Sample records for statistical consulting section

  1. The use of electronic consultations is associated with lower specialist referral rates: a cross-sectional study using population-based health administrative data.

    PubMed

    Liddy, Clare; Moroz, Isabella; Keely, Erin; Taljaard, Monica; Mark Fraser, Amy; Deri Armstrong, Catherine; Afkham, Amir; Kendall, Claire

    2018-04-04

    The referral-consultation process can be difficult to navigate. Electronic consultations (eConsults) can help streamline referrals by facilitating inter-provider communication. We evaluated the potential effect of eConsult on specialist referral rates in Ontario among family physicians providing comprehensive care. We conducted a retrospective 1:3 matched cohort study examining total referrals and referrals to all available medical specialties from primary care providers between 1 April 2014 and 31 March 2015. We used multivariable random effects Poisson regression analysis to compare referral rates between eConsult and non-eConsult users while adjusting for relevant patient and provider characteristics. Referral rates were expressed per physician, per 100 patients and per 100 patient encounters. There were 113197 referrals across all medical specialties made by 119 eConsult physicians and 352 matched controls. Referral rates per physician were significantly lower in the eConsult group for all specialty groupings [unadjusted rate ratio (RR) = 0.87, 95% confidence interval (CI) = 0.80-0.95; adjusted RR = 0.92, 95% CI = 0.85-1.00]. Referral rates per patient were lower among eConsult physicians (unadjusted RR = 0.91, 95% CI = 0.84-0.98) but this difference was not statistically significant after adjustment (adjusted RR = 0.96, 95% CI = 0.90-1.02). No statistically significant difference was observed when referrals were expressed per 100 patient encounters. This is the first Canadian study to examine the potential effect of eConsult on overall referrals at a population level. Our findings demonstrate that using eConsult service is associated with fewer referrals from primary to specialist care, with considerable potential for cost savings to our single-payer system.

  2. 78 FR 70059 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-22

    ... (as opposed to quantitative statistical methods). In consultation with research experts, we have... qualitative interviews (as opposed to quantitative statistical methods). In consultation with research experts... utilization of qualitative interviews (as opposed to quantitative statistical methods). In consultation with...

  3. Suicidal ideations, plans and attempts in primary care: cross-sectional study of consultants at primary health care system in Morocco.

    PubMed

    Oneib, Bouchra; Sabir, Maria; Otheman, Yassine; Abda, Naima; Ouanass, Abderrazzak

    2016-01-01

    The aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. We conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among 396 consultants in the primary health care system, using the Mini International neuropsychiatric interview. Patients were 18 years and older, without known psychiatric or chronic somatic disease. Statistical analysis was performed by the SPSS 13.0 software. The prevalence of suicidal ideation was 5.3%, and 2.7% of the patients planned their suicide and 1.2% tried to commit suicide. The multivariate analysis did not demonstrate significant association. Suicidal ideation, plan and suicide attempts are prevalent in primary health care patients, but they are still under diagnosed. An adequate training of physicians and the establishment of education programs is essential to reduce the rate of suicide.

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

    PubMed

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

    2017-04-01

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

  5. Should consultation recording use be a practice standard? A systematic review of the effectiveness and implementation of consultation recordings.

    PubMed

    Rieger, Kendra L; Hack, Thomas F; Beaver, Kinta; Schofield, Penelope

    2018-04-01

    To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health-care settings. A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies by using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. Of the 3373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). Most patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision-making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. Consultation recordings are valuable to patients and positively associated with patient-reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors. Copyright © 2017 John Wiley & Sons, Ltd.

  6. [Legal medicine specialists within the framework of acute care : Analysis of legal medicine consultations in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt].

    PubMed

    Pliske, G; Heide, S; Lucas, B; Brandstädter, K; Walcher, F; Kropf, S; Lessig, R; Piatek, S

    2018-05-01

    In acute medical care, there are patients who have been injured by the influence of others. The aim of this study was to analyze all cases which were presented to the Institute for Legal Medicine of the University Halle (Saale). The cases where analyzed in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt. The consultations of the Institute for Legal Medicine Halle-Wittenberg for 2012-2015 were evaluated with regard to the age and gender distribution, the reasons for the consultation and time until the request for consultations. These cases were statistically compared to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt 2014-2015. A total of 536 cases (55.6% male and 44.4% female patients) were evaluated. In all, 62.1% of patients were under 18 years of age; 43.5% of all consultations were requested by pediatric (surgery) clinics. The most common reasons for consultation were sexual child abuse or violence against children (50.7%). Compared to the victims' statistics, significantly more children were examined by legal medicine specialists than could have been expected (p < 0.001). In adult patients, the most common causes for consultation were acts of violence (20.4%) and domestic violence (10.1%). Among adults, significantly more women and fewer men were presented than expected (p = 0.001). There were only a small number of consultations of legal medicine specialists in relation to the victims' statistics. Most of them were children and women. The temporal latency between the act of violence and the consultations was one day and more. The latency and the renunciation of the consultation of the legal medicine specialists can lead to loss of evidence.

  7. Perspectives on statistics education: observations from statistical consulting in an academic nursing environment.

    PubMed

    Hayat, Matthew J; Schmiege, Sarah J; Cook, Paul F

    2014-04-01

    Statistics knowledge is essential for understanding the nursing and health care literature, as well as for applying rigorous science in nursing research. Statistical consultants providing services to faculty and students in an academic nursing program have the opportunity to identify gaps and challenges in statistics education for nursing students. This information may be useful to curriculum committees and statistics educators. This article aims to provide perspective on statistics education stemming from the experiences of three experienced statistics educators who regularly collaborate and consult with nurse investigators. The authors share their knowledge and express their views about data management, data screening and manipulation, statistical software, types of scientific investigation, and advanced statistical topics not covered in the usual coursework. The suggestions provided promote a call for data to study these topics. Relevant data about statistics education can assist educators in developing comprehensive statistics coursework for nursing students. Copyright 2014, SLACK Incorporated.

  8. Stage at diagnosis and delay in seeking medical care among women with breast cancer, delhi, India.

    PubMed

    Pakseresht, Sedigheh; Ingle, Gopal Krishna; Garg, Suneela; Sarafraz, Nahid

    2014-12-01

    Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease. The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India. This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer "detected in surgery Out Patient Department (OPD) from January 2007 to December 2009" at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X(2), Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P < 0.05). the mean age of women was 46.99 years. 38.4% of women were ≤ 40 years. 61% of women were in stage IV of cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P < 005). A significant association was found between ages of women with their delays in consultation. Delay is still prevalent amongst women with breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.

  9. The Effect of Web-Based Education on Patient Satisfaction, Consultation Time and Conversion to Surgery.

    PubMed

    Boudreault, David J; Li, Chin-Shang; Wong, Michael S

    2016-01-01

    To evaluate the effect of web-based education on (1) patient satisfaction, (2) consultation times, and (3) conversion to surgery. A retrospective review of 767 new patient consultations seen by 4 university-based plastic surgeons was conducted between May 2012 and August 2013 to determine the effect a web-based education program has on patient satisfaction and consultation time. A standard 5-point Likert scale survey completed at the end of the consultation was used to assess satisfaction with their experience. Consult times were obtained from the electronic medical record. All analyses were done with Statistical Analysis Software version 9.2 (SAS Inc., Cary, NC). A P value less than 0.05 was considered statistically significant. Those who viewed the program before their consultation were more satisfied with their consultation compared to those who did not (satisfaction scores, mean ± SD: 1.13 ± 0.44 vs 1.36 ± 0.74; P = 0.02) and more likely to rate their experience as excellent (92% vs 75%; P = 0.02). Contrary to the claims of Emmi Solutions, patients who viewed the educational program before consultation trended toward longer visits compared to those who did not (mean time ± SD: 54 ± 26 vs 50 ± 35 minutes; P = 0.10). More patients who completed the program went on to undergo a procedure (44% vs 37%; P = 0.16), but this difference was not statistically significant. Viewing web-based educational programs significantly improved plastic surgery patients' satisfaction with their consultation, but patients who viewed the program also trended toward longer consultation times. Although there was an increase in converting to surgical procedures, this did not reach statistical significance.

  10. Using Facebook Data to Turn Introductory Statistics Students into Consultants

    ERIC Educational Resources Information Center

    Childers, Adam F.

    2017-01-01

    Facebook provides businesses and organizations with copious data that describe how users are interacting with their page. This data affords an excellent opportunity to turn introductory statistics students into consultants to analyze the Facebook data using descriptive and inferential statistics. This paper details a semester-long project that…

  11. Attivita del Centro di Linguistica Applicata nel campo della lingua e della cultura italiana all'estero (Activities of the Italian Center for Applied Linguistics concerning Italian Language and Culture Abroad).

    ERIC Educational Resources Information Center

    Boriosi Katerinov, Maria Clotilde

    1979-01-01

    Outlines the activities of a recently created section of the Italian Center for Applied Linguistics (CILA), dealing with "Teaching Italian Abroad." Describes these activities as encompassing four areas: research, teaching methodology, consultation, teachers' training and bibliographical information. Lists statistical surveys, research papers, and…

  12. Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation.

    PubMed

    Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo

    2007-01-01

    The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

  13. Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality.

