasing number of referrals of orofacial pain patients to the center. This unit comprises specialists of various dental and medical disciplines as well as psychologists and physical therapists. This article highlights the most common clinical pictures of chronic orofacial pain patients and describes the organizational mechanisms associated with referrals to our interdisciplinary pain service.

  2. 22 CFR 224.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

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

    ERIC Educational Resources Information Center

    Yin, Robert K.; And Others

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

  4. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Referral of complaint and answer to the ALJ. 13.11 Section 13.11 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall file the complaint...

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  6. 29 CFR 22.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  7. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    PubMed

    Okulate, Gbenga T

    2005-07-01

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

  10. 75 FR 50880 - TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-18

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

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

    ERIC Educational Resources Information Center

    Gardner, John A.

    1991-01-01

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

  12. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  13. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  14. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  15. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  16. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  17. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  18. 7 CFR 1.311 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  19. 7 CFR 1.311 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  20. Frequent consulting and multiple morbidity: a qualitative comparison of ‘high’ and ‘low’ consulters of GPs

    PubMed Central

    Wyke, Sally; Hunt, Kate

    2008-01-01

    Background. Frequent consulting is associated with multiple and complex social and health conditions. It is not known how the impact of multiple conditions, the ability to self-manage and patient perception of the GP consultation combines to influence consulting frequency. Objective. To investigate reasons for frequent consultation among people with multiple morbidity but contrasting consulting rates. Methods. Qualitative study with in-depth interviews in the west of Scotland. Participants were 23 men and women aged about 50 years with four or more chronic illnesses; 11 reported consulting seven or more times in the last year [the frequent consulters (FCs)] and 12, three or fewer times [the less frequent consulters (LFCs)]. The main outcome measures were the participants’ accounts of their symptoms, self-management strategies and reasons for consulting a GP. Results. All participants used multiple self-management strategies. FCs described: more disruptive symptoms, which were resistant to self-management strategies; less access to fewer treatments and resources and more medical monitoring, for unstable conditions and drug regimens. The LFCs reported: less severe and more containable symptoms; accessing more efficacious self-management strategies and infrequent GP monitoring for stable conditions and routine drug regimens. All participants conveyed consulting as a ‘last resort’. However, the GP was seen as ‘ally’, for the FCs, and as ‘innocent bystander’, for the LFCs. Conclusions. This qualitative investigation into the combined significance of multiple morbidities and self-management on the GP consultation suggests that current models of self-management might have limited potential to reduce utilization rates among this vulnerable group. Severity of symptoms, stability of condition and complexity of drug regimens combine to influence the availability of effective resources and influence frequency of GP consultations. PMID:18448858

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

    PubMed

    Homola, Samuel

    2016-02-01

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

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

    ERIC Educational Resources Information Center

    Prandoni, Jogues R.

    1984-01-01

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

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

    PubMed Central

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Margan, Anamarija; Rustemović, Nadan

    2006-03-01

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

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

    PubMed Central

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

    2016-01-01

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

  6. A Family Counseling and Consultation Model for School Counselors.

    ERIC Educational Resources Information Center

    Nicoll, William G.

    1992-01-01

    Presents school counselors with a brief intervention model for conducting family (and classroom) assessment and consultation that can be used within the framework of a parent-teacher conference setting. The family counseling-consultation model described provides school counselors with practical, step-by-step format for assessment and intervention…

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

    ERIC Educational Resources Information Center

    Ibrahim, Farah A.

    2015-01-01

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

  8. Playing with Mirrors: Narrative Inquiry and Congregational Consultation

    ERIC Educational Resources Information Center

    Yust, Karen Marie

    2009-01-01

    This article proposes that narrative inquiry methods fruitfully shape the role and strategies of persons who consult with religious communities. It suggests that the composition of field texts and transition from research notes to narratives enables consultants to mirror the stories of congregations so congregants can recognize, claim, and…

  9. 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…

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

    PubMed

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

    2015-09-01

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

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

    NASA Technical Reports Server (NTRS)

    1995-01-01

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

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

    PubMed Central

    Roshier, A. L.; McBride, E. A.

    2013-01-01

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

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

    PubMed

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

    2015-10-01

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

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

    PubMed

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Thoman, Cherie; Moore, Jerry E.

    1977-01-01

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

  16. Blending Administrative and Clinical Needs: The Development of a Referring Physician Database and Automatic Referral Letter

    PubMed Central

    Roberts, Mark S.; Dreese, Elizabeth M.; Hurley, Noreen; Zullo, Nan; Peterson, Mark

    1991-01-01

    The development of a system to collect and verify the name of a patient's referring physician and link that to the automatic production of a referral letter and discharge summary is described. PMID:1807664

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

    NASA Astrophysics Data System (ADS)

    Hoffman, Jennifer Marie

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

  18. 20 CFR 416.941 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Alcoholism § 416.941 Establishment and use of referral and monitoring agencies. We will contract with one or... whose disabilities are based on a determination that drug addiction or alcoholism is a...

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

    PubMed Central

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

    2014-01-01

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

  20. Consultation on AIDS and the workplace.

    PubMed

    1988-12-01

    The 1988 Consultation on Acquired Immunodeficiency Syndrome (AIDS) and the Workplace, organized by the World Health Organization (WHO), addressed 3 issues: 1) risk factors associated with human immunodeficiency virus (HIV) infection in the workplace, 2) the response of businesses and workers to the AIDS epidemic, and 3) use of the workplace for AIDS education. There is no evidence to suggest that HIV can be transmitted by casual, person-to-person contact in the workplace. The central policy issue for businesses concerns protection of the human rights of workers with HIV infection. Most workers with HIV/AIDS want to continue working as long as they are able to, and they should be enabled to contribute their creativity and productivity in a supportive occupational setting. Consistent policies and procedures should be developed at national and enterprise levels before HIV-related questions arise in the workplace. Such policies should be communicated to all concerned, continually reviewed in the light of scientific and epidemiologic evidence, monitored for their successful implementation, and evaluated for their effectiveness. Pre-employment HIV/AIDS screening, whether for assessment of fitness to work or for insurance purposes, should not be required and raises serious concerns about discrimination. Moreover, there should be no obligation on the worker's part to inform his or her employer if HIV infection develops. Information and educational activities at the workplace are essential to create the climate of collective responsibility and mutual understanding required to protect individuals with HIV or AIDS from stigmatization and discrimination by co-workers, employers or clients, and unions.

  1. Can we Rely on a General Practitioner's Referral Letter to a Skin Lesion Clinic to Prioritise Appointments and Does it Make a Difference to the Patient's Prognosis?

    PubMed Central

    Webb, Jill B; Khanna, A

    2006-01-01

    INTRODUCTION This study was designed to: (i) determine if the priority of referral letters by general practitioners to a plastic surgery skin lesion clinic adhered to the national guidelines, what happened to these patients, and what was the histological diagnosis; and (ii) analyse whether the prognosis at diagnosis of malignant melanoma had improved since the introduction of the 2-week wait for patients with suspected cancer. MATERIALS AND METHODS The study involved a prospective audit questionnaire, retrospective note review and histology report review in the Plastic Surgery Department in a district general hospital and their ‘bespoke’ out-patient clinics. RESULTS Of 202 referral letters, 58 (29%) were referred as 2-week cancer referrals of which 13 (22%) suggested diagnoses that did not fall within the guidelines, and 11 gave no diagnosis. In addition, 84 (42%) had no indication of priority, though the text may suggest the need for it, either explicitly or implied. The prognostic indices for malignant melanoma have not altered since the 2-week wait rule has been implemented. CONCLUSIONS The guidelines are not being adhered to, thus patients with benign lesions are being given undue priority. The history and examination of skin lesions given in the referral letters is insufficient to allow the consultant to prioritise. Since the 2-week rule has be implemented, malignant melanomas have not been diagnosed at an earlier stage. PMID:16460639

  2. Applying research to practice: generalist and specialist (visual ergonomics) consultancy.

    PubMed

    Long, Jennifer; Long, Airdrie

    2012-01-01

    Ergonomics is a holistic discipline encompassing a wide range of special interest groups. The role of an ergonomics consultant is to provide integrated solutions to improve comfort, safety and productivity. In Australia, there are two types of consultants--generalists and specialists. Both have training in ergonomics but specialist knowledge may be the result of previous education or work experience. This paper presents three projects illustrating generalist and specialist (visual ergonomics) consultancy: development of a vision screening protocol, solving visual discomfort in an office environment and solving postural discomfort in heavy industry. These case studies demonstrate how multiple ergonomics consultants may work together to solve ergonomics problems. It also describes some of the challenges for consultants, for those engaging their services and for the ergonomics profession, e.g. recognizing the boundaries of expertise, sharing information with business competitors, the costs-benefits of engaging multiple consultants and the risk of fragmentation of ergonomics knowledge and solutions. Since ergonomics problems are often multifaceted, ergonomics consultants should have a solid grounding in all domains of ergonomics, even if they ultimately only practice in one specialty or domain. This will benefit the profession and ensure that ergonomics remains a holistic discipline.

  3. 20 CFR 404.1519g - Who we will select to perform a consultative examination.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Who we will select to perform a consultative... Referral and for Report Content § 404.1519g Who we will select to perform a consultative examination. (a... level of severity of your alleged impairments. (c) The medical source we choose may use support staff...

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

    ERIC Educational Resources Information Center

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

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

  5. Exploring accountability of clinical ethics consultants: practice and training implications.

    PubMed

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

    Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

  6. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  7. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  8. [Rapid headache guidelines. Neurology consensus between Neurology (SAN) and Primary Care (SEMERGEN Andalucía). Referral criteria].

    PubMed

    Gil Campoy, J A; González Oria, C; Fernández Recio, M; Gómez Aranda, F; Jurado Cobo, C M; Heras Pérez, J A

    2012-01-01

    Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population. The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal. In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm. A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache. We show you in this paper, the chapter that deals the alarm criteria and referral.

  9. The development and validation of a multivariable model to predict whether patients referred for total knee replacement are suitable surgical candidates at the time of initial consultation

    PubMed Central

    Churchill, Laura; Malian, Samuel J.; Chesworth, Bert M.; Bryant, Dianne; MacDonald, Steven J.; Marsh, Jacquelyn D.; Giffin, J. Robert

    2016-01-01

    Background In previous studies, 50%–70% of patients referred to orthopedic surgeons for total knee replacement (TKR) were not surgical candidates at the time of initial assessment. The purpose of our study was to identify and cross-validate patient self-reported predictors of suitability for TKR and to determine the clinical utility of a predictive model to guide the timing and appropriateness of referral to a surgeon. Methods We assessed pre-consultation patient data as well as the surgeon’s findings and post-consultation recommendations. We used multivariate logistic regression to detect self-reported items that could identify suitable surgical candidates. Results Patients’ willingness to undergo surgery, higher rating of pain, greater physical function, previous intra-articular injections and patient age were the factors predictive of patients being offered and electing to undergo TKR. Conclusion The application of the model developed in our study would effectively reduce the proportion of nonsurgical referrals by 25%, while identifying the vast majority of surgical candidates (> 90%). Using patient-reported information, we can correctly predict the outcome of specialist consultation for TKR in 70% of cases. To reduce long waits for first consultation with a surgeon, it may be possible to use these items to educate and guide referring clinicians and patients to understand when specialist consultation is the next step in managing the patient with severe osteoarthritis of the knee. PMID:28234616

  10. Referrals and Treatment Completion for Prescription Opioid Admissions: Five Years of National Data

    PubMed Central

    St Marie, Barbara; Sahker, Ethan; Arndt, Stephan

    2016-01-01

    This study examines sources of referral for prescription opioid admission to substance use disorder treatment facilities and their relative completion success rates using secondary analysis of an existing data set (Treatment Episode Datasets – Discharge). Five years of data from public and private treatment facilities were extracted for client discharges with no prior treatment (N = 2,909,884). Healthcare professionals account for very few referrals to treatment (<10%). Prescription opioid clients referred into treatment had lower treatment success compared to other substance clients and when referred by healthcare providers had lower success rates (OR = 0.72, 95% CI 0.70 – 0.75) than clients from other referral sources. Fewer treatment referrals for prescription opioid misuse by healthcare providers and lower success rates are significant and timely findings due to the prevalence of prescription opioid misuse. Healthcare providers are well positioned to refer early for prescription opioid misuse and continue support of their patients during treatment. PMID:26362002

  11. 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.

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

    PubMed

    Arapostathis, Stathis

    2013-03-20

    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.

  13. 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

  14. 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.

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

    ERIC Educational Resources Information Center

    Erbas, Dilek

    2010-01-01

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

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

    PubMed

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

    2016-06-01

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

  17. [The practice guideline 'Consultation psychiatry' of the Dutch Psychiatric Association for psychiatric consultations in primary care and the hospital].

    PubMed

    Leentjens, A F G; van der Feltz-Cornelis, C M; Boenink, A D; van Everdingen, J J E

    2008-08-30

    Psychiatric consultation in primary care as well as in the hospital is both effective and cost-effective if certain procedures are followed. With the professional guideline 'Consultation psychiatry', the Dutch Psychiatric Association aims at setting a standard for psychiatric consultations in non-psychiatric settings. In general practice, the psychiatric consultation is preferably embedded in 'collaborative care', an integrated care model including the general practitioner and a case manager (usually a nurse), with the consultant psychiatrist being regularly available for clearly defined indications. The psychiatrist should see the patient himself or herself, establish a diagnosis and treatment plan, and provide the general practitioner and the patient with a so-called 'consultation letter', which is then discussed with both. In a general hospital, systematic screening of patients at risk of psychiatric comorbidity can be organised. Early detection of complex patients can further improve the effectiveness of psychiatric consultation. Follow-up contacts and investing in liaison contacts improve adherence to the advice provided.

  18. Design and Implementation of a Physician Coaching Pilot to Promote Value-Based Referrals to Specialty Care

    PubMed Central

    Tuzzio, Leah; Ludman, Evette J; Chang, Eva; Palazzo, Lorella; Abbott, Travis; Wagner, Edward H; Reid, Robert J

    2017-01-01

    Introduction Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. Objectives To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. Methods The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation. Results Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered. Conclusion This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction. PMID:28368789

  19. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  1. Referral Systems to Integrate Health and Economic Strengthening Services for People with HIV: A Qualitative Assessment in Malawi

    PubMed Central

    Sears, Clinton; Andersson, Zach; Cann, Meredith

    2016-01-01

    ABSTRACT Background: Supporting the diverse needs of people living with HIV (PLHIV) can help reduce the individual and structural barriers they face in adhering to antiretroviral treatment (ART). The Livelihoods and Food Security Technical Assistance II (LIFT) project sought to improve adherence in Malawi by establishing 2 referral systems linking community-based economic strengthening and livelihoods services to clinical health facilities. One referral system in Balaka district, started in October 2013, connected clients to more than 20 types of services while the other simplified approach in Kasungu and Lilongwe districts, started in July 2014, connected PLHIV attending HIV and nutrition support facilities directly to community savings groups. Methods: From June to July 2015, LIFT visited referral sites in Balaka, Kasungu, and Lilongwe districts to collect qualitative data on referral utility, the perceived association of referrals with client and household health and vulnerability, and the added value of the referral system as perceived by network member providers. We interviewed a random sample of 152 adult clients (60 from Balaka, 57 from Kasungu, and 35 from Lilongwe) who had completed their referral. We also conducted 2 focus group discussions per district with network providers. Findings: Clients in all 3 districts indicated their ability to save money had improved after receiving a referral, although the percentage was higher among clients in the simplified Kasungu and Lilongwe model than the more complex Balaka model (85.6% vs. 56.0%, respectively). Nearly 70% of all clients interviewed had HIV infection; 72.7% of PLHIV in Balaka and 95.7% of PLHIV in Kasungu and Lilongwe credited referrals for helping them stay on their ART. After the referral, 76.0% of clients in Balaka and 92.3% of clients in Kasungu and Lilongwe indicated they would be willing to spend their savings on health costs. The more diverse referral network and use of an mHealth app to manage

  2. A comparison of general medical and clinical ethics consultations: what can we learn from each other?

    PubMed

    Geppert, Cynthia M A; Shelton, Wayne N

    2012-04-01

    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.

  3. 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

  4. Outcomes of Cardiovascular Disease Risk Factor Screening and Referrals in a Family Planning Clinic

    PubMed Central

    Keyserling, Thomas C.; Jilcott Pitts, Stephanie; Morrow, John; Moos, Merry-K; Johnston, Larry F.; Farr, Sherry L.

    2015-01-01

    Abstract Background: Cardiovascular disease (CVD) screening in Title X settings can identify low-income women at risk of future chronic disease. This study examines follow-up related to newly identified CVD risk factors in a Title X setting. Methods: Female patients at a North Carolina Title X clinic were screened for CVD risk factors (n=462) and 167/462 (36.1%) were rescreened one year later. Clinical staff made protocol-driven referrals for women identified with newly diagnosed CVD risk factors. We used paired t-tests and chi square tests to compare screening and rescreening results (two-tailed, p<0.05). Results: Among 11 women in need of referrals for newly diagnosed hypertension or diabetes, 9 out of 11 (81.8%) were referred, and 2 of 11 (18.2%) completed referrals. Among hypertensive women who were rescreened (n=21), systolic blood pressure decreased (139 to 132 mmHg, p=0.001) and diastolic blood pressure decreased (90 to 83 mmHg, p=0.006). Hemoglobin A1c did not improve among rescreened diabetic women (n=5, p=0.640). Among women who reported smoking at enrollment, 129 of 148 (87.2%) received cessation counseling and 8 of 148 (5.4%) accepted tobacco quitline referrals. Among smokers, 53 out of 148 (35.8%) were rescreened and 11 of 53 (20.8%) reported nonsmoking at that time. Among 188 women identified as obese at enrollment, 22 (11.7%) scheduled nutrition appointments, but only one attended. Mean weight increased from 221 to 225 pounds (p 0<.05) among 70 out of 188 (37.2%) obese women who were rescreened. Conclusions: The majority of women in need of referrals for CVD risk factors received them. Few women completed referrals. Future research should examine barriers and facilitators of referral care among low-income women. PMID:25517351

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    PubMed Central

    Mitchell, Jean M.

