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Sample records for referral and consultation

  1. Understanding the Impact of Residents' Interpersonal Relationships During Emergency Department Referrals and Consultations

    PubMed Central

    Chan, Teresa; Sabir, Kameron; Sanhan, Sarila; Sherbino, Jonathan

    2013-01-01

    Background Communicating with colleagues is a key physician competency. Yet few studies have sought to uncover the complex nature of relationships between referring and consulting physicians, which may be affected by the inherent relationships between the participants. Objective Our study examines themes identified from discussions about communications and the role of relationships during the referral-consultation process. Methods From March to September 2010, 30 residents (10 emergency medicine, 10 general surgery, 10 internal medicine) were interviewed using a semistructured focus group protocol. Two investigators independently reviewed the transcripts using inductive methods and grounded theory to generate themes (using codes for ease of analysis) until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. Measures for ensuring trustworthiness of the analysis included generating an audit trail and external auditing of the material by investigators not involved with the initial analysis. Results Two main relationship-related themes affected the referral-consultation process: familiarity and trust. Various subthemes were further delineated and studied in the context of pertinent literature. Conclusions Relationships between physicians have a powerful influence on the emergency department referral-consultation dynamic. The emergency department referral-consultation may be significantly altered by the familiarity and perceived trustworthiness of the referring and consulting physicians. Our proposed framework may further inform and improve instructional methods for teaching interpersonal communication. Most importantly, it may help junior learners understand inherent difficulties they may encounter during the referral process between emergency and consulting physicians. PMID:24455004

  2. Survey of Mental Health Consultation and Referral Among Primary Care Pediatricians

    PubMed Central

    Guevara, James P.; Greenbaum, Paul E.; Shera, David; Bauer, Laura; Schwarz, Donald F.

    2008-01-01

    Objective To determine availability of and test whether on-site mental health providers (MHP) is associated with greater odds of reported mental health consultation and referral among primary care pediatricians. Methods Pediatricians were identified from the American Medical Association's 2004 Physician Directory, stratified by region, and 600 were randomly selected to receive a mail survey. The main independent variable was on-site MHP. The dependent variable was reported frequency (4-point rating) of mental health consultation and referral. Estimates were weighted to account for survey design and non-response. Results Overall response rate was 51%. The majority of respondents were male (56%), age ≥46 years old (59%), white (68%), and practicing in suburban locations (52%). Approximately half reported consultation with (44%) or referral to (51%) MHP always or often, but few (17%) reported on-site MHP. After adjustment for demographic and practice characteristics, pediatricians with on-site MHP were more likely to consult (Odds Ratio [OR] 6.58, 95% confidence interval [CI] 3.55-12.18) or refer (OR 4.25, 95% CI 2.19-8.22) than those without on-site MHP. Among those without on-site MHP, pediatricians with greater practice burden were less likely to consult (OR 0.69, 95% CI 0.48-0.99) or refer (OR 0.75, 95% CI 0.54-1.04) than those with lesser burden. Conclusions Most pediatricians in the U.S. experienced practice-related burdens that limit mental health collaboration, but those with collocated services reported a greater likelihood of consultation and referral. Policy changes that encourage collocation of mental health services and limit practice burden may facilitate mental health consultation and referral. PMID:19329104

  3. Pre-referral general practitioner consultations and subsequent experience of cancer care: evidence from the English Cancer Patient Experience Survey.

    PubMed

    Mendonca, S C; Abel, G A; Saunders, C L; Wardle, J; Lyratzopoulos, G

    2016-05-01

    Prolonged diagnostic intervals may negatively affect the patient experience of subsequent cancer care, but evidence about this assertion is sparse. We analysed data from 73 462 respondents to two English Cancer Patient Experience Surveys to examine whether patients with three or more (3+) pre-referral consultations were more likely to report negative experiences of subsequent care compared with patients with one or two consultations in respect of 12 a priori selected survey questions. For each of 12 experience items, logistic regression models were used, adjusting for prior consultation category, cancer site, socio-demographic case-mix and response tendency (to capture potential variation in critical response tendencies between individuals). There was strong evidence (P < 0.01 for all) that patients with 3+ pre-referral consultations reported worse care experience for 10/12 questions, with adjusted odds ratios compared with patients with 1-2 consultations ranging from 1.10 (95% confidence intervals 1.03-1.17) to 1.68 (1.60-1.77), or between +1.8% and +10.6% greater percentage reporting a negative experience. Associations were stronger for processes involving primary as opposed to hospital care; and for evaluation than report items. Considering 1, 2, 3-4 and '5+' pre-referral consultations separately a 'dose-response' relationship was apparent. We conclude that there is a negative association between multiple pre-diagnostic consultations with a general practitioner and the experience of subsequent cancer care.

  4. 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…

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

    PubMed

    Keely, Erin; Traczyk, Lara; Liddy, Clare

    2015-08-01

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

  6. School-Based Client Consultation, Referral, and Management of Care. A Technical Aid Packet.

    ERIC Educational Resources Information Center

    California Univ., Los Angeles. Center for Mental Health in Schools.

    This booklet assumes that the first question that a mental health professional asks should not be what's wrong with this person, but what's making this person function like this. The answer may be that something's wrong with the way the person's environment is functioning, and, therefore, it is the environment that really should be changed, if…

  7. Inclusion and Discipline Referrals.

    ERIC Educational Resources Information Center

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

    2002-01-01

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

  8. Geropsychiatric consultation in a university hospital: a report on 67 referrals.

    PubMed

    Ruskin, P E

    1985-03-01

    The author describes the evaluation and treatment of 67 patients 60 years old or older who were referred to a consultation-liaison service in a university hospital. Age, sex, referring service, reasons for referral, psychiatric diagnosis, and interventions or recommendations were determined. Primary psychiatric diagnoses included depression (24%), dementia (19%), delirium (18%), schizophrenia (16%), and personality disorders (12%). Recommendations or interventions included advice in the use of psychotropic medications (61%), assistance with competency issues (25%), recommendation for further medical evaluation or treatment (36%), individual psychotherapy (28%), family therapy (25%), disposition planning (24%), and transfer to a geropsychiatry unit (12%). Hospitalized elderly patients with emotional problems represent a unique diagnostic and therapeutic challenge.

  9. Pre-referral GP consultations in patients subsequently diagnosed with rarer cancers: a study of patient-reported data

    PubMed Central

    Mendonca, Silvia C; Abel, Gary A; Lyratzopoulos, Georgios

    2016-01-01

    Background Some patients with cancer experience multiple pre-diagnostic consultations in primary care, leading to longer time intervals to specialist investigations and diagnosis. Patients with rarer cancers are thought to be at higher risk of such events, but concrete evidence of this is lacking. Aim To examine the frequency and predictors of repeat consultations with GPs in patients with rarer cancers. Design and setting Patient-reported data on pre-referral consultations from three English national surveys of patients with cancer (2010, 2013, and 2014), pooled to maximise the sample size of rarer cancers. Method The authors examined the frequency and crude and adjusted odds ratios for ≥3 (versus 1–2) pre-referral consultations by age, sex, ethnicity, level of deprivation, and cancer diagnosis (38 diagnosis groups, including 12 rarer cancers without prior relevant evidence). Results Among 7838 patients with 12 rarer cancers, crude proportions of patients with ≥3 pre-referral consultations ranged from >30.0% to 60.0% for patients with small intestine, bone sarcoma, liver, gallbladder, cancer of unknown primary, soft-tissue sarcoma, and ureteric cancer. The range was 15.0–30.0% for patients with oropharyngeal, anal, parotid, penile, and oral cancer. The overall proportion of responders with any cancer who had ≥3 consultations was 23.4%. Multivariable logistic regression indicated concordant patterns, with strong evidence for variation between rarer cancers (P <0.001). Conclusion Patients with rarer cancers experience pre-referral consultations at frequencies suggestive of middle-to-high diagnostic difficulty. The findings can guide the development of new diagnostic interventions and ‘safety-netting’ approaches for symptomatic presentations encountered in patients with rarer cancers. PMID:26917657

  10. Faculty Consulting and the Consultant.

    ERIC Educational Resources Information Center

    Lanning, Alan W.; Blackburn, Robert T.

    A random sample of 8,009 research university professors' paid consulting work was examined from the local-cosmopolitan framework. Analysis of the results, using four levels of consulting (none, mild, moderate, active) showed that: (1) 54 percent devote some portion of their normal work week to consulting; (2) the most active consultants (about 5…

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

    ERIC Educational Resources Information Center

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

    2002-01-01

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

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

    PubMed

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

    2006-08-01

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

  13. Psychiatric Consultation and Substance Use Disorders

    PubMed Central

    Specker, Sheila; Meller, William H.; Thurber, Steven

    2009-01-01

    Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although

  14. Modelling the consultation process in a secondary referral unit for children.

    PubMed

    David, R; Whitehouse, J

    1998-01-01

    This paper overviews a detailed study of a consultation service for children with severe and/or intractable speech and language difficulties. The Speech Therapy Clinical Unit at the University of Central England in Birmingham (UCE) offered multidisciplinary, in-depth assessment of such children to speech and language therapists, parents and other professions involved in their management. Documentary materials generated by the service were analysed using Grounded Theory to develop a model of the process of assessment and consultation employed in the Unit. The implications of this model for clinical education and practice are discussed.

  15. Ethics consultation and autonomy.

    PubMed

    Varelius, Jukka

    2008-03-01

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

  16. Resistance, Reactance, and Consultation.

    ERIC Educational Resources Information Center

    Hughes, Jan N.; Falk, Robert S.

    1981-01-01

    Presents a review of techniques for dealing with consultee resistance. Suggests the social psychological theory of reactance is a useful conceptual framework for considering resistance in consultation. Discusses examples of its application, variables that predict the likely effectiveness of a reactance utilization intervention, and ethical issues.…

  17. Market conditions and general practitioners' referrals.

    PubMed

    Iversen, Tor; Ma, Ching-to Albert

    2011-12-01

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

  18. 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…

  19. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  20. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults

    PubMed Central

    Podolsky, Anna; Stern, David T.; Peccoralo, Lauren

    2015-01-01

    Background Communication and courtesy are important elements of consultations, but there is limited published data about the quality of trainee consults. Objectives This study assessed residents' views on consult interactions, evaluated the impact of the consult interactions on patient care, and developed and implemented a pocket card and training on trainee consults. Methods We surveyed resident and fellow physicians at Mount Sinai Hospital to assess perceptions, created a CONSULT card that uses a mnemonic for key elements, and developed a training session for how to call consults. We also conducted a consult training session using the CONSULT card as part of orientation in 2011 for all interns. We assessed the acceptability, feasibility, and sustainability of this intervention. Results Of 1001 trainees, 403 (40%) responded. Respondents reported that the most important components of calling consults included giving patient name, medical record number, and location (91%), and giving a clear question/reason (89%). Respondents also reported that these behaviors are done consistently for only 64%, and 10% of consults, respectively. Trainees reported that consult interactions affect the timeliness of treatment (62%), timeliness of tests performed (57%), appropriateness of diagnosis (56%), and discharge planning (49%). Approximately 300 interns attended the consult training session, and their feedback demonstrated acceptability and utility of the session. Conclusions Trainees believe that consult interactions impact patient care, but important components of the consult call are often missing. Our training and CONSULT card is an acceptable, feasible, and novel training intervention. Once developed, the training session and CONSULT card require minimal faculty time to deliver. PMID:26217436

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

    PubMed Central

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

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

  3. Information and Referral Services: The Resource File.

    ERIC Educational Resources Information Center

    Long, Nicholas; And Others

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

  4. 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....

  5. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  6. 44 CFR 6.10 - Assistance and referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    PubMed Central

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

    1999-01-01

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

  8. Referral expectations of radiology.

    PubMed

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

    1992-08-01

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

  9. Nonwhite ethnicity and the provision of specialist palliative care services: factors affecting doctors' referral patterns.

    PubMed

    Karim, K; Bailey, M; Tunna, K

    2000-11-01

    The aim of this paper was to examine the use of palliative care services by members of black/minority ethnic communities. Referral patterns of hospital consultants and general practitioners (GPs) to Birmingham St Mary's Hospice were examined. Semistructured interviews were carried out to explore doctors' perceptions of the benefits and limitations of hospice services for their black/minority ethnic patients and to identify potential barriers to referral. In total, 27 doctors were interviewed: 15 hospital consultants and 12 GP. The GPs were selected according to size of practice within areas of Birmingham with significant black/minority ethnic populations. Referrals received by the hospice for the period April 1996 to November 1997 were collected from the Hospice's computerized database. Results show that, compared to white Europeans, there was an underutilization of day care and inpatient hospice services by members of black/minority ethnic communities. Doctors did, however, refer their black/minority ethnic patients for hospice home-care services: 8.5% of referrals received by the hospice were for nonwhite patients. This referral rate increased to 19.3% in specific postcode areas known to have significant black/minority ethnic communities. Further research is needed to establish levels of awareness, explore attitudes towards palliative care services and assess the demand for specific services within various black/minority ethnic communities.

  10. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  11. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  13. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  14. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

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

    ERIC Educational Resources Information Center

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

    1998-01-01

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

  16. Screening for hearing loss versus parental concern regarding hearing problems: Subsequent referral and treatment for otitis media in the Netherlands

    PubMed Central

    Lok, Willeke; Anteunis, Lucien J. C.; Chenault, Michelene N.; Meesters, Cor; Haggard, Mark P.

    2012-01-01

    Objective The present study investigates whether general practitioner (GP) consultation initiated by failing the population hearing screening at age nine months or GP consultation because of parental concern over ear/hearing problems was more important in deciding on referral and/or surgical treatment of otitis media (OM). Design A questionnaire covering the history between birth and 21 months of age was used to obtain information on referral after failing the hearing screening, GP consultations for ear/hearing problems, and subsequent referral to a specialist and possible surgical treatment at an ENT department. Setting The province of Limburg, the Netherlands. Subjects Healthy infants invited for the hearing screening at age nine months, who responded in an earlier study called PEPPER (Persistent Ear Problems, Providing Evidence for Referral, response rate 58%). Main outcome measures The odds of a child being surgically treated for OM. Results The response rate for the present questionnaire was 72%. Of all children tested, 3.9% failed the hearing screening and were referred to their GP. Of all 2619 children in this study, 18.6% visited their GP with ear/hearing problems. Children failing the hearing screening without GP consultation for ear/hearing problems were significantly more often treated surgically for OM than children passing the hearing screening but with GP consultation for ear/hearing problems. Conclusion Objectified hearing loss, i.e. failing the hearing screening, was important in the decision for surgical treatment in infants in the Netherlands. PMID:22794165

  17. 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…

  18. Generating Clients and Referral Sources.

    ERIC Educational Resources Information Center

    Russell, Martha; Price, Meg; Becht, Monika

    1997-01-01

    Includes three theme articles: "Visibility, Connectedness, and Collaboration: Keys to Marketing a Private Practice" (Martha Russell); "If You Build It (and Publicize It) They Will Come: An Overview of Private Practice Marketing Strategies" (Meg Price); and "The Art of Networking in Private Practice" (Monika Becht). (SK)

  19. 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…

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

    PubMed

    Borus, Joshua; Parhami, Iman; Levy, Sharon

    2016-10-01

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

  1. Under-diagnosis of pain by primary physicians and late referral to a palliative care team

    PubMed Central

    2012-01-01

    Background Under-diagnosis of pain is a serious problem in cancer care. Accurate pain assessment by physicians may form the basis of effective care. The aim of this study is to examine the association between late referral to a Palliative Care Team (PCT) after admission and the under-diagnosis of pain by primary physicians. Methods This retrospective study was performed in the Teikyo University teaching-hospital for a period of 20 months. We investigated triads composed of 213 adult cancer inpatients who had coexisting moderate or severe pain at the initial PCT consultation, 77 primary physicians, and 4 palliative care physicians. The outcome of the present study was the under-diagnosis of pain by primary physicians with routinely self-completed standard format checklists. The checklists included coexisting pain documented independently by primary and palliative care physicians at the time of the initial PCT consultation. Under-diagnosis of pain was defined as existing pain diagnosed by the palliative care physicians only. Late referral to PCTs after admission was defined as a referral to the PCT at ≥20 days after admission. Because the two groups displayed significantly different regarding the distributions of the duration from admission to referral to PCTs, we used 20 days as the cut-off point for “late referral.” Results Accurate pain assessment was observed in 192 triads, whereas 21 triads displayed under-diagnosis of pain by primary physicians. Under-diagnosis of pain by primary physicians was associated with a longer duration between admission and initial PCT consultation, compared with accurate pain assessment (25 days versus 4 days, p < 0.0001). After adjusting for potential confounding factors, under-diagnosis of pain by the primary physicians was significantly associated with late (20 or more days) referral to a PCT (adjusted odds ratio, 2.91; 95% confidence interval, 1.27 − 6.71). Other factors significantly associated with

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

    ERIC Educational Resources Information Center

    Tessari, Diane C.; And Others

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

  3. Non-consulters and high consulters in general practice: cardio-respiratory health and risk factors.

    PubMed

    Morris, J K; Cook, D G; Walker, M; Shaper, A G

    1992-06-01

    The 1990 General Practitioner contract requires that health promotion and illness prevention services should be provided to all patients aged 16-74 years. Consultation rates over a period of three years were examined in 7010 middle-aged men in Great Britain to compare the cardio-respiratory health and risk factor status of non-consulters (men who did not consult in three years) with those of average consulters (men who consulted 3-5 times in three years) and high consulters (men who consulted 24 or more times in three years) to assess their relative need for health promotion and illness prevention services. The non-consulters (n = 1025) were remarkably similar to the average consulters (n = 1585) in health and lifestyle characteristics. The high consulters (n = 306) had a greater burden of ill-health and a less healthy lifestyle. Chest pain on exertion, chronic bronchitis, breathlessness or wheeze were present in 23 per cent of non-consulters, 27 per cent of average consulters and over 50 per cent of high consulters. Similarly, 48 per cent of the non-consulters smoked, drank heavily or were obese compared with 47 per cent of the average consulters and 61 per cent of the high consulters. The prevalence of recall of high blood pressure which had been diagnosed by a doctor rose from 6 per cent in non-consulters and 10 per cent in average consulters to 29 per cent in high consulters.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1515196

  4. Improving efficiency and saving money in an otolaryngology urgent referral clinic.

    PubMed

    Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind

    2015-06-16

    A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost.

  5. Improving efficiency and saving money in an otolaryngology urgent referral clinic.

    PubMed

    Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind

    2015-06-16

    A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost. PMID:26090368

  6. 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…

  7. 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…

  8. 45 CFR 31.4 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  9. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  10. 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…

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

    PubMed

    Myers, Lynnea

    2014-12-13

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

  12. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  13. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... 49 Transportation 3 2010-10-01 2010-10-01 false Referral, evaluation, and treatment....

  14. 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…

  15. The 'iceberg' of illness and 'trivial' consultations.

    PubMed

    Hannay, D R

    1980-09-01

    The medical symptom 'iceberg' and 'trivia' were defined in terms of people's own perceptions of their symptoms and their subsequent referral behaviour. The data were collected by household interviews of patients registered at a health centre and included information on personal and environmental characteristics. Bivariate and multivariate analysis was used to explore associations between those who were part of the symptom 'iceberg' or 'trivia', and factors which might have caused such incongruous referral behaviour.