    PubMed

    Joyce, R; Webb, R; Peacock, J L

    2004-01-01

    Previous studies suggest that high risk and low birthweight babies have better outcomes if born in hospitals with level III neonatal intensive care units. Relations between obstetric care, particularly intrapartum interventions and perinatal outcomes, are less well understood, however. To investigate effects of obstetric, paediatric, and demographic factors on rates of hospital stillbirths and neonatal mortality. Cross sectional data on all 65 maternity units in all Thames Regions, 1994-1996, covering 540 834 live births and stillbirths. Hospital level analyses investigated associations between staffing rates (consultant/junior paediatricians, consultant/junior obstetricians, midwives), facilities (consultant obstetrician/anaesthetist sessions, delivery beds, special care baby unit, neonatal intensive care unit cots, etc), interventions (vaginal births, caesarean sections, forceps, epidurals, inductions, general anaesthetic), parental data (parity, maternal age, social class, deprivation, multiple births), and birthweight standardised stillbirth rates and neonatal mortality. Unifactorial analyses showed consistent negative associations between measures of obstetric intervention and stillbirth rates. Some measures of staffing, facilities, and parental data also showed significant associations. Scores for interventional, organisational, and parental variables were derived for multifactorial analysis to overcome the statistical problems caused by high intercorrelations between variables. A higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates. Organisational and parental factors were not significant after adjustment. Only Townsend deprivation score was significantly associated with neonatal mortality (positive correlation). Birthweight adjusted stillbirth rates were significantly lower in units that took a more interventionalist approach and in those with higher levels of consultant obstetric staffing. There were no apparent associations between neonatal death rates and the hospital factors measured here.

  14. 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

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 2790-055] Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section 106 Consultation Meeting On May 4, 2012, the... Hydropower, Inc. and the Eldred L. Field Hydroelectric Facility Trust (co-licensees for the Lowell...

  15. 77 FR 33729 - Disability and Rehabilitation Research Projects and Centers Program-National Data and Statistical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-07

    ... statistical and other methodological consultation to this collaborative project. Discussion: Grantees under... and technical assistance must be designed to contribute to the following outcomes: (a) Maintenance of... methodological consultation available for research projects that use the BMS Database, as well as site- specific...

  16. Mathematics and statistics research progress report, period ending June 30, 1983

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

    Beauchamp, J. J.; Denson, M. V.; Heath, M. T.

    1983-08-01

    This report is the twenty-sixth in the series of progress reports of Mathematics and Statistics Research of the Computer Sciences organization, Union Carbide Corporation Nuclear Division. Part A records research progress in analysis of large data sets, applied analysis, biometrics research, computational statistics, materials science applications, numerical linear algebra, and risk analysis. Collaboration and consulting with others throughout the Oak Ridge Department of Energy complex are recorded in Part B. Included are sections on biological sciences, energy, engineering, environmental sciences, health and safety, and safeguards. Part C summarizes the various educational activities in which the staff was engaged. Part Dmore » lists the presentations of research results, and Part E records the staff's other professional activities during the report period.« less

  17. Prevalence of psychiatric co-morbidity among patients attending dental OPD and the role of consultation-liaison psychiatry in dental practice in a tertiary care general hospital.

    PubMed

    Ray, Pradip K; Ray Bhattacharya, Sampa; Makhal, Manabendra; Majumder, Uttam; De, Shantanu; Ghosh, Subhankar

    2015-01-01

    Psychiatric co-morbidities are frequent among patients attending dental OPD, some of which go unrecognized and hence untreated. The present study has been carried out to detect the psychiatric co-morbidities among dental patients and determine the scope of consultation-liaison (C-L) psychiatry in a rural teaching hospital regarding comprehensive management of the patients. This cross-sectional, descriptive type study was conducted in a multi-speciality tertiary care teaching hospital in the northern part of West Bengal, India. One hundred patients attending the dental OPD were randomly included in the study and every patient was consecutively referred to psychiatry department for assessment, during the period from 1(st) November 2013 to 30(th) April 2014. All referred patients were clinically examined and psychiatric co-morbidity was assessed by the help of General Health Questionnaire (GHQ)-28 and Mental Status Examination. The data were subjected to statistical package for social sciences (SPSS), version 16, and statistically analyzed using Cross tab and Chi test. P <0.05 was considered to be statistically significant. The commonest dental illness was dental caries (22%). More than two-third of the patients had psychiatric co-morbidity according to GHQ-28 total score. Sixty-eight patients were diagnosed to have mental disorder on mental status examination. Somatoform disorder (25%) was the commonest type of mental disorder, followed by mixed anxiety and depression (14%). This study has pointed the need for psychological examination of patients visiting dental specialty with unexplained physical symptoms. Such patients can be identified and treated, provided a psychiatric consultation service exists.

  18. 40 CFR 725.17 - Consultation with EPA.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Consultation with EPA. 725.17 Section... Applicability § 725.17 Consultation with EPA. Persons may consult with EPA, either in writing or by telephone..., ATTN: Biotechnology Notice Consultation. Persons wishing to consult with EPA by telephone should call...

  19. 40 CFR 725.17 - Consultation with EPA.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Consultation with EPA. 725.17 Section... Applicability § 725.17 Consultation with EPA. Persons may consult with EPA, either in writing or by telephone..., ATTN: Biotechnology Notice Consultation. Persons wishing to consult with EPA by telephone should call...

  20. 40 CFR 725.17 - Consultation with EPA.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Consultation with EPA. 725.17 Section... Applicability § 725.17 Consultation with EPA. Persons may consult with EPA, either in writing or by telephone..., ATTN: Biotechnology Notice Consultation. Persons wishing to consult with EPA by telephone should call...

  1. 40 CFR 725.17 - Consultation with EPA.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Consultation with EPA. 725.17 Section... Applicability § 725.17 Consultation with EPA. Persons may consult with EPA, either in writing or by telephone..., ATTN: Biotechnology Notice Consultation. Persons wishing to consult with EPA by telephone should call...

  2. 24 CFR 200.192 - Removal of 203(k) consultant.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Removal of 203(k) consultant. 200.192 Section 200.192 Housing and Urban Development Regulations Relating to Housing and Urban... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.192 Removal of 203(k...

  3. 24 CFR 200.192 - Removal of 203(k) consultant.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Removal of 203(k) consultant. 200.192 Section 200.192 Housing and Urban Development Regulations Relating to Housing and Urban... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.192 Removal of 203(k...

  4. 24 CFR 200.192 - Removal of 203(k) consultant.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Removal of 203(k) consultant. 200.192 Section 200.192 Housing and Urban Development Regulations Relating to Housing and Urban... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.192 Removal of 203(k...

  5. 24 CFR 200.192 - Removal of 203(k) consultant.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Removal of 203(k) consultant. 200.192 Section 200.192 Housing and Urban Development Regulations Relating to Housing and Urban... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.192 Removal of 203(k...

  6. 24 CFR 200.192 - Removal of 203(k) consultant.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Removal of 203(k) consultant. 200.192 Section 200.192 Housing and Urban Development Regulations Relating to Housing and Urban... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.192 Removal of 203(k...

  7. Mathematics and Statistics Research Department progress report, period ending June 30, 1982

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

    Denson, M.V.; Funderlic, R.E.; Gosslee, D.G.

    1982-08-01

    This report is the twenty-fifth in the series of progress reports of the Mathematics and Statistics Research Department of the Computer Sciences Division, Union Carbide Corporation Nuclear Division (UCC-ND). Part A records research progress in analysis of large data sets, biometrics research, computational statistics, materials science applications, moving boundary problems, numerical linear algebra, and risk analysis. Collaboration and consulting with others throughout the UCC-ND complex are recorded in Part B. Included are sections on biology, chemistry, energy, engineering, environmental sciences, health and safety, materials science, safeguards, surveys, and the waste storage program. Part C summarizes the various educational activities inmore » which the staff was engaged. Part D lists the presentations of research results, and Part E records the staff's other professional activities during the report period.« less

  8. 5 CFR 2426.12 - Requests; petition and procedures for determination of eligibility for consultation rights on...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... determination of eligibility for consultation rights on Government-wide rules or regulations. 2426.12 Section... GENERAL COUNSEL OF THE FEDERAL LABOR RELATIONS AUTHORITY NATIONAL CONSULTATION RIGHTS AND CONSULTATION RIGHTS ON GOVERNMENT-WIDE RULES OR REGULATIONS Consultation Rights on Government-wide Rules or...

  9. 5 CFR 2426.2 - Requests; petition and procedures for determination of eligibility for national consultation rights.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... determination of eligibility for national consultation rights. 2426.2 Section 2426.2 Administrative Personnel... RELATIONS AUTHORITY NATIONAL CONSULTATION RIGHTS AND CONSULTATION RIGHTS ON GOVERNMENT-WIDE RULES OR REGULATIONS National Consultation Rights § 2426.2 Requests; petition and procedures for determination of...

  10. Use of remote video microscopy (telepathology) as an adjunct to neurosurgical frozen section consultation.

    PubMed

    Becker, R L; Specht, C S; Jones, R; Rueda-Pedraza, M E; O'Leary, T J

    1993-08-01

    We investigated the use of remote video microscopy (telepathology) to assist in the diagnosis of 52 neurosurgical frozen section cases. The TelMed system (Discovery Medical Systems, Overland Park, KS), in which the referring pathologist selects appropriate fields for transmission to the consultant, was used for the study. There was a high degree of concordance between the diagnosis rendered on the basis of transmitted video images and that rendered on the basis of direct evaluation of frozen sections; however, in seven cases there was substantial disagreement. Remote evaluation was associated with a more rapid consultation from the standpoint of the consultant, who spent approximately 2 minutes less per case when using remote microscopy; this was achieved at the expense of considerably greater effort on the part of the referring pathologist, who spent approximately 16 minutes per case selecting an average of 4.5 images for transmission to the consultant. The use of remote video microscopy for pathology consultation is associated with a complex series of tradeoffs involving cost, information loss, and timeliness of consultation.