    2012-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  8. Differentiating between a consultant nurse and a clinical nurse specialist.

    PubMed

    Maylor, Miles

    With the introduction of nurse consultants, and regulation of the use of the designation 'specialist nurse', experienced practitioners such as clinical nurse specialists have seen their position eroded. Nurse consultants are a new NHS-employment category, and are expected to be at the top rank of the profession both in status and in salary. However, this article argues that nurses at various levels have the same core functions, and that these do not differ for nurse consultants. Distinguishing between practitioners that might have the same job description could be better done by measuring outcomes. More care needs to be taken over the use of words such as 'expert', which is used differently in different contexts, and it is suggested that competencies be developed by which to measure the effects of expertise. Although nurse consultant appointments are often driven by various political directives and they are employed to meet local and national priorities, difficult issues need to be faced. First, if nurse consultant jobs are the top of the clinical career ladder, will clinical nurse specialists (CNSs) need to accept a lower rung on it? Further, perhaps the title CNS should become obsolete or be regulated? Can CNSs claim parity of pay using the 'Agenda for Change' framework?

  9. Consulting in Collection Development.

    ERIC Educational Resources Information Center

    Ash, Lee

    1980-01-01

    Considers the role of the consultant in the areas of library collection development and weeding, and offers suggestions on determining the need for a consultant, obtaining one, and what to do when the consultant arrives. (FM)

  10. Skills for Effective Consultation.

    ERIC Educational Resources Information Center

    Dustin, Dick; Ehly, Stewart

    1984-01-01

    Discusses counselor skills that promote effective consultation. Reviews research on effective school consultation and presents a five-stage model which involves phasing in, problem identification, implementation, evaluation, and termination. Provides recommendations for the process and products of consultation. (JAC)

  11. 25 CFR 170.101 - What is the IRR Program consultation and coordination policy?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What is the IRR Program consultation and coordination... Consultation, Collaboration, Coordination § 170.101 What is the IRR Program consultation and coordination policy? (a) The IRR Program's government-to-government consultation and coordination policy is to...

  12. 25 CFR 170.101 - What is the IRR Program consultation and coordination policy?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false What is the IRR Program consultation and coordination... Consultation, Collaboration, Coordination § 170.101 What is the IRR Program consultation and coordination policy? (a) The IRR Program's government-to-government consultation and coordination policy is to...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Are funds available for consultation, collaboration, and... Consultation, Collaboration, Coordination § 170.105 Are funds available for consultation, collaboration, and coordination activities? To fund consultation, collaboration, and coordination of IRR Program...

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  15. Meeting the challenge of consultation and collaboration: developing interactive teams.

    PubMed

    Coben, S S; Thomas, C C; Sattler, R O; Morsink, C V

    1997-01-01

    The roles of special educators as consultants and collaborators have long been established and supported. The rationale for these roles is also well documented. Many models--consultative, collaborative, and teaming--have been suggested in the literature; sometimes, these models exhibit similar goals, competencies, and processes. Because of intensified pressures to collaborate, successful implementation of collaborative and team efforts requires that special educators expand their roles as interactive professionals. The purpose of this article is to define and describe the consultation, collaboration, and teaming models that have been implemented, discuss their strengths and limitations, delineate how these models contribute to interactive teaming, outline key features of the interactive team, and provide some guiding principles for successful implementation.

  16. 3 CFR - Tribal Consultation

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... in regular and meaningful consultation and collaboration with tribal officials in the development of... is committed to regular and meaningful consultation and collaboration with tribal officials in...

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

    PubMed

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

    1977-05-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. 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…

  20. Rates and predictors of referral for individual psychotherapy, group psychotherapy, and medications among Iraq and Afghanistan veterans with PTSD.

    PubMed

    Mott, Juliette M; Barrera, Terri L; Hernandez, Caitlin; Graham, David P; Teng, Ellen J

    2014-04-01

    This study examined rates of referral for medication, individual psychotherapy, and group psychotherapy within a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty mental health clinic. Participants were 388 Iraq and Afghanistan veterans who were referred for PTSD treatment following a mental health evaluation required for all new VA enrollees. The majority of the sample was referred for medication (79 %), with comparatively fewer referrals for individual (39 %) or group psychotherapy (24 %). Forty percent of participants were referred for combined medication and psychotherapy. Patient demographic and clinical characteristics were examined to determine whether these variables predicted referral type. Female veterans and those with lower clinician ratings of overall functioning were more likely to be referred for individual therapy. Group psychotherapy referrals were more common in veterans who were older, unemployed, identified as an ethnic minority, and had a comorbid anxiety disorder. There were no significant predictors of medication referral.

  1. Directory of Marine and Marine Related Information Resources at the University of Wisconsin. Part I, Reference and Referral Resources.

    ERIC Educational Resources Information Center

    Luedtke, John R.

    This volume, part one of a two-volume directory, contains listings and descriptions of reference and referral resources for marine and marine-related information. These resources include the reference and referral services of the University of Wisconsin, other regional libraries and information centers, selected national oceanographic data…

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

    PubMed

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

    2013-08-01

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

  3. Lactation Consultant

    MedlinePlus

    ... human lactation. Job description Lactation consultants educate women, families, health professionals, and the community about breast feeding and human lactation; facilitate the development of policies which protect, promote, and support breastfeeding; ...

  4. Follow‐up care in cancer: adjusting for referral targets and extending choice

    PubMed Central

    Wilson, Kate; Lydon, Anne; Amir, Ziv

    2011-01-01

    Abstract Background  Over recent years, several initiatives have impacted on the referral of patients to secondary care, most notably targets for urgent referral in suspected cancer and the patient choice agenda. At the same time, improved long‐term survival in cancer has increased numbers attending follow‐up, doubts about the effectiveness of specialist follow‐up have emerged, and alternative models of follow‐up have been tested. Aim  The aim of the study was to explore patient and carer perspectives on the flexibility and responsiveness of cancer services. This article focuses on findings relating to referral, subsequent outpatient appointments and cessation of outpatient follow‐up. Methods  Issues were explored in a qualitative study using face‐to‐face interviews with a purposive sample of 54 people affected by cancer. Data were analysed concurrently with data collection, using qualitative analysis software. Findings  The study gave rise to a number of salient themes. Links were identified between three of these: choice and responsiveness during referral; the flexibility and responsiveness of outpatient appointment systems; and negotiating cessation of follow‐up. It appeared that policy on urgent referrals might be adversely affecting practice relating to appointment systems and the continuance of follow‐up. Discussion and conclusions  Hospital‐based cancer follow‐up is being given decreasing priority because of doubts about effectiveness and a target‐driven focus on referral. This is impacting on patients, who may value outpatient follow‐up as a ‘safety net’ but have difficulties in obtaining appointments, and may be discharged without negotiation or adequate support. For these reasons, new forms of flexible/responsive aftercare are urgently needed. PMID:21615642

  5. Marketing a Resource and Referral Resource Room to Child Care Providers and Parents.

    ERIC Educational Resources Information Center

    Eder, Sandra

    Recognizing the importance of providing parents and child care providers with current information on early childhood education, care, and support, this practicum project evaluated the design and implementation of a 10-week strategy to market a child care resource and referral agency resource room to child care providers and parents. Observations,…

  6. Effects of intervention on compliance to referral and lifestyle recommendations given at cholesterol screening programs.

    PubMed

    Gans, K M; Lapane, K L; Lasater, T M; Carleton, R A

    1994-01-01

    To enhance compliance to physician referral as well as dietary and other lifestyle recommendations given at blood cholesterol (BC) screening programs, we randomized Pawtucket Heart Health Program SCORE (screening, counseling, referral event) participants with elevated BC levels into one of four groups: usual care group; a participant intervention group (mailed reminder letter and refrigerator magnet); a physician intervention group (mailed packet to participant's physician including letter, National Cholesterol Education Program [NCEP] guidelines, and preaddressed postcard to mail to patient); and a group that received both interventions. Beginning four months after the screening, we surveyed study subjects by phone. The participant intervention increased recall of physician referral and dietary recommendations; however, neither intervention successfully improved compliance to referral or dietary and lifestyle recommendations. Overall, 58%, 67% and 34% of subjects reported complying to physician referral, dietary recommendations, and lifestyle recommendations, respectively. Referral compliance was associated with a longer time interval between screening and survey (relative risk [RR] = 1.3, 95% confidence interval [CI[ = 1.0, 1.7), possession of medical insurance that covered physician visits (RR = 2.1, 95% CI = 0.98, 4.4), and history of hypertension (RR = 2.6, 95% CI = 1.1, 5.8). Dietary compliance was positively associated with baseline BC levels > or = 240 mg/dL (RR = 3.3, 95% CI = 1.4, 7.3) and negatively associated with increasing age; each one year increase in age corresponded to a 3% decrease in compliance (RR = 0.97, 95% CI = 0.9. 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Loss of vision before ophthalmic referral in blind and partially sighted diabetics in Bristol.

    PubMed Central

    Clark, J B; Grey, R H; Lim, K K; Burns-Cox, C J

    1994-01-01

    Data from all patients registered blind from diabetic retinopathy in Avon during a 16 month period were analysed with regard to management before hospital referral. The main findings were: 50% of the patients had no screening for retinopathy and were known to be diabetic; 25% were regularly screened for retinopathy (three quarters by local opticians); 22% were newly diagnosed as diabetic at the time of hospital referral. The degree of visual loss at the time of first hospital attendance was found to be marked (average 4.4 Snellen lines of acuity) but was not significantly different for different sources of referral. Only one eye of one patient had normal acuity at first attendance and 88% had lost two or more lines; 72% of registrations were a result of diabetic maculopathy. Delay from waiting for hospital appointments did not contribute significantly to the outcome in the group of patients studied. PMID:7803348

  8. Locked Out: Researching Destinations and Outcomes for Pupils Excluded from Special Schools and Pupil Referral Units

    ERIC Educational Resources Information Center

    Pirrie, Anne; Macleod, Gale

    2009-01-01

    This article explores the methodological challenges encountered during a study of destinations and outcomes for pupils permanently excluded from Pupil Referral Units (PRUs) and special schools in England. It outlines the manner in which the key phrases and assumptions embedded within the specification, terms such as routes and trajectories,…

  9. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  10. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  11. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  12. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  13. 20 CFR 404.1541 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  14. A protocol for consultation of another physician in cases of euthanasia and assisted suicide

    PubMed Central

    van der

    2001-01-01

    Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project "support and consultation in euthanasia in Amsterdam" which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. Key Words: Euthanasia • assisted suicide • consultation • quality assurance • protocol PMID:11579191

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  16. Mix and Match Funding: Diversified Budgets for Child Care Resource and Referral Agencies.

    ERIC Educational Resources Information Center

    Ziegler, Sally

    In order to broaden its sources of funding, a child care resource and referral agency must follow several steps. First, the agency must identify its customers, who are typically children, parents, providers, employers, and the government. Next, the agency must define its functions, which may include advocacy; education and training; day care;…

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

    ERIC Educational Resources Information Center

    Rasmussen, Andrew

    2004-01-01

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

  18. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  19. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Consultation and comment period. 903.14 Section 903.14 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and Western Area...

  20. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Consultation and comment period. 903.14 Section 903.14 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and Western Area...

  1. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Consultation and comment period. 903.14 Section 903.14 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and Western Area...

  2. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Consultation and comment period. 903.14 Section 903.14 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and Western Area...

  3. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) UTAH RECLAMATION MITIGATION AND CONSERVATION COMMISSION POLICIES AND PROCEDURES FOR IMPLEMENTING THE... consultation requirements pursuant to other federal or state laws and regulations and will make this available... comply with the requirements of other federal or state laws and regulations, the associated...

  4. Consulting Young Children about Barriers and Supports to Learning

    ERIC Educational Resources Information Center

    Georgeson, Jan; Porter, Jill; Daniels, Harry; Feiler, Anthony

    2014-01-01

    From consideration of children's rights in general and equal opportunities for disabled children in particular, it is important to consult children about barriers and supports to learning and participation. Finding appropriate and feasible ways, however, to incorporate this into educational programmes for younger children can present challenges.…

  5. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  6. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Coordination and consultation. 98.12 Section 98.12 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  7. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Coordination and consultation. 98.12 Section 98.12 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  8. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Coordination and consultation. 98.12 Section 98.12 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  9. 45 CFR 98.12 - Coordination and consultation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Coordination and consultation. 98.12 Section 98.12 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... local government during the development of the Plan; and (c) Coordinate, to the maximum extent...

  10. [The diagnostic nurse consultation in head and neck oncology].

    PubMed

    Cambreleng, Christine; Goujon, Géraldine

    2015-09-01

    The diagnosis announcement nurse consultation is carried out with the patient and/or their family. It is a time of exchange, listening and sharing of information. The diagnosis announcement nurse is available to answer questions from the patient and their family about the disease, the treatments and the follow-up care.

  11. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Interested parties, participation, and consultation. 450.316 Section 450.316 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  12. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 23 Highways 1 2012-04-01 2012-04-01 false Interested parties, participation, and consultation. 450.316 Section 450.316 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Interested parties, participation, and consultation. 450.316 Section 450.316 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Interested parties, participation, and consultation. 450.316 Section 450.316 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Interested parties, participation, and consultation. 450.316 Section 450.316 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  16. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE MEASUREMENT SERVICES POLICIES... competence, NIST offers consulting and advisory services on various problems related to measurement, e.g... statistical control of the measurement process, automated acquisition of laboratory data, and data...

  17. 40 CFR 25.4 - Information, notification, and consultation responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... GENERAL PUBLIC PARTICIPATION IN PROGRAMS UNDER THE RESOURCE CONSERVATION AND RECOVERY ACT, THE SAFE DRINKING WATER ACT, AND THE CLEAN WATER ACT § 25.4 Information, notification, and consultation... Freedom of Information Act are set forth in part 2 of this chapter. Consistent with the objectives of §...

  18. Parent Education and Consultation Activities of School Counselors.

    ERIC Educational Resources Information Center

    Ritchie, Martin H.; Partin, Ronald L.

    1994-01-01

    Assessed extent and nature of involvement of school counselors in parenting skills training and parent consultation. Findings from 213 elementary and secondary school counselors revealed that school counselors on all levels recognized importance of working with parents for benefit of students, yet many had little contact with parents. Many…

  19. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  20. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  2. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  4. 40 CFR 93.112 - Criteria and procedures: Consultation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 20 2011-07-01 2011-07-01 false Criteria and procedures: Consultation. 93.112 Section 93.112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR..., Funded or Approved Under Title 23 U.S.C. or the Federal Transit Laws § 93.112 Criteria and...

  5. 40 CFR 93.112 - Criteria and procedures: Consultation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Criteria and procedures: Consultation. 93.112 Section 93.112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR..., Funded or Approved Under Title 23 U.S.C. or the Federal Transit Laws § 93.112 Criteria and...

  6. Directed Consultation, the SEALS Model, and Teachers' Classroom Management

    ERIC Educational Resources Information Center

    Motoca, Luci M.; Farmer, Thomas W.; Hamm, Jill V.; Byun, Soo-yong; Lee, David L.; Brooks, Debbie S.; Rucker, Nkecha; Moohr, Michele M.

    2014-01-01

    Directed consultation is presented as a professional development framework to guide and support teachers in the implementation of evidence-based interventions that involve contextual and process-oriented approaches designed to be incorporated into daily classroom management. This approach consists of four components: pre-intervention observations…

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

    ERIC Educational Resources Information Center

    Serpieri, Roberto; Grimaldi, Emiliano; Vatrella, Sandra

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Clark, Thomas

    2009-01-01

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

  9. 22 CFR 161.11 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Preservation for comments. (c) Executive Order 11988 (Floodplains Management) and Executive Order 11990... consultation for these additional requirements concurrently with and integrated with preparation of assessments...) Coastal Zone Management Act of 1972, as amended, 16 U.S.C. 1451 et seq. (h) Marine Protection,...

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... consultation responsibilities. 25.4 Section 25.4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... responsibilities. (a) General. EPA, State, interstate, and substate agencies shall conduct a continuing program for..., consistent with applicable statutory requirements, the social, economic, and environmental consequences...

  11. 5 CFR 2640.303 - Consultation and notification regarding waivers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Consultation and notification regarding waivers. 2640.303 Section 2640.303 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS INTERPRETATION, EXEMPTIONS AND WAIVER GUIDANCE CONCERNING 18 U.S.C. 208 (ACTS AFFECTING A PERSONAL...

  12. 5 CFR 2640.303 - Consultation and notification regarding waivers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Consultation and notification regarding waivers. 2640.303 Section 2640.303 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS INTERPRETATION, EXEMPTIONS AND WAIVER GUIDANCE CONCERNING 18 U.S.C. 208 (ACTS AFFECTING A PERSONAL...