  16. Tips for telephone and electronic medical consultation.

    PubMed

    Gupta, Sailesh G

    2013-11-01

    The world is gradually shrinking in terms of time, and communications, while expanding in terms of population and distances. Patients demand and expect telephone and e-mail consultations and medical professionals are only too happy to oblige. However, a telephone consult is never so satisfying for the patients and well as the doctor as a face consult. Besides much essential information, cues and clues to diagnosis may be missed only with an audio input from patients. A telephone consult should be offered only to know the patient, and only after a prior face consult. It should be ensured that the patient can definitely understand, and follow the directions, and manage the disorder at home. While a telephone consultation may be considered convenient and short, there may be several disadvantages of such consultation, a wrong diagnosis and an inappropriate prescription being just two of them. Telephone etiquette should be followed by the staff and the physician. A triage system may be set up to filter calls that need to be necessarily answered by the physician himself. Telephone consults should be charged, and should be followed by a face consult as soon as possible. E-mail consultations are governed essentially by the same principles that govern telephone consultations. There is a slight advantage of e-mail consultation in that reports can be submitted online, including radiological reports. However, confidentiality is an important and uncertain issue in cyber space. A memorandum of understanding maybe signed between the patient and the physician. The information provided on e-mail should be of a general nature and a face consult should precede e-mail consultation. Patients may be referred to web resources for information. Telemedicine is a useful tool to obtain a medical diagnosis and to provide medical advice, and is likely to be used vastly in the near future.

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

    PubMed

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

    2012-04-01

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

  18. 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…

  19. Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals.

    PubMed

    Hong, B; Shaikh, Z; Adcock, S; Aldallal, S N

    2016-05-27

    Objectives i) To prospectively explore patients' experience through the two-week wait (2WW) referral process; ii) To compare the relative true malignancy diagnostic rate between general medical practitioners (GMPs) and general dental practitioners (GDPs) over a six-month period; iii) To compare management of 2WW referral cases between GMPs and GDPs before the referral and during the 2 weeks in regards to symptomatic support, investigations in primary care, and information communicated to patients and secondary care clinicians; iv) To investigate the benign conditions that comprise 2WW referrals by finding out the final diagnoses of all cases included in the study.Method The patient inclusion criteria were all 2WW referral patients who attended consultation clinics during the six-month study period in Royal Cornwall Hospital NHS Trust. We prospectively distributed patient questionnaires and clinician's referral assessment forms. We obtained the final diagnoses of all participants electronically, and also identified all malignancies diagnosed via routine referral route during the study period from the cancer services team.Results Two hundred and twenty patients referred via 2WW pathway participated in the study. Of these, 148 referrals were from GMPs and 72 from GDPs. The overall malignancy diagnostic yield was 6.2%; markedly higher from GMPs (9.5%) than GDPs (1.4%), and higher number than those from routine pathway. The GMPs and GDPs showed similar levels of clinical management and information exchange judging from the participants' responses. We also identified the top nine most commonly urgently referred benign conditions.Conclusion We reiterate the need for improved communication between clinicians and patients and between clinicians. We also suggest more focus on education in commonly encountered conditions as well as malignant lesions. The number of 2WW referrals we received from GMPs was nearly twice as many as those from GDPs, highlighting the importance of

  20. ETP and Its Subcontractors and Consultants.

    ERIC Educational Resources Information Center

    Moore, Richard W.; Blake, Daniel R.; Anacker, Christopher; Cohen, Michael D.

    This study examined the role of subcontractors and consultants in California's Employment Training Panel (ETP) program. Methods included interviews, focus groups, a phone survey, and a survey of projects without subcontractors. Results indicated that the market in which administrative and training consultants sell their services to employers is…

  1. 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,…

  2. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  3. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  4. 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...

  5. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  6. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  7. Consulting/Linkage Knowledge and Skills Inventory.

    ERIC Educational Resources Information Center

    Gasaway, Carl; Erwin, Cliff

    This inventory is designed to help educational consultants assess their levels of knowledge and skills in ten broad areas of consulting: communication, entry/intervention, diagnosis, group facilitation, problem-solving, influence/power, resource utilization, conflict management/utilization, and evaluation. The instrument is designed to help…

  8. 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);…

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

    PubMed

    Travis, Frederick; Arenander, Alarik; DuBois, David

    2004-06-01

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

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

    PubMed

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

    2008-03-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Hull, William L.

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

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed Central

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

    1997-01-01

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

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

    PubMed

    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

  17. 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

  18. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  19. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  20. Academic Performance Difficulties: Age and Grade at First Referral

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  1. 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…

  2. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  3. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  4. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  5. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

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

  6. 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

  7. Managing Consultants.

    ERIC Educational Resources Information Center

    Malinconico, S. Michael

    1983-01-01

    Guidelines for managing library consulting engagements effectively cover the decision to use a consultant, definition of the problem area, finding the consultant, interviewing and evaluating the consultant, the psychological contract, the formal contract, and abdication of responsibility for the consulting project by the client. Seventeen sources…

  8. An Exploration of Consultation Approaches and Implementation in Heterogeneous Classrooms.

    ERIC Educational Resources Information Center

    Burdette, Paula J.; Crockett, Jean B.

    1999-01-01

    This review of the literature on consultation in heterogeneous classrooms provides first, an overview of consultation; second, a description of school-based consultation; third, a research synthesis of exemplary studies of school-based consultation; and, finally, suggestions for future research and implications for practice. (Author/DB)

  9. Incongruous referrals.

    PubMed

    Hannay, D R; Maddox, E J

    1975-12-13

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

  10. 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)…

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

    PubMed

    2016-07-01

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

  12. 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…

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

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

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

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

    ERIC Educational Resources Information Center

    Childers, Thomas

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

  15. [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.

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

    PubMed

    Lebowitz, P H

    2001-01-01

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

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

    PubMed

    Steinmann, Peter; Baimatova, Malika; Wyss, Kaspar

    2012-12-01

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

  18. 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.

  19. Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

    PubMed Central

    Marques, André C; Calderaro, Daniela; Yu, Pai C; Gualandro, Danielle M; Carmo, Gabriel A L; Azevedo, Fernanda R; Pastana, Adriana F; Lima, Eneas M O; Monachini, Maristela; Caramelli, Bruno

    2014-01-01

    OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations. PMID:25518017

  20. Toward a Feminist and Multicultural Model of Consultation and Advocacy

    ERIC Educational Resources Information Center

    Hoffman, Mary Ann; Phillips, Elaine L.; Noumair, Debra A.; Shullman, Sandra; Geisler, Carol; Gray, Jacque; Homer, Judith; Horne, Sharon; Paulk, Diana L.; Remer, Randa; Robinson, Shelagh; Rocha-Singh, Indra; Tinsley, Diane J.; Toporek, Rebecca; Ziegler, Donna

    2006-01-01

    The authors present core ideas or constructs that might be integral to a feminist and multicultural model of consultation. According to the model, the structure of consultation is (a) nonhierarchical and (b) an open triad (incorporating extrapersonal and outside factors). The process of consultation is (c) culturally responsive and (d) empowering.…

  1. 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)

  2. NICU consultants and support staff

    MedlinePlus

    ... x-rays and other imaging tests, such as barium enemas and ultrasounds. Pediatric radiologists have extra training ... make body parts easier to see, as with barium enemas. X-rays of bones are also commonly ...

  3. The Consultants' Comments and Recommendations.

    ERIC Educational Resources Information Center

    Labour Education, 1985

    1985-01-01

    This article contains a review of activities and approaches of the International Labour Office's (ILO) Workers' Education Programme, and a discussion of the role of the ILO in promoting wider concepts of workers' education linked to other forms of education and training. (CT)

  4. Capacity and Charter Project Consultation.

    ERIC Educational Resources Information Center

    Association of Colleges of Applied Arts and Technology of Ontario, North York.

    The 25 colleges of Ontario's Colleges of Applied Arts and Technology have strategic directions built upon new programs services, accessible diverse learning options, state-of-the-art learning technology, innovative alliances with business and education, and inter-institutional resource sharing. Yet the implementation of these strategic directions…

  5. Assessing clinical ethics consultation: processes and outcomes.

    PubMed

    Batten, Jason

    2013-06-01

    The vast majority of hospitals use clinical ethics consultation (CEC) as a service to address ethical issues in patient care. Both proponents and critics alike recognize a need to evaluate CEC. I review three outcomes of CEC that have been formally evaluated: healthcare cost, clinical indicators in the intensive care unit, and user satisfaction. These outcome indicators cannot be used to evaluate the worth of CEC because they are contingent and outside of the consultant's control. However, the failure of outcomes-based assessment poses no threat to CEC since the service is continually justified by the fundamental necessity of resolving ethical problems in patient care. While outcome indicators can be used as heuristics to investigate quality issues in CEC, process indicators can capture the quality of CEC more directly. Therefore, further research should be directed toward developing process-based conceptual models for CEC and various methods for assessing these processes. PMID:23967789

  6. Counselor-Client Similarity and Referral Bias

    ERIC Educational Resources Information Center

    Kunce, Joseph; Anderson, Wayne

    1970-01-01

    Based on ratings by classmates, counselors were dicotomized according to probability of being referred agitated or constrained clients. Counselors to whom the former were referred had higher MMPI scores on D and Pt scales and lower scores on Es scales. (Author)

  7. [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)

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

    PubMed

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

    2015-08-01

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

  9. 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…

  10. 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.

  11. 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. PMID:26116586

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

    PubMed

    Larsson, Laura S; Kuster, Emilie

    2013-01-01

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

  13. Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral.

    PubMed

    Bischoff, Alexander; Bovier, Patrick A; Rrustemi, Isah; Gariazzo, Françoise; Eytan, Ariel; Loutan, Louis

    2003-08-01

    The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is

  14. [Doctor, know that your patient has Googled: Internet and reason for medical consultation].

    PubMed

    van den Bruele, Tjitske; Vos, Hedwig M M

    2014-01-01

    The internet is increasingly used as a source of medical information, not only by healthcare professionals but by patients as well. We describe the case of Patient A, a 32-year-old male with symptoms of sinusitis. He found a treatment on the internet and was informed when to consult a general practitioner. We also describe Patient B, a 31-year-old female with symptoms of fatigue after the delivery of her second child. Her search on the internet led to several referrals to a medical specialist due to her conviction that her symptoms were caused by a hormonal imbalance. We conclude that medical information on the internet can support both the doctor and the patient, or it can present an obstacle to proper communication during a consultation. Awareness by medical professionals of the Googling behaviour of their patients may be helpful in detecting the underlying question and worries of the patient.

  15. 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…

  16. 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

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

    ERIC Educational Resources Information Center

    Wallingford, Elizabeth L.; Prout, H. Thompson

    2000-01-01

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

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

    PubMed

    Murray, Susan F; Pearson, Stephen C

    2006-05-01

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

  19. Red eyes and red-flags: improving ophthalmic assessment and referral in primary care.

    PubMed

    Kilduff, Caroline; Lois, Charis

    2016-01-01

    Up to five percent of primary care consultations are eye-related, yet 96% of General Practitioners (GPs) do not undergo postgraduate ophthalmology training. Most do not feel assured performing eye assessments. Some red eye conditions can become sight threatening, and often exhibit red-flag features. These features include moderate pain, photophobia, reduced visual acuity (VA), eye-trauma, or unilateral marked redness. The aim of this project was to improve primary care assessment and referral of patients presenting with red-flag features based on the NICE 'Red Eye' Clinical Knowledge Summary recommendations. Data was collected retrospectively from 139 red eye consultations. A practice meeting highlighted poor awareness of red-flag features, low confidence levels in eye assessments, and time-constraints during appointments. Interventions were based on feedback from staff. These included a primary care teaching session on red-flag features, a VA measurement tutorial, and provision of a red eye toolkit, including VA equipment, to each consultation room. At baseline, each patient had on average 0.9 red-flag features assessed. Only 36.0% (9/25) of patients with red-flag features were appropriately referred to same-day ophthalmology services. Following two improvement cycles, a significant improvement was seen in almost every parameter. On average, each patient had 2.7 red-flag features assessed (vs 0.9, p<0.001). VA was assessed in 55.6% of consultations (vs 7.9%, p<0.001), pain was quantified in 81.5% (vs 20.9%, p=0.005), eye-trauma or foreign-body (51.8% vs 8.6%, p<0.001), extent of redness was documented in 66.7% (vs 14.4%, p<0.001). Only photophobia remained poorly assessed (18.5% vs 14.4%, p=0.75). Following this, 75.0% (6/8) of patients were appropriately referred. This project reflected the literature regarding low confidence and inexperience amongst GPs when faced with ophthalmic conditions. Improvements in education are required to ensure accurate assessments

  20. Red eyes and red-flags: improving ophthalmic assessment and referral in primary care

    PubMed Central

    Kilduff, Caroline; Lois, Charis

    2016-01-01

    Up to five percent of primary care consultations are eye-related, yet 96% of General Practitioners (GPs) do not undergo postgraduate ophthalmology training. Most do not feel assured performing eye assessments. Some red eye conditions can become sight threatening, and often exhibit red-flag features. These features include moderate pain, photophobia, reduced visual acuity (VA), eye-trauma, or unilateral marked redness. The aim of this project was to improve primary care assessment and referral of patients presenting with red-flag features based on the NICE ‘Red Eye’ Clinical Knowledge Summary recommendations. Data was collected retrospectively from 139 red eye consultations. A practice meeting highlighted poor awareness of red-flag features, low confidence levels in eye assessments, and time-constraints during appointments. Interventions were based on feedback from staff. These included a primary care teaching session on red-flag features, a VA measurement tutorial, and provision of a red eye toolkit, including VA equipment, to each consultation room. At baseline, each patient had on average 0.9 red-flag features assessed. Only 36.0% (9/25) of patients with red-flag features were appropriately referred to same-day ophthalmology services. Following two improvement cycles, a significant improvement was seen in almost every parameter. On average, each patient had 2.7 red-flag features assessed (vs 0.9, p<0.001). VA was assessed in 55.6% of consultations (vs 7.9%, p<0.001), pain was quantified in 81.5% (vs 20.9%, p=0.005), eye-trauma or foreign-body (51.8% vs 8.6%, p<0.001), extent of redness was documented in 66.7% (vs 14.4%, p<0.001). Only photophobia remained poorly assessed (18.5% vs 14.4%, p=0.75). Following this, 75.0% (6/8) of patients were appropriately referred. This project reflected the literature regarding low confidence and inexperience amongst GPs when faced with ophthalmic conditions. Improvements in education are required to ensure accurate

  1. 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

    ... Energy Regulatory Commission Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section... implementing regulations of the Advisory Council on Historic Preservation, the following are consulting parties... party for the section 106 consultation process in this proceeding. This request is denied....

  2. 12 CFR 308.510 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Referral of complaint and answer to the ALJ. 308.510 Section 308.510 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE RULES OF PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.510 Referral...

  3. 12 CFR 308.510 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Referral of complaint and answer to the ALJ. 308.510 Section 308.510 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE RULES OF PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.510 Referral...

  4. 12 CFR 308.510 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 308.510 Section 308.510 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE RULES OF PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.510 Referral...

  5. 12 CFR 308.510 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Referral of complaint and answer to the ALJ. 308.510 Section 308.510 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE RULES OF PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.510 Referral...

  6. 12 CFR 308.510 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Referral of complaint and answer to the ALJ. 308.510 Section 308.510 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE RULES OF PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.510 Referral...

  7. An Employer's Guide to Child Care Consultants.

    ERIC Educational Resources Information Center

    Eichman, Caroline

    This guide is designed to help employers hire a qualified child care consultant who will evaluate child care options in light of employees' needs and help develop and implement appropriate child care options. These options include: (1) establishment of a child care facility; (2) financial assistance; (3) a resource and referral service; (4)…

  8. 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…

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

    PubMed

    Levy, Sharon J L; Williams, Janet F

    2016-07-01

    The enormous public health impact of adolescent substance use and its preventable morbidity and mortality highlight the need for the health care sector, including pediatricians and the medical home, to increase its capacity regarding adolescent substance use screening, brief intervention, and referral to treatment (SBIRT). The American Academy of Pediatrics first published a policy statement on SBIRT and adolescents in 2011 to introduce SBIRT concepts and terminology and to offer clinical guidance about available substance use screening tools and intervention procedures. This clinical report provides a simplified adolescent SBIRT clinical approach that, in combination with the accompanying updated policy statement, guides pediatricians in implementing substance use prevention, detection, assessment, and intervention practices across the varied clinical settings in which adolescents receive health care. PMID:27325634

  10. 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…

  11. 32 CFR 757.6 - Waiver, compromise, and referral of claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... accordance with 31 CFR part 904 shall be forwarded through the Judge Advocate General (Claims and Tort... AFFIRMATIVE CLAIMS REGULATIONS Property Damage Claims § 757.6 Waiver, compromise, and referral of claims. (a... 32 National Defense 5 2010-07-01 2010-07-01 false Waiver, compromise, and referral of claims....

  12. 32 CFR 757.6 - Waiver, compromise, and referral of claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... accordance with 31 CFR part 904 shall be forwarded through the Judge Advocate General (Claims and Tort... AFFIRMATIVE CLAIMS REGULATIONS Property Damage Claims § 757.6 Waiver, compromise, and referral of claims. (a... 32 National Defense 5 2012-07-01 2012-07-01 false Waiver, compromise, and referral of claims....

  13. 32 CFR 757.6 - Waiver, compromise, and referral of claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... accordance with 31 CFR part 904 shall be forwarded through the Judge Advocate General (Claims and Tort... AFFIRMATIVE CLAIMS REGULATIONS Property Damage Claims § 757.6 Waiver, compromise, and referral of claims. (a... 32 National Defense 5 2011-07-01 2011-07-01 false Waiver, compromise, and referral of claims....

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

    PubMed Central

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

    2011-01-01

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

  15. 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...

  16. 6 CFR 13.11 - Referral of Complaint and answer to the ALJ.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 6 Domestic Security 1 2012-01-01 2012-01-01 false Referral of Complaint and answer to the ALJ. 13.11 Section 13.11 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of Complaint and answer to the ALJ. Upon receipt of an answer,...

  17. 6 CFR 13.11 - Referral of Complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 6 Domestic Security 1 2011-01-01 2011-01-01 false Referral of Complaint and answer to the ALJ. 13.11 Section 13.11 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of Complaint and answer to the ALJ. Upon receipt of an answer,...

  18. The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger.

    PubMed

    Bossyns, Paul; Van Lerberghe, Wim

    2004-04-01

    BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. METHODS: Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants - patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. RESULTS: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. CONCLUSIONS: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns. PMID:15059284

  19. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  20. Evaluating racial disparity in referral source and successful completion of substance abuse treatment.