  11. Teaching statistics to nursing students: an expert panel consensus.

    PubMed

    Hayat, Matthew J; Eckardt, Patricia; Higgins, Melinda; Kim, MyoungJin; Schmiege, Sarah J

    2013-06-01

    Statistics education is a necessary element of nursing education, and its inclusion is recommended in the American Association of Colleges of Nursing guidelines for nurse training at all levels. This article presents a cohesive summary of an expert panel discussion, "Teaching Statistics to Nursing Students," held at the 2012 Joint Statistical Meetings. All panelists were statistics experts, had extensive teaching and consulting experience, and held faculty appointments in a U.S.-based nursing college or school. The panel discussed degree-specific curriculum requirements, course content, how to ensure nursing students understand the relevance of statistics, approaches to integrating statistics consulting knowledge, experience with classroom instruction, use of knowledge from the statistics education research field to make improvements in statistics education for nursing students, and classroom pedagogy and instruction on the use of statistical software. Panelists also discussed the need for evidence to make data-informed decisions about statistics education and training for nurses. Copyright 2013, SLACK Incorporated.

  12. 24 CFR 200.190 - HUD list of qualified 203(k) consultants.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false HUD list of qualified 203(k... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.190 HUD list of qualified 203(k) consultants. (a) Qualified consultant list. HUD maintains a list of qualified consultants for use...

  13. 24 CFR 200.190 - HUD list of qualified 203(k) consultants.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false HUD list of qualified 203(k... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.190 HUD list of qualified 203(k) consultants. (a) Qualified consultant list. HUD maintains a list of qualified consultants for use...

  14. 24 CFR 200.190 - HUD list of qualified 203(k) consultants.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false HUD list of qualified 203(k... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.190 HUD list of qualified 203(k) consultants. (a) Qualified consultant list. HUD maintains a list of qualified consultants for use...

  15. 24 CFR 200.190 - HUD list of qualified 203(k) consultants.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false HUD list of qualified 203(k... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.190 HUD list of qualified 203(k) consultants. (a) Qualified consultant list. HUD maintains a list of qualified consultants for use...

  16. 24 CFR 200.190 - HUD list of qualified 203(k) consultants.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false HUD list of qualified 203(k... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.190 HUD list of qualified 203(k) consultants. (a) Qualified consultant list. HUD maintains a list of qualified consultants for use...

  17. 40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Consultants for Environmental Protection. 18.10 Section 18.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL ENVIRONMENTAL PROTECTION RESEARCH FELLOWSHIPS AND SPECIAL RESEARCH CONSULTANTS FOR ENVIRONMENTAL PROTECTION § 18.10 Appointment of Special Research Consultants for Environmental Protection. (a...

  18. 21 CFR 211.34 - Consultants.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  19. 21 CFR 211.34 - Consultants.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  20. 21 CFR 211.34 - Consultants.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  1. 21 CFR 211.34 - Consultants.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  2. 21 CFR 211.34 - Consultants.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  3. 40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  4. 40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  5. 40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  6. 5 CFR 2426.13 - Obligation to consult.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Obligation to consult. 2426.13 Section 2426.13 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE FEDERAL... Regulations § 2426.13 Obligation to consult. (a) When a labor organization has been accorded consultation...

  7. Data contradict common perceptions about a controversial provision of the US Endangered Species Act

    PubMed Central

    Malcom, Jacob W.; Li, Ya-Wei

    2015-01-01

    Separating myth and reality is essential for evaluating the effectiveness of laws. Section 7 of the US Endangered Species Act (Act) directs federal agencies to help conserve threatened and endangered species, including by consulting with the US Fish and Wildlife Service (FWS) or National Marine Fisheries Service on actions the agencies authorize, fund, or carry out. Consultations ensure that actions do not violate the Act’s prohibitions on “jeopardizing” listed species or “destroying or adversely modifying” these species’ critical habitat. Because these prohibitions are broad, many people consider section 7 the primary tool for protecting species under the Act, whereas others believe section 7 severely impedes economic development. This decades-old controversy is driven primarily by the lack of data on implementation: past analyses are either over 25 y old or taxonomically restricted. We analyze data on all 88,290 consultations recorded by FWS from January 2008 through April 2015. In contrast to conventional wisdom about section 7 implementation, no project was stopped or extensively altered as a result of FWS finding jeopardy or adverse modification during this period. We also show that median consultation duration is far lower than the maximum allowed by the Act, and several factors drive variation in consultation duration. The results discredit many of the claims about the onerous nature of section 7 but also raise questions as to how federal agencies could apply this tool more effectively to conserve species. We build on the results to identify ways to improve the effectiveness of consultations for imperiled species conservation and increase the efficiency of consultations. PMID:26668392

  8. Data contradict common perceptions about a controversial provision of the US Endangered Species Act.

    PubMed

    Malcom, Jacob W; Li, Ya-Wei

    2015-12-29

    Separating myth and reality is essential for evaluating the effectiveness of laws. Section 7 of the US Endangered Species Act (Act) directs federal agencies to help conserve threatened and endangered species, including by consulting with the US Fish and Wildlife Service (FWS) or National Marine Fisheries Service on actions the agencies authorize, fund, or carry out. Consultations ensure that actions do not violate the Act's prohibitions on "jeopardizing" listed species or "destroying or adversely modifying" these species' critical habitat. Because these prohibitions are broad, many people consider section 7 the primary tool for protecting species under the Act, whereas others believe section 7 severely impedes economic development. This decades-old controversy is driven primarily by the lack of data on implementation: past analyses are either over 25 y old or taxonomically restricted. We analyze data on all 88,290 consultations recorded by FWS from January 2008 through April 2015. In contrast to conventional wisdom about section 7 implementation, no project was stopped or extensively altered as a result of FWS finding jeopardy or adverse modification during this period. We also show that median consultation duration is far lower than the maximum allowed by the Act, and several factors drive variation in consultation duration. The results discredit many of the claims about the onerous nature of section 7 but also raise questions as to how federal agencies could apply this tool more effectively to conserve species. We build on the results to identify ways to improve the effectiveness of consultations for imperiled species conservation and increase the efficiency of consultations.

  9. 42 CFR 493.1453 - Condition: Laboratories performing high complexity testing; clinical consultant.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... testing; clinical consultant. 493.1453 Section 493.1453 Public Health CENTERS FOR MEDICARE & MEDICAID... Condition: Laboratories performing high complexity testing; clinical consultant. The laboratory must have a clinical consultant who meets the requirements of § 493.1455 of this subpart and provides clinical...

  10. 42 CFR 493.1415 - Condition: Laboratories performing moderate complexity testing; clinical consultant.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... complexity testing; clinical consultant. 493.1415 Section 493.1415 Public Health CENTERS FOR MEDICARE... § 493.1415 Condition: Laboratories performing moderate complexity testing; clinical consultant. The laboratory must have a clinical consultant who meets the qualification requirements of § 493.1417 of this...

  11. 22 CFR 401.21 - Consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Consultation. 401.21 Section 401.21 Foreign Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE Applications § 401.21 Consultation. The Commission may meet or consult with the applicant, the Governments and other persons or their...

  12. 12 CFR 1320.11 - Consultation with financial market utility.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... materials timely submitted by the financial market utility under this section before making a proposed... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Consultation with financial market utility... FINANCIAL MARKET UTILITIES Consultations, Determinations and Hearings § 1320.11 Consultation with financial...

  13. 12 CFR 1320.11 - Consultation with financial market utility.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... materials timely submitted by the financial market utility under this section before making a proposed... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Consultation with financial market utility... FINANCIAL MARKET UTILITIES Consultations, Determinations and Hearings § 1320.11 Consultation with financial...

  14. 12 CFR 1320.11 - Consultation with financial market utility.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... materials timely submitted by the financial market utility under this section before making a proposed... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Consultation with financial market utility... FINANCIAL MARKET UTILITIES Consultations, Determinations and Hearings § 1320.11 Consultation with financial...

  15. 6 CFR 27.120 - Designation of a coordinating official; Consultations and technical assistance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... covered facility shall submit a written request for consultation or technical assistance to the...; Consultations and technical assistance. 27.120 Section 27.120 Domestic Security DEPARTMENT OF HOMELAND SECURITY... coordinating official; Consultations and technical assistance. (a) The Assistant Secretary will designate a...

  16. Personal birth preferences and actual mode of delivery outcomes of obstetricians and gynaecologists in South West England; with comparison to regional and national birth statistics.