  13. 5 CFR 2640.303 - Consultation and notification regarding waivers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Consultation and notification regarding waivers. 2640.303 Section 2640.303 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS INTERPRETATION, EXEMPTIONS AND WAIVER GUIDANCE CONCERNING 18 U.S.C. 208 (ACTS AFFECTING A PERSONAL...

  14. 5 CFR 2640.303 - Consultation and notification regarding waivers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Consultation and notification regarding waivers. 2640.303 Section 2640.303 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS INTERPRETATION, EXEMPTIONS AND WAIVER GUIDANCE CONCERNING 18 U.S.C. 208 (ACTS AFFECTING A PERSONAL...

  15. 5 CFR 2640.303 - Consultation and notification regarding waivers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Consultation and notification regarding waivers. 2640.303 Section 2640.303 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS INTERPRETATION, EXEMPTIONS AND WAIVER GUIDANCE CONCERNING 18 U.S.C. 208 (ACTS AFFECTING A PERSONAL...

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

    PubMed Central

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

    2016-01-01

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

  17. Microcomputers and consultation psychiatry in the general hospital.

    PubMed

    Hammer, J S; Hammond, D; Strain, J J; Lyons, J S

    1985-04-01

    The microcomputer allows for the design of a system that functions integrally with both the day-to-day and long-term needs of a consultation-liaison psychiatric service. This article describes a microcomputer system and data structure that can accomplish many of the same research tasks as a minicomputer system. In addition, the same data item inputs can be used to develop management reports that can facilitate the administrative as well as the pedagogic needs of a consultation-liaison service. Because of the daily availability and review of output reports, supervisors' corrections are made that enhance the reliability of the data. The program format provides 1) an intake form with pertinent identifying demographic data; 2) an activity file that contains every encounter between the consultant and the patient as well as research, supervisory, and liaison activities (which permit cost-effectiveness analysis); 3) a master clinical data base containing 255 variables for each case seen; 4) a computer-generated chart note; 5) letters to referring physicians; 6) clinical activity descriptions for billing; and 7) a file for pertinent literature searches. Since certain analyses may be limited in the microsystem, its interactive capacity with mainframe computers allows for complex functions. The microsystem described presently emphasizes flexibility, accessibility, and step-by-step development of files as needed by a particular consultation-liaison service. Finally, microcomputers are available at a fraction of the cost of the minicomputer or mainframe systems.

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

    PubMed

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

    2016-06-01

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

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

    PubMed

    Iltis, Ana S; Sheehan, Mark

    2016-08-01

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

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

    PubMed Central

    2015-01-01

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

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

    PubMed

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

    2014-07-01

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

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

    ERIC Educational Resources Information Center

    Bonnet, Deborah G.

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Efstathiou, G.

    2009-01-01

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

  4. 46 CFR 508.101 - Cross-referrence to employee ethical conduct standards and financial disclosure regulations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 9 2012-10-01 2012-10-01 false Cross-referrence to employee ethical conduct standards... GENERAL AND ADMINISTRATIVE PROVISIONS EMPLOYEE ETHICAL CONDUCT STANDARDS AND FINANCIAL DISCLOSURE REGULATIONS § 508.101 Cross-referrence to employee ethical conduct standards and financial...

  5. Adult Education Information and Referral Hot-Line. Adult Education Special Project. Final Report, July 1980-June 1981.

    ERIC Educational Resources Information Center

    Morgan, Jim

    A toll-free adult education information and referral hotline provided information and referral services to approximately 1500 adults in Region IX in Texas from September 1980 to June 1981. Adult education co-ops and testing centers forwarded pertinent program information (class schedules, General Educational Development testing information) to the…

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

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  8. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  9. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  10. 16 CFR 5.54 - Referral to the Office of Government Ethics and to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  11. 46 CFR 508.101 - Cross-referrence to employee ethical conduct standards and financial disclosure regulations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 9 2014-10-01 2014-10-01 false Cross-referrence to employee ethical conduct standards and financial disclosure regulations. 508.101 Section 508.101 Shipping FEDERAL MARITIME COMMISSION... REGULATIONS § 508.101 Cross-referrence to employee ethical conduct standards and financial...

  12. 46 CFR 508.101 - Cross-referrence to employee ethical conduct standards and financial disclosure regulations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 9 2013-10-01 2013-10-01 false Cross-referrence to employee ethical conduct standards and financial disclosure regulations. 508.101 Section 508.101 Shipping FEDERAL MARITIME COMMISSION... REGULATIONS § 508.101 Cross-referrence to employee ethical conduct standards and financial...

  13. 46 CFR 508.101 - Cross-referrence to employee ethical conduct standards and financial disclosure regulations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 9 2011-10-01 2011-10-01 false Cross-referrence to employee ethical conduct standards and financial disclosure regulations. 508.101 Section 508.101 Shipping FEDERAL MARITIME COMMISSION... REGULATIONS § 508.101 Cross-referrence to employee ethical conduct standards and financial...

  14. 46 CFR 508.101 - Cross-referrence to employee ethical conduct standards and financial disclosure regulations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 9 2010-10-01 2010-10-01 false Cross-referrence to employee ethical conduct standards and financial disclosure regulations. 508.101 Section 508.101 Shipping FEDERAL MARITIME COMMISSION... REGULATIONS § 508.101 Cross-referrence to employee ethical conduct standards and financial...

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  16. 24 CFR 103.100 - Notification and referral to substantially equivalent State or local agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Notification and referral to substantially equivalent State or local agencies. 103.100 Section 103.100 Housing and Urban Development Regulations Relating to Housing and Urban Development OFFICE OF ASSISTANT SECRETARY FOR EQUAL...

  17. Special Education Referral, Evaluation, and Placement Practices for Preschool English Language Learners

    ERIC Educational Resources Information Center

    Hardin, Belinda J.; Roach-Scott, Marisa; Peisner-Feinberg, Ellen S.

    2007-01-01

    The number of English language learners (ELLs) in early childhood regular and special education services has increased dramatically in the past decade. A survey was conducted with 141 early childhood administrators and teachers to examine their beliefs and practices concerning the special education referral, evaluation, and placement process for…

  18. An assessment of the cost-effectiveness, safety of referral and patient satisfaction of a general practice teledermatology service

    PubMed Central

    Solomon, Jessica

    2015-01-01

    Background In the cost-constrained NHS and in the quest for rapid diagnosis, teledermatology is a tool that can be used within general practice to aid in the diagnosis of benign-looking skin lesions and reduce referrals to secondary care. The setting for the study was a single general practice of 6500 patients in suburban Greater London. The aim of the study was to determine: (1) whether teledermatology in a single general practice is cost-effective, (2) whether the correct types of cases are being referred, and (3) if patients are satisfied with the service. Methods Teledermatology was provided by a private provider. A trained member of staff took photographs in the practice. A consultant dermatologist carried out reporting. This is a retrospective analysis of case records over three years. The cases were adult patients (aged 18+) using teledermatology for the diagnosis and management of skin lesions thought to be benign by the general practitioner. Cost-effectiveness was calculated by considering savings made through reduced referral to secondary care, taking into account the cost of the service. To evaluate whether the correct cases were referred we reviewed whether the assessing dermatologist identified any previously undiagnosed skin cancer. Patient satisfaction assessment was performed using a standard questionnaire. Results Two hundred and forty-eight patients had teledermatology. These were patients who would have been referred to secondary care for a routine appointment. Of these, 102 were subsequently referred to secondary care and 146 were managed within the practice. Teledermatology saved £12 460 over the 3-year period. Patients were followed for up to 51 months and no lesions were found to be malignant. Ninety-seven percent of patients rated themselves as satisfied/very satisfied and 93% found the procedure comfortable/very comfortable. The median wait for the photos to be taken was 7 days, and 1–2 weeks for results. Conclusions Teledermatology has

  19. 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.

  20. Relation of Psychiatric Symptoms with Epilepsy, Asthma, and Allergy in Youth with ASD vs. Psychiatry Referrals.

    PubMed

    Weber, Rebecca J; Gadow, Kenneth D

    2016-10-11

    The present study aimed to characterize the association of psychopathology with the clinical correlates of epilepsy, asthma, and allergy within and between neurobehavioral syndromes. Participants were consecutively evaluated youth (6-18 years, 75 % male) with autism spectrum disorder (ASD; n = 589) and non-ASD outpatient psychiatry referrals (n = 653). Informants completed a background questionnaire (parents) and a psychiatric symptom severity rating scale (parents, teachers). Youth with ASD had higher rates of epilepsy and allergy but not asthma than psychiatry referrals, even when analyses were limited to youth with IQ ≥ 70. Somatic conditions evidenced variable associations with medical services utilization, educational interventions, family income, and maternal education. Youth with ASD with versus without epilepsy had more severe ASD social deficits (parents' ratings) and less severe ASD repetitive behaviors (teachers' ratings). Epilepsy was associated with more severe depression, mania, and schizophrenia symptoms in youth with ASD. Youth with allergy (psychiatry referrals only) had more severe anxiety and depression symptoms (parents' ratings) but less severe aggression (teachers' ratings) thus providing evidence of both context- and diagnostic-specificity. Youth with ASD versus non-ASD psychiatry referrals evidence a variable pattern of relations between somatic conditions and a range of clinical correlates, which suggests that the biologic substrates and psychosocial concomitants of neurodevelopmental disorders and their co-occurring somatic conditions may interact to produce unique clinical phenotypes.

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

    ERIC Educational Resources Information Center

    Nicholson, Nikki

    2007-01-01

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

  2. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

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

    ERIC Educational Resources Information Center

    Robinson, Cordelia C.; And Others

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Dutcher, Gale A.

    1989-01-01

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

  9. 41 CFR 105-70.011 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Referral of complaint and answer to the ALJ. 105-70.011 Section 105-70.011 Public Contracts and Property Management Federal... Services Administration 70-IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 §...

  10. 38 CFR 42.11 - Referral of complaint and answer to the Administrative Law Judge (ALJ).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Referral of complaint and answer to the Administrative Law Judge (ALJ). 42.11 Section 42.11 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) STANDARDS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT §...

  11. 38 CFR 42.11 - Referral of complaint and answer to the Administrative Law Judge (ALJ).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Referral of complaint and answer to the Administrative Law Judge (ALJ). 42.11 Section 42.11 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) STANDARDS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT §...

  12. Physician investment and self-referral: philosophical analysis of a contentious debate.

    PubMed

    Morreim, E H

    1990-08-01

    A new economic phenomenon, in which physicians refer their patients to ancillary facilities of which they themselves are owners or substantial investors, presents a 'laboratory' for assessing philosophers' potential contributions to public policy issues. In this particular controversy, 'prohibitionists' who wish to ban all such self-referral focus on the dangers that patients and payers may receive or be billed for unnecessary or poor-quality care. 'Laissez-fairists', in contrast, argue that self-referral should be freely permitted, with a reliance on personal ethics and internal professional monitoring to guard against abuse. Undue government regulation, they argue, infringes providers' and patients' economic freedom, and stifles the competition that can yield better quality care at lower prices. As this debate features basic values and large amounts of money, it has been marked by rancorous rhetoric, shallow argument, and muddled reasoning. The philosopher's first contribution, therefore, is to expose simplistic and fallacious arguments, whether empirical, conceptual, moral, or legal. Beyond this the philosopher can help to identify the important values at stake and, perhaps, to identify resolutions that honor those values better than the more simplistic answers proffered previously. For abusive self-referral, as distinguished from kickbacks, the author recommends that civil remedies be favored over criminal prohibitions. She suggests that the doctrine of 'bad faith breach of contract' might appropriately be extended into this new area to provide a powerful means by which aggrieved patients and payers can hold physicians personally accountable for abusive self-referrals.

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  15. 42 CFR 455.13 - Methods for identification, investigation, and referral.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Methods for identification, investigation, and referral. 455.13 Section 455.13 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID...

  16. 42 CFR 455.13 - Methods for identification, investigation, and referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Methods for identification, investigation, and referral. 455.13 Section 455.13 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID...

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

    PubMed

    Larocca, Liliana Muller; Mazza, Verônica de Azevedo

    2003-08-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... institutional request for review and response. The ASC X12 Standards for Electronic Data Interchange Technical... Standards for Electronic Data Interchange Technical Report Type 3, April 2008, ASC X12N/005010X217E1... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Referral Certification...

  19. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... institutional request for review and response. The ASC X12 Standards for Electronic Data Interchange Technical... Standards for Electronic Data Interchange Technical Report Type 3, April 2008, ASC X12N/005010X217E1... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Referral Certification...

  20. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... institutional request for review and response. The ASC X12 Standards for Electronic Data Interchange Technical... Standards for Electronic Data Interchange Technical Report Type 3, April 2008, ASC X12N/005010X217E1... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Referral Certification...

  1. 76 FR 13576 - Jurisdictional Separations and Referral to the Federal-State Joint Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-14

    ... COMMISSION 47 CFR Part 36 Jurisdictional Separations and Referral to the Federal-State Joint Board AGENCY: Federal Communications Commission. ACTION: Proposed rule. SUMMARY: Jurisdictional separations is the... jurisdictional separations. Extending the freeze would allow the Commission to provide stability for, and...

  2. 75 FR 30301 - Jurisdictional Separations and Referral to the Federal-State Joint Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-01

    ... COMMISSION 47 CFR Part 36 Jurisdictional Separations and Referral to the Federal-State Joint Board AGENCY: Federal Communications Commission. ACTION: Interim rule. SUMMARY: Jurisdictional separations is the... jurisdictional separations. Extending the freeze provides stability for, and avoids imposing undue burdens...

  3. 77 FR 16899 - Jurisdictional Separations and Referral to the Federal-State Joint Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-22

    ... March 22, 2012 Part II Federal Communications Commission 47 CFR Part 36 Jurisdictional Separations and... Jurisdictional Separations and Referral to the Federal-State Joint Board AGENCY: Federal Communications Commission. ACTION: Proposed rule. SUMMARY: Jurisdictional separations is the process by which...

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

    ERIC Educational Resources Information Center

    McCue, Michael J.; Nayar, Preethy

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  6. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for self-referral and point of service option. 422.105 Section 422.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits...

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

    ERIC Educational Resources Information Center

    Cunningham, Melissa M.; Wodrich, David L.

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    DePass Pipkin, Tamika S.

    2012-01-01

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

  9. Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care.

    PubMed

    Allen, J; Annells, M; Nunn, R; Petrie, E; Clark, E; Lang, L; Robins, A

    2011-06-01

    The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.

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

    PubMed

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

    2015-09-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  12. 41 CFR 105-70.011 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services Administration 70-IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 105-70.011... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Referral of...

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  15. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  16. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  17. The Effects of Response to Intervention Implementation on Special Education Referral and Identification Rates

    ERIC Educational Resources Information Center

    Kreider, Theresa E.

    2010-01-01

    Special education referral and identification rates have risen dramatically over the last thirty years. In fact, several studies report an increase of nearly 200% (Cortiella, 2008; Vaughn, Linan-Thompson, & Hickman, 2003). During the last several years a new model of identifying students with learning difficulties has received much…

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  19. 77 FR 30410 - Jurisdictional Separations and Referral to the Federal-State Joint Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-23

    ... COMMISSION 47 CFR Part 36 Jurisdictional Separations and Referral to the Federal-State Joint Board AGENCY: Federal Communications Commission. ACTION: Interim rule. SUMMARY: Jurisdictional separations is the... separations until June 30, 2014. Extending the freeze will allow the Commission to provide stability...

  20. 75 FR 17109 - Jurisdictional Separations and Referral to the Federal-State Joint Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-05

    ... COMMISSION 47 CFR Part 36 Jurisdictional Separations and Referral to the Federal-State Joint Board AGENCY: Federal Communications Commission. ACTION: Proposed rule. SUMMARY: Jurisdictional separations is the... factors used in jurisdictional separations, which freeze would otherwise expire on June 30,...

  1. 76 FR 30840 - Jurisdictional Separations and Referral to the Federal-State Joint Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-27

    ... COMMISSION 47 CFR Part 36 Jurisdictional Separations and Referral to the Federal-State Joint Board AGENCY: Federal Communications Commission. ACTION: Interim rule. SUMMARY: Jurisdictional separations is the... separations until June 30, 2012. Extending the freeze will allow the Commission to provide stability for,...

  2. 20 CFR 355.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Referral of complaint and answer to the ALJ. 355.11 Section 355.11 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 §...

  3. 20 CFR 355.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Referral of complaint and answer to the ALJ. 355.11 Section 355.11 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 §...

  4. 28 CFR 71.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Referral of complaint and answer to the ALJ. 71.11 Section 71.11 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) IMPLEMENTATION OF THE PROVISIONS OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 Implementation for Actions Initiated...

  5. 20 CFR 355.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Referral of complaint and answer to the ALJ. 355.11 Section 355.11 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 §...

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

    PubMed Central

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

    2016-01-01

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

  7. Referral patterns in a global store-and-forward telemedicine system.

    PubMed

    Wootton, R; Youngberry, K; Swinfen, R; Swinfen, P

    2005-01-01

    We examined the nature of the referral patterns in the email telemedicine network operated by the Swinfen Charitable Trust with a view to informing long-term resource planning. Over the first six years of operation, 62 hospitals from 19 countries registered with the Trust in order to be able to refer cases for specialist advice; 55 of these hospitals (89%) actually referred cases during this period. During the first six years of operation, nearly 1,000 referrals were submitted and answered, from a wide range of specialty areas. Between July 2002 and March 2005 the referral rate rose from 127 to 318 cases per year. The median length of time required to provide a specialist's response was 2.3 days during the first 12 months and 1.8 days during the last 12 months. Five hospitals submitted cases for more than four years (together sending a total of 493 cases). Their activity data showed a trend to declining referral rates over the four-year period, which may represent successful knowledge transfer. There is some evidence that over the last three years the growth in demand has been exponential, while the growth in resources available (i.e. specialists) has been linear, a situation which cannot continue for very long before demand outstrips supply.