    PubMed

    Sahker, Ethan; Toussaint, Maisha N; Ramirez, Marizen; Ali, Saba R; Arndt, Stephan

    2015-09-01

    Health disparity is a significant problem in the United States, and particularly for substance abuse treatment programs. A better understanding of racial differences in treatment pathways associated with successful treatment completion is needed to reduce the existing health disparities. Referral source is a strong predictor of treatment success and most research on health disparities has focused on the criminal justice referrals. However, little research has examined other types of referral sources, and the interaction with race. The current study sought to compare the effect of referral sources on national substance abuse successful treatment completion rates between Black clients (n=324,625) and White clients (n=1,060,444) by examining the interaction of race on referral source and successful treatment completion. Race significantly moderated the difference between referral source and successful treatment completion (Wald χ(2)=1477.73, df=6, p<0.0001). Employment referral was associated with the greatest percentage of successful treatment completion for Black clients. Criminal justice referral was associated with the greatest percentage of successful treatment completion for White clients. Results from the present study support a reevaluation of incentives leading to successful treatment completion with a multicultural perspective.

  1. 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. PMID:16130633

  2. 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

    ... of the Secretary 32 CFR Part 199 RIN 0720-AB36 TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy AGENCY: Office of the Secretary, Department of Defense. ACTION: Final... engage in referrals of beneficiaries to the Military Health System for physical therapy,...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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... ADMINISTRATION AND PROCEDURE Vocational Rehabilitation § 702.505 Vocational rehabilitation; referrals to other... disabled persons such as public welfare agencies, Public Health Services facilities, social services...

  8. 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. PMID:26806448

  9. A blood bank consultation service: principles and practice.

    PubMed

    Popovsky, M A; Moore, S B; Wick, M R; Devine, P; Pineda, A A; Taswell, H F

    1985-05-01

    In the blood bank setting, a close relationship with both clinicians and patients is essential for good medical practice. In July 1982, the Mayo Clinic Blood Bank and Transfusion Services formally organized a consultation service with daily visits to patients of mutual interest to blood bank consultants and clinicians for practice and education. Detailed diaries of this activity were maintained for 12 months, during which time 802 impatient visits were recorded. The most frequent reasons for consultations were clarification or amplification of the clinical history (34.0%), evaluation of transfusion reactions (27.2%), and assessment of serologic problems (18.2%). These consultations resulted in diagnostic, management, and therapeutic recommendations for a wide variety of medical problems. Of the 802 consultations, 23% were conducted at the direct request of clinicians. We believe that a blood bank consultation service is feasible, is enlightening for the blood bank and clinicians, and contributes to patient care.

  10. 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)

  11. 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.

  12. 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…

  13. Consultants' Handbook.

    ERIC Educational Resources Information Center

    Tuttle, Lester E., Jr., Ed.; Hooker, Dennis A., Ed.

    Two conferences held in Florida in 1968 to prepare consultants to work with in-service professional and para-professional personnel serving migrant children in Florida, led to this analysis of consultant, consultee, and professional staff reactions. Characteristics of a consultant and when and how to use his services are outlined. It is shown how…

  14. Neglected ends: clinical ethics consultation and the prospects for closure.

    PubMed

    Fiester, Autumn

    2015-01-01

    Clinical ethics consultations (CECs) are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient "closure" for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as "bioethics mediation."

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  16. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  17. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  18. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  19. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... consultation process required under the EPA transportation conformity regulations (40 CFR part 93), a summary... RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and Programming §...

  20. 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…

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

    PubMed

    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

  2. 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

  3. Delay to orthopedic consultation for isolated limb injury

    PubMed Central

    Rouleau, Dominique M.; Feldman, Debbie Ehrmann; Parent, Stefan

    2009-01-01

    ABSTRACT OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation. PMID:19826162

  4. 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.

  5. 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

  6. 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.

  7. Differential referral of women and men to employee assistance programs: the role of supervisory attitudes.

    PubMed

    Young, D W; Reichman, W R; Levy, M F

    1987-01-01

    Potential factors underlying sex differences in the referral of problem-drinking subordinates to employee assistance programs (EAPs) were explored in interviews with 120 supervisors in four organizations. Analyses of data obtained in these interviews assessed the relative ability of eight variables to predict supervisor's actual identification and referral of female and male problem drinkers. In addition to numbers of employees supervised, the supervisors' judgment of the EAP's effectiveness was the best predictor of referral and identification, regardless of the sex of the referred subordinate. Knowledge and training in the EAP was a secondary contributor to referral of men, but played no role in female referrals. When controlling for all other variables, the extent to which supervisors held an egalitarian attitude toward women's rights and roles was found to be marginally positively related to identification of female drinkers. Similarly, a less stigmatized, stereotyped view of women's use and abuse of alcohol was marginally associated with a greater likelihood of referral of a female drinker to the EAP. Neither of these attitudinal variables was related to identification or referral of male problem drinkers.

  8. 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.

  9. 43 CFR 3425.4 - Consultation and sale procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Consultation and sale procedures. 3425.4... § 3425.4 Consultation and sale procedures. (a)(1) Prior to holding any lease sale in response to any... environmental impact statement, the proposed sale and the fair market value and maximum economic recovery on...

  10. 43 CFR 3425.4 - Consultation and sale procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Consultation and sale procedures. 3425.4... § 3425.4 Consultation and sale procedures. (a)(1) Prior to holding any lease sale in response to any... environmental impact statement, the proposed sale and the fair market value and maximum economic recovery on...

  11. 43 CFR 3425.4 - Consultation and sale procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Consultation and sale procedures. 3425.4... § 3425.4 Consultation and sale procedures. (a)(1) Prior to holding any lease sale in response to any... environmental impact statement, the proposed sale and the fair market value and maximum economic recovery on...

  12. 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…

  13. Consultation and the TADS Experience. Occasional Paper Number 1.

    ERIC Educational Resources Information Center

    Trohanis, Pascal L.; And Others

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

  14. Handbook of Consultation with Individuals and Small Groups.

    ERIC Educational Resources Information Center

    Brown, Duane; And Others

    This handbook is one of four handbooks developed for preservice and inservice counselor preparation and professional development. It was developed as a practical guide for practicing professionals and as a textbook or supplementary material for use in courses or workshops on consultation. Chapter 1 provides an introduction to consultation,…

  15. 43 CFR 10005.7 - Agency consultation and public involvement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Agency consultation and public involvement. 10005.7 Section 10005.7 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH... COMMISSION'S MITIGATION AND CONSERVATION PLAN § 10005.7 Agency consultation and public involvement....

  16. 43 CFR 10005.7 - Agency consultation and public involvement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Agency consultation and public involvement. 10005.7 Section 10005.7 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH... COMMISSION'S MITIGATION AND CONSERVATION PLAN § 10005.7 Agency consultation and public involvement....

  17. 43 CFR 10005.7 - Agency consultation and public involvement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Agency consultation and public involvement. 10005.7 Section 10005.7 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH... COMMISSION'S MITIGATION AND CONSERVATION PLAN § 10005.7 Agency consultation and public involvement....

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

    PubMed

    Roshier, A L; McBride, E A

    2013-03-01

    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.

  19. 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. PMID:26245879

  20. 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.

  1. Exit Interview-Consultation for Research Validation and Dissemination

    PubMed Central

    Utley-Smith, Queen; Bailey, Donald; Ammarell, Natalie; Corazzini, Kirsten; Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Piven, Mary L.; Anderson, Ruth A.

    2006-01-01

    Dissemination of research findings to practice and maintaining rigor and validity in qualitative research is a continuing challenge for nurse researchers. Using three nursing home case studies as examples, we describe how exit interview-consultation was used as: (1) a validation strategy, and; (2) as a rapid research dissemination tool that is particularly useful for nursing systems research. Through an exit interview–consultation method, researchers validated inferences made from qualitative and quantitative data collected in three comprehensive nursing home case studies that examined nursing management practices. This exit interview-consultation strategy extends the traditional member check approach by providing confirmation at the individual and organizational level. We examined how using the exit interview-consultation strategy can potentially assist nursing home organizations to increase their capacity for improving operations. Benefits from research participation are often indirect; this study's results suggest that exit interview-consultation can provide direct and immediate benefits to organizations and individuals. PMID:17099107

  2. 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.

  3. Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

    PubMed

    Berge, T I

    1992-02-01

    A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated. PMID:1533083

  4. 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....

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

    ERIC Educational Resources Information Center

    Harris, J. W.

    1987-01-01

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

  6. 20 CFR 416.919p - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... perform ongoing special management studies on the quality of consultative examinations purchased from... equipment required to provide an adequate assessment and record of the existence and level of severity of... Type of Referral and for Report Content § 416.919p Reviewing reports of consultative examinations....

  7. 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.

  8. Knowledge, Attitudes and Referral Patterns of Lynch Syndrome: A Survey of Clinicians in Australia

    PubMed Central

    Tan, Yen Y.; Spurdle, Amanda B.; Obermair, Andreas

    2014-01-01

    This study assessed Australian clinicians’ knowledge, attitudes and referral patterns of patients with suspected Lynch syndrome for genetic services. A total of 144 oncologists, surgeons, gynaecologists, general practitioners and gastroenterologists from the Australian Medical Association and Clinical Oncology Society responded to a web-based survey. Most respondents demonstrated suboptimal knowledge of Lynch syndrome. Male general practitioners who have been practicing for ≥10 years were less likely to offer genetic referral than specialists, and many clinicians did not recognize that immunohistochemistry testing is not a germline test. Half of all general practitioners did not actually refer patients in the past 12 months, and 30% of them did not feel that their role is to identify patients for genetic referral. The majority of clinicians considered everyone to be responsible for making the initial referral to genetic services, but a small preference was given to oncologists (15%) and general practitioners (13%). Patient information brochures, continuing genetic education programs and referral guidelines were favoured as support for practice. Targeted education interventions should be considered to improve referral. An online family history assessment tool with built-in decision support would be helpful in triaging high-risk individuals for pathology analysis and/or genetic assessment in general practice. PMID:25563224

  9. Summary of Field Test and Outcome Milestone Report for Preparing Educational Training Consultants: Consulting (PETC-II).

    ERIC Educational Resources Information Center

    George, Catherine A.; Murray, Stephen L.

    Preparing Educational and Training Consultants (PECT-II) is the second in a series of three cumulative and sequential instructional systems designed to help a cadre of educators acquire process training and consulting skills. The PETC-II graduate should be capable of forming a temporary relationship with a small group or major subsystem of an…

  10. Nurses' and Patients' Experiences of Tele-Consultations.

    PubMed

    Dichmann Sorknaes, Anne

    2016-01-01

    The study focused on real-time video consultations (tele-consultations) as experienced by Danish hospital-based, respiratory nurses (tele-nurses) and patients with chronic obstructive pulmonary disease, COPD, discharged after hospitalization with acute exacerbation (tele-patients). Tele-patients and tele-nurses consider tele-consultations as distinct, but qualified care, enabling close relationships between patient and nurse. The nurses' performance and their professional identity changed. The patients become active, participants in their treatment and care. PMID:27332392

  11. A Guiding Framework for Integrating the Consultation Process and Behavior Analytic Practice in Schools: The Treatment Validation Consultation Model

    ERIC Educational Resources Information Center

    Andersen, Melissa N.; Hofstadter, Kristi L.; Kupzyk, Sara; Daly, Edward J., III; Bleck, Amanda A.; Collaro, Alyssa L.; Jones, Kristin E.; Clure, Lynne F.; Blevins, Carrie A.

    2010-01-01

    Since behavioral consultation (BC) was introduced over 30 years ago, the core procedures and assumptions of the model have remained largely unchanged in spite of its widespread popularity in practice. This article presents the Treatment Validation Consultation (TVC) model, which addresses limitations of BC and integrates recent technological…

  12. Antimicrobial stewardship program prompts increased and earlier infectious diseases consultation.

    PubMed

    Morrill, Haley J; Gaitanis, Melissa M; LaPlante, Kerry L

    2014-01-01

    A recent analysis demonstrated that infectious diseases (ID) specialty intervention was associated with decreased mortality and hospital readmission. These benefits were greatest if involvement occurred within two days of hospital admission. Antimicrobial stewardship programs should augment the services of an ID specialist team and promote formal consultation. Implementation of an antimicrobial stewardship program at the Providence Veterans Affairs Medical Center was associated with an increased number of consults (increase of 72.2%) and decreased time to consult (3.5 days sooner), which might also dramatically improve patient outcomes, including mortality and readmission rates. PMID:24742249

  13. Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation.

    PubMed

    Dugdill, Lindsey; Graham, Rebecca C; McNair, Fiona

    This review critically explores the development, impact and evaluation of exercise referral schemes (ERS) in the UK. A rapid expansion in the use of such ERSs has been recorded throughout leisure and primary care settings, but the evidence underpinning their implementation has been sparse and predominantly limited to randomized control trial (RCT) research design. Consequently, understanding of exercise referral as a 'real world' intervention has been limited. Considering the increasing importance being placed on evidence-based practice and clinical effectiveness, it is no longer sufficient for service providers of exercise referral to ignore the need to evaluate schemes. The guidelines on evaluation provided by the National Quality Assurance Framework for Exercise Referral are limited, hence practitioners are often unsure of the best measures to use when assessing effectiveness. Predominantly, exercise professionals focus on the collection of physiological data but tend to ignore relevant psychological and environmental parameters. Also, few UK studies have followed participants up in the long term, to see if physical activity behaviour is sustained over time. Here, evidence from two on-going, large-scale (n = 1600/annum) evaluation studies of exercise referral schemes, based in urban localities in the northwest of England, are described. A participatory action research framework for evaluation was utilized and incorporated multi-method research approaches for the assessment of both ERS participants and health professionals involved in intervention delivery. This framework is an appropriate methodology for the evaluation and development of complex interventions, and here incorporates case study, focus groups, interviews and survey questionnaires. Included was a 12-month tracking study of a cohort of exercise referral participants (n = 342), which measured leisure-time physical activity levels (Godin leisure time score), at baseline (entry to exercise referral) and

  14. 77 FR 49792 - FIFRA Pesticide Registration Review and ESA Consultation Processes; Proposal Regarding...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-17

    ... AGENCY FIFRA Pesticide Registration Review and ESA Consultation Processes; Proposal Regarding Stakeholder... process which are intended to facilitate ESA pesticide consultations and coordination across these Federal... Consultation Processes and Development of Economically and Technologically Feasible Reasonable and...

  15. 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.

  16. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  17. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  18. 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...

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

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  20. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  1. Continuing medical education: experience and opinions of consultants.

    PubMed Central

    Kerr, D N; Jones, S A; Easmon, C S

    1993-01-01

    The right of consultants to study leave and expenses is not binding on trusts and has been eroded in directly managed units. Complaints led to a survey of consultants in North West Thames region. This showed that most consultants use their own time and money to maintain their knowledge by buying and consulting journals and textbooks, attending local meetings, and using their annual leave for study, but they feel the need for study leave to attend meetings of specialist societies and courses. Leave is usually granted readily but without cover provided by a locum and with a very limited contribution to expenses. To maintain quality of medical care both the right and obligation to take study leave should be contractual. PMID:8518610

  2. 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

  3. 10 CFR 903.14 - Consultation and comment period.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... consult with and obtain information from the PMA, to examine backup data, and to make suggestions for... during this period, interested persons may submit written comments to the PMA regarding the...

  4. 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.

  5. Teaching Hospital Inpatient Consultation to Psychology Trainees and Interns.

    ERIC Educational Resources Information Center

    Gabinet, Laille; Schubert, Daniel S.P.

    1981-01-01

    Discusses the value of training clinical psychologists in consultation-liaison roles for hospital patients in nonpsychiatric wards. Training would involve communication with hospital staff, the medical chart, case presentation, approach to the patient, differential diagnosis, and psychotropic medication. (KC)

  6. Exploring the interface between first and second level of care: referrals in rural Africa.

    PubMed

    Nordberg, E; Holmberg, S; Kiugu, S

    1996-02-01

    The studies aimed to determine the referral rate, the characteristics of patients referred, the reasons for referral and, in a sub-sample, its outcome. Study I recorded data on 602 patients referred to hospital from 13 rural clinics; follow-up interviews were conducted with a sub-sample of 57 referred patients. Study II interviewed 97 consecutive outpatients seeking care at Meru District Hospital. Both studies were carried out in a rural area of Meru district in central Kenya. The 602 referred cases represent between 0.3 and 1.8% of all new patients at the respective clinic with a mean of 0.5%, or 8.7 referrals annually per 1000 catchment area population. More than half of the referrals were for treatment only while 13% were for investigation, 63% were considered urgent, and 85% were referred in writing. Of the 57 subsequently interviewed, all except one had complied, and 52 patients, mostly with infections, injuries or obstetric disorders, reported improvement at the time of interview. The second study found that only 19 (20%) of the 97 outpatients had been referred (II in writing and 8 verbally). Rates of formal clinic-to-hospital referral were very low. Reasons included poor access to transport; patient inability to pay user fees, transport outlays, and other expenses; time constraints in emergency situations; and lack of feedback information from hospital to clinic. Verbal referral was common. Further research should focus on the selection of patients for referral, on follow-up of cases referred, on the communication between institutions involved, and on options for the financing of emergency transport to hospital.

  7. 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.

  8. 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…

  9. Over- and Undercontrolled Clinic Referral Problems of Jamaican and American Children and Adolescents: The Culture General and the Culture Specific.

    ERIC Educational Resources Information Center

    Lambert, Michael C.; And Others

    1989-01-01

    Studied clinical referrals of two different societies (Jamaica, where Afro-British culture discourages child aggression, and United States, where uncontrolled child behavior appears more accepted) to determine influence of cultural factors in clinical referral patterns. Found significant difference in clinic-referred problems of American and…

  10. Physicians’ Tacit and Stated Policies for Determining Patient Benefit and Referral to Cardiac Rehabilitation

    PubMed Central

    Beckstead, Jason W.; Pezzo, Mark V.; Beckie, Theresa M.; Shahraki, Farnaz; Kentner, Amanda C.; Grace, Sherry L.

    2015-01-01

    Background The benefits of prescribing cardiac rehabilitation (CR) for patients following heart surgery is well documented. However physicians continue to underutilize CR programs and disparities in the referral of women are common. Previous research into the causes of these problems has relied on self-report methods which presume that physicians have insight into their referral behavior and can describe it accurately. In contrast, the research presented here employed clinical judgment analysis (CJA) to discover the tacit judgment and referral policies of individual physicians. Purpose The specific aims were to determine 1) what these policies were, 2) the degree of self-insight that individual physicians had into their own policies, 3) the amount of agreement among physicians, and 4) the extent to which judgments were related to attitudes toward CR. Method Thirty-six Canadian physicians made judgments and decisions regarding 32 hypothetical cardiac patients, each described on five characteristics (gender, age, type of surgical procedure, presence/absence of musculoskeletal pain, and degree of motivation) and then completed the 19 items of the Attitude towards Cardiac Rehabilitation Referral instrument. Results There was wide variation among physicians in their tacit and stated judgment policies. Physicians exhibited greater agreement in what they believed they were doing (stated policies) than in what they actually did (tacit policies). Nearly one-third of the physicians showed evidence of systematic, and perhaps subliminal, gender bias as they judged women as less likely than men to benefit from CR. Correlations between attitude statements and CJA measures were modest. Conclusions These findings offer some explanation for the slow progress of efforts to improve CR referrals and for gender disparities in referral rates. PMID:23784848

  11. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Referrals. 612.2301 Section 612.2301 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a) Each institution and its board of...