    PubMed

    Lightly, Katie; Shaw, Elisabeth; Dailami, Narges; Bisson, Dina

    2014-10-01

    To determine personal birth preferences of obstetricians in various clinical scenarios, in particular elective caesarean section for maternal request. To determine actual rates of modes of deliveries amongst the same group. To compare the obstetrician's mode of delivery rates, to the general population. Following ethical approval, a piloted online survey link was sent via email to 242 current obstetricians and gynaecologists, (consultants and trainees) in South West England. Mode of delivery results were compared to regional and national population data, using Hospital Episode Statistics and subjected to statistical analysis. The response rate was 68%. 90% would hypothetically plan a vaginal delivery, 10% would consider a caesarean section in an otherwise uncomplicated primiparous pregnancy. Of the 94/165 (60%) respondents with children (201 children), mode of delivery for the first born child; normal vaginal delivery 48%, caesarean section 26.5% (elective 8.5%, emergency 18%), instrumental 24.5% and vaginal breech 1%. Only one chose an elective caesarean for maternal request. During 2006-2011 obstetricians have the same overall actual modes of birth as the population (p=0.9). Ten percent of obstetricians report they would consider requesting caesarean section for themselves/their partner, which is the lowest rate reported within UK studies. However only 1% actually had a caesarean solely for maternal choice. When compared to regional/national statistics obstetricians currently have modes of delivery that are not significantly different than the population and suggests that they choose non interventional delivery if possible. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. 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 subcontractors...

  18. 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 subcontractors...

  19. 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 subcontractors...

  20. 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 subcontractors...

  1. Practically Speaking: A Sourcebook for Instructional Consultants in Higher Education.

    ERIC Educational Resources Information Center

    Brinko, Kathleen T., Ed.; Menges, Robert J., Ed.

    The selections in this sourcebook offer a blend of research-based principles and practical advice to the instructional consultant. The first section, Skills and Techniques of Instructional Consultation, contains: (1) The Interactions of Teaching Improvement (Kathleen T. Brink); (2) Instructional Consulting: A Guide for Developing Professional…

  2. 45 CFR 400.57 - Planning and consultation process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  3. 43 CFR 3420.4-4 - Consultation with Indian tribes.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Consultation with Indian tribes. 3420.4-4 Section 3420.4-4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... § 3420.4-4 Consultation with Indian tribes. The Secretary shall consult with any Indian tribe which may...

  4. 43 CFR 3420.4-4 - Consultation with Indian tribes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Consultation with Indian tribes. 3420.4-4 Section 3420.4-4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... § 3420.4-4 Consultation with Indian tribes. The Secretary shall consult with any Indian tribe which may...

  5. 43 CFR 3420.4-4 - Consultation with Indian tribes.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Consultation with Indian tribes. 3420.4-4 Section 3420.4-4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... § 3420.4-4 Consultation with Indian tribes. The Secretary shall consult with any Indian tribe which may...

  6. 43 CFR 3420.4-4 - Consultation with Indian tribes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Consultation with Indian tribes. 3420.4-4 Section 3420.4-4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND... § 3420.4-4 Consultation with Indian tribes. The Secretary shall consult with any Indian tribe which may...

  7. 24 CFR 200.193 - Responsibilities of 203(k) consultants on the list.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Responsibilities of 203(k... Removal Procedures for Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.193 Responsibilities of 203(k) consultants on the list. All consultants included on the list are...

  8. 24 CFR 200.193 - Responsibilities of 203(k) consultants on the list.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Responsibilities of 203(k... Removal Procedures for Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.193 Responsibilities of 203(k) consultants on the list. All consultants included on the list are...

  9. 24 CFR 200.193 - Responsibilities of 203(k) consultants on the list.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Responsibilities of 203(k... Removal Procedures for Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.193 Responsibilities of 203(k) consultants on the list. All consultants included on the list are...

  10. 24 CFR 200.193 - Responsibilities of 203(k) consultants on the list.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Responsibilities of 203(k... Removal Procedures for Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.193 Responsibilities of 203(k) consultants on the list. All consultants included on the list are...

  11. 24 CFR 200.193 - Responsibilities of 203(k) consultants on the list.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Responsibilities of 203(k... Removal Procedures for Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.193 Responsibilities of 203(k) consultants on the list. All consultants included on the list are...

  12. Use of evidence-based management in healthcare administration decision-making.

    PubMed

    Guo, Ruiling; Berkshire, Steven D; Fulton, Lawrence V; Hermanson, Patrick M

    2017-07-03

    Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( r s = 0.217, n = 152, p < 0.01), attitude towards EBMgt ( r s = 0.517, n = 152, p < 0.01), and the number of organization employees ( r s = 0.195, n = 152, p = 0.016). Originality/value This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.

  13. Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study.

    PubMed

    Pan, Hsueh-Hsing; Shih, Hsiu-Ling; Wu, Li-Fen; Hung, Yu-Chun; Chu, Chi-Ming; Wang, Kwua-Yun

    2017-08-17

    The Taiwanese government has promoted palliative care consultation services (PCCS) to support terminally ill patients in acute ward settings to receive palliative care since 2005. Such an intervention can enhance the quality of life and dignity of terminally ill patients. However, research focusing on the relationship between the knowledge, attitude and practice of a PCCS using path modelling in nursing staff is limited. Therefore, the aim of this study was to elucidate the effect of path modeling on the knowledge, attitude and practice toward PCCS in Taiwanese nursing staff. This was a cross-sectional, descriptive study design using convenience sampling. Data collected included demographics, knowledge, attitude and practice as measured by the PCCS inventory (KAP-PCCSI). Two hundred and eighty-four nursing staff from a medical center in northern Taiwan participated in the study in 2013. We performed descriptive statistics, regression analysis, and path modeling using SPSS 19.0 and set p < 0.05 as the statistical significance threshold. The results showed that the identical factor significantly associated with knowledge, attitude, and practice toward PCCS among nurses was the frequency of contact with PCCS. In addition, higher level of knowledge toward PCCS was associated with working in haematology and oncology wards, and participation in education related to palliative care. A more positive attitude toward PCCS was associated with working in a haematology and oncology ward, and experience of friends or relatives dying. Higher level of practice toward PCCS was associated with nurses who participated in education related to palliative care. In the path modeling, we found that holders of a master's degree indirectly positive affected practice toward PCCS. Possession of a bachelor degree or above, being single, working within a haematology and oncology ward, and frequency of contact with PCCS positively affected practice toward PCCS. Based on this study, it is proposed that consultation with PCCS has a positive impact on the care of terminally ill patients. Encouragement of staff to undertake further education can improve the practice of ward staff providing palliative care.

  14. Accreditation of Distance Learning in the Field of Dentistry

    ERIC Educational Resources Information Center

    Hanlon, Linda L.

    2004-01-01

    This study looked at criteria important to dental accreditation consultants when evaluating programs that utilized some distance technology. Attitudinal and demographic data were collected to determine any relationships between these profiles and how a consultant would apply predetermined evaluative criteria. Descriptive statistics, internal…

  15. 40 CFR 161.40 - Consultation with the Agency.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Consultation with the Agency. 161.40 Section 161.40 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR REGISTRATION OF ANTIMICROBIAL PESTICIDES General Provisions § 161.40 Consultation...

  16. 42 CFR 493.1455 - Standard; Clinical consultant qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  17. 42 CFR 493.1417 - Standard; Clinical consultant qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  18. 42 CFR 493.1457 - Standard; Clinical consultant responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  19. 42 CFR 493.1419 - Standard; Clinical consultant responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  20. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  1. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  2. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  3. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  4. 14 CFR 413.5 - Pre-application consultation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Pre-application consultation. 413.5 Section 413.5 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION LICENSING LICENSE APPLICATION PROCEDURES § 413.5 Pre-application consultation. A...

  5. 34 CFR 75.191 - Consultation costs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Consultation costs. 75.191 Section 75.191 Education... Development of Curricula Or Instructional Materials § 75.191 Consultation costs. An applicant may budget... instructional materials. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

  6. 77 FR 64829 - Renewal of the Bureau of Labor Statistics Technical Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-23

    ... DEPARTMENT OF LABOR Bureau of Labor Statistics Renewal of the Bureau of Labor Statistics Technical... of Labor has determined that the renewal of the Bureau of Labor Statistics Technical Advisory... upon the Commissioner of Labor Statistics by 29 U.S.C. 1 and 2. This determination follows consultation...

  7. THE EFFECT OF OUTPATIENT SERVICE QUALITY ON PATIENT SATISFACTION IN TEACHING HOSPITALS IN IRAN

    PubMed Central

    Pouragha, Behrouz; Zarei, Ehsan

    2016-01-01

    Aim: The quality of services plays a primary role in achieving patient satisfaction. The main purpose of this study was to explore the effect of outpatient service quality on patient satisfaction in teaching hospitals in Iran. Methods: this cross-sectional study was conducted in 2014. The study sample included 500 patients were selected with systematic random method from the outpatient departments (clinics) of four teaching hospitals in Tehran. The survey instrument was a questionnaire consisted of 44 items, which were confirmed its reliability and validity. The data were analyzed by using descriptive statistics, Pearson’s correlation, and multivariate regression methods with the SPSS.18 software. Results: According to the findings of this study, the majority of patients had a positive experience in the outpatient departments of the teaching hospitals and thus evaluated the services as good. Perceived service costs, physician consultation, physical environment, and information to patient were found to be the most important determinants of outpatient satisfaction. Conclusion: The results suggest that improving the quality of consultation, providing information to the patients during examination and consultation, creating value for patients by reducing costs or improving service quality, and enhancing the physical environment quality of the clinic can be regarded as effective strategies for the management of teaching hospitals toward increasing outpatient satisfaction. PMID:27047262

  8. THE EFFECT OF OUTPATIENT SERVICE QUALITY ON PATIENT SATISFACTION IN TEACHING HOSPITALS IN IRAN.

    PubMed

    Pouragha, Behrouz; Zarei, Ehsan

    2016-02-01

    The quality of services plays a primary role in achieving patient satisfaction. The main purpose of this study was to explore the effect of outpatient service quality on patient satisfaction in teaching hospitals in Iran. this cross-sectional study was conducted in 2014. The study sample included 500 patients were selected with systematic random method from the outpatient departments (clinics) of four teaching hospitals in Tehran. The survey instrument was a questionnaire consisted of 44 items, which were confirmed its reliability and validity. The data were analyzed by using descriptive statistics, Pearson's correlation, and multivariate regression methods with the SPSS.18 software. According to the findings of this study, the majority of patients had a positive experience in the outpatient departments of the teaching hospitals and thus evaluated the services as good. Perceived service costs, physician consultation, physical environment, and information to patient were found to be the most important determinants of outpatient satisfaction. The results suggest that improving the quality of consultation, providing information to the patients during examination and consultation, creating value for patients by reducing costs or improving service quality, and enhancing the physical environment quality of the clinic can be regarded as effective strategies for the management of teaching hospitals toward increasing outpatient satisfaction.