  8. Development and Validation of a Diabetic Retinopathy Referral Algorithm Based on Single-Field Fundus Photography

    PubMed Central

    Srinivasan, Sangeetha; Shetty, Sharan; Natarajan, Viswanathan; Sharma, Tarun; Raman, Rajiv

    2016-01-01

    Purpose To develop a simplified algorithm to identify and refer diabetic retinopathy (DR) from single-field retinal images specifically for sight-threatening diabetic retinopathy for appropriate care (ii) to determine the agreement and diagnostic accuracy of the algorithm as a pilot study among optometrists versus “gold standard” (retinal specialist grading). Methods The severity of DR was scored based on colour photo using a colour coded algorithm, which included the lesions of DR and number of quadrants involved. A total of 99 participants underwent training followed by evaluation. Data of the 99 participants were analyzed. Fifty posterior pole 45 degree retinal images with all stages of DR were presented. Kappa scores (κ), areas under the receiver operating characteristic curves (AUCs), sensitivity and specificity were determined, with further comparison between working optometrists and optometry students. Results Mean age of the participants was 22 years (range: 19–43 years), 87% being women. Participants correctly identified 91.5% images that required immediate referral (κ) = 0.696), 62.5% of images as requiring review after 6 months (κ = 0.462), and 51.2% of those requiring review after 1 year (κ = 0.532). The sensitivity and specificity of the optometrists were 91% and 78% for immediate referral, 62% and 84% for review after 6 months, and 51% and 95% for review after 1 year, respectively. The AUC was the highest (0.855) for immediate referral, second highest (0.824) for review after 1 year, and 0.727 for review after 6 months criteria. Optometry students performed better than the working optometrists for all grades of referral. Conclusions The diabetic retinopathy algorithm assessed in this work is a simple and a fairly accurate method for appropriate referral based on single-field 45 degree posterior pole retinal images. PMID:27661981

  9. Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia

    PubMed Central

    Bolton, Carolyn; Lyabola, Lane-Lee; Phiri, Gabriel; Samona, Alick; Kaonga, Albert; Thirumurthy, Harsha

    2016-01-01

    Background: Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. Methods: The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention. Results: During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised. Conclusions: The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male

  10. 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…

  11. Causes and characteristics of medical student referrals to a professional behaviour board

    PubMed Central

    Bolk, Jan H.; Ottenhoff- de Jonge, Marleen W.; van Mook, Walther N.K.A.; de Beaufort, Arnout Jan

    2017-01-01

    Objectives To describe the nature of unprofessional behaviour displayed by medical students, as well as the characteristics of students referred to the professional behaviour board. Methods A descriptive mixed methods approach was taken, in which qualitative data on unprofessional behaviour, as well as quantitative data on the demographics of referred students were collected during the study period between June 1, 2009 and January 1, 2014. In order to compare the referred students with the total student population, data on gender, nationality and phase in the curriculum of the total student population, collected from the student administration desk, were also used. Results In the study period, a total of 107 referrals were reported, concerning 93 different students (3% of the total student population). Sixty-five of the 107 referrals (61%) concerned male students. Thirty referrals (28%) concerned non-Dutch students. Most referrals (71%) occurred during clinical rotations. The referrals were equally distributed over three professional behaviour domains: dealing with oneself, dealing with others, and dealing with tasks/work. ‘Withdrawn behaviour’ was reported 17 times, ‘insufficient Dutch language proficiency’ 14 times, ‘impertinent emails’ 9 times and ‘placing privacy-sensitive photos on the internet’ 3 times. Conclusions Although only a minority of students are referred to a professional behaviour board, this study shows that student characteristics such as gender and nationality may correlate to a higher incidence of unprofessional behaviour. Further explanatory and exploratory research is needed to unravel this relationship, and to study the influence of curriculum reforms on these relationships, respectively. PMID:28088777

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    PubMed

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

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

  14. 78 FR 18585 - FIFRA Pesticide Registration Review and ESA Consultation Processes; Stakeholder Input; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... AGENCY FIFRA Pesticide Registration Review and ESA Consultation Processes; Stakeholder Input; Notice of... pesticide registrations under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and associated... facilitate ESA pesticide consultations and coordination across these Federal agencies, and calls for...

  15. 77 FR 31348 - Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section 106 Consultation Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-25

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

  16. 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:…

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

    PubMed

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

    2015-01-01

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

  18. Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral

    PubMed Central

    2014-01-01

    Background Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. Methods A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ2 tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. Results Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were ‘accessibility and convenience’ and perceived ‘medical necessity’. Conclusions A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem. PMID:25097670

  19. Entrepreneurial Consulting: Some Structural and Personal Learnings

    ERIC Educational Resources Information Center

    Lyons, Morgan; Harrington, Maura J.

    2006-01-01

    These authors, who have managed a small, entrepreneurial applied-research firm for more than twenty years, share their reflections about what elements of organizational structure have worked best for them, and offer some observations on a personal level as well about how to optimize and remain viable in a volatile professional field. The term…

  20. Better Decisions through Consultation and Collaboration

    EPA Pesticide Factsheets

    This manual discusses the benefits of public involvement to agency decision makers, including expanding shared baseline knowledge, generating support for the decision, and developing ongoing relationships that will help in implementing decisions.

  1. Organizational and Consultant Conflicts of Interest.

    DTIC Science & Technology

    2007-11-02

    conflict of interest. We did not use statistical sampling procedures to conduct this audit. Use of Computer-Processed Data . We relied on computer...processed data from the DoD Contract Action Reporting System to determine which contracting activities would receive questionnaires and to determine...audit sample selection. Although we did not perform a formal reliability assessment of the computer-processed data , we determined that contract

  2. Three quantitative studies of gender and identity in psychotherapy consultations.

    PubMed

    Langs, R; Rapp, P E; Pinto, A; Cramer, G; Badalamenti, A

    1992-04-01

    This paper details the application of three distinctive approaches to the analysis of line-by-line scores for themes of gender and identity in recorded psychotherapy consultations conducted by three male analysts with a female patient. The first method involved commonly used statistical comparisons of the frequency with which gender subthemes and allusions to identity appeared in each consultation session. The results of this study indicate three significantly different patterns of gender material in the communications from the patient with each of the analysts who interviewed her--and from each analyst and patient/analyst system as well. Therapist dominance in this area appeared to be quite strong. The second study involved measures of overall informational complexity for various aspects of the gender/identity sequence of communications. Here too, individual differences emerged. They not only add to the evidence for therapist dominance in these protocols, but also provide indications that sessions differ in respect to the extent to which the information they contain is ordered and repetitive or redundant, as compared to disordered, complex, and varied. The third study availed itself of stochastic methods in which the Box-Jenkins models were used to define mathematically and post hoc, the deeper structure of aspects of the vicissitudes of gender/identity expressions in the course of these consultations. The main finding was that change in speaker role in respect to these themes accelerated in response to random interventional shocks to the system that occurred at the time of measurement and inversely with shocks to the system sustained the previous second. This look into the deeper structure of these sequences revealed considerable sensitivity to recent shocks to the patient/therapist system, much underlying instability, and strong tendencies toward establishing stability or equilibrium when the system destabilized. Of note is the finding that all three

  3. Consultant pharmacists, advanced practice nurses, and the interdisciplinary team.

    PubMed

    Resnick, Barbara

    2014-03-01

    Although in geriatrics we are better than many other clinical disciplines in terms of providing interdisciplinary care to older adults, I hope that we will continue to recognize how much more could actually be done. Before addressing the relationship between advanced practice nurses (APNs) and consultant pharmacists in real world settings, I want to review teamwork in geriatrics in general. It is critical to define what we mean by team, what type of team, and what the goals are of this teamwork.

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

    PubMed

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

    2004-01-01

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

  5. "Care and feeding": the Asian environmental tobacco smoke consultants programme

    PubMed Central

    Assunta, M; Fields, N; Knight, J; Chapman, S

    2004-01-01

    Study objective: To review the tobacco industry's Asian environmental tobacco smoke (ETS) consultants programme, focusing on three key nations: China, Hong Kong, and Malaysia. Methods: Systematic keyword and opportunistic website searches of formerly private internal industry documents. Main results: The release of the 1986 US Surgeon General's report on second hand smoke provoked tobacco companies to prepare for a major threat to their industry. Asian programme activities included conducting national/international symposiums, consultant "road shows" and extensive lobbying and media activities. The industry exploited confounding factors said to be unique to Asian societies such as diet, culture and urban pollution to downplay the health risks of ETS. The industry consultants were said to be "...prepared to do the kinds of things they were recruited to do". Conclusions: The programme was successful in blurring the science on ETS and keeping the controversy alive both nationally and internationally. For the duration of the project, it also successfully dissuaded national policy makers from instituting comprehensive bans on smoking in public places. PMID:15564219

  6. Segmenting and accessing the market in consultation-liaison psychiatry.

    PubMed

    Wise, T N

    1987-09-01

    Although the importance of consultation-liaison (C-L) psychiatry is increasingly recognized, obstacles to acceptance of the specialty persist in many service delivery settings. These can be countered by identifying specific consumers of C-L services and demonstrating that products of the specialty will meet consumers' needs. Once access to the market is gained, it is important to monitor potential sources of competition in the interest of ensuring continued high quality patient care.

  7. [Laboratory information and consultation service with a ordering system].

    PubMed

    Shibazaki, Mitsuei; Shimetani, Naoto; Mori, Mikio

    2002-04-01

    We built a laboratory information system that does not require resident medical technologists or medical doctors. The laboratory information system used the following two methods. In the first method, the receiver of questions/complaints/consultations about laboratory tests used e-mail carried by an ordering system. In the second method, the Web utilized a laboratory test information retrieval system by intranet. As for e-mail inquirers, doctors made up 76.7%(46/60), and other types of job were office workers 11.7% (7/60), nurses 8.3%(5/60), and pharmacists 3.3%(2/60). The question(consultation) contents were test methods 30.0%, demands/complaints 28.3% for ordering, specimen saving requests 13.3%, consultations 11.7%, and other 16.7%. Since introducing this system, compared to previously telephone inquiries have by about 60% decreased, and basic questions such as reference intervals or containers have decreased even more. The system operates 24 hours a day and dose not increase the current workload, thus allowing the accumulation of a laboratory information system.

  8. Referral Process Improvement: A Study of the Efficiency and Tracking Processes for In-house Referrals at Blanchfield Army Community Hospital

    DTIC Science & Technology

    2006-05-31

    emerged in the 1920s and 1930s when the advances and costs in medicine and hospital care, along with the Great Depression , eroded the public’s ability...57 McPhee, SJ., Lo, B., Saika, GY., and Meltzer , R. (1984). How good is communication between primary care physicians and subspecialty consultants

  9. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    PubMed Central

    Ryoo, Hyeon-Ju; Choo, Esther K.

    2016-01-01

    Introduction Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02–1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15–1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17–1.43]). This significant association prevailed after controlling for “seeking detox.” Conclusion Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes. PMID:27330662

  10. Gender Comparison in Referrals and Treatment Completion to Residential and Outpatient Alcohol Treatment

    PubMed Central

    Bazargan-Hejazi, Shahrzad; De Lucia, Valory; Pan, Deyu; Mojtahedzadeh, Mona; Rahmani, Elham; Jabori, Sinan; Zahmatkesh, Golara; Bazargan, Mohsen

    2016-01-01

    BACKGROUND Residential treatment for alcoholism is associated with high completion rates for clients, yet there appear to be gender disparities in patient referrals and treatment completion rates. We studied whether (A) gender is associated with differential patient placement to outpatient vs. residential treatment facilities and (B) completion rates differ by gender. METHODS In this cross-sectional study, we analyzed the admission and discharge data from 185 publicly funded substance abuse treatment facilities across Los Angeles County between 2005 and 2010. RESULTS Among the 33,745 studied cases, women were referred to residential treatment facilities less frequently than men (75% vs. 66%). The adjusted results derived from logistic regression models confirmed that females were more likely to be referred to outpatient treatment than to residential treatment facilities (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05–1.26). In addition, we observed that compared to White/Caucasian patients, all other races were associated with more referral to outpatient facilities (ie, less referral to residential facilities), indicating a racial disparity on the top of the observed gender disparity. However, there was no significant link between gender and treatment completion rates (OR: 0.93, 95% CI: 0.86–1.00). CONCLUSIONS Women seem to have treatment completion rates comparable to men, yet they are less likely to be referred to residential treatment facilities. Hence, there still remains a gender disparity in alcoholic patient referrals. Further studies should delineate which specific therapeutic aspects and programmatic components of women-focused treatments are essential to augment positive treatment outcomes. PMID:28008266

  11. Telemedicine for clinical management of diabetes - a process analysis of video consultations.

    PubMed

    Fatehi, Farhad; Gray, Leonard C; Russell, Anthony W

    2013-10-01

    We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210-1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant's opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists.

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  13. 15 CFR 971.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Consultation and cooperation with... Applications Procedures § 971.211 Consultation and cooperation with Federal agencies. (a) Promptly after...) NOAA will use this process of consultation and cooperation to facilitate necessary Federal decisions...

  14. 15 CFR 970.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Consultation and cooperation with... Applications Procedures § 970.211 Consultation and cooperation with Federal agencies. (a) Promptly after his... benefits of this process of consultation and cooperation to facilitate necessary Federal decisions on...

  15. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Consultation and cooperation with... § 970.502 Consultation and cooperation with Federal agencies. Prior to the issuance or transfer of an exploration license, the Administrator will continue the consultation and cooperation with other...

  16. 15 CFR 971.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 3 2011-01-01 2011-01-01 false Consultation and cooperation with... Applications Procedures § 971.211 Consultation and cooperation with Federal agencies. (a) Promptly after...) NOAA will use this process of consultation and cooperation to facilitate necessary Federal decisions...

  17. 15 CFR 970.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Consultation and cooperation with... Applications Procedures § 970.211 Consultation and cooperation with Federal agencies. (a) Promptly after his... benefits of this process of consultation and cooperation to facilitate necessary Federal decisions on...

  18. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Consultation and cooperation with... § 970.502 Consultation and cooperation with Federal agencies. Prior to the issuance or transfer of an exploration license, the Administrator will continue the consultation and cooperation with other...

  19. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 15 Commerce and Foreign Trade 3 2012-01-01 2012-01-01 false Consultation and cooperation with... § 970.502 Consultation and cooperation with Federal agencies. Prior to the issuance or transfer of an exploration license, the Administrator will continue the consultation and cooperation with other...

  20. 15 CFR 971.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 15 Commerce and Foreign Trade 3 2012-01-01 2012-01-01 false Consultation and cooperation with... Applications Procedures § 971.211 Consultation and cooperation with Federal agencies. (a) Promptly after...) NOAA will use this process of consultation and cooperation to facilitate necessary Federal decisions...

  1. 15 CFR 970.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 15 Commerce and Foreign Trade 3 2012-01-01 2012-01-01 false Consultation and cooperation with... Applications Procedures § 970.211 Consultation and cooperation with Federal agencies. (a) Promptly after his... benefits of this process of consultation and cooperation to facilitate necessary Federal decisions on...

  2. 15 CFR 970.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 3 2013-01-01 2013-01-01 false Consultation and cooperation with... Applications Procedures § 970.211 Consultation and cooperation with Federal agencies. (a) Promptly after his... benefits of this process of consultation and cooperation to facilitate necessary Federal decisions on...

  3. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 3 2013-01-01 2013-01-01 false Consultation and cooperation with... § 970.502 Consultation and cooperation with Federal agencies. Prior to the issuance or transfer of an exploration license, the Administrator will continue the consultation and cooperation with other...

  4. 15 CFR 971.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 3 2013-01-01 2013-01-01 false Consultation and cooperation with... Applications Procedures § 971.211 Consultation and cooperation with Federal agencies. (a) Promptly after...) NOAA will use this process of consultation and cooperation to facilitate necessary Federal decisions...

  5. 15 CFR 970.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 3 2011-01-01 2011-01-01 false Consultation and cooperation with... Applications Procedures § 970.211 Consultation and cooperation with Federal agencies. (a) Promptly after his... benefits of this process of consultation and cooperation to facilitate necessary Federal decisions on...

  6. 15 CFR 971.211 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Consultation and cooperation with... Applications Procedures § 971.211 Consultation and cooperation with Federal agencies. (a) Promptly after...) NOAA will use this process of consultation and cooperation to facilitate necessary Federal decisions...

  7. Treatment and outcomes of head and neck oedema referrals to a hospital-based lymphoedema service.

    PubMed

    Jeffs, Eunice; Huit, Martine

    2015-04-01

    A retrospective review of all head and neck cancer-related lymphoedema (HNCRL) referrals from 1 October 2009 to 30 September 2013 was undertaken. HNCRL referrals significantly increased over a 4-year period. Lymphoedema clinic records were manually examined for the presentation of HNCRL, treatments provided, and outcomes. Some 207 HNCRL referrals were received, increasing by 251% from 2009 to 2013. A total of 110 men and 50 women were assessed and treated over the 4 years; 67% were discharged, 26% continued treatment/monitoring by clinic; 8% are deceased. The average time to discharge reduced from 16 to 5 months. From the results, it seems that self-management with exercise and counter-pressure/compression is very effective and the requirement for manual lymph drainage is reduced. There is increased patient engagement with effective self-care. Provision of appropriate education and information facilitated simple, effective self-management. This reduced treatment time, shortened time to discharge and released valuable practitioner time to treat patients with complex oedema.