  12. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Referrals. 612.2301 Section 612.2301 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a) Each institution and its board of...

  13. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Referrals. 612.2301 Section 612.2301 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a) Each institution and its board of...

  14. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Referrals. 612.2301 Section 612.2301 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a) Each institution and its board of...

  15. Why general practitioners and consultants change their clinical practice: a critical incident study.

    PubMed Central

    Allery, L. A.; Owen, P. A.; Robling, M. R.

    1997-01-01

    OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. CONCLUSIONS: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered. PMID:9093100

  16. 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

  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. Prevalence and Determinants of True Thyroid Dysfunction Among Pediatric Referrals for Abnormal Thyroid Function Tests

    PubMed Central

    Lahoti, Amit; Klein, Jason; Schumaker, Tiffany; Vuguin, Patricia; Frank, Graeme

    2016-01-01

    Background/Aims. Abnormalities in thyroid function tests (TFTs) are a common referral reason for pediatric endocrine evaluation. However, a sizable proportion of these laboratory abnormalities do not warrant therapy or endocrine follow-up. The objectives of this study were (a) to evaluate the prevalence of true thyroid dysfunction among pediatric endocrinology referrals for abnormal TFTs; (b) to identify the historical, clinical, and laboratory characteristics that predict decision to treat. Methods. This was a retrospective chart review of patients evaluated in pediatric endocrinology office during a weekly clinic designated for new referrals for abnormal TFTs in 2010. Results. A total of 230 patients were included in the study. Median age at referral was 12 years (range = 2-18); 56% were females. Routine screening was cited as the reason for performing TFTs by 33% patients. Majority was evaluated for hypothyroidism (n = 206). Elevated thyroid-stimulating hormone was the most common referral reason (n = 140). A total of 41 out of 206 patients were treated for hypothyroidism. Conclusions. Prevalence of hypothyroidism was 20%. Thyroid follow-up was not recommended for nearly one third of the patients. Among all the factors analyzed, an elevated thyroid-stimulating hormone level and antithyroglobulin antibodies strongly correlated with the decision to treat (P < .005). PMID:27336020

  19. Prevalence and Determinants of True Thyroid Dysfunction Among Pediatric Referrals for Abnormal Thyroid Function Tests.

    PubMed

    Lahoti, Amit; Klein, Jason; Schumaker, Tiffany; Vuguin, Patricia; Frank, Graeme

    2016-01-01

    Background/Aims. Abnormalities in thyroid function tests (TFTs) are a common referral reason for pediatric endocrine evaluation. However, a sizable proportion of these laboratory abnormalities do not warrant therapy or endocrine follow-up. The objectives of this study were (a) to evaluate the prevalence of true thyroid dysfunction among pediatric endocrinology referrals for abnormal TFTs; (b) to identify the historical, clinical, and laboratory characteristics that predict decision to treat. Methods. This was a retrospective chart review of patients evaluated in pediatric endocrinology office during a weekly clinic designated for new referrals for abnormal TFTs in 2010. Results. A total of 230 patients were included in the study. Median age at referral was 12 years (range = 2-18); 56% were females. Routine screening was cited as the reason for performing TFTs by 33% patients. Majority was evaluated for hypothyroidism (n = 206). Elevated thyroid-stimulating hormone was the most common referral reason (n = 140). A total of 41 out of 206 patients were treated for hypothyroidism. Conclusions. Prevalence of hypothyroidism was 20%. Thyroid follow-up was not recommended for nearly one third of the patients. Among all the factors analyzed, an elevated thyroid-stimulating hormone level and antithyroglobulin antibodies strongly correlated with the decision to treat (P < .005).

  20. Handbook for Behavioral Consultation.

    ERIC Educational Resources Information Center

    Gresham, Frank M.

    This handbook provides an overview of the consultation role for the school psychologist and distinguishes between consultation and other forms of school psychological services. Three major consultation models in school psychology are reviewed: (1) mental health consultation; (2) organization-development consultation; and (3) behavioral…

  1. Mergers and acquisitions: director and consultant liability exposure.

    PubMed

    Waxman, J M

    1995-02-01

    Corporate directors and their consultants must make decisions in an uncertain and changing health care environment. The losses each may face as a result of an incomplete analysis of the true value of the entities involved in mergers or acquisitions may extend beyond the failure of the transaction to the creation of personal liability as well. Accordingly, objective, careful, detailed, and fair decision-making based upon adequate information is more critical than ever for directors if they are to be able to take advantage of the business judgment rule, and also for consultants to avoid their own liability when transactions fail to deliver the values they have estimated. PMID:10141069

  2. 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.

  3. Facilitating physician referrals on the World Wide Web: representation and appropriate utilization of clinical expertise.

    PubMed

    McHolm, G; Obeid, J; Karson, T H; Sato, L; Schaffer, J L; Greenes, R A

    1996-01-01

    In highly integrated and increasingly complex health care systems, the identification and proper utilization of clinical staff expertise are key factors for efficiently delivering high quality patient care. To achieve these capabilities on an enterprise-wide scale, we have embarked on a multi-phased project to develop World Wide Web (WWW)-based physician referral capabilities for two large teaching hospitals. Currently, users may search for information concerning the education, training, board certifications, and self-designated clinical interests of staff members. Address, phone number, email address, and a photo are also presented. Our experience indicates that institutional changes are required to successfully deploy and maintain online physician referral services and that accurate and equitable representation of clinical expertise and the incorporation of referral guidelines require an incremental introduction of a carefully planned program that addresses the needs of clinicians, administrators, and health care policy-makers. PMID:8947760

  4. Safety referral procedures clarified.

    PubMed

    2014-12-01

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

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

    PubMed

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

    1995-12-01

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

  6. 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.

  7. Paediatric orbital fractures: the importance of regular thorough eye assessment and appropriate referral.

    PubMed

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated "red flags", and appropriate referral are discussed in this short paper. PMID:24349804

  8. A Survey of the Salaries, Benefits, and Working Conditions for California Child Care Resource and Referral Staff.

    ERIC Educational Resources Information Center

    Kinley, Gary J.; And Others

    This document reports the results of a survey of resource and referral programs and their parent agencies. All the agencies were members of the California Child Care Resource and Referral Network. The survey instrument was a 96-item questionnaire divided into four sections: (1) staff salaries and qualifications; (2) working conditions; (3)…

  9. How we do it: analysing GP referral priorities: the unforeseen effect of 'Choose and Book'.

    PubMed

    Pothier, D D; Repanos, C; Awad, Z

    2006-08-01

    The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category. PMID:16911656

  10. Investigation into Factors Influencing Roles, Relationships, and Referrals in Integrative Medicine

    PubMed Central

    Orrock, Paul

    2014-01-01

    Abstract Introduction: Integrative medicine (IM) is a recent phenomenon within primary care practice. It is defined variously as a process of integration or convergence of complementary and alternative medicine (CAM) with mainstream medicine or as the incorporation of alternative therapies into mainstream medical practice. Little is known about the attitude of complementary medicine practitioners regarding their place within this model or the factors that influence referral between them and medical practitioners. Objectives: The aim of this research was to explore practitioners' perspectives of the theory and practice of the IM model, relevant to factors influencing referral among them. Design: This research applied a qualitative method with semi-structured interviews to determine practitioner perspectives of factors influencing referral in the IM setting. One family practice physician (called a general practitioner [GP] in Australia), one osteopath, and one naturopath were interviewed at each of two IM clinics in regional Australia. Thematic analysis was used to identify themes and concepts. Results: Thematic analysis of the transcribed data allowed for an in-depth understanding of themes and concepts surrounding practitioner perceptions of IM. Predominant themes centered on the notion of interpractitioner relationships and collaborations. Insight into these relationships within IM revealed concepts of interpractitioner trust and respect. In addition, sharing a philosophy of care and a common understanding pertaining to scope of practice and area of expertise appeared to support the IM framework. These concepts and themes were determined as important factors influencing referrals between GPs, osteopathic physicians, and naturopathic practitioners in the IM clinics studied. Conclusion: This research has highlighted the significance of interprofessional relationships and multidisciplinary referral networks as pivotal in the efficacy of the IM clinics represented in

  11. BRCA testing of breast cancer patients: medical specialists' referral patterns, knowledge and attitudes to genetic testing.

    PubMed

    Van Riel, E; Wárlám-Rodenhuis, C C; Verhoef, S; Rutgers, E J T H; Ausems, M G E M

    2010-05-01

    This study explores knowledge about hereditary breast cancer, attitudes about BRCA testing and referral pattern to a family cancer clinic among medical specialists. A total of 92 questionnaires were completed by surgeons (38), medical oncologists (29), radiation oncologists (13) and radiologists (12). The response rate was 51%. A substantial (11-56%) proportion of medical specialists do not refer patients who meet current criteria for BRCA testing. Although questions on inheritance were less well answered, overall knowledge was good. They had a positive attitude, but were concerned about the distress DNA testing might cause to family members. The majority (75%) stated that the best time for referral is after adjuvant therapy or during follow-up, but another important determinant was the patient's wish or need (12%). Further studies are needed to gain insight into the actual referral process, while ongoing training of medical specialists about genetic aspects of breast cancer is also necessary.

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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…

  18. 34 CFR 300.535 - Referral to and action by law enforcement and judicial authorities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES Procedural Safeguards Due Process Procedures for Parents and Children Discipline Procedures § 300.535 Referral to and action by law enforcement and... crime committed by a child with a disability to appropriate authorities or prevents State...

  19. Phase II: Resource and Referral Service, Research and Development Exchange. Final Report.

    ERIC Educational Resources Information Center

    Hull, William L.

    Activities of the Resource and Referral Service (RRS), a central service contractor to the Research and Development Exchange (RDx), are documented for the period between March 1, 1977, when Phase II was funded, to November 30, 1977. Product outputs from RRS are described and related to project objectives. The objectives, which correspond to…

  20. 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…

  1. 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

  2. Athletic Training Educators' Instructional Methods and Confidence in Graduating Students' Abilities regarding Psychosocial Intervention and Referral

    ERIC Educational Resources Information Center

    Hamson-Utley, Jennifer Jordan; Stiller-Ostrowski, Jennifer L.

    2011-01-01

    Context: Graduating athletic training students must consider both physical and mental aspects of injury to fully rehabilitate the injured athlete; however, programs may not be preparing students to apply psychosocial strategies that can improve the recovery process. Objective: To examine Psychosocial Intervention and Referral (PIR) content area…

  3. 10 rare tumors that warrant a genetics referral.

    PubMed

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

    2013-03-01

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

  4. 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…

  5. Reflecting on the Role of Competence and Culture in Consultation at the International Level

    ERIC Educational Resources Information Center

    Rosenfield, Sylvia

    2014-01-01

    International educational consultation is challenging work that requires not only attention to best practices in consultation but also additional focus on cultural norms and regularities. In the three articles of this special issue, the consultation competencies of consultants play a critical role, as exemplified by entry issues, problem-solving…

  6. PERCEPTION AND EXPERIENCE AND OF NIGERIAN PAEDIATRICIANS TO DENTAL REFERRAL FOR CHILDREN WITH CHRONIC ILLNESSES

    PubMed Central

    Nkwocha, FG; Ifesanya, JU; Brown, BJ

    2015-01-01

    BACKGROUND Interdisciplinary collaboration in the management of patients offers several advantages especially for children with chronic illnesses who are often at risk for other health conditions. Diseases in other parts of the body can be detected by a physician and lead to subsequent referral to the appropriate managing team. This study assessed the perception and experience of dental referral among Nigerian paediatricians as well as factors that may influence their decision to refer to a dentist. METHODS Self administered questionnaires were used to obtain socio-demographic data, history of exposure to dental teachings as well as experience with dental referral. Two hundred and sixty nine paediatricians and paediatric practitioners were involved in the study. Descriptive statistics and measures of central tendencies generated. Associations were tested with Chi Squares and Statistical significance was set at P <0.05 RESULTS A total of 269 respondents participated in the study out of whom 142(52.8%) trained at institutions where there was a sister dental school, but 243(90.3%) of them had no official dentistry postings. Majority of the respondents 259(96.3%) were in favour of routine professional oral check-up for children but only 83(30.9%) endorsed the recommended bi annual oral checks. A referral rate of 0.76-1.9% was obtained. CONCLUSION Although paediatricians are a known source of dental referral for children globally, a lot needs to be done to equip the physicians with the necessary knowledge and skill that will enable them participate more actively in the promotion of oral health for Nigerian children. PMID:26688607

  7. 42 CFR 457.232 - Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General. 457.232... to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General... during any quarter to be an overpayment. (c) Allegations or indications of waste fraud and abuse...

  8. 42 CFR 457.232 - Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General. 457.232... to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General... during any quarter to be an overpayment. (c) Allegations or indications of waste fraud and abuse...

  9. 42 CFR 457.232 - Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General. 457.232... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES... to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector...

  10. HIV and AIDS in inpatient dermatology. Approach to the consultation.

    PubMed

    Finkelstein, M; Berman, B

    2000-07-01

    In the inpatient setting, the dermatologic consultant is called on to address the whole spectrum of cutaneous disease seen in HIV/AIDS patients, with severity varying from severe life-threatening to less serious conditions that dramatically affect quality of life. Rather than reviewing a "laundry list" of conditions associated with HIV/AIDS or the most severe conditions, this article aims to demonstrate a systematic approach to inpatient dermatology consultation in HIV/AIDS patients and to briefly review several common and interesting topics frequently addressed in the inpatient setting (e.g., medications issues, and phototherapy in HIV-infected patients).

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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…

  17. A la Recherche du Temps Perdu: Case-Study Evidence from Off-Site and Pupil Referral Units.

    ERIC Educational Resources Information Center

    Garner, Philip

    1996-01-01

    Argues that current provisions for students excluded for behavior problems (Pupil Referral Units) differ little from those found before 10 years of educational reform (the former "off-site units"). Presents evidence gathered from excluded children and their teachers in four aspects of provisions: (1) resourcing and accommodation; (2) referral and…

  18. Police Referrals to Shelters and Mental Health Treatment: Examining Their Decisions in Domestic Assault Cases.

    ERIC Educational Resources Information Center

    Finn, Mary A.; Stalans, Loretta J.

    1995-01-01

    Reports how husband's mental state, antagonism between the disputants, and victim injury affected officers' inferences and referral decisions to battered women shelters and outpatient mental health centers. Officers' age and perceptions of: husband's mental state, wife's credibility, wife's intent, husband's responsibility, and victim injury…

  19. The Trauma Syndrome: Identification, Treatment, and Referral of Commonly Seen Problems.

    ERIC Educational Resources Information Center

    Cohon, Donald J., Jr.

    This paper provides counselors and social service case workers serving Indochinese refugees in northern California with guidelines for identifying, treating and making referrals of clients with emotional problems. Freud's theory of trauma neurosis and its effect on refugees' language acquisition, learning ability and job readiness are described.…

  20. Teachers' Recognition and Referral of Anxiety Disorders in Primary School Children

    ERIC Educational Resources Information Center

    Headley, Clea J.; Campbell, Marilyn A.

    2011-01-01

    This study investigated the ability of primary school teachers to recognise and refer children with anxiety symptoms. Two hundred and ninety-nine primary school teachers completed a questionnaire exploring their recognition and referral responses to five hypothetical vignettes that described boys and girls with varying severity of anxiety…

  1. 31 CFR 560.417 - Facilitation; change of policies and procedures; referral of business opportunities offshore.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Facilitation; change of policies and procedures; referral of business opportunities offshore. 560.417 Section 560.417 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF...

  2. Pupil and Staff Perceptions of Rewards at a Pupil Referral Unit

    ERIC Educational Resources Information Center

    Capstick, Joanna

    2005-01-01

    The present study investigated the perceptions of both pupils and staff at a pupil referral unit (PRU) towards the reward system currently in use. The main aims were to establish whether teachers and pupils perceived the same rewards as effective, to determine whether staff and pupils perceived that rewards changed behaviour, and finally whether…

  3. Stereotyping in a Traditional Society and Its Implications for School Psychologist Referral Patterns: The Case of the Negev Bedouin

    ERIC Educational Resources Information Center

    Thein, Ram

    2007-01-01

    The present report describes the psycho-educational services referral pattern in the school system serving both a permanent Bedouin town A and its vicinity in Israel's Negev desert. The subjects of the study were students in the school system in A between the years 1997 to 2002 (with additional data from 2004). The total number of referrals to…

  4. 1998 Buyer's Guide and Consultants Directory. A Decade of Changes.

    ERIC Educational Resources Information Center

    Brandt, D. Scott, Comp.

    1998-01-01

    This annual compilation is designed as a resource for access to products (hardware and software) and services related to library automation and information storage. Sections include products and services by category, vendor, and brand name, as well as addresses (including phone/fax, e-mail, and URL for web pages) of companies and consultants. (AEF)

  5. Perceived barriers and enablers to referrals to community-based hospice palliative care volunteer programs in Canada.

    PubMed

    Claxton-Oldfield, Stephen; Marrison-Shaw, Hayley

    2014-12-01

    Two separate studies were conducted to identify perceived barriers and enablers to referrals to community-based hospice palliative care volunteer programs in 2 Atlantic Canadian provinces. In study 1, a physician, home support nurse manager, social worker, and volunteer coordinator (VC) were interviewed. More barriers than enablers were identified. Based on these results and a review of the literature, a "Perceived Barriers and Enablers to Hospice Palliative Care Volunteer Referrals Questionnaire" (PBEQ) was developed. In study 2, a total of 10 VCs completed the PBEQ and (1) rated the extent to which they perceived 18 items to be barriers to referrals; (2) rated the extent to which they perceived 12 items to be enablers to referrals; and (3) described additional barriers and enablers. A Tips for Referrals sheet was created.

  6. 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

  7. 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…

  8. 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…

  9. 45 CFR 79.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of complaint and answer to the ALJ. 79.11 Section 79.11 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD... reviewing official shall file the complaint and answer with the ALJ....

  10. 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…

  11. Resource and Referral Service: A Report on Electronic Networks for Educators.

    ERIC Educational Resources Information Center

    Gordon, Ruth; Smink, Jay

    This report describes the activities of the Resource and Referral Service (RRS), which was established in 1977 as a member of a nationwide dissemination network called the Research and Development Exchange (RDx), in using electronic networks as part of its dissemination effort. Discussed first are the history and objectives of RRS. The next…

  12. 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…

  13. 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…

  14. 38 CFR 42.11 - Referral of complaint and answer to the Administrative Law Judge (ALJ).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 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 § 42.11 Referral of complaint and answer to the Administrative Law Judge (ALJ). Upon receipt of an...

  15. 40 CFR 27.11 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PROGRAM FRAUD CIVIL REMEDIES § 27.11 Referral of complaint and answer to the presiding officer. (a) Upon.... (b) The hearing clerk shall forward the complaint and answer to the Chief administrative law judge who shall assign himself or herself or another administrative law judge as presiding officer....