  9. CONSULT-I Reading. Cincinnati Project. Final Report.

    ERIC Educational Resources Information Center

    Newman, Anabel; And Others

    A study examined the effectiveness of the spring-semester 1993 implementation of the CONSULT-I(R) program, which uses artificial intelligence with statistical pattern recognition in constructing a diagnosis and recommending treatment of reading difficulties. Eight classroom teachers and two Gifted and Talented coordinators at South Avondale…

  10. 24 CFR 92.358 - Consultant activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...

  11. 24 CFR 92.358 - Consultant activities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...

  12. 24 CFR 92.358 - Consultant activities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...

  13. 24 CFR 92.358 - Consultant activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...

  14. 24 CFR 92.358 - Consultant activities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...

  15. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  16. 48 CFR 31.205-33 - Professional and consultant service costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  17. 20 CFR 416.919t - Consultative examination oversight.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Consultative examination oversight. 416.919t Section 416.919t Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... will also perform ongoing special management studies of the quality of consultative examinations...

  18. 20 CFR 416.919t - Consultative examination oversight.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination oversight. 416.919t Section 416.919t Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... will also perform ongoing special management studies of the quality of consultative examinations...

  19. 20 CFR 416.919t - Consultative examination oversight.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Consultative examination oversight. 416.919t Section 416.919t Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... will also perform ongoing special management studies of the quality of consultative examinations...

  20. 20 CFR 416.919t - Consultative examination oversight.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Consultative examination oversight. 416.919t Section 416.919t Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... will also perform ongoing special management studies of the quality of consultative examinations...

  1. 20 CFR 404.1519t - Consultative examination oversight.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Consultative examination oversight. 404.1519t Section 404.1519t Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... will also perform ongoing special management studies of the quality of consultative examinations...

  2. 20 CFR 404.1519t - Consultative examination oversight.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Consultative examination oversight. 404.1519t Section 404.1519t Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... will also perform ongoing special management studies of the quality of consultative examinations...

  3. 20 CFR 416.919t - Consultative examination oversight.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Consultative examination oversight. 416.919t Section 416.919t Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... will also perform ongoing special management studies of the quality of consultative examinations...

  4. 20 CFR 404.1519t - Consultative examination oversight.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Consultative examination oversight. 404.1519t Section 404.1519t Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... will also perform ongoing special management studies of the quality of consultative examinations...

  5. 20 CFR 404.1519t - Consultative examination oversight.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination oversight. 404.1519t Section 404.1519t Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... will also perform ongoing special management studies of the quality of consultative examinations...

  6. 20 CFR 404.1519t - Consultative examination oversight.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Consultative examination oversight. 404.1519t Section 404.1519t Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... will also perform ongoing special management studies of the quality of consultative examinations...

  7. 20 CFR 404.1517 - Consultative examination at our expense.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination at our expense. 404.1517 Section 404.1517 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Evidence § 404.1517 Consultative...

  8. 10 CFR 19.15 - Consultation with workers during inspections.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Consultation with workers during inspections. 19.15 Section 19.15 Energy NUCLEAR REGULATORY COMMISSION NOTICES, INSTRUCTIONS AND REPORTS TO WORKERS: INSPECTION AND INVESTIGATIONS § 19.15 Consultation with workers during inspections. (a) Commission inspectors...

  9. Mathematics and statistics research department. Progress report, period ending June 30, 1981

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

    Lever, W.E.; Kane, V.E.; Scott, D.S.

    1981-09-01

    This report is the twenty-fourth in the series of progress reports of the Mathematics and Statistics Research Department of the Computer Sciences Division, Union Carbide Corporation - Nuclear Division (UCC-ND). Part A records research progress in biometrics research, materials science applications, model evaluation, moving boundary problems, multivariate analysis, numerical linear algebra, risk analysis, and complementary areas. Collaboration and consulting with others throughout the UCC-ND complex are recorded in Part B. Included are sections on biology and health sciences, chemistry, energy, engineering, environmental sciences, health and safety research, materials sciences, safeguards, surveys, and uranium resource evaluation. Part C summarizes the variousmore » educational activities in which the staff was engaged. Part D lists the presentations of research results, and Part E records the staff's other professional activities during the report period.« less

  10. The Statistical Consulting Center for Astronomy (SCCA)

    NASA Technical Reports Server (NTRS)

    Akritas, Michael

    2001-01-01

    The process by which raw astronomical data acquisition is transformed into scientifically meaningful results and interpretation typically involves many statistical steps. Traditional astronomy limits itself to a narrow range of old and familiar statistical methods: means and standard deviations; least-squares methods like chi(sup 2) minimization; and simple nonparametric procedures such as the Kolmogorov-Smirnov tests. These tools are often inadequate for the complex problems and datasets under investigations, and recent years have witnessed an increased usage of maximum-likelihood, survival analysis, multivariate analysis, wavelet and advanced time-series methods. The Statistical Consulting Center for Astronomy (SCCA) assisted astronomers with the use of sophisticated tools, and to match these tools with specific problems. The SCCA operated with two professors of statistics and a professor of astronomy working together. Questions were received by e-mail, and were discussed in detail with the questioner. Summaries of those questions and answers leading to new approaches were posted on the Web (www.state.psu.edu/ mga/SCCA). In addition to serving individual astronomers, the SCCA established a Web site for general use that provides hypertext links to selected on-line public-domain statistical software and services. The StatCodes site (www.astro.psu.edu/statcodes) provides over 200 links in the areas of: Bayesian statistics; censored and truncated data; correlation and regression, density estimation and smoothing, general statistics packages and information; image analysis; interactive Web tools; multivariate analysis; multivariate clustering and classification; nonparametric analysis; software written by astronomers; spatial statistics; statistical distributions; time series analysis; and visualization tools. StatCodes has received a remarkable high and constant hit rate of 250 hits/week (over 10,000/year) since its inception in mid-1997. It is of interest to scientists both within and outside of astronomy. The most popular sections are multivariate techniques, image analysis, and time series analysis. Hundreds of copies of the ASURV, SLOPES and CENS-TAU codes developed by SCCA scientists were also downloaded from the StatCodes site. In addition to formal SCCA duties, SCCA scientists continued a variety of related activities in astrostatistics, including refereeing of statistically oriented papers submitted to the Astrophysical Journal, talks in meetings including Feigelson's talk to science journalists entitled "The reemergence of astrostatistics" at the American Association for the Advancement of Science meeting, and published papers of astrostatistical content.

  11. Consultation-Based Academic Intervention for Children with Attention Deficit Hyperactivity Disorder: School Functioning Outcomes

    ERIC Educational Resources Information Center

    Jitendra, Asha K.; DuPaul, George J.; Volpe, Robert J.; Tresco, Katy E.; Junod, Rosemary E. Vile; Lutz, J. Gary; Cleary, Kristi S.; Flammer-Rivera, Lizette M.; Manella, Mark C.

    2007-01-01

    This study evaluated the effectiveness of two consultation-based models for designing academic interventions to enhance the educational functioning of children with attention deficit hyperactivity disorder. Children (N = 167) meeting "Diagnostic and Statistical Manual" (4th ed.--text revision; American Psychiatric Association, 2000) criteria for…

  12. CONSULT-I Reading South Avondale Elementary School Cincinnati Project. Final Report.

    ERIC Educational Resources Information Center

    Newman, Anabel; And Others

    A study examined the effectiveness of the third year of implementation of the CONSULT-I program, which uses artificial intelligence with statistical pattern recognition in constructing a diagnosis and recommending treatment of reading difficulties. Six elementary classroom teachers at South Avondale Elementary School in Cincinnati, Ohio,…

  13. CONSULT-I Reading. South Avondale Elementary School, Cincinnati Project. Final Report.

    ERIC Educational Resources Information Center

    Newman, Anabel; And Others

    A study examined the effectiveness of the second year of implementation of the CONSULT-I program, which uses artificial intelligence with statistical pattern recognition in constructing a diagnosis and recommending treatment of reading difficulties. Five elementary classroom teachers, two ESEA (Elementary and Secondary Education Act) teachers, and…

  14. CONSULT-I Reading. Ohio Project. Final Report.

    ERIC Educational Resources Information Center

    Newman, Anabel; And Others

    A study examined the effectiveness of the 1991-1992 implementation of the CONSULT-I(R) program (which uses artificial intelligence with statistical pattern recognition in constructing a diagnosis and recommending treatment of reading difficulties) at five cities in Ohio (Akron, Cincinnati, Cleveland, Columbus, and Toledo). A total of 30 teachers…

  15. 20 CFR 410.472 - Consultative examinations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examinations. 410.472 Section... Consultative examinations. Upon reasonable notice of the time and place thereof, any individual filing a claim... physical examinations or tests, at the expense of the Administration, by a physician or other professional...