  8. 25 CFR 170.100 - What do the terms “consultation, collaboration, and coordination” mean?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What do the terms âconsultation, collaboration, and... Consultation, Collaboration, Coordination § 170.100 What do the terms “consultation, collaboration, and... explanation. (b) Collaboration means that all parties involved in carrying out planning and...

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

    PubMed

    Johnstone, P; Grice, D

    1995-08-10

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

  10. Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences

    PubMed Central

    Shabazz, Tariq; Parry-Smith, William; Oates, Sharon; Henderson, Steven; Mountfield, Joanna

    2016-01-01

    Objective To explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine. Design Questionnaire survey. Setting Royal College of Obstetricians and Gynaecologists (RCOG). Participants O&G consultant members/fellows of the RCOG working in the UK. Main outcome measures Measures included a typology of 4 bullying and undermining consequences from major to coping. Results There was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on ‘frequency of occurrence’, 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not. Conclusions Significant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions. PMID:27324715

  11. Direct Behavioral Consultation: Effects on Teachers' Praise and Student Disruptive Behavior

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Lestremau, Lauren; Zoder-Martell, Kimberly

    2014-01-01

    Direct behavioral consultation is an extension of traditional behavioral consultation and focuses on assessment and training in the classroom during ongoing classroom activities. This study evaluated direct behavioral consultation services in two elementary alternative classrooms referred following a program evaluation in which data suggested…

  12. Bridging Theory and Practice: A Conceptual Framework for Consulting Organisations

    ERIC Educational Resources Information Center

    Mohammed, Meca B.; Welch, Jennie; Hazle Bussey, Leslie

    2015-01-01

    A growing number of organisations are emerging as partners to districts pursuing systemic improvement. Given the critical role a consulting organisation could play in supporting system reform efforts, how does a district leader looking to establish a consulting partnership determine what characteristics in a consulting organisation may be more…

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

    PubMed Central

    Boy, Sonja; Crossley, David; Steenkamp, Gerhard

    2016-01-01

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

  14. Informational influences on physician referrals.

    PubMed

    Beltramini, R F; Sirsi, A K

    1992-01-01

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

  15. Behavior Psychology in the Schools: Innovations in Evaluation, Support, and Consultation.

    ERIC Educational Resources Information Center

    Luiselli, James K., Ed.; Diament, Charles, Ed.

    This volume of "Behavior Psychology in the Schools," discusses key topics in behavioral consultations in public school settings. Following an introduction, articles include: (1) "Focus, Scope, and Practice of Behavioral Consultation to Public Schools" (James K. Luiselli), which describes a four-stage process of consultation and…

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

    PubMed

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

    2016-06-01

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

  17. 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

  18. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2017-01-01

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

  2. Electronic Referrals and Digital Imaging Systems in Ophthalmology: A Global Perspective.

    PubMed

    Jeganathan, V Swetha E; Hall, H Nikki; Sanders, Roshini

    2017-01-01

    Ophthalmology departments face intensifying pressure to expedite sight-saving treatments and reduce the global burden of disease. The use of electronic communication systems, digital imaging, and redesigned service care models is imperative for addressing such demands. The recently developed Scottish Eyecare Integration Project involves an electronic referral system from community optometry to the hospital ophthalmology department using National Health Service (NHS) email with digital ophthalmic images attached, via a virtual private network connection. The benefits over the previous system include reduced waiting times, improved triage, e-diagnosis in 20% without the need for hospital attendance, and rapid electronic feedback to referrers. We draw on the experience of the Scottish Eyecare Integration Project and discuss the global applications of this and other advances in teleophthalmology. We focus particularly on the implications for management and screening of chronic disease, such as glaucoma and diabetic eye disease, and ophthalmic disease, such as retinopathy of prematurity where diagnosis is almost entirely and critically dependent on fundus appearance. Currently in Scotland, approximately 75% of all referrals are electronic from community to hospital. The Scottish Eyecare Integration Project is globally the first of its kind and unique in a national health service. Such speedy, safe, and efficient models of communication are geographically sensitive to service provision, especially in remote and rural regions. Along with advances in teleophthalmology, such systems promote the earlier detection of sight-threatening disease and safe follow-up of non-sight-threatening disease in the community.

  3. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

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

    PubMed Central

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

    2016-01-01

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

  5. Keeping mammography referral appointments: motivation, health beliefs, and access barriers experienced by older minority women.

    PubMed

    Bernstein, J; Mutschler, P; Bernstein, E

    2000-01-01

    Older women of color tend to have much lower rates of regular mammography screening for breast cancer than younger Caucasian women; yet, they have higher rates of mortality. This study was designed to increase mammography rates among inner-city women aged 50 years or older. Another goal was to investigate differences in mammography utilization related to race/ethnicity and language after barriers associated with cost and the difficulty of making an appointment are removed. A peer delivered intervention, which consisted of interview, mammography referral, and the scheduling of a next-day appointment, was conducted among a convenience sample of 151 culturally and racially diverse older women through a primary care referral project operating within an urban emergency department (ED). A brief motivational interview and mammography referral at the time of an ED visit, including scheduling of a next-day no cost appointment, was followed by a cross-sectional telephone survey of utilization and motivating and hindering factors. Follow-up was achieved with 96 women (66%). Fifty-eight women (60%) had a post-intervention mammogram; of those, 69% were first time users. More than 90% planned a repeat mammogram the following year. Of the 27 who did not receive a mammogram, 21 (77%) requested a "second try" appointment. These findings demonstrate that an interactive intervention among older women of color has the potential to dramatically increase mammography rates.

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

    PubMed

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

    2015-04-01

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

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2015-10-01

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

  9. An Analysis of WhatsApp Usage for Communication Between Consulting and Emergency Physicians.

    PubMed

    Gulacti, Umut; Lok, Ugur; Hatipoglu, Sinan; Polat, Haci

    2016-06-01

    The aim of this study was to evaluate WhatsApp messenger usage for communication between consulting and emergency physicians. A retrospective, observational study was conducted in the emergency department (ED) of a tertiary care university hospital between January 2014 and June 2014. A total of 614 consultations requested by using the WhatsApp application were evaluated, and 519 eligible consultations were included in the study. The WhatsApp messages that were transferred to consultant physicians consisted of 510 (98.3%) photographic images, 517 (99.6%) text messages, 59 (11.3%) videos, and 10 (1.9%) voice messages. Consultation was most frequently requested from the orthopedics clinic (n = 160, 30.8%). The majority of requested consultations were terminated only by evaluation via WhatsApp messages. (n = 311, 59.9%). Most of the consulting physicians were outside of the hospital or were mobile at the time of the consultation (n = 292, 56.3%). The outside consultation request rate was significantly higher for night shifts than for day shifts (p = .004), and the majority of outside consultation request were concluded by only WhatsApp application (p < .001). WhatsApp is useful a communication tool between physicians, especially for ED consultants who are outside the hospital, because of the ability to transfer large amounts of clinical and radiological data during a short period of time.

  10. Proactive screening for health needs in United Way’s 2-1-1 information and referral service

    PubMed Central

    Eddens, Katherine S.; Kreuter, Matthew W.

    2011-01-01

    Cancer disproportionately affects the underserved. United Way 2-1-1 is an information and referral system that links underserved populations to community services. This study explores the feasibility of integrating proactive screening and referral to health services into 2-1-1. A cancer risk assessment was administered to callers (n=297), measuring their need for six cancer control services. A subset of respondents was randomized to receive generic or tailored referrals to needed services. Nearly all participants (85%) needed at least one of the services. Those who received tailored referrals were more likely to make appointments. Future research will explore approaches to address and eliminate health disparities through 2-1-1. PMID:21566702

  11. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a..., appropriate investigation, and reporting of criminal activity. Within 30 calendar days of determining...

  12. And on the Seventh Day. Faculty Consulting and Supplemental Income. ASHE-ERIC Higher Education Report No. 3, 1985.

    ERIC Educational Resources Information Center

    Boyer, Carol M.; Lewis, Darrell R.

    The incidence and extent of faculty consulting are examined, along with the characteristics of faculty who consult and those who do not, costs and benefits of faculty consulting, the economic status of faculty, and policy considerations. A conceptual framework and historical context are provided that relate consulting and other faculty activities…

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

    PubMed Central

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

    1999-01-01

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

 Keywords: congenital heart disease;  ambulatory clinics PMID:10220546

  14. The Relationship between Reading Fluency Intervention and the Need for Special Education Referrals

    ERIC Educational Resources Information Center

    Polcyn, Dawn M.

    2012-01-01

    Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate…

  15. Can a self-referral system help improve access to psychological treatments?

    PubMed

    Brown, June S L; Boardman, Jed; Whittinger, Naureen; Ashworth, Mark

    2010-05-01

    Referrals for psychological treatment have been problematic for many years. Even though GPs have attempted to limit access into the small psychological treatment services, long waiting lists have developed which have deterred referrals and deferred psychological care. GPs have understandably been frustrated. In addition, the consultation rate for psychological problems is low when compared with the rate of identified mental health problems in population surveys. Possible reasons include patients' failure to recognise the problem as psychological and thus not consulting one's GP, and/or the problem not being detected by the GP. While a self-referral system may be seen as a way of trying to allow non-consulters to receive treatment, this has been viewed with some scepticism since it may allow the 'worried well' to access already limited services. However, a study has shown that those self-referring to advertised psychological workshops had high levels of psychological morbidity and also were more representative of the population, in terms of ethnicity, than GP referrals. The government has set up the Increasing Access to Psychological Therapies (IAPT) programme to address some of the service shortfalls by expanding the provision of psychological therapists. Notably, the IAPT programme is allowing self-referrals such that any member of the public can access the service directly, bypassing general practice. Although not available at all the sites, this represents a radical shift from the present system in which access to talking therapy is generally only available through direct referral by the GP. The implications of this new development are discussed.

  16. Consulting the community: public expectations and attitudes about genetics research

    PubMed Central

    Etchegary, Holly; Green, Jane; Dicks, Elizabeth; Pullman, Daryl; Street, Catherine; Parfrey, Patrick

    2013-01-01

    Genomic discoveries and technologies promise numerous opportunities for improving health. Key to these potential health improvements, however, are health-care consumers' understanding and acceptance of these new developments. We identified community groups and invited them to a public information-consultation session in order to explore public awareness, perception and expectations about genetics and genomics research. One hundred and four members of seven community groups in Newfoundland, Canada took part in the community sessions. Content analysis of participant comments revealed they were largely hopeful about genetics research in its capacity to improve health; however, they did not accept such research uncritically. Complex issues arose during the community consultations, including the place of genetics in primary care, the value of genetics for personal health, and concerns about access to and uses of genetic information. Participants unequivocally endorsed the value of public engagement with these issues. The rapid pace of discoveries in genomics research offers exciting opportunities to improve population health. However, public support will be crucial to realize health improvements. Our findings suggest that regular, transparent dialog between researchers and the public could allow a greater understanding of the research process, as well as assist in the design of efficient and effective genetic health services, informed by the public that will use them. PMID:23591403

  17. Clinical audit of genetic testing and referral patterns for fragile X and associated conditions.

    PubMed

    Cotter, Megan; Archibald, Alison D; McClaren, Belinda J; Burgess, Trent; Francis, David; Hills, Louise; Martyn, Melissa; Oertel, Ralph; Slater, Howard; Cohen, Jonathan; Metcalfe, Sylvia A

    2016-06-01

    An audit was conducted of laboratory/clinical databases of genetic tests performed between January 2003 and December 2009, and for 2014, as well as referrals to the clinical service and a specialist multidisciplinary clinic, to determine genetic testing request patterns for fragile X syndrome and associated conditions and referrals for genetic counseling/multidisciplinary management in Victoria, Australia. An expanded allele (full mutation, premutation or intermediate) was found in 3.7% of tests. Pediatricians requested ∼70% of test samples, although fewer general practitioners and more obstetricians/gynecologists ordered tests in 2014. Median age at testing for individuals with a full mutation seeking a diagnosis without a fragile X family history was 4.3 years (males) and 9.4 years (females); these ages were lower when pediatricians ordered the tests (2.1 years and 6.1 years, respectively). Individuals with a premutation were generally tested at a later age (median age: males, 33.2 years; females, 36.4 years). Logistic regression showed that a family history of ID (OR 3.28 P = 0.005, CI 1.77-5.98) was the only indication to independently increase the likelihood of a test-positive (FM or PM) result. Following testing, ∼25% of full mutation or premutation individuals may not have attended clinical services providing genetic counseling or multidisciplinary management for these families. The apparent delay in fragile X syndrome diagnosis and lack of appropriate referrals for some may result in less than optimal management for these families. These findings suggest continued need for awareness and education of health professionals around diagnosis and familial implications of fragile X syndrome and associated conditions. © 2016 Wiley Periodicals, Inc.

  18. New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation

    PubMed Central

    Brice, Steven; Akhter, Nasima; Kasim, Adetayo; Gunning, Ann; Slight, Sarah P; Watson, Neil W

    2016-01-01

    Objectives To evaluate an electronic patient referral system from one UK hospital Trust to community pharmacies across the North East of England. Setting Two hospital sites in Newcastle-upon-Tyne and 207 community pharmacies. Participants Inpatients who were considered to benefit from on-going support and continuity of care after leaving hospital. Intervention Electronic transmission of an information related to patient's medicines to their nominated community pharmacy. Community pharmacists to provide a follow-up consultation tailored to the individual patient needs. Primary and secondary outcomes Number of referrals made to and received by different types of pharmacies; reasons for referrals; accepted/completed and rejected referred rates; reasons for rejections by community pharmacists; time to action referrals; details of the follow-up consultations; readmission rates at 30, 60 and 90 days post referral and number of hospital bed days. Results 2029 inpatients were referred over a 13-month period (1 July 2014–31 July 2015). Only 31% (n=619) of these patients participated in a follow-up consultation; 47% (n=955) of referrals were rejected by community pharmacies with the most common reason being ‘patient was uncontactable’ (35%, n=138). Most referrals were accepted/completed within 7 days of receipt and most rejections were made >2 weeks after referral receipt. Most referred patients were over 60 years of age and referred for a Medicines Use Review (MUR) or enrolment for the New Medicines Service (NMS). Those patients who received a community pharmacist follow-up consultation had statistically significant lower rates of readmissions and shorter hospital stays than those patients without a follow-up consultation. Conclusions Hospital pharmacy staff were able to use an information technology (IT) platform to improve the coordination of care for patients transitioning back home from hospital. Community pharmacists were able to contact the majority of

  19. Retinoblastoma Referral Pattern in Kenya

    PubMed Central

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

    2014-01-01

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

  20. A Plan for Itinerant Educational Consultant Services for Preschool Visually Handicapped Children.

    ERIC Educational Resources Information Center

    Allegheny County Schools, Pittsburgh, PA.

    A demonstration project was conducted involving itinerant educational consultant services for preschool visually handicapped children with the objective of preventing social and sensory deprivation and of developing personal independence. Channels were established for referral of applicable visually handicapped preschool children to the program.…

  1. Validation of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm.

    PubMed

    Lawson, Sara Nicole; Zaluski, Neal; Petrie, Amanda; Arnold, Cathy; Basran, Jenny; Dal Bello-Haas, Vanina

    2013-01-01

    Objectif : Étudier la validité concurrente de l'algorithme de dépistage des risques de chute et de renvoi en consultation (Falls Screening and Referral Algorithm, FSRA) du Saskatoon Falls Prevention Consortium. Méthode : Vingt-neuf personnes âgées (moyenne d'âge [ET] de 77,7 ans [4,0]) vivant dans une résidence pour personnes âgées autonomes satisfaisaient les critères d'inclusion; elles ont rempli un questionnaire démographique et ont été soumises à certaines composantes du FSRA et du test d'équilibre de l'échelle de Berg (EEB). Le FSRA comprend un test de dépistage des risques de chute (Elderly Fall Screening Test, EFST) et le questionnaire multifactoriel en matière de chutes (Multi-Factor Falls Questionnaire, MFQ). Il est conçu pour classer les individus dans trois catégories – risque de chute élevé, modéré ou faible – afin d'établir les approches de gestion appropriées. Un modèle prédictif de probabilité des risques de chute basé sur une étude antérieure a été utilisé pour établir la validité concurrente du FRSA. Résultats : Au total, 79 % des participants ont été classés dans la catégorie à faible risque du FSRA, puisque le modèle prédictif a permis d'établir la probabilité des risques de chute dans leur cas entre 0,04 et 0,74, avec une moyenne de 0,35 (ET=0,25). On n'a pu établir aucune corrélation significative sur le plan statistique entre le FSRA et le modèle prédictif de la probabilité des risques de chute (ρ de Spearman=0,35, p=0,06). Conclusion : Le FSRA manque de validité concurrente si on le compare à un modèle de risques de chute préalablement établi et semble « surclasser » les individus dans le segment à faible risque. D'autres études sur le FSRA en tant qu'outil approprié de dépistage chez les aînés résidant dans la communauté sont recommandées.