  16. 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.…

  17. 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…

  18. [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.

  19. 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…

  20. 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…

  1. 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... answer, the reviewing official shall file the complaint and answer with the ALJ....

  2. Promotion, Prevention and Early Intervention for Mental Health: National Consultation.

    ERIC Educational Resources Information Center

    2003

    This report provides a description of a national consultation that was undertaken in 2001-2002 to provide feedback on two companion national policy documents: "National Action Plan for Promotion, Prevention and Early Intervention for Mental Health 2000" and "Promotion, Prevention and Early Intervention for Mental Health: A Monograph," and to…

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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…

  8. Consulting with Parents: Applying Family Systems Concepts and Techniques.

    ERIC Educational Resources Information Center

    Mullis, Fran; Edwards, Dana

    2001-01-01

    This article describes family systems concepts and techniques that school counselors, as consultants, can use to better understand the family system. The concepts are life cycle transitions and extrafamilial influences, extended family influences, boundaries, parental hierarchy and power, and triangulation. (Contains 39 references.) (GCP)

  9. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... consultation requirements. See 40 CFR 1502.25. (a) For Federal projects, NEPA documents shall be prepared... Principles and Guidelines for Water and Related Land Resources Implementation Studies. Reviews and..., 1979, 32 CFR part 197. Procedural requirements for Civil Works studies and projects are discussed...

  10. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... consultation requirements. See 40 CFR 1502.25. (a) For Federal projects, NEPA documents shall be prepared... Principles and Guidelines for Water and Related Land Resources Implementation Studies. Reviews and..., 1979, 32 CFR part 197. Procedural requirements for Civil Works studies and projects are discussed...

  11. 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...

  12. 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

  13. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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...

  14. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...., details of design and construction, operational aspects, unusual or extreme conditions, methods of statistical control of the measurement process, automated acquisition of laboratory data, and data reduction and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended...

  15. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...., details of design and construction, operational aspects, unusual or extreme conditions, methods of statistical control of the measurement process, automated acquisition of laboratory data, and data reduction and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended...

  16. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...., details of design and construction, operational aspects, unusual or extreme conditions, methods of statistical control of the measurement process, automated acquisition of laboratory data, and data reduction and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended...

  17. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...., details of design and construction, operational aspects, unusual or extreme conditions, methods of statistical control of the measurement process, automated acquisition of laboratory data, and data reduction and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended...

  18. 15 CFR 200.103 - Consulting and advisory services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...., details of design and construction, operational aspects, unusual or extreme conditions, methods of statistical control of the measurement process, automated acquisition of laboratory data, and data reduction and analysis by computer. Brief consultation may be obtained at no charge; the fee for extended...

  19. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Environmental review and...

  20. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Environmental review and...

  1. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Environmental review and...

  2. 43 CFR 10010.36 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... NATIONAL ENVIRONMENTAL POLICY ACT Environmental Impact Statements § 10010.36 Environmental review and consultation requirements. (a) The Commission will maintain a list of applicable environmental review and... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Environmental review and...

  3. 24 CFR 971.9 - Tenant and local government consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Tenant and local government... REQUIRED BY LAW § 971.9 Tenant and local government consultation. (a) PHAs are required to proceed in... approved by the local officials as not inconsistent with the Consolidated Plan....

  4. 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…

  5. 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...

  6. 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 §...

  7. 40 CFR 25.4 - Information, notification, and consultation responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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 §...

  8. Consultation and Collaboration: Novice Educators' Reflections on Their Learning Experiences

    ERIC Educational Resources Information Center

    Robertson, Eleanor T.; Breidenstein, Angela

    2007-01-01

    This article describes a project to teach consultation and collaboration to high school teacher interns and school psychology students at the university level. For 4 years, students participated in a performance-based project as part of a class. Surveys were mailed to graduates to determine the impact of the experience and their current…

  9. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PAYMENT Financial Relationships Between Physicians and Entities Furnishing Designated Health Services... relationship with an entity, or who has an immediate family member who has a direct or indirect financial relationship with the entity, may not make a referral to that entity for the furnishing of DHS for...

  10. 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...

  11. 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...

  12. 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…

  13. 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'…

  14. 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…

  15. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... RESTORATION PLAN Program Goals and Responsibilities § 385.10 Implementation responsibilities, consultation, and coordination. (a) Implementing agencies. Implementation of the Plan shall be the responsibility of... Environmental Policy Act, the Clean Air Act, the Clean Water Act, the National Historic Preservation Act,...

  16. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... RESTORATION PLAN Program Goals and Responsibilities § 385.10 Implementation responsibilities, consultation, and coordination. (a) Implementing agencies. Implementation of the Plan shall be the responsibility of... Environmental Policy Act, the Clean Air Act, the Clean Water Act, the National Historic Preservation Act,...

  17. 33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... RESTORATION PLAN Program Goals and Responsibilities § 385.10 Implementation responsibilities, consultation, and coordination. (a) Implementing agencies. Implementation of the Plan shall be the responsibility of... Environmental Policy Act, the Clean Air Act, the Clean Water Act, the National Historic Preservation Act,...

  18. Building Vocabulary: Dictionary Consultation and the ESL Student.

    ERIC Educational Resources Information Center

    Gonzalez, Orsini

    1999-01-01

    Describes two activities (the use of a newspaper and consultation with a dictionary) that English-as-a-second language (ESL) college students can use to independently learn new vocabulary. Finds that dictionary work was laborious but necessary, and that ESL students need to be taught prudent use of the dictionary. (SR)

  19. 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…

  20. 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

  1. Minor surgery in general practice and effects on referrals to hospital care: Observational study

    PubMed Central

    2011-01-01

    Background Strengthening primary care is the focus of many countries, as national healthcare systems with a strong primary care sector tend to have lower healthcare costs. However, it is unknown to what extent general practitioners (GPs) that perform more services generate fewer hospital referrals. The objective of this study was to examine the association between the number of surgical interventions and hospital referrals. Methods Data were derived from electronic medical records of 48 practices that participated in the Netherlands Information Network of General Practice (LINH) in 2006-2007. For each care-episode of benign neoplasm skin/nevus, sebaceous cyst or laceration/cut it was determined whether the patient was referred to a medical specialist and/or minor surgery was performed. Multilevel multinomial regression analyses were used to determine the relation between minor surgery and hospital referrals on the level of the GP-practice. Results Referral rates differed between diagnoses, with 1.0% of referrals for a laceration/cut, 8.2% for a sebaceous cyst and 10.2% for benign neoplasm skin/nevus. The GP practices performed minor surgery for a laceration/cut in 8.9% (SD:14.6) of the care-episodes, for a benign neoplasm skin/nevus in 27.4% (SD:14.4) of cases and for a sebaceous cyst in 26.4% (SD:13.8). GP practices that performed more minor surgery interventions had a lower referral rate for patients with a laceration/cut (-0.38; 95%CI:-0.60- -0.11) and those with a sebaceous cyst (-0.42; 95%CI:-0.63- -0.16), but not for people with benign neoplasm skin/nevus (-0.26; 95%CI:-0.51-0.03). However, the absolute difference in referral rate appeared to be relevant only for sebaceous cysts. Conclusions The effects of minor surgery vary between diagnoses. Minor surgery in general practice appears to be a substitute for specialist medical care only in relation to sebaceous cysts. Measures to stimulate minor surgery for sebaceous cysts may induce substitution. PMID

  2. 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

  3. 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.

  4. Problem defining and the consulting/intervention process.

    PubMed

    Kilmann, R; Mitroff, I

    1979-01-01

    Although many different approaches are currently being used to create planned change in organizations, Kilmann and Mitroff feel that too little attention has been paid to determining the effectiveness of these different methods in solving the organizations' problems. Based on intervention theory and the consulting process, the authors offer a method of evaluating an organization's approach to change to determine if it is well-suited to the types of problems being experienced. The process of change is diagrammed as a five-step cycle: 1) sensing problems; 2) defining problems; 3) deriving solutions; 4) implementing solutions; and 5) evaluating outcomes. Most consultants enter the process at step 3 which increases the probability that they will try to solve the wrong problem (termed Type III error). A second source of trouble is that consultants are usually trained in one or two disciplines and, therefore, see problems primarily in those perspectives. Kilmann and Mitroff suggest the use of teams of consultants so the problems can be conceptualized from a number of different viewpoints.

  5. 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

  6. 33 CFR 230.25 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... consultation requirements. See 40 CFR 1502.25. (a) For Federal projects, NEPA documents shall be prepared..., 1979, 32 CFR part 197. Procedural requirements for Civil Works studies and projects are discussed below. (1) The district commander through the division commander will notify CECW-PE, PN, PS or PW...

  7. 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…

  8. Corpus Consultation and Advanced Learners' Writing Skills in French

    ERIC Educational Resources Information Center

    Chambers, Angela; O'Sullivan, Ide

    2004-01-01

    In the rapidly changing environment of language learning and teaching, electronic literacies have an increasingly important role to play. While much research on new literacies focuses on the World Wide Web, the aim in this study is to investigate the importance of corpus consultation as a new type of literacy which is of particular relevance in…

  9. Cops, Consultants, and Goldfish: Variations in Nursing Home Regulation.

    ERIC Educational Resources Information Center

    Gardiner, John A.

    Nursing home regulatory agencies are subjected to a variety of pressures. Nursing home residents' families and friends want the agencies to "get tough" while the nursing home industry wants agencies to act as consultants rather than cops. The task of regulating nursing homes in the United States is primarily carried out by units of state…

  10. Treatment Integrity in Behavioral Consultation: Measurement, Promotion, and Outcomes

    ERIC Educational Resources Information Center

    Sanetti, Lisa M. Hagermoser; Kratochwill, Thomas R.

    2008-01-01

    The purpose of this article is to provide an overview of the current state of research in the area of treatment integrity as it relates to behavioral consultation. To this end, four primary topics are discussed. First, a rationale for why treatment integrity is an important professional and methodological concern is presented. Second,…

  11. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  12. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  13. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  14. 43 CFR 46.430 - Environmental review and consultation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Environmental Impact Statements § 46.430 Environmental review and consultation requirements. (a) Any environmental impact statement that also addresses.... The environmental impact statement must include these associated analyses, studies, or surveys,......

  15. Selling Academies: Local Democracy and the Management of "Consultation"

    ERIC Educational Resources Information Center

    Hatcher, Richard

    2008-01-01

    Academies (state schools owned and run by private sponsors on a non-profit basis) are a key element in Labour's education agenda. Proposals to set up Academies, in most cases by taking over existing schools, have provoked local campaigns of opposition in many areas. Replacing a Local Authority with an Academy entails a process of consultation.…

  16. A comparison between telephone and bedside consultations given by palliative care consultation teams in the Netherlands: results from a two-year nationwide registration.

    PubMed

    Schrijnemaekers, Veron; Courtens, Annemie; Kuin, Annemieke; van der Linden, Barbara; Vernooij-Dassen, Myrra; van Zuylen, Lia; van den Beuken, Marieke

    2005-06-01

    Palliative Care Consultation (PCC) teams in The Netherlands give support to professional caregivers in palliative care. In contrast to many other countries, consultants only give advice. They do not give prescriptions. Most consultations are given by phone; in some, the consultant also visits the patient. For two years, the PCC teams registered all consultations prospectively on a standard registration form in a nationwide database. The aim of this study was to obtain more insight into the possible differences between telephone and bedsides consultations with regard to characteristics of consultants, requesting caregivers, and the patients, as well as the number and kind of problems discussed. The data demonstrate that bedside consultations show more variety in requesting caregivers and are conducted more often for patients. Bedside consultations also addressed a higher number of problems and a wider range of domains (e.g., psychological, spiritual, daily functioning, and support for informal caregivers). These results suggest that bedside consultations have a surplus value compared to telephone consultations. More rigorous study is needed to compare the relative merits of different methods of consultations in palliative care. PMID:15963863

  17. Consulting on Academic Library Buildings.

    ERIC Educational Resources Information Center

    Mason, Ellsworth

    1980-01-01

    Addresses the following aspects of consulting on library buildings: new trends, the need for a consultant, selecting a consultant, timeliness in hiring, expectations, following through, and the cost of consulting. (FM)

  18. 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.

  19. HCEC pearls and pitfalls: suggested do's and don't's for healthcare ethics consultants.

    PubMed

    Carrese, Joseph A; Antommaria, Armand H Matheny; Berkowitz, Kenneth A; Berger, Jeffrey; Carrese, Joseph; Childs, Brian H; Derse, Arthur R; Gallagher, Colleen; Gallagher, John A; Goodman-Crews, Paula; Heesters, Ann; Jurchak, Martha; Mitchell, Christine; Mokwyune, Nneka; Parsi, Kayhan; Powell, Tia; Powderly, Kathleen E; Rosell, Tarris; Shelton, Wayne; Smith, Martin L; Spike, Jeffrey; Tarzian, Anita; Wocial, Lucia

    2012-01-01

    Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

  20. Priority-setting tools for rheumatology disease referrals: a review of the literature.

    PubMed

    De Coster, Carolyn; Fitzgerald, Avril; Cepoiu, Monica

    2008-11-01

    As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12). No single set of priority-setting criteria was identified for rheumatologic disorders across the spectrum of patients who may be referred from primary care providers (PCPs) to rheumatologists. There appears to be more congruence on conditions at either end of the urgency spectrum with conditions such as suspected cranial arteritis or systemic vasculitis deemed to be emergency referrals and fibromyalgia and other soft-tissue syndromes deemed to be more routine referrals. Between these two extremes, there is a divergence of opinion about urgency and few papers on the issue. The exception to this is referral for early RA for which several criteria have been established. Despite the inherent complexities in developing a tool to prioritize patients referred by PCPs to rheumatologists, there are compelling reasons to proceed. With the aging of the population, the number of patients being referred to rheumatologists is expected to increase. With pharmaceutical advances, there are demonstrable benefits in early referral for some conditions. These trends have led to increased pressure on scarce rheumatological human resources. A tool to prioritize referrals is a critical component of improving access and the referral process.

  1. Methadone and Buprenorphine Prescribing and Referral Practices in US Prison Systems: Results from a Nationwide Survey

    PubMed Central

    Nunn, Amy; Zaller, Nickolas; Dickman, Samuel; Trimbur, Catherine; Nijhawan, Ank; Rich, Josiah D.

    2009-01-01

    Background More than 50% of incarcerated individuals have a history of substance use, and over 200,000 individuals with heroin addiction pass through American correctional facilities annually. Opiate replacement therapy (ORT) with methadone or buprenorphine is an effective treatment for opiate dependence and can reduce drug-related disease and recidivism for inmates. Provision of ORT is nevertheless a frequently neglected intervention in the correctional setting. Objective and Methods We surveyed the 50 state; Washington, District of Columbia (DC); and Federal Department of Corrections' medical directors or their equivalents about their facilities' ORT prescribing policies and referral programs for inmates leaving prison. Results We received responses from 51 of 52 prison systems nationwide. Twenty-eight prison systems (55%) offer methadone to inmates in some situations. Methadone use varies widely across states: over 50% of correctional facilities that offer methadone do so exclusively for pregnant women or for chronic pain management. Seven states' prison systems (14%) offer buprenorphine to some inmates. The most common reason cited for not offering ORT was that facilities “prefer drug-free detoxification over providing methadone or buprenorphine.” Twenty-three states' prison systems (45%) provide referrals for some inmates to methadone maintenance programs after release, which increased from 8% in 2003; 15 states' prison systems (29%) provide some referrals to community buprenorphine providers. Conclusion Despite demonstrated social, medical, and economic benefits of providing ORT to inmates during incarceration and linkage to ORT upon release, many prison systems nationwide still do not offer pharmacological treatment for opiate addiction or referrals for ORT upon release. PMID:19625142

  2. 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

  3. 18 CFR 401.116 - Disclosure to consultants, advisory committees, State and local government officials, and other...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... consultants, advisory committees, State and local government officials, and other special government employees... Disclosure to consultants, advisory committees, State and local government officials, and other special... Commission consultants, advisory committees, state and local government officials, and other...

  4. 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…

  5. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  6. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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...

  7. 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...

  8. 48 CFR 52.244-4 - Subcontractors and outside associates and consultants (Architect-engineer services).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

  9. Building access to specialist care through e-consultation

    PubMed Central

    Liddy, Clare; Rowan, Margo S; Afkham, Amir; Maranger, Julie; Keely, Erin

    2013-01-01

    Background Limited access to specialist care remains a major barrier to health care in Canada, affecting patients and primary care providers alike, in terms of both long wait times and inequitable availability. We developed an electronic consultation system, based on a secure web-based tool, as an alternative to face-to-face consultations, and ran a pilot study to evaluate its effectiveness and acceptability to practitioners. Methods In a pilot program conducted over 15 months starting in January 2010, the e-consultation system was tested with primary care providers and specialists in a large health region in Eastern Ontario, Canada. We collected utilization data from the electronic system itself (including quantitative data from satisfaction surveys) and qualitative information from focus groups and interviews with providers. Results Of 18 primary care providers in the pilot program, 13 participated in focus groups and 9 were interviewed; in addition, 10 of the 11 specialists in the program were interviewed. Results of our evaluation showed good uptake, high levels of satisfaction, improvement in the integration of referrals and consultations, and avoidance of unnecessary specialist visits. A total of 77 e-consultation requests were processed from 1 Jan. 2010 to 1 Apr. 2011. Less than 10% of the referrals required face-to-face follow-up. The most frequently noted benefits for patients (as perceived by providers) included improved access to specialist care and reduced wait times. Primary care providers valued the ability to assist with patient assessment and management by having access to a rapid response to clinical questions, clarifying the need for diagnostic tests or treatments, and confirming the need for a formal consultation. Specialists enjoyed the improved interaction with primary care providers, as well as having some control in the decision on which patients should be referred. Interpretation This low-cost referral system has potential for broader

  10. 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.

  11. Advocacy and Empowerment in Parent Consultation: Implications for Theory and Practice

    ERIC Educational Resources Information Center

    Holcomb-McCoy, Cheryl; Bryan, Julia

    2010-01-01

    In this article, the authors expand the view of parental consultation to include advocacy and empowerment as important contextual considerations. A brief review of existing approaches to parent consultation is provided. Selected advances in multicultural parent consultation are also presented. An advocacy- and empowerment-focused perspective is…

  12. 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

  13. 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.

  14. Research and Consultation in the Natural Environment.

    ERIC Educational Resources Information Center

    Henderson, Ronald W.

    This discription of a Follow Through Implementation Project summarizes research related to environmental variables and intellectual performance, and describes an environmental intervention program that manipulates these variables. Analysis of environmental data collected on 33 disadvantaged families of first grade children suggested that their…

  15. Reflexivity and countertransference in a psychiatric cultural consultation clinic.

    PubMed

    Good, B J; Herrera, H; Good, M J; Cooper, J

    1982-09-01

    A Mexican-American woman who complained of persistent head pain and a bothersome "voice" was seen by a team consisting of a psychiatrist, social scientists, and spiritualist healers in a Cultural Consultation Clinic of a Psychiatric Consultation Liaison Service. This single case is analyzed to provide an understanding of the interpretive dimensions of psychiatric practice. It is argued that a hermeneutic analysis of clinical phenomena focuses attention on three distinct aspects of interpretation: on the interpretation by clinicians and clients of the discourse of the other in terms of their own clinical models; on the influence of deeply embedded personal meanings on this interpretive process; and on the role of the observer in clinical ethnography. It is argued that to sustain a hermeneutic analysis of psychiatric practice, an account of transference and countertransference in terms of interpretation theory will have to be developed.