  16. 10 CFR 76.53 - Consultation with Environmental Protection Agency.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Consultation with Environmental Protection Agency. 76.53 Section 76.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Certification § 76.53 Consultation with Environmental Protection Agency. In reviewing an application for a...

  17. 10 CFR 76.53 - Consultation with Environmental Protection Agency.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Consultation with Environmental Protection Agency. 76.53 Section 76.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Certification § 76.53 Consultation with Environmental Protection Agency. In reviewing an application for a...

  18. 10 CFR 76.53 - Consultation with Environmental Protection Agency.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Consultation with Environmental Protection Agency. 76.53 Section 76.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Certification § 76.53 Consultation with Environmental Protection Agency. In reviewing an application for a...

  19. 10 CFR 76.53 - Consultation with Environmental Protection Agency.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Consultation with Environmental Protection Agency. 76.53 Section 76.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Certification § 76.53 Consultation with Environmental Protection Agency. In reviewing an application for a...

  20. 10 CFR 76.53 - Consultation with Environmental Protection Agency.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Consultation with Environmental Protection Agency. 76.53 Section 76.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Certification § 76.53 Consultation with Environmental Protection Agency. In reviewing an application for a...

  1. 48 CFR 3452.237-71 - Services of consultants.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  2. 34 CFR 75.190 - Consultation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Consultation. 75.190 Section 75.190 Education Office of... Curricula Or Instructional Materials § 75.190 Consultation. Each applicant that intends to develop curricula... other individuals experienced in dissemination. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

  3. Central nervous system lesions: correlation of intraoperative and final diagnoses, six year experience at a referral centre in a developing country, Pakistan.

    PubMed

    Ud Din, Nasir; Memon, Aisha; Idress, Romana; Ahmad, Zubair; Hasan, Sheema

    2011-01-01

    Intraoperative consultation of CNS lesions provides accurate diagnosis to neurosurgeons. Some lesions, however, may cause diagnostic difficulty. In this study accuracy of intraoperative consultations of CNS lesions and discrepancies in diagnosis and deferrals were analysed. All CNS cases from May 1, 2004 to September 20, 2010 in which intraoperative frozen section had been performed, and which were reported in the Section of Histopathology, Aga Khan University Hospital, Karachi Pakistan were retrieved. The diagnoses given on FS were compared with the final diagnosis given on permanent sections (and additional material if received), as indicated in the frozen section and final pathology report. During the study period, 171 CNS cases were received for intraoperative consultation. In all cases, cryostat sections (FS) plus cytology smears were prepared. The ages of the patients ranged from 03 to 77 years. 106 were males and 65 were females. Out of these 171 cases, 160 cases (94.1 %) were concordant, 10 cases (5.8 %) were discrepant, and one case was deferred until permanent sections. The diagnostic accuracy of frozen section was 88.9%. The sensitivity and specificity were 94.8% and 87.5% respectively. The positive predictive value was 98.6% and negative predictive value was 63.6%. All our cases in which intraoperative consultation was requested were sent for primary diagnosis. Adequacy per se was not a criterion for sending cases for intraoperative consultation. Our results show a reasonably high percentage of accuracy in the intraoperative diagnosis of CNS lesions. However, there are limitations and some lesions pose a diagnostic challenge. There is a need to improve our own diagnostic skills and establish better communication with neurosurgeons.

  4. 78 FR 14784 - Northern Natural Gas Company; Notice of Intent To Prepare an Environmental Assessment for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-07

    .... Consultations Under Section 106 of the National Historic Preservation Act In accordance with the Advisory Council on Historic Preservation's implementing regulations for section 106 of the National Historic Preservation Act, we are using this notice to initiate consultation with the Iowa State Historic Preservation...

  5. 78 FR 78350 - Houston Pipe Line Company, LP; Notice of Intent to Prepare an Environmental Assessment for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-26

    ... notice. Consultations Under Section 106 of the National Historic Preservation Act In accordance with the Advisory Council on Historic Preservation's implementing regulations for section 106 of the National Historic Preservation Act, we are using this notice to initiate consultation with the Texas Historical...

  6. 77 FR 2970 - Notice of Intent To Prepare an Environmental Assessment for the Proposed Elba BOG Compressor...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-20

    ... 1501.6. Consultations Under Section 106 of the National Historic Preservation Act In accordance with the Advisory Council on Historic Preservation's implementing regulations for section 106 of the National Historic Preservation Act, we are using this notice to initiate consultation with applicable State...

  7. 15 CFR 2006.11 - Consultations before making determinations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Consultations before making determinations. 2006.11 Section 2006.11 Commerce and Foreign Trade Regulations Relating to Foreign Trade Agreements OFFICE OF THE UNITED STATES TRADE REPRESENTATIVE PROCEDURES FOR FILING PETITIONS FOR ACTION UNDER SECTION 301 OF THE TRADE ACT OF 1974, AS...

  8. 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 ALCOHOL...

  9. 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 ALCOHOL...

  10. 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 ALCOHOL...

  11. 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 ALCOHOL...

  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 ALCOHOL...

  13. 10 CFR 960.3-3 - Consultation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Consultation. 960.3-3 Section 960.3-3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-3 Consultation. The DOE shall provide to designated officials of the affected...

  14. 10 CFR 960.3-3 - Consultation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Consultation. 960.3-3 Section 960.3-3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-3 Consultation. The DOE shall provide to designated officials of the affected...

  15. 10 CFR 960.3-3 - Consultation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Consultation. 960.3-3 Section 960.3-3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-3 Consultation. The DOE shall provide to designated officials of the affected...

  16. 10 CFR 960.3-3 - Consultation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Consultation. 960.3-3 Section 960.3-3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-3 Consultation. The DOE shall provide to designated officials of the affected...

  17. 22 CFR 61.6 - Consultation with subject matter specialists.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Consultation with subject matter specialists. 61.6 Section 61.6 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES WORLD-WIDE FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The...

  18. 22 CFR 61.6 - Consultation with subject matter specialists.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Consultation with subject matter specialists. 61.6 Section 61.6 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES WORLD-WIDE FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The...

  19. 22 CFR 61.6 - Consultation with subject matter specialists.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Consultation with subject matter specialists. 61.6 Section 61.6 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES WORLD-WIDE FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The...

  20. 45 CFR 1302.3 - Consultation with public officials and consumers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Consultation with public officials and consumers. 1302.3 Section 1302.3 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... officials and consumers. Responsible HHS officials will consult with Governors, or their representatives...

  1. 43 CFR 2203.4 - Consultation with the Attorney General.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.4 Consultation with the Attorney General. (a... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Consultation with the Attorney General. 2203.4 Section 2203.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  2. 43 CFR 2203.4 - Consultation with the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.4 Consultation with the Attorney General. (a... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Consultation with the Attorney General. 2203.4 Section 2203.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  3. 43 CFR 2203.4 - Consultation with the Attorney General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.4 Consultation with the Attorney General. (a... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Consultation with the Attorney General. 2203.4 Section 2203.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  4. 43 CFR 2203.4 - Consultation with the Attorney General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.4 Consultation with the Attorney General. (a... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Consultation with the Attorney General. 2203.4 Section 2203.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  5. 48 CFR 931.205-33 - Professional and consultant service costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  6. 25 CFR 170.106 - When must State governments consult with tribes?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false When must State governments consult with tribes? 170.106 Section 170.106 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION ROADS PROGRAM Indian Reservation Roads Program Policy and Eligibility Consultation, Collaboration...

  7. 25 CFR 170.106 - When must State governments consult with tribes?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false When must State governments consult with tribes? 170.106 Section 170.106 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION ROADS PROGRAM Indian Reservation Roads Program Policy and Eligibility Consultation, Collaboration...

  8. 29 CFR 401.13 - Labor relations consultant.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Labor relations consultant. 401.13 Section 401.13 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS MEANING OF TERMS USED IN THIS SUBCHAPTER § 401.13 Labor relations consultant. Labor relations...

  9. 22 CFR 61.6 - Consultation with subject matter specialists.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Consultation with subject matter specialists. 61.6 Section 61.6 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES WORLD-WIDE FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The...

  10. 36 CFR 1270.50 - Consultation with law enforcement agencies.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Consultation with law enforcement agencies. 1270.50 Section 1270.50 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION PRESIDENTIAL RECORDS PRESIDENTIAL RECORDS Presidential Records Compiled for Law Enforcement Purposes § 1270.50 Consultation with...

  11. 10 CFR 7.5 - Consultation with Committee Management Secretariat on establishment of advisory committees...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Consultation with Committee Management Secretariat on establishment of advisory committees; advisory committee charters. 7.5 Section 7.5 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.5 Consultation with Committee Management Secretariat on establishment of...

  12. 10 CFR 7.5 - Consultation with Committee Management Secretariat on establishment of advisory committees...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Consultation with Committee Management Secretariat on establishment of advisory committees; advisory committee charters. 7.5 Section 7.5 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.5 Consultation with Committee Management Secretariat on establishment of...