  2. Teacher Characteristics Associated with Responsiveness and Exposure to Consultation and On-line Professional Development Resources

    PubMed Central

    Downer, Jason T.; Locasale-Crouch, Jennifer; Hamre, Bridget; Pianta, Robert

    2014-01-01

    This paper is a natural follow-up to intent-to-treat findings indicating that the MyTeachingPartner Consultancy, inclusive of on-line video resources and web-mediated consultation, improved the quality of pre-k teachers’ interactions with children. This study takes a close look at implementation fidelity within the effective MTP Consultancy condition over both years of implementation, in order to learn more about the ingredients of professional development that may have contributed to the success of the intervention. Variation in teachers’ responsiveness (e.g., ratings of Consultancy worth) and exposure to the intervention (e.g., number of consultation cycles completed) are examined, with particular interest in the identification of teacher factors that may serve as supports or barriers to successfully implementing consultation supports and on-line professional development resources. PMID:25419081

  3. Inpatient Consultative Dermatology.

    PubMed

    Biesbroeck, Lauren K; Shinohara, Michi M

    2015-11-01

    Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information.

  4. Committees and Controversy: Consultants in the Construction of Education Policy

    ERIC Educational Resources Information Center

    Gabriel, Rachael; Paulus, Trena

    2015-01-01

    The increasingly common practice of engaging consulting firms to assist states with educational policy agendas requires an analysis of the role these consultants play in what is positioned as a democratic decision-making process. In this study, we examine the discourse of a state-level advisory committee formed to develop a new teacher evaluation…

  5. Modeling the Teaching Consultant.

    ERIC Educational Resources Information Center

    Johnson, Brian L.; And Others

    1990-01-01

    Discusses the teaching consultant process in computer programing courses, describes a teaching consultant model from both the teachers' and students' perspectives, and shows how this model can be used to develop an intelligent teaching consultant (ITC). Differences between this collection of expert systems and conventional intelligent tutoring…

  6. The Effect of Training and Consultation Condition on Teachers' Self-Reported Likelihood of Adoption of a Daily Report Card

    ERIC Educational Resources Information Center

    Holdaway, Alex S.; Owens, Julie Sarno

    2015-01-01

    Using a within-subjects design and validated vignettes, this study examined the relative effects of four training and consultation conditions (i.e., consultation with key opinion leaders, consultation with observation and performance feedback, consultation with motivational interviewing, and professional development-as-usual) on teachers' (N =…

  7. The Bulimic (Binge-Purge) Resident: Identification, Confrontation, and Referral.

    ERIC Educational Resources Information Center

    Hornak, N. Joan

    1984-01-01

    Suggestions for how housing personnel can meaningfully cope with bulimic residents are presented. Emphasis is placed on developing written procedures which clarify and define the mystique about and fear of the bulimic resident. (BL)

  8. Family Counseling Interventions: Understanding Family Systems and the Referral Process.

    ERIC Educational Resources Information Center

    McWhirter, Ellen Hawley; And Others

    1993-01-01

    This article describes concepts underlying the idea of the "family as a system"; compares and contrasts four approaches to family therapy (those of Virginia Satir, Jay Haley, Murray Bowen, and Salvador Minuchin); and offers suggestions to teachers referring parents for family counseling. (DB)

  9. Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

    ERIC Educational Resources Information Center

    Becker, Janet E.

    2004-01-01

    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care,…

  10. Optimizing Consulting Delivery Systems.

    ERIC Educational Resources Information Center

    Spottswood, Curran

    1980-01-01

    Summarizes a study of several types of consulting groups in the Bell System and describes characteristics which are associated with high-impact consulting. A strategy which is designed for internal consulting organizations to maximize the likelihood of both initial success and long-term survival of the group is proposed. (Author/MER)

  11. Cognitive Predictors of Reading and Math Achievement among Gifted Referrals

    ERIC Educational Resources Information Center

    Rowe, Ellen W.; Miller, Cristin; Ebenstein, Lauren A.; Thompson, Dawna F.

    2012-01-01

    This study investigated the predictive power of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Full Scale IQ (FSIQ), the General Ability Index (GAI), and the WISC-IV index score composites on subsequent reading and math standardized test scores among high-achieving students. The sample consisted of 84 elementary-age students…

  12. Cognitive predictors of reading and math achievement among gifted referrals.

    PubMed

    Rowe, Ellen W; Miller, Cristin; Ebenstein, Lauren A; Thompson, Dawna F

    2012-09-01

    This study investigated the predictive power of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Full Scale IQ (FSIQ), the General Ability Index (GAI), and the WISC-IV index score composites on subsequent reading and math standardized test scores among high-achieving students. The sample consisted of 84 elementary-age students who received an individual cognitive assessment with the WISC-IV in the previous year as part of the application process for gifted and talented programming through their schools. Although there were no significant differences among the mean WISC-IV index scores, 77% of the individual students evidenced statistically significant WISC-IV index score variability. Thus, intraindividual test score variability appears to be the norm among high-achieving students. In spite of this variability, regression analyses indicated that the FSIQ predicted reading comprehension and mathematics achievement better than, or as well as, the GAI or individual scores for verbal comprehension and perceptual reasoning. None of the cognitive variables correlated significantly with achievement scores for Word Reading or Pseudoword Decoding scores, but the FSIQ, GAI, Verbal Comprehension, and Perceptual Reasoning scores predicted reading comprehension. Limitations and directions for future research are discussed.

  13. Early pregnancy in adolescents: diagnosis, assessment, options counseling, and referral.

    PubMed

    Aruda, Mary M; Waddicor, Kathleen; Frese, Liesl; Cole, Joanna C M; Burke, Pamela

    2010-01-01

    Health care providers are faced with many challenges when working with adolescents. Vague symptoms, unreliable menstrual history, and adolescent reluctance to disclose sexual activity present challenges to early diagnosis. When pregnancy is suspected, clinicians need skills for accurate diagnosis, conducting comprehensive assessments, and providing options counseling. Complexities of providing confidential care while balancing the needs of the adolescent and family may deter some clinicians. A clinical case scenario illustrates important elements of care. Through sharing lessons learned from 10 years of working in a Pregnancy Follow-up Clinic, the authors hope to empower other clinicians as they care for adolescents during this critical time.

  14. [Current situation and countermeasures of two-way referral between wound healing department and community health system].

    PubMed

    Mao, Yi-hao; Luo, Xuan; Chen, Xi-lu; Xie, Ting; Zhang, Zhi-ruo

    2012-12-01

    This study analyzed the current situation and problems of two-way referral between wound healing department of general hospitals and community health service centers through stipulated interview with physicians in general hospitals and community health service centers, and patients visiting these organizations from March 2011 to April. It was found that the current two-way referral process for wound repair were facing a series of problems, including hospitals-transfer difficulty, incomplete two-way referral policy and undefined practice protocol, information-sharing obstacle between general hospitals and community health service centers. The critical countermeasures for overcoming these obstacles in two-way referral of wound ailments shall include construction of further linkage mechanism among all levels of hospitals, establishment of the drug-obtaining mechanism, establishment of an explicit two-way referral process of wound repair, and establishment of a database of diagnosis and treatment information of patients that can be accessed by doctors of different levels of hospitals, etc.

  15. CAPTA Referrals for Infants and Toddlers: Measuring Early Interventionists' Perceptions

    ERIC Educational Resources Information Center

    Herman-Smith, Robert L.

    2009-01-01

    In 2003, Congress amended the Child Abuse Protection and Treatment Act (CAPTA) to require that all child victims of substantiated abuse or neglect under the age of 3 years be assessed for developmental concerns. To date, there has been little study of CAPTA's implementation in Part C early intervention programs. The "Professional…

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

    ERIC Educational Resources Information Center

    Rinaldi, Claudia; Samson, Jennifer

    2008-01-01

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

  17. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... for nontraditional training and employment. (c) Assessment during intake. Some limited assessment... suitability for title II program services. This assessment should be a method, in difficult cases, to finalize determinations for enrollment. The amount of assessment provided during intake is not restricted,...

  18. Conscientious objection in healthcare, referral and the military analogy.

    PubMed

    Clarke, Steve

    2017-04-01

    An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional.

  19. The Importance of School Staff Referrals and Follow-Up in Connecting High School Students to HIV and STD Testing.

    PubMed

    Rasberry, Catherine N; Liddon, Nicole; Adkins, Susan Hocevar; Lesesne, Catherine A; Hebert, Andrew; Kroupa, Elizabeth; Rose, India D; Morris, Elana

    2017-04-01

    This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample ( n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 ( SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [ OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral ( OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male ( OR = 2.49; 95% CI = [1.70, 3.65]), "other" or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority ( OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced ( OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students.

  20. 5 CFR 2426.2 - Requests; petition and procedures for determination of eligibility for national consultation rights.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... determination of eligibility for national consultation rights. 2426.2 Section 2426.2 Administrative Personnel... RELATIONS AUTHORITY NATIONAL CONSULTATION RIGHTS AND CONSULTATION RIGHTS ON GOVERNMENT-WIDE RULES OR REGULATIONS National Consultation Rights § 2426.2 Requests; petition and procedures for determination...

  1. Haematological malignancies and acute kidney injury requiring nephrology consultation: challenging the worst of the worst

    PubMed Central

    Chuva, Teresa; Maximino, José; Barbosa, Joselina; Silva, Sandra; Paiva, Ana; Baldaia, Jorge; Loureiro, Alfredo

    2016-01-01

    Background Acute kidney injury (AKI) often complicates the course of haematological malignancies (HMs) and confers a worse prognosis. The majority of these patients are managed by the attending physician, yet, a small group, mostly coincident with the worst presentation and outcomes, requires nephrology consultation, challenging the clinician with ethical issues regarding the decision to initiate or forgo renal support therapy. The purpose of this work is to identify the prognostic determinants for in-hospital mortality in this population. Methods A retrospective, observational chart review was undertaken at a single tertiary referral oncological centre. We reviewed the medical records of in-hospital patients with AKI and HM between 1 January 1995 and 31 December 2014 who met the criteria for RIFLE (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) classification of I or higher and were followed by a nephrologist. Results Three hundred and forty-five patients were included in the study. Predictors of in-hospital death in patients with HM and AKI were septic shock [odds ratio (OR) 4.290 (95% CI 2.058–8.943)], invasive mechanical ventilation (IMV) [OR 4.305 (95% CI 2.075–8.928)] and allogeneic stem cell transplantation (SCT) [OR 2.232 (95% CI 1.260–3.953)]. The combination of each risk factor was used to estimate the probability of dying. Patients with all three risk factors had a risk of death of 86%. Conclusions Septic shock, IMV and allogeneic SCT were identified as independent predictors of death in patients with HM and AKI, with only a small chance of survival if all three were present. Depending on the combination of risk factors, the indication for aggressive life support therapies, such as RST, might be questionable. PMID:27274827

  2. Incidental Findings on Cone Beam Computed Tomography and Reasons for Referral by Dental Practitioners in Indore City (M.P)

    PubMed Central

    Nagarajappa, Sandesh; Dasar, Prahlad L; Warhekar, Ashish M; Parihar, Ajay; Phulambrikar, Tushar; Airen, Bhuvnesh; Jain, Deepika

    2015-01-01

    Introduction: Cone beam computed tomography is a new diagnostic innovation to dental imaging. Despite the use of CBCT in oral and maxillofacial imaging, reports on its use either by individual practitioners or referral patterns to CBCT centers is lacking. Hence, a study was conducted to determine incidental findings on CBCT and reasons for referral by dental practitioners in Indore city. Materials and Methods: A retrospective analysis of 795 records that were referred for CBCT imaging at Institutional and Oracal CBCT Centre, Indore was undertaken. Referrals from both within and outside institution, as well as from private practitioners were considered. The reason for CBCT referral, provision diagnosis, final diagnosis and any incidental diagnosis were recorded. Results: This retrospective chart audit revealed that 56.7 % were male and 43.3% were females. Greatest source of patients was referred by oral surgeons (21.9%) followed by oral and maxillofacial radiologist (14.2%) and prosthodontist (9.3%). The most common reason for referral was for implant analysis (24.2%) and the most common incidental finding diagnosed by CBCT was oral malignancies. Conclusion: In Institutional set-up, CBCT referrals were mostly for the reason of planning implant placement followed by trauma whereas private practitioners used CBCT mostly for implant placement followed by impaction. CBCT was being utilized more by Oral surgeons in private sector whereas it in an Institutional setup majority of referrals from Department of Oral Diagnosis and Radiology. Findings that were most commonly diagnosed incidentally on CBCT were Orofacial malignancies followed maxillary sinus pathologies. PMID:25859519

  3. Kickbacks, self-referrals, and false claims: the hazy boundaries of health-care fraud.

    PubMed

    Krause, Joan H

    2013-09-01

    The fraud and abuse laws that govern conduct related to the federal health-care programs, such as Medicare and Medicaid, impose broad and complex limitations on billing practices and financial relationships among providers. Given the potential consequences of engaging in fraudulent behavior, it is crucial that physicians appreciate the types of activities that may run afoul of these laws. This article summarizes the major aspects of the fraud laws that are most likely to have a daily impact on physician practice: the Civil False Claims Act, the Medicare and Medicaid Anti-Kickback Statute, and the so-called Stark Law prohibition on physician self-referrals.

  4. Solid organ transplantation: referral, management, and outcomes in HIV-infected patients.

    PubMed

    Roland, Michelle E; Carlson, Laurie L; Frassetto, Lynda A; Stock, Peter G

    2006-12-01

    Advances in HIV management make it difficult to deny solid organ transplantation to HIV-infected patients based on futility arguments. Preliminary studies suggest that both patient and graft survival are similar in HIV-negative and HIV-positive transplant recipients. While there has been no significant HIV disease progression, substantial interactions between immunosuppressants and antiretroviral drugs necessitate careful monitoring. The evaluation and management of HIV-infected transplant candidates and recipients require excellent communication among a multidisciplinary team, the primary HIV care provider, and the patient. Timely referral for transplant evaluation will prevent unnecessary mortality during the pre-transplant evaluation process.

  5. 5 CFR 2426.12 - Requests; petition and procedures for determination of eligibility for consultation rights on...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... determination of eligibility for consultation rights on Government-wide rules or regulations. 2426.12 Section... GENERAL COUNSEL OF THE FEDERAL LABOR RELATIONS AUTHORITY NATIONAL CONSULTATION RIGHTS AND CONSULTATION RIGHTS ON GOVERNMENT-WIDE RULES OR REGULATIONS Consultation Rights on Government-wide Rules...

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

    PubMed Central

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

    2017-01-01

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

  7. Capacity planning and appointment scheduling for new patient oncology consults.

    PubMed

    Ma, Xiang; Sauré, Antoine; Puterman, Martin L; Taylor, Marianne; Tyldesley, Scott

    2016-12-01

    To ensure that patients receive timely access to care, it has become increasingly important to use existing care provider capacity as efficiently as possible and to make informed capacity planning decisions. To support this decision-making process at a regional cancer center in British Columbia (Canada), we undertook a simulation and optimization based study that investigated the simultaneous impact of the available number of new patient consultation slots, appointment scheduling policies and oncologist specialization configurations on the timeliness of patient access to care and physician workload. The key contribution of this paper is the methodological framework it provides to decision makers who manage specialty clinics to ensure that they are using their resources efficiently and making informed strategic short- and mid-term capacity planning decisions for new patient demand.

  8. "Speeding up the road to recovery": The Complex Recovery Assessment and Consultation (CRAC) service.

    PubMed

    Davis Le Brun, Stephanie

    2015-01-01

    The number of bed closures in mental health is on the rise, creating additional pressure on services, including acute mental health services. An efficient way of working is required in order to streamline the acute care pathway and decrease unnecessary delays to length of stay, ensuring all individuals can be offered an inpatient bed when in crisis. The Complex Recovery Assessment and Consultation (CRAC) service was created in order to support acute mental health inpatient clinicians in streamlining hospital stays for service users who present with complex presentations that require lengthier admissions (over 40 days) by offering assessment, advice, and intervention from a rehabilitation perspective. The team was also created to understand why individuals may require a lengthy hospital stay. Preliminary data showed that requiring a placement on discharge proved to be the most significant factor in increased length of stay and so the team took on a new role of discharge coordinator after around a year of operating. This involved assisting in decreasing any delays out of hospital through improved communication and dedicated time to complete tasks, such as completing paperwork for placement referrals and funding panels. Since taking on this role it was found that the time taken for individuals to be discharged to a rehabilitation or specialist placement decreased; a rehabilitation placement by 13.12 days and a specialist placement by 9.22 days. Discharge to a family address also decreased by 2.9 days and a home address by 2.47 days. Those patients with complex presentations benefit from having one dedicated team to coordinate the discharge process. Their lengthier acute inpatient stay is improved through streamlining care pathways, ultimately decreasing delays in discharge.

  9. Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

    PubMed

    Haswell, Kate; Gilmour, John Martin; Moore, Barbara Joyce

    2015-04-01

    Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management.

  10. Detection, advice, and referral to services (DARTS) procedures among clients with public defenders.

    PubMed

    Mericle, Amy A; Belenko, Steven; Festinger, David S

    2011-01-01

    Although screening and brief intervention techniques have been found to be efficacious in a variety of medical settings, their use in the criminal justice system has been limited. We present data from Chief Public Defenders (PDs) in 24 Pennsylvania counties who were surveyed about their approach to substance-using clients and their attitudes toward treatment and talking to clients about substance use. A random subsample (n = 8) participated in an additional semistructured interview. Results provide preliminary support for the use of Detection, Advice, and Referral to Services (DARTS) procedures by PDs and identify potential barriers to its implementation.