  16. Consultation and collaboration programs for individuals with autism.

    PubMed

    Nalitz, N G

    1993-01-01

    Students with autism present a challenge to the SLP not only because of the severity of their communication disorders, but also because of the great variety of learning styles and social skills. Collaboration- and consultation-based service delivery systems offer an alternative to traditional therapy for these students. This model uses the strength of a team approach and permits strategies for improving communication that are not possible in other environments.

  17. \\Defining Patient Advocacy for the Context of Clinical Ethics Consultation: A Review of the Literature and Recommendations for Consultants.

    PubMed

    Brazg, Tracy; Lindhorst, Taryn; Dudzinski, Denise; Wilfond, Benjamin

    2016-01-01

    The idea of patient advocacy as a function of clinical ethics consultation (CEC) has been debated in the bioethics literature. In particular, opinion is divided as to whether patient advocacy inherently is in conflict with the other duties of the ethics consultant, especially that of impartial mediator. The debate is complicated, however, because patient advocacy is not uniformly conceptualized. This article examines two literatures that are crucial to understanding patient advocacy in the context of bioethical deliberations: the CEC literature and the literature on advocacy in the social work profession. A review of this literature identifies four distinct approaches to patient advocacy that are relevant to CEC: (1) the best interest approach, (2) the patient rights approach, (3) the representational approach, and (4) the empowerment approach. After providing a clearer understanding of the varied meanings of patient advocacy in the context of CEC, we assert that patient advocacy is not inherently inconsistent with the function of the ethics consultant and the CEC process. Finally, we provide a framework to help consultants determine if they should adopt an advocacy role.

  18. 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.

  19. Comparative access rates for online documentation and human consulting

    SciTech Connect

    Girill, T.R.; Tull, C.G.

    1988-10-01

    The National Magnetic Fusion Energy Computer Center has taken a strongly collaborative approach to user services, developing its consulting staff and its online documentation software as joint aspects of a unified effort to answer user questions. A fairly strong positive correlation between consulting-query rates and online-reading rates across many subject categories suggests that computerized passage delivery can successfully complement human contact as a way to provide information to users. We also found sharp discrepancies in rates for some topics. A few were artifacts of our system; others suggest an agenda for online documentation improvements as well as an enduring need for diverse responses to user inquiries. 10 refs., 2 figs.

  20. The Effectiveness of “Two-Week” Referrals for Suspected Bone and Soft Tissue Sarcoma

    PubMed Central

    Malik, A.; Wigney, L.; Murray, S.; Gerrand, C. H.

    2007-01-01

    The two-week “wait” target introduced in 2000 requires that patients with suspected cancer referred by general practitioners should be seen within two weeks. We reviewed patients who had been referred under this standard to the North of England Bone and Soft Tissue Tumour Service, to determine if the referral guidelines had been followed, and what proportion of patients referred under the guideline had malignant tumours. 40 patients were referred under the guideline between January 2004 and December 2005. Ten of these patients (2548%) had malignant tumours, compared with 243 of 507 (48%) of those referred from other sources. In 9 of the 40 cases, the patient did not meet the criteria for urgent referral. Although this target has focussed attention on shortening the time to diagnosis and treatment, prioritising patients referred from general practitioners has the potential to disadvantage those with malignant tumours referred from other sources. PMID:18288262

  1. Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong.

    PubMed

    Chung, Vincent C H; Hillier, Sheila; Lau, Chun Hong; Wong, Samuel Y S; Yeoh, Eng Kiong; Griffiths, Sian M

    2011-01-01

    Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster

  2. 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

  3. Community care workers, poor referral networks and consumption of personal resources in rural South Africa.

    PubMed

    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.

  4. Interactive software for cooperative medicine and remote consultations

    NASA Astrophysics Data System (ADS)

    Ligier, Yves; Ratib, Osman M.; Rejmer, Marek; Moricz, Robert

    1993-09-01

    A multimodality image manipulation and analysis software called OSIRIS was developed at the University Hospital of Geneva. This software package is currently used on different hardware platforms as part of a hospital-wide PACS project. An extension of this software was recently designed to allow cooperative work on remotely located workstations. This extension was developed to allow remote consultations and communications between physicians over local and wide area networks. For teleradiology and cooperative consultations, images are exchanged between the different workstations in an ACR-NEMA based format called PAPYRUS. The interactive session can then take place where the communication protocol between the two remote stations allows for simultaneous manipulation of the same images and a live conversation through a vocal link. A special communication protocol was developed to transmit the different actions performed on one station to the other. The lower level communication protocol is TCP-IP. In addition to the local usage in Geneva, this platform was also adopted as part of a European teleradiology project called TELEMED, regrouping 17 partners from 9 different countries. It is being tested on international broadband networks for remote consultations between different countries in Europe.

  5. Magnetic Resonance Arthrogram Referrals by Subspecialist and Non-Subspecialist Orthopaedic Surgeons: What are the Findings?

    PubMed Central

    Al-Ani, Zeid; Ali, Syed; Beardmore, Simon; Parmar, Vinay; Chooi Oh, Teik

    2016-01-01

    Background: Although subspecialist orthopaedic surgeons usually request Magnetic Resonance Arthrogram (MRA) examinations, some orthopaedic surgeons may request this examination for a body part that is different from their subspecialty. The purpose of the study is to compare the MRA and the clinical findings in the subspecialist and non-subspecialist groups. Method: Retrospective analysis of MRA examinations over a 6-month period. Findings were compared with the clinical information. Results: There were 144 examinations (69 shoulder, 42 wrist and 33 hip). 85% of these were subspecialist referrals; 60% of them showed findings compatible with the clinical diagnosis. 15% of the MRA examinations were non-subspecialist referrals; 52% of them correlated with the clinical findings. Overall, clinical information agreed with MRA findings for shoulder labral tears, hip labral tears and wrist triangular fibrocartilage complex tears in 63.3%, 64.5% and 61.5% respectively. The subspecialist group were more accurate than the non-subspecialist group in diagnosing hip labral tears (68% vs. 50%) and triangular fibrocartilage complex tears (62.5% vs. 50%). On the contrary, shoulder MRA and clinical findings correlated better in the non-subspecialist group (77.8%) compared to the subspecialist group (63.3%). However, the small number of requests generated by the non-subspecialist group may affect the results. Suspected scapholunate ligament injury showed low correlation with MRA at 26.7% (33.3% in the subspecialist group and 0% in the non-subspecialist group). Conclusion: Generally, the clinical findings are more accurate in the subspecialist referrals when compared to MRA findings and therefore a subspecialist referral is preferred. The low agreement between clinically suspected scapholunate ligament injuries and wrist MRA probably reflects the relative difficulty in establishing this diagnosis clinically. PMID:27733882

  6. 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

  7. 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…

  8. Dealing with extracontractual referrals.

    PubMed Central

    Williamson, J D

    1991-01-01

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

  9. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  10. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  11. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  13. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  14. 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...

  15. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  16. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  18. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  19. Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning

    PubMed Central

    Roysden, Nathaniel; Wright, Adam

    2015-01-01

    Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient’s first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis. PMID:26958306

  20. 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.

  1. 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. PMID:25824071

  2. 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

  3. GP views of their management and referral of psychological problems: a qualitative study.

    PubMed

    Sigel, Paul; Leiper, Rob

    2004-09-01

    The ways that GPs manage and make referral decisions for psychological problems are crucial for the provision of mental health care, although the ways they undertake these tasks are not well understood. A long tradition of psychiatric research in the UK has identified significant shortcomings in detection rates, raising concerns that a large proportion of mental health problems go unrecognized and untreated. Other research has suggested that GPs have a different approach to psychological problems than their mental health colleagues, accounting for some of the particular conditions of primary care, although this approach may differ from the methods used by mental health specialists. The present study explored the views of 10 GPs in one geographic locality about managing and making referral decisions for psychological problems. Grounded theory analysis of interview data allowed for the development of a model made up of five components. This model described the ways that GPs explored psychological problems in the context of containing patients' health problems. Referral decisions were made when GPs felt they had reached the limits of their capabilities for treating a particular problem, taking account of the patient's suitability for psychological therapy and access to psychology services. These decisions were influenced by GPs' views of psychological problems and therapies as well as by their professional interactions with psychologists. The implications of the findings for understanding how GPs work with mental health problems and the ways that psychological services can help are discussed. PMID:15355581

  4. 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. PMID:25827302

  5. The Use of Consultation to Improve Academic and Psychosocial Outcomes for Gifted Students

    ERIC Educational Resources Information Center

    Knotek, Steven E.; Kovac, Megan; Bostwick, Emily

    2011-01-01

    School psychologists can make use of consultation within a prevention and wellness framework to heighten gifted students' academic, social, mental health, and life competencies. The triadic and indirect nature of consultation allows school-based consultants the opportunity to support a larger population of students than they could with traditional…

  6. 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...

  7. 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

  8. Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation

    PubMed Central

    Moll van Charante, Eric Peter; ter Riet, Gerben; Drost, Sara; van der Linden, Loes; Klazinga, Niek S; Bindels, Patrick JE

    2006-01-01

    Background Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. Methods For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. Results The mean NTAA rate was 27.5% – ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48–1.76) and lower with increasing age (RR 0.96, CI 0.93–0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51–0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18–1.78) and lowest for chest pain (RR 0.18; CI 0.06–0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04–1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5). Conclusion Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates. PMID:17163984

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  10. 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 the expanding role…

  11. [Specialist referral with photography for faster diagnosis of skin tumor. Management can be better planned--and saves resources].

    PubMed

    Adolfsson, Jan; Cedermark, Björn; Terstappen, Karin

    2014-11-25

    Adding a photograph of suspected skin cancer to the standard referral can shorten the time to the initial evaluation by a specialist department. The management of the patient can also be better planned and resources can be saved.

  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. [Bioclimatic consultation].

    PubMed

    Cordes, H; Reinke, R

    1975-01-23

    The climatological environment may effect the human state of health, disadvantageously or favourably. This knowledge, confirmed by empiric as well as scientific research can be used by e.g. changing the place of residence towards a healthy and benefical climate. For a professional climatological planning of such a project the "Deutscher Wetterdienst" renders bioclimatic consultations within the Federal Republic of Germany. For this purpose individual reactions as well as state health of the person in question have to be considered. A method will be shown how to combine medical diagnostic facts and bioclimatic consultation.

  14. 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

  15. Impact of Referral Protocols on the Dental Management of Patients Undergoing Treatment for Head and Neck Oncology in Northern Ireland.

    PubMed

    Moore, Ciaran; Killough, Simon; Markey, Neill; McLister, Conor; McKenna, Gerald

    2016-03-01

    Management of head and neck oncology necessitates an extensive multidisciplinary approach. Throughout Northern Ireland all oral care for Head and Neck Oncology patients is overseen within the Centre for Dentistry, Queens University Belfast via referral from the Head and Neck Multidisciplinary Team. The aim of this study was to develop and introduce a referral pro-forma to improve communication between members of the multidisciplinary team and ultimately expedite provision of oral care prior to patients undergoing treatment for Head and Neck Oncology. The study period ran from June 2013 until November 2014. All patients undergoing treatment for Head and Neck Oncology in Northern Ireland were included in the study. A referral pro-forma was introduced in June 2014 in an attempt to streamline the referral process. Data was gathered on patient waiting times, extraction protocols with comparisons made between the period before and after introduction of the pro-forma. In total 137 patients were included in the study: 96 patients were referred to the service using referral letters, confidential emails and via telephone; 41 patients were referred using the pro-forma. The introduction of the referral pro-forma resulted in a significant decrease in the mean number of days from referral to assessment (12 to 7 days) (p < 0.05) and significantly increased mean interval time between extractions and patients beginning radiotherapy (13 to 17 days) (p < 0.05). Significant improvements have been made with the introduction of the referral pro-forma where patients are waiting significantly less time for dental assessment and having extractions completed in a more timely manner therefore expediting the commencement of their oncology treatment. PMID:27039474

  16. 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…

  17. 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

  18. Digital Video Capture and Synchronous Consultation in Open Surgery

    PubMed Central

    Rafiq, Azhar; Moore, James A.; Zhao, Xiaoming; Doarn, Charles R.; Merrell, Ronald C.

    2004-01-01

    Objective: To achieve real-time or simultaneous surgical consultation and education to students in distant locations, we report the successful integration of robotics, video-teleconferencing, and intranet transmission using currently available hardware and Internet capabilities. Summary Background Data: Accurate visualization of the surgical field with high-resolution video imaging cameras such as the closed-coupled device (CCD) of the laparoscope can serve to insure clear visual observation of surgery and share the surgical procedure with trainees and, or consultants in a distant location. Prior work has successfully applied optics and technical advances to achieve precise visualization in laparoscopy. Methods: Twenty-five thyroidectomy explorations in 15 patients were monitored and transmitted bidirectionally with audio and video data in real-time. Remotely located surgical trainees (n = 4) and medical students (n = 3) confirmed 7 different anatomic landmarks during each surgical procedure. The study used the Socrates System (Computer Motion, Inc. [CMI], Goleta, CA), an interactive telementoring system inclusive of a telestration whiteboard, in conjunction with the AESOP robotic arm and Hermes voice command system (CMI). A 10-mm flat laparoscopic telescope was used to capture the optical surgical field. As voice, telestrator, or marker confirmed each anatomic landmark the image parameters of resolution, chroma (light position and intensity), and luminance were assessed with survey responses. Results: Confirmation of greater than 90% was achieved for the majority of relevant anatomic landmarks, which were viewed by the remote audience. Conclusion: The data presented in this study support the feasibility for mentoring and consultation to a remote audience with visual transmission of the surgical field, which is otherwise very difficult to share. Additionally, validation of technical protocols as teaching tools for robotic instrumentation and computer imaging of

  19. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  20. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  1. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  3. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  4. Changes in the remuneration system for general practitioners: effects on contact type and consultation length.

    PubMed

    van Dijk, Christel E; Verheij, Robert A; te Brake, Hans; Spreeuwenberg, Peter; Groenewegen, Peter P; de Bakker, Dinny H

    2014-01-01

    In The Netherlands, the remuneration system for GPs changed in 2006. Before the change, GPs received a capitation fee for publicly insured patients and fee for service (FFS) for privately insured patients. In 2006, a combined system was introduced for all patients, with elements of capitation as well as FFS. This created a unique opportunity to investigate the effects of the change in the remuneration system on contact type and consultation length. Our hypothesis was that for former publicly insured patients the change would lead to an increase in the proportion of home visits, a decrease in the proportion of telephone consultations and an increase in consultation length relative to formerly privately insured patients. Data were used from electronic medical records from 36 to 58 Dutch GP practices and from 532,800 to 743,961 patient contacts between 2002 and 2008 for contact type data. For consultation length, 1,994 videotaped consultations were used from 85 GP practices in 2002 and 499 consultations from 16 GP practices in 2008. Multilevel multinomial regression analysis was used to analyse consultation type. Multilevel logistic and linear regression analyses were used to examine consultation length. Our study shows that contact type and consultation length were hardly affected by the change in remuneration system, though the proportion of home visits slightly decreased for privately insured patients compared with publicly insured patients. Declaration behaviour regarding telephone consultations did change; GP practices more consistently declared telephone consultations after 2006.

  5. 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.

  6. Intraoperative consultation for the retroperitoneum and adrenal glands.

    PubMed

    Klein, E A; Streem, S B; Novick, A C

    1985-08-01

    An incidentally discovered mass lesion is the most frequent indication for intraoperative consultation involving the retroperitoneum or adrenal gland. The goal of the surgeon is to determine the nature and extent of the lesion and, for solid lesions, to obtain a biopsy adequate for histopathologic diagnosis. Benign lesions may be excised locally, whereas therapy for malignancies depends upon the individual circumstances of the patient, the histology of the lesion, and involvement of adjacent organs. Treatment of hematomas requires early vascular control. Adrenal tissue should be preserved whenever possible.

  7. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... provided accurate vocational rehabilitation information and guidance (which may include counseling and... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE VOCATIONAL REHABILITATION SERVICES PROGRAM State Plan and Other Requirements for Vocational Rehabilitation Services Administration §...

  8. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... provided accurate vocational rehabilitation information and guidance (which may include counseling and... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE VOCATIONAL REHABILITATION SERVICES PROGRAM State Plan and Other Requirements for Vocational Rehabilitation Services Administration §...

  9. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... provided accurate vocational rehabilitation information and guidance (which may include counseling and... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE VOCATIONAL REHABILITATION SERVICES PROGRAM State Plan and Other Requirements for Vocational Rehabilitation Services Administration §...

  10. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... provided accurate vocational rehabilitation information and guidance (which may include counseling and... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE VOCATIONAL REHABILITATION SERVICES PROGRAM State Plan and Other Requirements for Vocational Rehabilitation Services Administration §...

  11. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... provided accurate vocational rehabilitation information and guidance (which may include counseling and... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE VOCATIONAL REHABILITATION SERVICES PROGRAM State Plan and Other Requirements for Vocational Rehabilitation Services Administration §...

  12. 20 CFR 404.1519g - Who we will select to perform a consultative examination.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Who we will select to perform a consultative examination. 404.1519g Section 404.1519g Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Standards for the Type of Referral and for Report Content...

  13. 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)

  14. 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,…

  15. Orthodontic treatment and referral patterns: A survey of pediatric dentists, general practitioners, and orthodontists

    PubMed Central

    Aldrees, Abdullah M.; Tashkandi, Nada E.; AlWanis, Areej A.; AlSanouni, Munerah S.; Al-Hamlan, Nasir H.

    2014-01-01

    Objective This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists. Materials and methods Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions. Results In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups. Conclusions The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners. PMID:25544812

  16. Information and Referral Service Usage among Caregivers for Dementia Patients.

    ERIC Educational Resources Information Center

    Coyne, Andrew C.

    1991-01-01

    Analyzed data from 125 questionnaires completed by callers of telephone helpline specializing in Alzheimer's disease and related dementing illnesses. On average, 3.94 requests for information were made per call. Most common requests concerned home services, general information about dementia, information about adult day care, and support group…

  17. A Reference and Referral System Using Expert System Techniques.

    ERIC Educational Resources Information Center

    Vickery, Alina; And Others

    1987-01-01

    Describes PLEXUS, an expert system for information retrieval related to gardening, designed at the University of London for use in public libraries. Focusing on the semantic problems encountered, methods used in artificial intelligence and information science to resolve them are discussed, including classification and facet analysis. (Author/LRW)

  18. 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.