  13. 10 CFR 7.5 - Consultation with Committee Management Secretariat on establishment of advisory committees...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Consultation with Committee Management Secretariat on establishment of advisory committees; advisory committee charters. 7.5 Section 7.5 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.5 Consultation with Committee Management Secretariat on establishment of...

  14. 20 CFR 404.1519s - Authorizing and monitoring the consultative examination.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... examination. 404.1519s Section 404.1519s Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE... Social Security disability programs of at least $100,000; or (2) Any consultative examination provider... at a minimum will provide: (1) An ongoing active recruitment program for consultative examination...

  15. 22 CFR 61.6 - Consultation with subject matter specialists.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Consultation with subject matter specialists. 61.6 Section 61.6 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES WORLD-WIDE FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The...

  16. 10 CFR 51.40 - Consultation with NRC staff.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Consultation with NRC staff. 51.40 Section 51.40 Energy....40 Consultation with NRC staff. (a) A prospective applicant or petitioner for rulemaking is encouraged to confer with NRC staff as early as possible in its planning process before submitting...

  17. 10 CFR 51.40 - Consultation with NRC staff.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Consultation with NRC staff. 51.40 Section 51.40 Energy....40 Consultation with NRC staff. (a) A prospective applicant or petitioner for rulemaking is encouraged to confer with NRC staff as early as possible in its planning process before submitting...

  18. 10 CFR 51.40 - Consultation with NRC staff.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Consultation with NRC staff. 51.40 Section 51.40 Energy....40 Consultation with NRC staff. (a) A prospective applicant or petitioner for rulemaking is encouraged to confer with NRC staff as early as possible in its planning process before submitting...

  19. 10 CFR 51.40 - Consultation with NRC staff.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Consultation with NRC staff. 51.40 Section 51.40 Energy....40 Consultation with NRC staff. (a) A prospective applicant or petitioner for rulemaking is encouraged to confer with NRC staff as early as possible in its planning process before submitting...

  20. 10 CFR 51.40 - Consultation with NRC staff.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Consultation with NRC staff. 51.40 Section 51.40 Energy....40 Consultation with NRC staff. (a) A prospective applicant or petitioner for rulemaking is encouraged to confer with NRC staff as early as possible in its planning process before submitting...

  1. 10 CFR 7.5 - Consultation with Committee Management Secretariat on establishment of advisory committees...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Consultation with Committee Management Secretariat on establishment of advisory committees; advisory committee charters. 7.5 Section 7.5 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.5 Consultation with Committee Management Secretariat on establishment of...

  2. 10 CFR 7.5 - Consultation with Committee Management Secretariat on establishment of advisory committees...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Consultation with Committee Management Secretariat on establishment of advisory committees; advisory committee charters. 7.5 Section 7.5 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.5 Consultation with Committee Management Secretariat on establishment of...

  3. 45 CFR 1302.3 - Consultation with public officials and consumers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Consultation with public officials and consumers. 1302.3 Section 1302.3 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... officials and consumers. Responsible HHS officials will consult with Governors, or their representatives...

  4. Self-Esteem Among the Elderly Visiting the Healthcare Centers in Kermanshah-Iran (2012).

    PubMed

    Jafari, Franak; Khatony, Alireza; Mehrdad, Malek

    2015-04-15

    Self-esteem is viewed the most decisive factor in the psychological development of the elderly. This study was performed to assess self-esteem among the elderly referring to the elderly consulting unit of the healthcare centers in Kermanshah, Iran. A cross-sectional study was completed with 201 elderly respondents visiting the consulting unit of the healthcare services in Kermanshah, Iran. The samples were selected through convenience sampling. Rosenberg Self-esteem Scale (RSC) was used to gather the required data. Data were analyzed by using both descriptive (frequency, mean, median and standard deviation) and inferential statistics (chi-square and independent t-test). The findings showed a mean of 35.63±5.25 for self-esteem, indicating a high level of self-esteem (66.2%) among the elderly. A statistically significant difference was reported between the mean of self-esteem and career (p<0.001), marital status (p<0.04), history of health problems (p<0.04), residence (p<0.001), education (p<0.001) and income (p<0.001). The findings of this study indicated that approximately one third of the elderly had a low self-esteem, which is indicative of the need to promote the self-esteem of the elderly in order to reduce their physical, psychological and social problems. Thus, it is necessary for the healthcare authorities to provide the elderly with financial, social and psychological support.

  5. OFF-SITE SMARTPHONE VS. STANDARD WORKSTATION IN THE RADIOGRAPHIC DIAGNOSIS OF SMALL INTESTINAL MECHANICAL OBSTRUCTION IN DOGS AND CATS.

    PubMed

    Noel, Peter G; Fischetti, Anthony J; Moore, George E; Le Roux, Alexandre B

    2016-09-01

    Off-site consultations by board-certified veterinary radiologists benefit residents and emergency clinicians by providing immediate feedback and potentially improving patient outcome. Smartphone devices and compressed images transmitted by email or text greatly facilitate availability of these off-site consultations. Criticism of a smartphone interface for off-site consultation is mostly directed at image degradation relative to the standard radiographic viewing room and monitors. The purpose of this retrospective, cross-sectional, methods comparison study was to compare the accuracy of abdominal radiographs in two imaging interfaces (Joint Photographic Experts Group, off-site, smartphone vs. Digital Imaging and Communications in Medicine, on-site, standard workstation) for the diagnosis of small intestinal mechanical obstruction in vomiting dogs and cats. Two board-certified radiologists graded randomized abdominal radiographs using a five-point Likert scale for the presence of mechanical obstruction in 100 dogs or cats presenting for vomiting. The area under the receiver operator characteristic curves for both imaging interfaces was high. The accuracy of the smartphone and traditional workstation was not statistically significantly different for either reviewer (P = 0.384 and P = 0.536). Correlation coefficients were 0.821 and 0.705 for each reviewer when the same radiographic study was viewed in different formats. Accuracy differences between radiologists were potentially related to years of experience. We conclude that off-site expert consultation with a smartphone provides an acceptable interface for accurate diagnosis of small intestinal mechanical obstruction in dogs and cat. © 2016 American College of Veterinary Radiology.

  6. [Mobile geriatric consultant services for rest homes. Study of the effects of consultations by internal medicine specialists in the medical care of rest home residents].

    PubMed

    Schippinger, W; Hartinger, G; Hierzer, A; Osprian, I; Bohnstingl, M; Pilgram, E H

    2012-12-01

    Hospital admissions are frequent among long-term residents of nursing homes and can result in detrimental complications affecting the patients' somatic, psychological, and cognitive status. In this prospective controlled study, we investigated the effects of a mobile geriatric consultant service (GECO) offered by specialists in internal medicine on frequency of hospitalizations in nursing home residents. During a 10-month observation period, residents in a control nursing home received medical attendance by general practitioners as is common in Austrian nursing homes. Residents in the intervention nursing home also received the medical service of GECO. Within the group of rest home residents receiving GECO support, a statistically significant lower frequency of acute transports to hospitals was observed in comparison to residents of the control nursing home (mean number of acute transports to hospitals/100 residents/month: 6.1 versus 11.7; p < 0.01). The number of planned non-acute hospital and specialist office presentations was also lower in the intervention nursing home (mean number of hospital and specialist office presentations/100 residents/month: 14.4 versus 18.0); however, this difference did not reach statistical significance. This study shows that a mobile medical geriatric consultant service based on specialists in internal medicine can improve medical care in nursing homes resulting in a statistically significant reduction of acute transports to hospitals.

  7. 30 CFR 243.201 - How will MMS determine if I am financially solvent?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  8. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... RESERVE BANKS § 269.10 Time for internal labor organization business, consultations and negotiations... time, but the President or a duly authorized officer of a Bank may require that negotiations with a...

  9. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... § 269.10 Time for internal labor organization business, consultations and negotiations. Solicitation of..., but the President or a duly authorized officer of a Bank may require that negotiations with a labor...

  10. 14 CFR § 1261.403 - Consultation with appropriate officials; negotiation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Consultation with appropriate officials; negotiation. § 1261.403 Section § 1261.403 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... Consultation with appropriate officials; negotiation. (a) The authority pursuant to § 1261.402 to determine to...

  11. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 1 2012-07-01 2012-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD may...

  12. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... RESERVE BANKS § 269.10 Time for internal labor organization business, consultations and negotiations... time, but the President or a duly authorized officer of a Bank may require that negotiations with a...

  13. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... RESERVE BANKS § 269.10 Time for internal labor organization business, consultations and negotiations... time, but the President or a duly authorized officer of a Bank may require that negotiations with a...

  14. 12 CFR 269.10 - Time for internal labor organization business, consultations and negotiations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., consultations and negotiations. 269.10 Section 269.10 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD... § 269.10 Time for internal labor organization business, consultations and negotiations. Solicitation of..., but the President or a duly authorized officer of a Bank may require that negotiations with a labor...

  15. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 1 2014-07-01 2014-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD may...

  16. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD may...

  17. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 1 2013-07-01 2013-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD may...

  18. 32 CFR 176.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 1 2011-07-01 2011-07-01 false HUD's negotiations and consultations with the LRA. 176.25 Section 176.25 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE... REDEVELOPMENT AND HOMELESS ASSISTANCE § 176.25 HUD's negotiations and consultations with the LRA. HUD may...