  11. Discrepancy in Diagnosis of Primary Myelofibrosis between Referral and Tertiary Care Centers

    PubMed Central

    Yi, Cecilia Arana; Jeyakumar, Ghayathri; Medina, Pedro; Cortes, Jorge; Pierce, Sherry; Bueso-Ramos, Carlos; Kantarjian, Hagop; Verstovsek, Srdan

    2015-01-01

    Primary myelofibrosis (PMF) is myeloproliferative neoplasm whose diagnosis is based on a combination of clinical and pathology criteria. We evaluated 560 consecutive patients who were diagnosed with PMF upon a referral to our center and evaluated the frequency of and reasons for diagnostic discordance. Discordance in the diagnosis was found in 70 (12.5%) patients. Discordant cases had a significantly lower grade of bone marrow fibrosis (grade 0–1), more likely to be JAK2V617F-mutation negative, and have no peripheral blood blasts, possibly explaining the difficulty in making a proper diagnosis and underscoring the need for a complete evaluation at a tertiary center. PMID:24284333

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

    PubMed Central

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

    2015-01-01

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

  13. Screening, brief intervention, and referral to treatment (SBIRT) as an integral part of nursing practice.

    PubMed

    Finnell, Deborah S; Nowzari, Shahrzad; Reimann, Brie; Fischer, Leigh; Pace, Elizabeth; Goplerud, Eric

    2014-01-01

    ABSTRACT. Substance use screening, brief intervention, and referral to treatment (SBIRT) should be an integral part of the scope of nursing practice. This commentary is an appeal for nurses to advance their knowledge and competencies related to SBIRT. The question of how to move SBIRT into the mainstream of nursing practice was posed to several leaders of federal agencies, health care and nursing organizations, nurse educators, and nurse leaders. The authors provide recommendations for moving this set of clinical strategies (i.e., SBIRT) into day-to-day nursing practice.

  14. Collaboration, Consultation and Cooperation: 3 Cs for Multicultural General and Special Education.

    ERIC Educational Resources Information Center

    Obiakor, Festus E.; And Others

    Changes in the social demography of the United States call for increasing multicultural collaboration, consultation, and cooperation at educational and leadership levels. General and special educators must learn to collaborate, consult, and cooperate with each other if they are serious about addressing local, national, or global problems. The…

  15. Training District Personnel as Peer Consultants and Inservice Leaders: Implementation and Evaluation of a Training Program.

    ERIC Educational Resources Information Center

    Anderson, Dana McCoy; Ritter, Shirley A.

    1987-01-01

    A Furman University program called School Initiated Teacher Education Outreach trained school personnel as peer inservice providers and consultants to general education personnel. The 61 special education teachers, speech therapists, and curriculum specialists completed three courses on inservice content and presentation and peer consultation.…

  16. Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster-Randomized Controlled Trial

    PubMed Central

    Olayiwola, J. Nwando; Anderson, Daren; Jepeal, Nicole; Aseltine, Robert; Pickett, Christopher; Yan, Jun; Zlateva, Ianita

    2016-01-01

    PURPOSE Communication between specialists and primary care clinicians is suboptimal, and access to referrals is often limited, which can lead to lower quality, inefficiency, and errors. An electronic consultation (e-consultation) is an asynchronous, non-face-to-face consultation between a primary care clinician and a specialist using a secure electronic communication platform. The purpose of this study was to conduct a randomized controlled trial of e-consultations to test its efficacy and effectiveness in reducing wait times and improving access to specialty care. METHODS Primary care clinicians were randomized into a control (9 traditional) or an intervention (17 e-consultation) arm for referrals to cardiologists. Primary care clinicians were recruited from 12 practice sites in a community health center in Connecticut with mainly medically underserved patients. Two end points were analyzed with a Cox proportional hazards model where the hazard of either a visit or an e-consultation was linked to study arm, sex, race, and age. RESULTS Thirty-six primary care clinicians participated in the study, referring 590 patients. In total, 69% of e-consultations were resolved without a visit to a cardiologist. After adjusting for covariates, median days to a review for an electronic consultation vs a visit for control patients were 5 and 24, respectively. A review of 6-month follow-up data found fewer cardiac-related emergency department visits for the intervention group. CONCLUSION E-consultation referrals improved access to and timeliness of care for an underserved population, reduced overall specialty utilization, and streamlined specialty referrals without any increase in adverse cardiovascular outcomes. e-consultations are a potential solution for improving access to specialty care. PMID:26951588

  17. Consultation with another physician on euthanasia and assisted suicide in the Netherlands.

    PubMed

    Onwuteaka-Philipse, B D; van der Wal, G; Kostense, P J; van der Maas, P J

    2000-08-01

    Consultation with another physician is considered to be an important safeguard of the practice of euthanasia and physician-assisted suicide. The objective is to describe the frequency and characteristics of consultation in cases of euthanasia or physician-assisted suicide (EAS) in the Netherlands. Data from two cross-sectional descriptive nationwide surveys, carried out in 1995, were used. Questionnaires were mailed to physicians attending 6060 deaths, identified from death certificates, and a stratified sample of 405 physicians were interviewed. In 1990, a cross-sectional descriptive postal survey of a random sample of 1042 general practitioners took place. Consultation took place in 63% of cases of EAS in the Netherlands, in 99% of the cases reported to the public prosecutor and in approximately 37% of unreported cases. In almost half of the unreported cases the decision had been discussed less formally with at least one colleague. In 1990, 7% of general practitioners met all 8 criteria for good consultation; this increased to 64% in 1995. Of the respondents, 26% had at some time advised against performing euthanasia or assisted suicide when acting as a consultant. This study shows that approximately two thirds of all cases of EAS are safeguarded by consultation. Although in the majority of these cases the consultation is of good quality, there is certainly still room for improvement. The quality of consultation could be improved, for instance, by appointing independent and specifically trained consultants.

  18. Inpatient allergy/immunology consultations in a tertiary care setting.

    PubMed

    Otto, Hans F; England, Ronald W; Quinn, James M

    2010-01-01

    Few studies have examined inpatient referral patterns for fellowship training programs and none for allergy/immunology (AI) since 2003. The primary end point was the reason for consultation, and secondary end points included the AI diagnosis made and outcomes. We retrospectively reviewed all inpatient AI consultations from July 1, 2001 through June 30, 2007. These 6 years of data were combined with 14 years of data examining the reason for consult from a previous study. The data were analyzed for trends and changes over the entire 20-year period. A total of 254 AI inpatient consults were reviewed over the 6 years studied. Thirty-six percent (92/254) of inpatient consults were for evaluation of adverse drug reactions (ADRs), 22% (55/254) miscellaneous reasons, 17% (43/254) urticaria/angioedema, 13% (32/254) for possible immunodeficiency, 9% (23/254) for anaphylaxis, and 3% (8/254) for asthma. AI inpatient consults show a significant decline over the recent 6-year period (p = 0.0023) despite stable total hospital admissions since 1998. Over the last 20 years, an 85% decrease (p < 0.00001) in inpatient asthma consults and increases (p < 0.05) in immunodeficiency, rash, and urticaria/angioedema evaluations have been observed. Not following AI recommendations resulted in a 16.6 odds ratio (95% CI, 5.55-49.93) that a patient's clinical status would be worse or unchanged. Inpatient AI consults have declined with associated reduction in asthma inpatient consults. Although ADRs and anaphylaxis consults have been stable, evaluations for immunodeficiency, rash, and urticaria/angioedema have increased. Following inpatient AI recommendations is associated with improved patient outcomes.

  19. Consultation and Teaming: Problem-Solving among Educators, Parents, and Support Personnel.

    ERIC Educational Resources Information Center

    Elliott, Stephen N.; Sheridan, Susan M.

    1992-01-01

    Examines the use of consultation and school-based multidisciplinary team conferences in the delivery of educational and psychological services for mainstreamed handicapped children. Step-by-step illustrations of problem solving in a consultative relationship are extended to team problem solving. Reviews research that supports these practices. (GLR)

  20. Factors predicting crisis counselor referrals to other crisis counseling, disaster relief, and psychological services: a cross-site analysis of post-Katrina programs.

    PubMed

    Rosen, Craig S; Matthieu, Monica M; Norris, Fran H

    2009-05-01

    An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3-18 months after Hurricane Katrina. Referrals for disaster relief were predicted by clients' losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban-rural disparities in access to services.

  1. A multifaceted approach to improving the quality of ENT Emergency Clinic referrals

    PubMed Central

    Swords, Chloe; Leach, Laura; Kasbekar, Anand; Jani, Piyush

    2017-01-01

    It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient. We conducted a Quality Improvement Project to improve the efficiency of the referral process. A prospective evaluation of referrals was collected continuously over a two-month period. Overall, 5 domains were deemed crucial to enable timely and accurate booking of patients to clinic: booking date, urgency, legibility, patient identification and appropriateness. Our proposed standard set for this project was 100% compliance over the 5 domains. Three separate interventions were instigated following the first cycle. The main components of the intervention were the phased development of an electronic referral system and an educational initiative for junior doctors. 20 referral forms were analysed during the initial 3-week period. No referrals met the recommended overall compliance standard of 100% (mean number of domains achieved: 3.38; standard deviation (SD): 0.637). Legibility and patient information were included in 21% and 30% of referrals, respectively. There was a trend of improvement following initiation of interventions. The mean number of domains achieved was 4.27 (SD 0.647; n=13) in the second data collection period, 4.53 (SD 0.514; n=16) in the third, and 4.75 (SD 0.452; n=24) in the fourth. Using linear regression, this change demonstrates a statistically significant improvement (p<0.001). An e-Proforma referral system represents a safe and efficient communication technology. When implementing policy change, it is crucial to acquire

  2. Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views

    PubMed Central

    Cook, Neil; Thomson, Gillian; Dey, Paola

    2014-01-01

    Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives. PMID:24928585

  3. Role of the emergency medical services system in regionwide health monitoring and referral.

    PubMed

    Hsiao, A K; Hedges, J R

    1993-11-01

    The emergency medical services (EMS) system of the future has the opportunity to serve as a regional community health monitoring and referral system. Such a system would shift attention from care of the individual to cost-effective community health efforts using community resource integration, while emphasizing individual responsibility for health. This health care system model requires the establishment of a centralized monitoring agency, the "regional center." The regional center would coordinate the monitoring of regional EMS use and linkage of patients with essential health promotion and behavior change organizations. Many of these supporting organizations are in place but are functioning without the benefit of communitywide health monitoring or effective referral and follow-up links with other resources. Coordination through the EMS system and a regional center would permit these resources to be used in an efficient and accountable fashion. We propose a model in which the EMS system could contribute to coordinated regional health monitoring and maintenance, timely and appropriate health care legislation and regulation, and high-impact health care education and intervention in the setting of self-destructive individual behavior.

  4. Primary-to-secondary care referral experience of suspected colorectal malignancy in young adults

    PubMed Central

    Patel, K; Doulias, T; Hoad, T; Lee, C; Alberts, JC

    2016-01-01

    Introduction Colorectal cancer in patients younger than 50 years of age is increasing steadily in the UK with limited guidelines available indicating need for secondary care referral. The aims of this study were to report the cancer incidence in those aged under 50 years referred to secondary care with suspected colorectal malignancy and also to analyse the quality of those referrals. Methods A total of 197 primary care referrals made between 2008 and 2014 to a UK district general hospital for suspected colorectal malignancy were analysed. All confirmed cancers were further evaluated regarding presenting symptoms, tumour characteristics and clinical outcomes. Each referral was given a referral performance score (out of 9) dependant on relevant information documented. Results The overall malignancy rate was 9.1% (11 male and 7 female patients). The median age in this cohort was 41.5 years (interquartile range [IQR]: 37–49 years). Abdominal pain was the only presenting symptom to differ significantly when comparing malignant with non-malignant patients (44.4% vs 21.8% respectively, p=0.042). The median time period between referral date and colorectal specialist consultation was 11 days (IQR: 7–13 days) and the median referral performance score was 5 (range: 3–9). Conclusions Malignancy is prevalent in patients under 50 years of age who are referred to secondary care for suspected colorectal cancer. Those referred with abdominal pain in the presence of other high risk lower gastrointestinal symptoms are at significant risk of having a malignancy. Major deficiencies are apparent in urgent primary care referrals, highlighting the need for further national guidance to aid early diagnosis of colorectal cancer in the young. PMID:27023637

  5. Improving Teaching and Learning in Higher Education: Metaphors and Models for Partnership Consultancy

    ERIC Educational Resources Information Center

    Morrison, Keith

    2003-01-01

    The management of partnerships with external consultants is discussed with reference to seven metaphors of partnership, illuminated by an external consultancy review of teaching and learning in a University Language Centre. Shortcomings are shown in each of the seven metaphors. A model of partnership is advocated, based on Habermas' principles of…

  6. Teacher Characteristics Associated with Responsiveness and Exposure to Consultation and Online Professional Development Resources

    ERIC Educational Resources Information Center

    Downer, Jason T.; Locasale-Crouch, Jennifer; Hamre, Bridget; Pianta, Robert

    2009-01-01

    Research Findings: This article is a natural follow-up to intent-to-treat findings indicating that the MyTeachingPartner Consultancy, inclusive of online video resources and Web-mediated consultation, improved the quality of pre-K teachers' interactions with children. This study takes a close look at implementation fidelity within the effective…

  7. The British Society of Periodontology referral policy and parameters of care.

    PubMed

    Dowell, P; Chapple, I L C

    2002-09-01

    This referral policy and parameters of care document was commissioned by the Council of the British Society of Periodontology to provide guidance for practitioners, given the changing environment of primary and secondary care dentistry in the UK. These changes included the provision of the so-called 'high street' specialists in various mono-specialties and engendered a new paradigm of openness and information giving from the profession outwards. This was in turn necessitated by both dento-legal requirements and an increasing demand from the public for the provision of more advanced periodontal care. The promotion of periodontal therapy is both public and practitioner based, and by promoting periodontology to the general practitioner there is an inevitable knock-on effect to the patient base. Thus, in October 2000, these guidelines for referring from primary to secondary care were published so that GDPs could be given some indications of good referral practice, based upon the well-known tenets of the Basic Periodontal Examination (BPE). In addition, a number of succinct and relevant parameters of care were proposed, highlighting the need for the practitioner to not only examine the periodontium but also to make a diagnosis and effect a treatment plan and defined therapeutic goals using evidence based procedures.

  8. The Nature of All "Inappropriate Referrals" Made to a Countywide Physical Activity Referral Scheme: Implications for Practice

    ERIC Educational Resources Information Center

    Johnston, Lynne Halley; Warwick, Jane; De Ste Croix, Mark; Crone, Diane; Sldford, Adrienne

    2005-01-01

    Objective: The aim of this study was to evaluate the impact of a centralised referral mechanism (CRM) upon the number and type of "inappropriate referrals" made to a countywide physical activity referral scheme. Design: Case study. Method: Phase 1: Hierarchical Content Analysis of 458 "inappropriate referrals" made to a countywide scheme over a…

  9. Sexual and Nonsexual Offenders With Intellectual and Learning Disabilities: A Comparison of Characteristics, Referral Patterns, and Outcome

    ERIC Educational Resources Information Center

    Lindsay, William R.; Smith, Anne H. W.; Law, Jacqueline; Quinn, Kathleen; Anderson, Andrew; Smith, Astrid; Allan, Ronald

    2004-01-01

    This article reports an evaluation of a community intellectual disability offender service over the period from 1990 to 2001. Men who committed sex offenses or sexually abusive incidents (n = 106) and men who committed other types of offenses and serious incidents (n = 78) are compared on personal characteristics, referral sources, forensic…

  10. 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…

  11. Disability prevention and medical rehabilitation (DPMR)--prevention of disability and timely referral in leprosy.

    PubMed

    Mahato, Margaret E

    2006-12-01

    The stigma and discrimination due to disabilities in leprosy has a profound effect on a leprosy individual and the disability hampers his/her earning capacity and therefore socio-economic status. The Government of India has recently come out with an approved plan for disability prevention and medical rehabilitation. There are some objectives to provide appropriate services to the disabled or to prevent the disability. In order to prevent disability early treatment is necessary but there are a lot of studies on delayed presentation. It is in fact suggested that not only early correct treatment of leprosy with MDT but also early correct treatment of reactions and nuritis can prevent disability. Some cases as specified in the text require referral to prevent the menace. Many deformities can be corrected by reconstructive surgery. The management protocol to prevent primary impairment is depicted in Figs within the article.

  12. 41 CFR 105-8.148 - Consultation with the Architectural and Transportation Barriers Compliance Board.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Architectural and Transportation Barriers Compliance Board. 105-8.148 Section 105-8.148 Public Contracts and... GENERAL SERVICES ADMINISTRATION § 105-8.148 Consultation with the Architectural and Transportation Barriers Compliance Board. GSA shall consult with the Architectural and Transportation Barriers...

  13. Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting

    PubMed Central

    Marrón, Belén; Ostrowski, Janusz; Török, Marietta; Timofte, Delia; Orosz, Attila; Kosicki, Andrzej; Całka, Alicja; Moro, Daniela; Kosa, Dezider; Redl, Jenö; Qureshi, Abdul Rashid; Divino-Filho, Jose Carolino

    2016-01-01

    Introduction Integrated Care Settings (ICS) provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT), offering at least both types of dialysis. Objectives To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics. Methods Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start. Results Modality information (80% of patients) and renal education (87%) were more frequent (p<0.001) in Planned (P) than in Non-Planned (NP) start. Median time from information to dialysis start was 2 months. 89% of patients started on hemodialysis, 49% were referred late to ICS (<3 months from referral to RRT) and 58% were NP start. Late referral, non-vascular renal etiology, worse clinical status, shorter time from information to RRT and less peritoneal dialysis (PD) were associated with NP start (p<0.05). In multivariate logistic regression analysis, P start (p≤0.05) was associated with early referral, eGFR >8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. “Optimal care,” defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%. Conclusions Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD. PMID:27228101

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

    ERIC Educational Resources Information Center

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  16. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and...