  19. 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…

  20. 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 Interventionist…

  1. 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

  2. Managing referrals of 'people you know': views of child and adolescent mental health professionals.

    PubMed

    Wurr, Kate; McKenzie, Manny

    2013-10-01

    Referrals of 'people you know' to Child and Adolescent Mental Health Services (CAMHS) raise issues around anxiety, equity and confidentiality. Research in this area is limited. The framework approach was used to analyse interviews with CAMHS teams across Yorkshire. Issues identified included choice (and whose choice this is), power and perceived imbalances of power and relative lack of 'professional distance'. The notion that health staff should receive preferential treatment by right was not widespread, but nevertheless existed. Standard procedure has to be flexibly applied to offer the best quality care. Families should not be inappropriately advantaged by 'knowing us', but disadvantage should be recognised and kept to a minimum.

  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. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia

    PubMed Central

    2014-01-01

    Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). Results Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. Conclusions Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended. PMID:24826198

  5. Induced Second Trimester Abortion and Associated Factors in Amhara Region Referral Hospitals

    PubMed Central

    Mulat, Amlaku; Bayu, Hinsermu; Mellie, Habtamu; Alemu, Amare

    2015-01-01

    Background. Although the vast majority of abortions are performed in the first trimester, still 10–15% of terminations of pregnancies have taken place in the second trimester period globally. As compared to first trimester, second trimester abortions are disproportionately contribute for maternal morbidity and mortality especially in low-resource countries where access to safe second trimester abortion is limited. The main aim of this study was to assess the prevalence and associated factors of induced second trimester abortion in Amhara region referral hospitals, northwest Ethiopia. Methods. Institution based cross-sectional study was conducted in Amhara region referral hospitals among 416 women who sought abortion services. Participants were selected using systematic sampling technique. Data were collected using pretested structured questionnaire through interviewing. After the data were entered and analyzed; variables which have P value < 0.2 in bivariate analysis, not colinear, were entered into multiple logistic regressions to see the net effect with 95% CI and P value < 0.05. Results. The prevalence of induced second trimester abortion was 19.2%. Being rural (AOR = 1.86 [95% CI = 1.11–3.14]), having irregular menstrual cycle (AOR = 1.76 [95% CI = 1.03–2.98]), not recognizing their pregnancy at early time (AOR = 2.05 [95% CI = 1.21–3.48]), and having logistics related problems (AOR = 2.37 [95% CI = 1.02–5.53]) were found to have statistically significant association with induced second trimester abortion. Conclusion. Induced second trimester abortion is high despite the availability of first trimester abortion services. Therefore, increase accessibility and availability of safe second trimester abortion services below referral level, counseling and logistical support are helpful to minimize late abortions. PMID:25918704

  6. Criminal offense, psychiatric diagnosis, and psycholegal opinion: an analysis of 894 pretrial referrals.

    PubMed

    Warren, J I; Fitch, W L; Dietz, P E; Rosenfeld, B D

    1991-01-01

    This article presents the results of a study of 894 criminal defendants referred by Virginia courts for evaluation of competency to stand trial or criminal responsibility. All evaluations were conducted on an outpatient basis by mental health professionals who had received specialized training in forensic evaluation. Findings as to the referral questions posed, the criminal offenses charged, and the clinical diagnoses and psycholegal opinions offered by the evaluators are described. Statistical analyses demonstrate significant relationships between both diagnosis and criminal charge and the psycholegal opinion rendered.

  7. Consultants as Coaches.

    ERIC Educational Resources Information Center

    McCarthy, Robert J.

    1990-01-01

    Increasingly, school boards are using consultants to help them hire the right superintendents for their school systems. Proposes extending the consultants' contracts to coaching both board and superintendents on developing an effective working relationship. (MLF)

  8. Discounting and per diem arrangements lock in patient referrals. Part 2.

    PubMed

    Porn, L; Manning, M

    1988-02-01

    Discounting and per diem arrangements are the most popular payment methods used by hospitals today because they are relatively simple methods. A properly negotiated discount or per diem contract can provide a hospital with the opportunity to lock in patient referrals from the many healthcare providers in its local markets. This article is the second in a three-part series on the strategic pricing of healthcare services. The final article discusses the intricacies of capitation arrangements, an increasingly popular payment method for healthcare services.

  9. 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…

  10. Civil money penalties for referrals to entities and for prohibited arrangements and schemes--HHS. Final rule with comment period.

    PubMed

    1995-03-31

    This final rule implements the civil money penalty (CMP) provisions established through sections 1877(g)(3) and 1877(g)(4) of the Social Security Act. Specifically, in accordance with section 1877(g)(3), these regulations set forth CMPs, assessments and an exclusion against any person who presents, or causes to be presented, a bill or claim the person knows or should know is for a service unlawfully referred under section 1877(a)(1)(A) of the Act, or has not refunded amounts inappropriately collected for a prohibited referral. In addition, in accordance with section 1877(g)(4), these regulations set forth CMPs, assessments and an exclusion in cases where a physician or entity enters into an arrangement or scheme in which the physician or entity knows, or should have known, that the principal purpose is to assure referrals by the physician which, if made directly to a particular entity, would violate the prohibition on referrals described in section 1877(a) of the Act.

  11. eConsultation in Plastic and Reconstructive Surgery

    PubMed Central

    Trovato, M. J.; Scholer, A. J.; Vallejo, E.; Buncke, G. M.; Granick, M. S.

    2011-01-01

    Objective: Early studies of plastic surgery patient triage using telemedicine are descriptive and deal with feasibility rather than accuracy. The inpatient study arm compares on-site wound-evaluation accuracy with remotely viewed digital images. The outpatient arm prospectively compares on-site and remote diagnosis, management, and outcomes in a busy, urban, reconstructive-surgery clinic. The concurrent 6 patient case studies illustrate significant systems improvement by using remote consultation. Methods: A total of 43 inpatients and 100 consecutive outpatients were evaluated by on-site and remote surgeons as performed in previous arms with digital-camera and store and forward technology. Consent was obtained from all patients participating. Agreements regarding diagnosis (skin lesion, hand injury, wound type, and scar character) and management (healing problem, emergent evaluation, antibiotics, and hospitalization) were calculated. Results: In the first study arm, on-site and remote agreement (46%-86% for wound description and 65%-81% for management) generally matched agreement among on-site surgeons (68%-100% and 84%-89%). Moreover, when on-site agreement was low (68% for edema), agreement between on-site and remote surgeons was also low (57%). Remote evaluation was least sensitive detecting wound drainage (46%). On-site surgeons opted for more treatment, often prescribing antibiotics and admitting the patient. The second teleconsult arm provides further evidence of accuracy, overall agreement of 32%, sensitivity 48.55%, specificity 96.92%, positive predictive value 49.26%, negative predictive value 96.83%, and P < .001 regarding diagnosis (skin lesion, hand injury, wound type, wound problem, and scar character). Patient transfer, postoperative monitoring, and outcomes via electronic image transfer, as well as cost-benefit analysis of this clinic-based study, are presented. Conclusions: eConsultation renders similar outcomes to standard, on-site examination in a

  12. 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 =…

  13. 29 CFR 20.105 - Minimum referral amount.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  14. [Suicidality at the general hospital – perspective of consultation and liaison psychiatry].

    PubMed

    Imboden, Christian; Hatzinger, Martin

    2015-10-01

    Suicidality is a common problem in the general hospital. Patients with comorbid psychiatric disorders or during a psychosocial crisis can develop suicidal ideation during their stay at the general hospital, especially if they suffer from chronic disease. Some somatic disorders, such as cancer, epilepsy, chronic obstructive pulmonary disease, asthma, stroke and chronic pain conditions are associated with an increased risk of suicide. The fact that (1) a major part of patients are treated in the emergency room (ER) after a suicide attempt and (2) a suicide attempt is the strongest predictor for later completed suicide emphasizes the importance of expertise in dealing with suicidal patients in the ER. In order to improve prevention of suicides and suicide attempts within the general hospital and after discharge it is important to educate staff concerning suicidality and enhance detection of suicidal patients. A consultation and liaison psychiatrist should always be involved when there are suicidal patients on wards and in the ER. Assessment of suicidal patients has always to include clear recommendations concerning patient safety and treatment of the underlying condition as well as specific approaches in dealing with suicidal thoughts. Safety measures can include close monitoring, constant observation, restriction to means of suicide, referral to a psychiatric clinic and treatment with sedatives, generally benzodiazepines. Psychiatric disorders are ideally treated according to guidelines and clear recommendations should be given concerning treatment after discharge. Specific psychotherapy for suicidal behaviour possibly reduces the risk of future suicides. A special situation is created by assisted suicides which attribute to suicides in the elderly with a recent increase in the Swiss population. In some cases, undiagnosed depression may contribute to the decision making process, hence, underlining the importance of improved detection and treatment of depression in

  15. Toward Effective Quality Assurance in Evidence-Based Practice: Links between Expert Consultation, Therapist Fidelity, and Child Outcomes

    ERIC Educational Resources Information Center

    Schoenwald, Sonja K.; Sheidow, Ashli J.; Letourneau, Elizabeth J.

    2004-01-01

    This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was…

  16. Special program to reduce cardiology consultation waiting lists: report on an innovatory experience.

    PubMed

    Proença, Gonçalo; Ferreira, Daniel; Freitas, António; Madeira, Francisco; Soares, Ana Oliveira; Ferreira, Rafael

    2003-11-01

    The problem of waiting lists has been widely debated in the Portuguese society. In this paper, the authors report the first results of a prioritization approach, started in March 2000. In this program cardiologists and general practitioners work in close proximity, coordinating efforts in order to improve the establishment of clinical priorities, and consequently optimize hospital referral. Working as cardiology consultants, the authors were able to reduce the number of first consultation requests by 77.9% (December 2002). For the first time it was possible to match the number of requests with the available consultation times, halting the growth of the waiting list.

  17. 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.

  18. Specialist Pediatric Palliative Care Referral Practices in Pediatric Oncology: A Large 5-year Retrospective Audit

    PubMed Central

    Ghoshal, Arunangshu; Salins, Naveen; Damani, Anuja; Deodhar, Jayita; Muckaden, MaryAnn

    2016-01-01

    Purpose: To audit referral practices of pediatric oncologists referred to specialist pediatric palliative care services. Patients and Methods: Retrospective review of medical case records of pediatric palliative care patients over a period of 5 years from January 1, 2010 to December 31, 2014. Descriptive summaries of demographic, clinical variables, and patient circumstances at the time of referral and during end-of-life care were examined. Results: A total of 1135 patients were referred from pediatric oncology with a gradual increasing trend over 5 years. About 84.6% consultations took place in the outpatient setting. In 97.9% of the cases, parents were the primary caregivers. Availability of specialist pediatric health-care services at local places was available in 21.2% cases and 48% families earned <5000 INR (approximately 73 USD) in a month. Around 28.3% of the referrals were from leukemia clinic and maximum references were late with 72.4% patients having advanced disease at presentation. 30.3% of the referrals were made for counseling and communication and 54.2% had high symptom burden during referral. After referral, 21.2% patients continued with oral metronomic chemotherapy and 10.5% were referred back to oncology services for palliative radiotherapy. Only 4.9% patients had more than 2 follow-ups. 90.8% of the patients were cared for at home in the last days of illness by local general practitioners. 70.6% of the deaths were anticipated. Conclusions: Oncologists referred patients late in the course of disease trajectory. Most of the referrals were made for counseling and communication, but many patients had high symptom burden during referral. PMID:27559254

  19. 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

  20. "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. PMID:26734397

  1. An Exploratory Investigation of the Association between Clinicians’ Attitudes toward Twelve-step Groups and Referral Rates

    PubMed Central

    Laudet, Alexandre B.; White, William L.

    2005-01-01

    Affiliation with 12-step groups has been consistently linked to the achievement of abstinence among persons experiencing alcohol and other drug problems. Clinicians play a critical role in fostering clients’ engagement in 12-step, yet, little is known about clinicians’ attitudes and beliefs about 12-step groups, or about the association between such beliefs and referral practices. This exploratory study investigates this association to gain a greater understanding of determinants of referral practices. Participants were 100 clinicians working within outpatient treatment programs in New York City. Participants held highly positive views of 12-step groups in terms of helpfulness to recovery, but a large percentage endorsed items describing potential points of resistance to 12-step groups, in particular the emphasis such groups place on spirituality and powerlessness. More positive attitudes were associated with greater rates of referral, while resistance to the concepts of spirituality/powerlessness was associated with lower rates of referral. Implications of findings for clinical settings are discussed as well as a research agenda designed to more fully elucidate determinants of clinicians’ 12-step referrals. PMID:16467900

  2. [Diagnosis and follow-up of endometriosis during consultation: changes].

    PubMed

    Salvat, J

    2001-09-01

    In a literature review, news in symptomatology and follow-up of endometriosis were analyzed (infertility, pain, hemorrhage, adnexal tumors). Survey and examination can be made with improved quality (pain scale, menorragha scheme of Higham). Diagnosis and follow-up of endometriosis are more perfect by ultrasonographical examination by the gynecologist in his office. Ultrasonography is better for endometrioma and adenomyosis than other localisation (complementary explorations-magnetic resonance imaging, outside of consultation, are useful for deeper and superficial lesions). In follow-up, clinical research and ultrasonic exploration show the true relapses. Treatment's observance and success will be improved by ultrasonic analysis. Intolerances, add-back therapy, contraception, substitutive hormonal treatment of menopauses and cancer risk, are different problem and solution will be offer.

  3. Negotiation and the structure of discourse in medical consultation.

    PubMed

    Drass, K A

    1982-11-01

    Using audio tape recordings of consultations between mid-level providers and patients in a health maintenance organization, a model of medical negotiation is presented. This model conceptualizes negotiation as a process in which mid-level providers and patients introduce their perspectives on the definition and treatment of medical problems by linking together units of discourse (acts, turns, sequences and phases). This model clearly locates negotiation in observable activities of interactants and demonstrates how the process changes over the course of an encounter as provider and patient participate in the taking of a medical history, the performance of a physical examination, and the discussion of the problem and treatment. Because of the formal yet flexible nature of this model, it lends itself for use in comparative studies of medical practitioner-patient negotiation. PMID:10260462

  4. Assessment of providers' referral decisions in Rural Burkina Faso: a retrospective analysis of medical records

    PubMed Central

    2012-01-01

    Background A well-functioning referral system is fundamental to primary health care delivery. Understanding the providers' referral decision-making process becomes critical. This study's aim was to assess the correctness of diagnoses and appropriateness of the providers' referral decisions from health centers (HCs) to district hospitals (DHs) among patients with severe malaria and pneumonia. Methods A record review of twelve months of consultations was conducted covering eight randomly selected HCs to identify severe malaria (SM) cases among children under five and pneumonia cases among adults. The correctness of the diagnosis and appropriateness of providers' referral decisions were determined using the National Clinical Guidebook as a 'gold standard'. Results Among the 457 SM cases affecting children under five, only 66 cases (14.4%) were correctly diagnosed and of those 66 correctly diagnosed cases, 40 cases (60.6%) received an appropriate referral decision from their providers. Within these 66 correctly diagnosed SM cases, only 60.6% were appropriately referred. Among the adult pneumonia cases, 5.9% (79/1331) of the diagnoses were correctly diagnosed; however, the appropriateness rate of the provider's referral decision was 98.7% (78/79). There was only one case that should not have been referred but was referred. Conclusions The adherence to the National Guidelines among the health center providers when making a diagnosis was low for both severe malaria cases and pneumonia cases. The appropriateness of the referral decisions was particularly poor for children with severe malaria. Health center providers need to be better trained in the diagnostic process and in disease management in order to improve the performance of the referral system in rural Burkina Faso. PMID:22397326

  5. The association between social capital and burnout in nurses of a trauma referral teaching hospital.

    PubMed

    Farahbod, Farzin; Goudarzvand Chegini, Mehrdad; Kouchakinejad Eramsadati, Leila; Mohtasham-Amiri, Zahra

    2015-01-01

    Social capital is a multi-faceted phenomenon in social sciences that massively affects many social fields. It can be a helpful factor in promoting health. Among the groups with high burnout, nurses have always shown higher levels of burnout. Studies have revealed that social capital can be an important factor affecting burnout. This study aimed to determine the extent of the effect of social capital on burnout in nurses of a trauma referral teaching hospital in Rasht. This was a descriptive correlational study conducted on 214 nurses of a trauma referral teaching hospital. Maslach standard questionnaire and the social capital questionnaire devised by Boyas and colleagues were used. Data were analyzed using descriptive statistics, Pearson correlation coefficient, and linear regression analysis to determine the extent of the effect of social capital on burnout. The study showed an inverse association between social capital and burnout. The intensity of the relationship was -0.451 (P<0.0001). Also, the linear regression model of social capital on burnout variable showed that the regression coefficient of social capital equaled -0.34. The determination coefficient of this regression model indicated that social capital explained 20% of burnout changes. The results showed high burnout in emotional exhaustion dimension and an inverse association between social capital and burnout. Thus, attempts should be made to promote social capital dimensions among nurses. Given the inevitability of job stress in a nursing environment, and managers should plan on improving the working conditions and training techniques to deal with such stress.

  6. 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…

  7. Advanced nurse practitioner-led referral for specialist care and rehabilitation.

    PubMed

    Mashlan, Wendy; Hayes, Julie; Thomas, Ceri

    2016-02-01

    In response to the need for appropriate and timely care of frail older patients admitted to hospital, a dedicated advanced nurse practitioner (ANP)-led referral service was developed. The service has continued to evolve over the 13 years since its implementation in accordance with changing service demands. This article describes the role of the ANP in care of the elderly/rehabilitation medicine and focuses on one area of clinical practice developed by the team: an ANP-led referral service. The aim of developing the service was to ensure that patients who required specialist care and rehabilitation could be identified and assessed as soon as possible after admission, with the premise that they could be transferred to a bed in care of the elderly medical wards. This was perceived by the ANPs to be advantageous for patients, who would receive care from a specialist team, and for care of the elderly staff who could use their knowledge and skills appropriately and safely.

  8. 29 CFR 1908.5 - Requests and scheduling for onsite consultation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... following: (i) Paid newspaper advertisements; (ii) Newspaper, magazine, and trade publication articles; (iii... publications, descriptive materials, and other appropriate items on consultative services; (viii) Free...

  9. 29 CFR 1908.5 - Requests and scheduling for onsite consultation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... following: (i) Paid newspaper advertisements; (ii) Newspaper, magazine, and trade publication articles; (iii... publications, descriptive materials, and other appropriate items on consultative services; (viii) Free...

  10. 29 CFR 1908.5 - Requests and scheduling for onsite consultation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... following: (i) Paid newspaper advertisements; (ii) Newspaper, magazine, and trade publication articles; (iii... publications, descriptive materials, and other appropriate items on consultative services; (viii) Free...

  11. 29 CFR 1908.5 - Requests and scheduling for onsite consultation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... following: (i) Paid newspaper advertisements; (ii) Newspaper, magazine, and trade publication articles; (iii... publications, descriptive materials, and other appropriate items on consultative services; (viii) Free...

  12. 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…

  13. Telemedicine consultation and monitoring for pediatric liver transplant.

    PubMed

    Fiadjoe, John; Gurnaney, Harshad; Muralidhar, Kanchi; Mohanty, Surya; Kumar, John; Viswanath, Raja; Sonar, Srinivas; Dunn, Stephen; Rehman, Mohamed

    2009-04-01

    Telemedicine provides the opportunity to bring medical expertise to the bedside, even if the medical expert is not physically near the patient. Internet technology has facilitated telemedicine allowing for voice, video and other data to be exchanged between remote locations. To date, applications of telemedicine to anesthesia (Teleanesthesia) have been limited. Previous work by Cone et al., (Anesth Analg 2006;1463-7) demonstrated the ability to direct an anesthetic in a remote location using satellite communication. In this report, we describe the use of telemedicine to support two cases of elective living related pediatric liver transplants performed at the Narayana Hrudayalaya Institute of Medical Sciences in Bangalore, India with preoperative and intraoperative consultation provided by physicians at the Children's Hospital of Philadelphia.

  14. 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

  15. 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.

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... entity that furnishes DHS is not imputed to his or her group practice or its members or its staff. However, a referral made by a physician's group practice, its members, or its staff may be imputed to the physician if the physician directs the group practice, its members, or its staff to make the referral or...

  17. 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…

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  19. 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. PMID:25596511

  20. 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 in the…

  1. Perceptions of Helpfulness in Conjoint Behavioral Consultation: Congruence and Agreement between Teachers and Parents

    ERIC Educational Resources Information Center

    Sheridan, Susan M.; Erchul, William P.; Brown, Melissa S.; Dowd, Shannon E.; Warnes, Emily D.; Marti, Diane C.; Schemm, Ariadne V.; Eagle, John W.

    2004-01-01

    Conjoint behavioral consultation (CBC) can be considered a help-giving model, wherein consultants work with parents and teachers in an effort to develop constructive partnerships aimed at addressing needs of students for whom both parties share responsibility. The development of strong relationships among systems in a child's life is related to…

  2. Collective Consultation on Literacy and Education for All. Appraisal and Prospects.

    ERIC Educational Resources Information Center

    Thomas-Fontaine, Jeannine

    During 9 years of operation, the Collective Consultation has provided a structure within which nongovernmental organizations (NGOs) exchange information and experience related to literacy more effectively. The bureau known as "the working group" is responsible for implementation of decisions taken during the Collective Consultation, for their…

  3. 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),…

  4. 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'…

  5. Impact of primary care provider knowledge, attitudes, and beliefs about cancer clinical trials: implications for referral, education and advocacy.

    PubMed

    Michaels, Margo; D'Agostino, Thomas A; Blakeney, Natasha; Weiss, Elisa S; Binz-Scharf, Maria C; Golant, Mitch; Bylund, Carma L

    2015-03-01

    Primary Care Providers (PCPs) can be instrumental in helping to prepare patients for referral to cancer treatment. It has been suggested that PCPs can have an important impact on priming patients about the possibility of receiving care within a cancer treatment clinical trial (CCT). However, little is understood about how to effectively engage primary care providers in educating patients about trials. Data were collected as part of two qualitative research projects about primary care providers' role in referral to treatment and to CCTs. Participants were 27 PCPs who agreed to take part in qualitative face-to-face or telephone interviews and serve predominantly underserved, minority populations. Interviews identified a number of factors influencing referral to oncologists, including patients' insurance coverage, location and proximity to treatment facilities, and the strength of ongoing relationships with and/or previous experience with a specialist. PCPs overwhelmingly expressed disinterest in discussing any treatment options, including CCTs. Misconceptions about quality of care received through trials were also common, presenting a deterrent to discussion. PCPs need targeted, evidence-based educational interventions to appropriately address their concerns about cancer clinical trials, enhance provider communication skills, and alter patient referral behavior. Steps must also be taken to strengthen communication between oncologists and referring PCPs. PMID:24805229

  6. 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

  7. Ethnic differences in Internal Medicine referrals and diagnosis in the Netherlands

    PubMed Central

    Lanting, Loes C; Bootsma, Aart H; Lamberts, Steven WJ; Mackenbach, Johan P; Joung, Inez MA

    2008-01-01

    Background As in other Western countries, the number of immigrants in the Netherlands is growing rapidly. In 1980 non-western immigrants constituted about 3% of the population, in 1990 it was 6% and currently it is more than 10%. Nearly half of the migrant population lives in the four major cities. In the municipality of Rotterdam 34% of the inhabitants are migrants. Health policy is based on the ideal that all inhabitants should have equal access to health care and this requires an efficient planning of health care resources, like staff and required time per patient. The aim of this study is to examine ethnic differences in the use of internal medicine outpatient care, specifically to examine ethnic differences in the reason for referral and diagnosis. Methods We conducted a study with an open cohort design. We registered the ethnicity, sex, age, referral reasons, diagnosis and living area of all new patients that visited the internal medicine outpatient clinic of the Erasmus Medical Centre in Rotterdam (Erasmus MC) for one year (March 2002–2003). Additionally, we coded referrals according to the International Classification of Primary Care (ICPC) and categorised diagnosis according to the Diagnosis Treatment Combination (DTC). We analysed data by using Poisson regression and logistic regression. Results All ethnic minority groups (Surinam, Turkish, Moroccan, Antillean/Aruban and Cape Verdean immigrants) living in Rotterdam municipality, make significantly more use of the outpatient clinic than native Dutch people (relative risk versus native Dutch people was 1.83, 1.97, 1.79, 1.65 and 1.88, respectively). Immigrant patients are more likely to be referred for analysis and treatment of 'gastro-intestinal signs & symptoms' and were less often referred for 'indefinite, general signs'. Ethnic minorities were more frequently diagnosed with 'Liver diseases', and less often with 'Analysis without diagnosis'. The increased use of the outpatient facilities seems to be

  8. Physician Associate and General Practitioner Consultations: A Comparative Observational Video Study

    PubMed Central

    de Lusignan, Simon; McGovern, Andrew P.; Tahir, Mohammad Aumran; Hassan, Simon; Jones, Simon; Halter, Mary; Joly, Louise; Drennan, Vari M.

    2016-01-01

    Background Physician associates, known internationally as physician assistants, are a mid-level practitioner, well established in the United States of America but new to the United Kingdom. A small number work in primary care under the supervision of general practitioners, where they most commonly see patients requesting same day appointments for new problems. As an adjunct to larger study, we investigated the quality of the patient consultation of physician associates in comparison to that of general practitioners. Method We conducted a comparative observational study using video recordings of consultations by volunteer physician associates and general practitioners with consenting patients in single surgery sessions. Recordings were assessed by experienced general practitioners, blinded to the type of the consulting practitioner, using the Leicester Assessment Package. Assessors were asked to comment on the safety of the recorded consultations and to attempt to identify the type of practitioner. Ratings were compared across practitioner type, alongside the number of presenting complaints discussed in each consultation and the number of these which were acute, minor, or regarding a chronic condition. Results We assessed 62 consultations (41 general practitioner and 21 physician associates) from five general practitioners and four physician associates. All consultations were assessed as safe; but general practitioners were rated higher than PAs in all elements of consultation. The general practitioners were more likely than physician associates to see people with multiple presenting complaints (p<0.0001) and with chronic disease related complaints (p = 0.008). Assessors correctly identified general practitioner consultations but not physician associates. The Leicester Assessment Package had limited inter-rater and intra-rater reliability. Conclusions The physician associate consultations were with a less complex patient group. They were judged as competent and safe

  9. Fetal alcohol spectrum disorders: guidance for recognition, diagnosis, differential diagnosis and referral.

    PubMed

    Senturias, Yasmin; Asamoah, Alexander

    2014-04-01

    FASDs are the most common preventable cause of developmental and intellectual disabilities in the United States and yet can easily be overlooked in pediatric and adolescent practices. Early diagnosis, presence of developmental and educational services, and a nurturing home environment have been associated with decreased occurrence of secondary disabilities such as substance use and criminal involvement.23 Therefore, it is important for providers to know how to go about the identification, diagnostic, and evaluation process. Pediatric care clinicians should be knowledgeable about the diagnostic criteria for fetal alcohol syndrome and know common differentiating conditions. Furthermore, they should be able to recognize other disorders on the spectrum, and in doing so, they should facilitate appropriate referral, initial management, and coordination of care. PMID:24810411

  10. 27 CFR 447.55 - Departments of State and Defense consulted.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., AMMUNITION AND IMPLEMENTS OF WAR Miscellaneous Provisions § 447.55 Departments of State and Defense consulted... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Departments of State and Defense consulted. 447.55 Section 447.55 Alcohol, Tobacco Products, and Firearms BUREAU OF...

  11. 27 CFR 447.55 - Departments of State and Defense consulted.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., AMMUNITION AND IMPLEMENTS OF WAR Miscellaneous Provisions § 447.55 Departments of State and Defense consulted... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Departments of State and Defense consulted. 447.55 Section 447.55 Alcohol, Tobacco Products, and Firearms BUREAU OF...

  12. 27 CFR 447.55 - Departments of State and Defense consulted.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., AMMUNITION AND IMPLEMENTS OF WAR Miscellaneous Provisions § 447.55 Departments of State and Defense consulted... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Departments of State and Defense consulted. 447.55 Section 447.55 Alcohol, Tobacco Products, and Firearms BUREAU OF...

  13. 27 CFR 447.55 - Departments of State and Defense consulted.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., AMMUNITION AND IMPLEMENTS OF WAR Miscellaneous Provisions § 447.55 Departments of State and Defense consulted... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Departments of State and Defense consulted. 447.55 Section 447.55 Alcohol, Tobacco Products, and Firearms BUREAU OF...

  14. 27 CFR 447.55 - Departments of State and Defense consulted.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., AMMUNITION AND IMPLEMENTS OF WAR Miscellaneous Provisions § 447.55 Departments of State and Defense consulted... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Departments of State and Defense consulted. 447.55 Section 447.55 Alcohol, Tobacco Products, and Firearms BUREAU OF...

  15. 21 CFR 20.84 - Disclosure to consultants, advisory committees, State and local government officials commissioned...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... disclosure may be disclosed to Food and Drug Administration consultants, advisory committees, State and local... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Disclosure to consultants, advisory committees, State and local government officials commissioned pursuant to 21 U.S.C. 372(a), and other...

  16. 21 CFR 20.84 - Disclosure to consultants, advisory committees, State and local government officials commissioned...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... disclosure may be disclosed to Food and Drug Administration consultants, advisory committees, State and local... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Disclosure to consultants, advisory committees, State and local government officials commissioned pursuant to 21 U.S.C. 372(a), and other...

  17. 21 CFR 20.84 - Disclosure to consultants, advisory committees, State and local government officials commissioned...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... disclosure may be disclosed to Food and Drug Administration consultants, advisory committees, State and local... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Disclosure to consultants, advisory committees, State and local government officials commissioned pursuant to 21 U.S.C. 372(a), and other...

  18. 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…

  19. The theory and practice of consultation-liaison (CL) psychiatry in Trinidad and Tobago with reference to suicidal behavior.

    PubMed

    Maharajh, Hari D; Abdool, Petal; Mohammed-Emamdee, Rehanna

    2008-01-01

    Consultation-Liaison Psychiatry (CL Psychiatry) is not a well-established discipline in developing countries. It is a multifaceted area that incorporates clinical, teaching, and research activities both within the hospital and extramurally in community health services. Our purpose was first to define the role of CL Psychiatry, to review essential steps in the process, and to advise on how to set up services. Second, a 1-year retrospective analysis was conducted on all patients referred. A total of 708 persons were referred for psychiatric consultation, of which 41% (291) were referred because of suicidal behavior. Sixty-six percent were female and there was an over-representation of Indo-Trinidadians (67%). Twenty-six percent of all cases of suicidal behavior were diagnosed with clinical depression, 3% were suffering from a psychotic illness (schizophrenia), and 8% (24/291) were under the influence of alcohol. The most vulnerable group was the 25- to 35-year-old age group, accounting for 27% (78/291) of attempters, with the largest number of female attempters. The 36- to 55-year-old males were most likely to attempt suicide (35/99). Ingestion of a toxic substance was the most popular method among all races, genders, and age groups. Of all referrals, 95% originated from medical wards. The most common reason cited for attempts was depressed mood, secondary to a domestic dispute with a family member or significant other. Among Caribbean countries, Trinidad and Tobago has high rates of suicide and suicidal behavior, depression, and alcoholism. CL psychiatrists have a major role to play in the delivery of services to these groups, facilitating the transition of care from admission in the emergency room to discharge and follow-up in the community. PMID:18836659

  20. Developing and Testing a Checklist to Enhance Quality in Ethics Consultation

    PubMed Central

    Flicker, Lauren Sydney; Rose, Susannah L.; Eves, Margot M.; Flamm, Anne Lederman; Sanghani, Ruchi; Smith, Martin L.

    2015-01-01

    Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics professionals. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants' perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self

  1. School Consultation and Response to Intervention: A Tale of Two Literatures

    ERIC Educational Resources Information Center

    Erchul, William P.

    2011-01-01

    School consultation and response to intervention (RTI) are both problem-solving methods employed in school-based service delivery, but beyond that characteristic, how are they the same and how are they different? A major purpose of this commentary is to compare and contrast the scholarly literatures of school consultation and RTI. A selective…

  2. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1992-01-01

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

  3. Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates

    PubMed Central

    Karssemeijer, Nico; Beijerinck, David; Deurenberg, Jan J. M.; van Engen, Ruben E.; Broeders, Mireille J. M.; den Heeten, Gerard J.

    2010-01-01

    Objectives: To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Methods: Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. Results: A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010). Conclusion: As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection. PMID:20407901

  4. Discharge and referral data exchange using global standards--the SCIPHOX project in Germany.

    PubMed

    Heitmann, Kai U; Schweiger, Ralf; Dudeck, Joachim

    2003-07-01

    The goal of the German project "Standardization of Communication between Information Systems in Physician Offices and Hospitals using XML" (aka SCIPHOX) in its first phase is to provide information exchange based on the Extended Markup Language XML between Hospital Information Systems (HIS) and Physician Office Systems (POS). The Clinical Document Architecture (CDA), a standard developed by the Health Level Seven organization (HL7), was chosen to serve as the "backbone" specification. The CDA is an ANSI approved document architecture for exchange of clinical information using XML. In phase I of the SCIPHOX project the proposal specifies the use of the CDA as a generalized international standard in the national context of discharge and referral letters in Germany. The specification defines how to use the CDA header and associated vocabularies by providing a translation and interpretation of the CDA header tags and provides a solution for taking local needs (insurance information etc.) into account.

  5. 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. PMID:15689647

  6. 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.

  7. 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.

  8. 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)

  9. 48 CFR 970.0905 - Organizational and consultant conflicts of interest.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Qualifications 970.0905 Organizational and consultant conflicts of interest. Management and operating contracts... advantage. To this end, the organizational conflicts of interest clause in management and operating... consultant conflicts of interest. 970.0905 Section 970.0905 Federal Acquisition Regulations System...

  10. 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...

  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. Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a Public Health Approach to the Management of Substance Abuse

    ERIC Educational Resources Information Center

    Babor, Thomas F.; McRee, Bonnie G.; Kassebaum, Patricia A.; Grimaldi, Paul L.; Ahmed, Kazi; Bray, Jeremy

    2007-01-01

    Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive and integrated approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders and those at risk. This paper describes research on the components of SBIRT conducted during the past 25 years,…

  13. Pain referral and regional deep tissue hyperalgesia in experimental human hip pain models.

    PubMed

    Izumi, Masashi; Petersen, Kristian Kjær; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas

    2014-04-01

    Hip disorder patients typically present with extensive pain referral and hyperalgesia. To better understand underlying mechanisms, an experimental hip pain model was established in which pain referrals and hyperalgesia could be studied under standardized conditions. In 16 healthy subjects, pain was induced by hypertonic saline injection into the gluteus medius tendon (GMT), adductor longus tendon (ALT), or gluteus medius muscle (GMM). Isotonic saline was injected contralaterally as control. Pain intensity was assessed on a visual analogue scale (VAS), and subjects mapped the pain distribution. Before, during, and after injections, passive hip joint pain provocation tests were completed, together with quantitative sensory testing as follows: pressure pain thresholds (PPTs), cuff algometry pain thresholds (cuff PPTs), cutaneous pin-prick sensitivity, and thermal pain thresholds. Hypertonic saline injected into the GMT resulted in higher VAS scores than hypertonic injections into the ALT and GMM (P<.05). Referred pain areas spread to larger parts of the leg after GMT and GMM injections compared with more regionalized pain pattern after ALT injections (P<.05). PPTs at the injection site were decreased after hypertonic saline injections into GMT and GMM compared with baseline, ALT injections, and isotonic saline. Cuff PPTs from the thigh were decreased after hypertonic saline injections into the ALT compared with baseline, GMT injections, and isotonic saline (P<.05). More subjects had positive joint pain provocation tests after hypertonic compared with isotonic saline injections (P<.05), indicating that this provocation test also assessed hyperalgesia in extra-articular soft tissues. The experimental models may open for better understanding of pain mechanisms associated with painful hip disorders.

  14. 29 CFR 1902.6 - Consultation with the National Institute for Occupational Safety and Health.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 5 2010-07-01 2010-07-01 false Consultation with the National Institute for Occupational Safety and Health. 1902.6 Section 1902.6 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... Occupational Safety and Health. The Assistant Secretary will consult, as appropriate, with the Director of...

  15. 29 CFR 1902.6 - Consultation with the National Institute for Occupational Safety and Health.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 5 2014-07-01 2014-07-01 false Consultation with the National Institute for Occupational Safety and Health. 1902.6 Section 1902.6 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... Occupational Safety and Health. The Assistant Secretary will consult, as appropriate, with the Director of...

  16. 29 CFR 1902.6 - Consultation with the National Institute for Occupational Safety and Health.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 5 2013-07-01 2013-07-01 false Consultation with the National Institute for Occupational Safety and Health. 1902.6 Section 1902.6 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... Occupational Safety and Health. The Assistant Secretary will consult, as appropriate, with the Director of...

  17. 29 CFR 1902.6 - Consultation with the National Institute for Occupational Safety and Health.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 5 2011-07-01 2011-07-01 false Consultation with the National Institute for Occupational Safety and Health. 1902.6 Section 1902.6 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... Occupational Safety and Health. The Assistant Secretary will consult, as appropriate, with the Director of...

  18. 29 CFR 1902.6 - Consultation with the National Institute for Occupational Safety and Health.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 5 2012-07-01 2012-07-01 false Consultation with the National Institute for Occupational Safety and Health. 1902.6 Section 1902.6 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... Occupational Safety and Health. The Assistant Secretary will consult, as appropriate, with the Director of...

  19. 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…

  20. The Evaluation Consultant's Life Cycle: Theory, Practice, and Implications for Learning

    ERIC Educational Resources Information Center

    Barrington, Gail V.

    2006-01-01

    The purpose of the study reported in this chapter was to determine if senior evaluation consultants experienced stages of growth in their practice similar to the small business development stages described by Bruce and Scott, to identify the stimuli that led to those changes, to determine what the consultants learned from these incidents, and to…