  17. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and...

  18. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and...

  19. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and...

  20. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and...

  1. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... § 269.10 Time for internal labor organization business, consultations and negotiations. Solicitation of..., but the President or a duly authorized officer of a Bank may require that negotiations with a...

  2. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 1 2011-07-01 2011-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD...

  3. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD...

  4. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... § 269.10 Time for internal labor organization business, consultations and negotiations. Solicitation of..., but the President or a duly authorized officer of a Bank may require that negotiations with a...

  5. Blowing Smoke and Billowing Logic: Consulting on Cigarette Excise Tax Increase Messages

    ERIC Educational Resources Information Center

    Hart, Joy L.; Esrock, Stuart L.; Leichty, Greg

    2008-01-01

    This article describes a consulting project with an advocacy organization to raise cigarette excise taxes in Kentucky and to improve public health in the state. We describe the theoretical underpinnings of the project, the client, and our consultation process, objectives, products, and results.

  6. Accelerated Professional Development and Peer Consultation: Two Strategies for Continuing Professional Education for Nurses.

    ERIC Educational Resources Information Center

    Hart, Gail; Clinton, Michael; Edwards, Helen; Evans, Katie; Lunney, Paul; Posner, Natasha; Tooth, Barbara; Weir, Derek; Ryan, Yoni

    2000-01-01

    A comparison was made of accelerated professional development (APD) for nurses (n=64), involving peer consultation and reflective practice, and peer consultation alone (n=30). Although APD participants had a higher completion rate, improvements in caregiver behaviors and work environment were not significantly different. (SK)

  7. 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…

  8. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) POLICY ON LABOR RELATIONS FOR THE FEDERAL RESERVE BANKS § 269.10 Time for internal labor organization business, consultations and...

  9. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) POLICY ON LABOR RELATIONS FOR THE FEDERAL RESERVE BANKS § 269.10 Time for internal labor organization business, consultations and...

  10. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) POLICY ON LABOR RELATIONS FOR THE FEDERAL RESERVE BANKS § 269.10 Time for internal labor organization business, consultations and...

  11. Creating a Bridge between Industry and Higher Education through an Operations Consultancy Module

    ERIC Educational Resources Information Center

    Bak, Ozlem

    2011-01-01

    This paper explores the challenges and use of a postgraduate consultancy module in teaching operations management. The consultancy module extends the traditional learning boundaries between students and lecturers to a tripartite grouping of students, university and industry. The interaction within this group may be influenced by students' skills…

  12. Integrating screening, brief intervention and referral to treatment (SBIRT) into an abortion clinic: an exploratory study of acceptability.

    PubMed

    Appel, Lindsay; Ramanadhan, Shaalini; Hladky, Katherine; Welsh, Chris; Terplan, Mishka

    2015-04-01

    Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6, respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use.

  13. Pediatric hospital dermatology: experience with inpatient and consult services at the Mayo Clinic.

    PubMed

    Storan, Eoin R; McEvoy, Marian T; Wetter, David A; el-Azhary, Rokea A; Hand, Jennifer L; Davis, Dawn M R; Bridges, Alina G; Camilleri, Michael J; Davis, Mark D P

    2013-01-01

    Data describing the management of pediatric patients admitted to a hospital under the care of a dermatologist and dermatology hospital consults for pediatric inpatients are limited. We aim to describe the role of an inpatient hospital service jointly run by dermatology and pediatrics and the activities of a pediatric dermatology hospital consult service. We retrospectively identified pediatric (age < 18 yrs) dermatology inpatients and hospital consult patients from January 1, 2009, through December 31, 2010. We examined patient demographics, indications for admission, length of stay, treatment provided, consult-requesting service, and consult diagnosis. One hundred eight admissions were by a dermatologist. The mean age was 5.8 years; the median length of stay was 3 days. Indications for admission included atopic dermatitis (86.1%), psoriasis (3.7%), and eczema herpeticum (2.8%). The main treatment provided was wet dressings (97.2%). Eighty-three dermatology hospital consults were requested. The mean age was 7.4 years. The main indications for dermatology consultation included drug rash (12.1%), cutaneous infections (12.1%), contact dermatitis (9.6%), psoriasis (8.4%), atopic dermatitis (6.0%), and hemangiomas (6.0%). This study describes the utility of the hospital pediatric dermatology inpatient and consult services in treating patients with severe skin disease.

  14. Teachers, Time, Staff and Money: Committing to Community Consultation in High Schools

    ERIC Educational Resources Information Center

    Maxwell, Jacinta

    2012-01-01

    State and Federal education departments have increasingly recognised the importance of community consultation in the development of school curricula, and the requirement for teachers to consult with Indigenous communities is explicit in many curriculum documents. This article reports the findings of research into how teachers of senior Aboriginal…

  15. The Knowledge, Skills and Personal Qualities of Early Childhood Resource Consultants as Agents of Change

    ERIC Educational Resources Information Center

    Frankel, Elaine B.

    2006-01-01

    This naturalistic investigation explored the knowledge, skills, and personal qualities demonstrated by two early childhood resource consultants when preschool children with special needs were included in community-based early childhood settings. This article describes the dilemmas, challenges and barriers faced by the resource consultants as they…

  16. 45 CFR 1302.3 - Consultation with public officials and consumers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Consultation with public officials and consumers. 1302.3 Section 1302.3 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... officials and consumers. Responsible HHS officials will consult with Governors, or their...

  17. 43 CFR 46.155 - Consultation, coordination, and cooperation with other agencies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Consultation, coordination, and cooperation with other agencies. 46.155 Section 46.155 Public Lands: Interior Office of the Secretary of the... Environmental Quality § 46.155 Consultation, coordination, and cooperation with other agencies. The...

  18. University-Industry Spillovers, Government Funding, and Industrial Consulting. NBER Working Paper No. 15732

    ERIC Educational Resources Information Center

    Jensen, Richard; Thursby, Jerry; Thursby, Marie C.

    2010-01-01

    This paper presents a theoretical model of faculty consulting in the context of government and industry funding for research within the university, which then frames an empirical analysis of the funding and consulting of 458 individual faculty inventors from 8 major US universities. In the theory, firms realize that they free ride on government…

  19. 78 FR 33331 - Tribal Consultation and Coordination Policy for the U.S. Department of Commerce

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...: Amend the definition of ``Consultation'' to incorporate the following key principles: Consultation is a... builds upon and expands the principles expressed in the Department's previous policy, ``American Indian... to the policy principles. The notice also includes comments and the Department's responses to...

  20. Increasing the Physical Educator's Impact: Consulting, Collaborating, and Teacher Training in Early Childhood Programs.

    ERIC Educational Resources Information Center

    Helm, Judy Harris; Boos, Suzi

    1996-01-01

    This article describes how an early childhood education center in Peoria, Illinois, used physical educators as ongoing consultants/collaborators to develop a structured movement curriculum. Five interactive workshops for teachers provided training in movement principles and skills; individual consultations; and information on developmentally…

  1. 45 CFR 1302.3 - Consultation with public officials and consumers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Consultation with public officials and consumers. 1302.3 Section 1302.3 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... officials and consumers. Responsible HHS officials will consult with Governors, or their...

  2. 43 CFR 46.155 - Consultation, coordination, and cooperation with other agencies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Consultation, coordination, and cooperation with other agencies. 46.155 Section 46.155 Public Lands: Interior Office of the Secretary of the... Environmental Quality § 46.155 Consultation, coordination, and cooperation with other agencies. The...

  3. 43 CFR 46.155 - Consultation, coordination, and cooperation with other agencies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Consultation, coordination, and cooperation with other agencies. 46.155 Section 46.155 Public Lands: Interior Office of the Secretary of the... Environmental Quality § 46.155 Consultation, coordination, and cooperation with other agencies. The...

  4. 43 CFR 46.155 - Consultation, coordination, and cooperation with other agencies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Consultation, coordination, and cooperation with other agencies. 46.155 Section 46.155 Public Lands: Interior Office of the Secretary of the... Environmental Quality § 46.155 Consultation, coordination, and cooperation with other agencies. The...

  5. 43 CFR 46.155 - Consultation, coordination, and cooperation with other agencies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Consultation, coordination, and cooperation with other agencies. 46.155 Section 46.155 Public Lands: Interior Office of the Secretary of the... Environmental Quality § 46.155 Consultation, coordination, and cooperation with other agencies. The...

  6. Final Report to the National Commission on Libraries and Information Science from the Community Information and Referral Services Task Force.

    ERIC Educational Resources Information Center

    National Commission on Libraries and Information Science, Washington, DC.

    This report describes the work of the Community Information and Referral (CI&R) Services Task Force, which was appointed by the National Commission on Libraries and Information Science (NCLIS) to investigate the status of CI&R in libraries and social service agencies and to make recommendations regarding the appropriate role for libraries…

  7. Developing and Implementing a Multispecialty Graduate Medical Education Curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT)

    ERIC Educational Resources Information Center

    Tetrault, Jeanette M.; Green, Michael L.; Martino, Steve; Thung, Stephen F.; Degutis, Linda C.; Ryan, Sheryl A.; Martel, Shara; Pantalon, Michael V.; Bernstein, Steven L.; O'Connor, Patrick G.; Fiellin, David A.; D'Onofrio, Gail

    2012-01-01

    The authors sought to evaluate the feasibility and acceptability of initiating a Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol and other drug use curriculum across multiple residency programs. SBIRT project faculty in the internal medicine (traditional, primary care internal medicine, medicine/pediatrics),…

  8. Teachers' Perception of Satisfaction, Skill Development, and Skill Application after Instructional Consultation Services

    ERIC Educational Resources Information Center

    Kaiser, Lauren; Rosenfield, Sylvia; Gravois, Todd

    2009-01-01

    A primary hypothesized outcome of consultee-centered consultation, including instructional consultation (IC), is that consultees will become more skilled. However, these claims have not been well researched. Data from 274 teachers implementing IC were analyzed to investigate perceptions of satisfaction and skill development. Results indicated that…

  9. Teaching Consultation-Liaison Psychotherapy: Assessment of Adaptation to Medical and Surgical Illness

    ERIC Educational Resources Information Center

    Hunter, Jonathan J.; Maunder, Robert G.; Gupta, Mona

    2007-01-01

    Objective: Little has been written about teaching consultation-liaison inpatient psychotherapy to residents or other trainees. Method: Resident interviews at completion of consultation-liaison training identified learning needs. In response, the authors created a seminar series and modified it reiteratively eight times. Results: In this approach,…

  10. Ecological Approaches to Organizational Consultation and Systems Change in Educational Settings

    ERIC Educational Resources Information Center

    Meyers, Adena B.; Meyers, Joel; Graybill, Emily C.; Proctor, Sherrie L.; Huddleston, Lillie

    2012-01-01

    This article presents the conceptual foundations and specific features of an ecologically oriented model of school-based organizational consultation. We begin by providing an overview of ecological theory. This is followed by a brief description of a model of school-based organizational consultation with a special focus on the ecological elements…

  11. Counsellors and Organisational Change: Egan's Systems Model as a Tool in Organisational Consulting.

    ERIC Educational Resources Information Center

    Hermansson, Gary L.

    1993-01-01

    Considers the increasing involvement of counselors as consultants to effect organizational change. Presents a case example to demonstrate how Egan's systems model, "Model A," can be applied effectively for both the development of a consultation relationship and for organizational change. (JPS)

  12. Creative Counseling Techniques Applied to the Business World: The Use of Theory and Creativity in Consultation

    ERIC Educational Resources Information Center

    Stone, Victoria; Jacobs, E.

    2008-01-01

    This article presents an overview of the use of impact therapy, a multisensory, creative approach to counseling, in a consultation project the authors conducted with the managers of a local car dealership. The purpose of the consultation was to help the managers with the stress and anxiety associated with working in the car sales industry.…

  13. 76 FR 33180 - Tribal Consultation on No Child Left Behind School Facilities and Construction Negotiated...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-08

    ... Bureau of Indian Affairs 25 CFR Chapter I Tribal Consultation on No Child Left Behind School Facilities... announcing that it will conduct five consultation meetings with Indian tribes to obtain oral and written... No Child Left Behind Act of 2001. See the SUPPLEMENTARY INFORMATION section of this notice...

  14. Preliminary experience of shared clinical management between Milan and Pointe Noire using the INteractive TeleConsultation Network for Worldwide HealthcAre Services (INCAS): telemedicine between Milan and Africa.

    PubMed

    Malacarne, Mara; Lesma, Alessandro; Madera, Angelo; Malfatti, Eugenio; Castelli, Alberto; Lucini, Daniela; Pizzinelli, Paolo; Pagani, Massimo

    2004-01-01

    This paper describes preliminary experience in shared clinical management of patients located in Pointe Noire, Africa, and a referral center, Sacco University Hospital, located in Milan, Italy. The employed infrastructure INteractive TeleConsultation Network for Worldwide HealthcAre Services (INCAS) jointly developed by CEFRIEL (Center of Excellence For Research, Innovation, Education & Industrial Labs partnership) and ENI (Ente Nazionale Idrocarburi) is based on commercial off-the-shelf technology. This minimizes maintenance problems, while permitting a simple and friendly sharing of data using the telephone and e-mail for store-and-forward applications. The critical aspect of the flow of events comprising the exchange of information is discussed. In 60% of cases, only one telemedicine consultation was required. In the remainder 40%, a number of telemedicine consultations were required for appropriate management of clinical cases. The project demonstrated flexibility as documented by the wide range of pathologies that can be dealt with it. Finally the possibility of using shared clinical management as a learning tool is highlighted by the steep and rising learning curve. We conclude, however, that the patient, although handled in a "virtual" manner, should be viewed as very "real," as some of them elected to close the gap physically between Pointe Noire and Milan, and chose to be treated at the referral site.

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

    PubMed Central

    Peters, D; Davies, P; Pietroni, P

    1994-01-01

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

  16. Patterns in Referral and Admission to Vocational Rehabilitation Associated with Coexisting Psychiatric and Substance-Use Disorders.

    ERIC Educational Resources Information Center

    Drebing, Charles E.; Rosenheck, Robert; Schutt, Russell; Kasprow, Wesley J.; Penk, Walter

    2003-01-01

    Studies homeless adults entering the Healthcare for Homeless Veterans program to identify whether the rate of referral and admission to vocational rehabilitation differed between adults with psychiatric disorders and those with a coexisting substance-use disorder (SUD). Participants with an SUD had an 11% greater chance of being referred to…

  17. Teaching the Teachers: Faculty Preparedness and Evaluation of a Retreat in Screening, Brief Intervention, and Referral to Treatment

    ERIC Educational Resources Information Center

    Childers, Julie W.; Broyles, Lauren M.; Hanusa, Barbara H.; Kraemer, Kevin L.; Conigliaro, Joseph; Spagnoletti, Carla; McNeil, Melissa; Gordon, Adam J.

    2012-01-01

    Effective clinical faculty are essential for disseminating substance abuse screening, brief intervention, and referral to treatment (SBIRT). The authors developed an 8-hour SBIRT training for internal medicine faculty preceptors. Trainers conducted SBIRT lectures and small-group communication practice sessions. The authors assessed participants'…

  18. The relationship between consultation length, process and outcomes in general practice: a systematic review.

    PubMed Central

    Wilson, Andrew; Childs, Susan

    2002-01-01

    The aim of the study was to examine differences in consultation process and health outcomes between primary care physicians who consult at different rates. A systematic review of observational studies was carried out, restricted to English language journal papers reporting original research or systematic reviews. Qualitative analysis with narrative overview of methodology and key results was undertaken, using MEDLINE (1966 to 1999), EMBASE (1981 to 1999), and the NHS National Research Register. Secondary references from this search were also considered for inclusion. Main outcome measures were objectively measured process or healthcare outcomes. Thirteen papers, describing ten studies, were identified. There were consistent differences in several elements of process and outcome between general practitioners (GPs) who consult at different rates. Although average consultation length may be a marker of other doctor attributes, the evidence suggests that patients seeking help from a doctor who spends more time with them are more likely to have a consultation that includes important elements of care. PMID:12528590

  19. Consultation techniques using shared decision making for patients with cancer and their families.

    PubMed

    Kawasaki, Yuko

    2014-12-01

    This article elucidates the nursing consultation techniques in shared decision making (SDM) for patients with cancer and their family members. Descriptive data (207 records) from the nurse-led SDM consultation facility and content analysis were used to extract the nursing consultation techniques. In addition, the order in which these techniques were used to structure the SDM process for patients with cancer was identified. The author extracted eight categories pertaining to nurse consultation techniques for the SDM process: sharing feelings, helping to identify the focus of the consultations, helping to devise a personalized recovery plan, providing information in accordance with the patient's responses, supporting the patient to understand the information provided, ensuring continued treatment and care, strengthening the patient support system, and exploring possibilities on the basis of patient needs. The identified logical order in which these techniques were applied may be useful as a guide to systematic decision-making support.

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

    PubMed

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

    2017-04-01

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