  19. 43 CFR 3420.1-7 - Consultation with states and Indian tribes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Consultation with states and Indian tribes. 3420.1-7 Section 3420.1-7 Public Lands: Interior Regulations Relating to Public Lands (Continued... Competitive Leasing § 3420.1-7 Consultation with states and Indian tribes. Before adopting a comprehensive...

  20. 43 CFR 3420.1-7 - Consultation with states and Indian tribes.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Consultation with states and Indian tribes. 3420.1-7 Section 3420.1-7 Public Lands: Interior Regulations Relating to Public Lands (Continued... Competitive Leasing § 3420.1-7 Consultation with states and Indian tribes. Before adopting a comprehensive...

  1. 43 CFR 3420.1-7 - Consultation with states and Indian tribes.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Consultation with states and Indian tribes. 3420.1-7 Section 3420.1-7 Public Lands: Interior Regulations Relating to Public Lands (Continued... Competitive Leasing § 3420.1-7 Consultation with states and Indian tribes. Before adopting a comprehensive...

  2. 43 CFR 3420.1-7 - Consultation with states and Indian tribes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Consultation with states and Indian tribes. 3420.1-7 Section 3420.1-7 Public Lands: Interior Regulations Relating to Public Lands (Continued... Competitive Leasing § 3420.1-7 Consultation with states and Indian tribes. Before adopting a comprehensive...

  3. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and the...

  4. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and the...

  5. 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 the...

  6. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and the...

  7. 40 CFR 166.22 - Consultation with the Secretary of Agriculture and Governors of the States.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Agriculture and Governors of the States. 166.22 Section 166.22 Protection of Environment ENVIRONMENTAL... Consultation with the Secretary of Agriculture and Governors of the States. The Agency, in determining whether or not such emergency conditions exist, shall consult with the Secretary of Agriculture and the...

  8. A Survey of Statistical Capstone Projects

    ERIC Educational Resources Information Center

    Martonosi, Susan E.; Williams, Talithia D.

    2016-01-01

    In this article, we highlight the advantages of incorporating a statistical capstone experience in the undergraduate curriculum, where students perform an in-depth analysis of real-world data. Capstone experiences develop statistical thinking by allowing students to engage in a consulting-like experience that requires skills outside the scope of…

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

    PubMed

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

    2017-01-01

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

  10. Confidence Intervals for Effect Sizes: Compliance and Clinical Significance in the "Journal of Consulting and Clinical Psychology"

    ERIC Educational Resources Information Center

    Odgaard, Eric C.; Fowler, Robert L.

    2010-01-01

    Objective: In 2005, the "Journal of Consulting and Clinical Psychology" ("JCCP") became the first American Psychological Association (APA) journal to require statistical measures of clinical significance, plus effect sizes (ESs) and associated confidence intervals (CIs), for primary outcomes (La Greca, 2005). As this represents the single largest…

  11. 22 CFR 63.6 - Assignment of United States Government employees to consult, lecture, teach, engage in research...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... employees to consult, lecture, teach, engage in research, or demonstrate special skills. 63.6 Section 63.6... Government employees to consult, lecture, teach, engage in research, or demonstrate special skills. An..., teach, engage in research, or demonstrate special skills, may be entitled to any or all of the following...

  12. 22 CFR 63.6 - Assignment of United States Government employees to consult, lecture, teach, engage in research...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... employees to consult, lecture, teach, engage in research, or demonstrate special skills. 63.6 Section 63.6... Government employees to consult, lecture, teach, engage in research, or demonstrate special skills. An..., teach, engage in research, or demonstrate special skills, may be entitled to any or all of the following...

  13. 22 CFR 63.6 - Assignment of United States Government employees to consult, lecture, teach, engage in research...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... employees to consult, lecture, teach, engage in research, or demonstrate special skills. 63.6 Section 63.6... Government employees to consult, lecture, teach, engage in research, or demonstrate special skills. An..., teach, engage in research, or demonstrate special skills, may be entitled to any or all of the following...

  14. 22 CFR 63.6 - Assignment of United States Government employees to consult, lecture, teach, engage in research...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... employees to consult, lecture, teach, engage in research, or demonstrate special skills. 63.6 Section 63.6... Government employees to consult, lecture, teach, engage in research, or demonstrate special skills. An..., teach, engage in research, or demonstrate special skills, may be entitled to any or all of the following...

  15. 22 CFR 63.6 - Assignment of United States Government employees to consult, lecture, teach, engage in research...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... employees to consult, lecture, teach, engage in research, or demonstrate special skills. 63.6 Section 63.6... Government employees to consult, lecture, teach, engage in research, or demonstrate special skills. An..., teach, engage in research, or demonstrate special skills, may be entitled to any or all of the following...

  16. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research misconduct...

  17. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research misconduct...

  18. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research misconduct...

  19. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research misconduct...

  20. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research misconduct...

  1. 49 CFR 7.17 - Consultation with submitters of commercial and financial information.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Consultation with submitters of commercial and financial information. 7.17 Section 7.17 Transportation Office of the Secretary of Transportation PUBLIC AVAILABILITY OF INFORMATION Availability of Reasonably Described Records Under the Freedom of Information Act § 7.17 Consultation with submitters o...

  2. 24 CFR 200.191 - Placement of 203(k) consultant.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Placement of 203(k) consultant. 200... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.191 Placement of 203(k... certify that it has read and fully understands the requirements of the HUD handbook on the 203(k) Program...

  3. 24 CFR 200.191 - Placement of 203(k) consultant.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Placement of 203(k) consultant. 200... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.191 Placement of 203(k... certify that it has read and fully understands the requirements of the HUD handbook on the 203(k) Program...

  4. 24 CFR 200.191 - Placement of 203(k) consultant.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Placement of 203(k) consultant. 200... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.191 Placement of 203(k... certify that it has read and fully understands the requirements of the HUD handbook on the 203(k) Program...

  5. 24 CFR 200.191 - Placement of 203(k) consultant.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Placement of 203(k) consultant. 200... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.191 Placement of 203(k... certify that it has read and fully understands the requirements of the HUD handbook on the 203(k) Program...

  6. 24 CFR 200.191 - Placement of 203(k) consultant.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Placement of 203(k) consultant. 200... Participation in FHA Programs Section 203(k) Rehabilitation Loan Consultants § 200.191 Placement of 203(k... certify that it has read and fully understands the requirements of the HUD handbook on the 203(k) Program...

  7. 22 CFR 63.3 - Grants to foreign participants to observe, consult, demonstrate special skills, or engage in...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., consult, demonstrate special skills, or engage in specialized programs. 63.3 Section 63.3 Foreign... observe, consult, demonstrate special skills, or engage in specialized programs. A citizen or national of... special skills, or engage in specialized programs, may be entitled to any or all of the following benefits...

  8. 22 CFR 63.3 - Grants to foreign participants to observe, consult, demonstrate special skills, or engage in...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., consult, demonstrate special skills, or engage in specialized programs. 63.3 Section 63.3 Foreign... observe, consult, demonstrate special skills, or engage in specialized programs. A citizen or national of... special skills, or engage in specialized programs, may be entitled to any or all of the following benefits...

  9. Size and consistency of problem-solving consultation outcomes: an empirical analysis.

    PubMed

    Hurwitz, Jason T; Kratochwill, Thomas R; Serlin, Ronald C

    2015-04-01

    In this study, we analyzed extant data to evaluate the variability and magnitude of students' behavior change outcomes (academic, social, and behavioral) produced by consultants through problem-solving consultation with teachers. Research questions were twofold: (a) Do consultants produce consistent and sizeable positive student outcomes across their cases as measured through direct and frequent assessment? and (b) What proportion of variability in student outcomes is attributable to consultants? Analyses of extant data collected from problem-solving consultation outcome studies that used single-case, time-series AB designs with multiple participants were analyzed. Four such studies ultimately met the inclusion criteria for the extant data, comprising 124 consultants who worked with 302 school teachers regarding 453 individual students. Consultants constituted the independent variable, while the primary dependent variable was a descriptive effect size based on student behavior change as measured by (a) curriculum-based measures, (b) permanent products, or (c) direct observations. Primary analyses involved visual and statistical evaluation of effect size magnitude and variability observed within and between consultants and studies. Given the nested nature of the data, multilevel analyses were used to assess consultant effects on student outcomes. Results suggest that consultants consistently produced positive effect sizes on average across their cases, but outcomes varied between consultants. Findings also indicated that consultants, teachers, and the corresponding studies accounted for a significant proportion of variability in student outcomes. This investigation advances the use of multilevel and integrative data analyses to evaluate consultation outcomes and extends research on problem-solving consultation, consultant effects, and meta-analysis of case study AB designs. Practical implications for evaluating consultation service delivery in school settings are also discussed. Copyright © 2015 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  10. 7 CFR 1486.201 - Under what conditions may research and consultant organizations, individuals, or any other for...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., individuals, or any other for-profit entity apply to the program? (a) Proposals from research and consulting... 7 Agriculture 10 2010-01-01 2010-01-01 false Under what conditions may research and consultant organizations, individuals, or any other for-profit entity apply to the program? 1486.201 Section 1486.201...

  11. 25 CFR 115.807 - Will OTFM consult with tribes about investments of tribal trust funds?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Tribal Trust Funds § 115.807 Will OTFM consult with tribes about investments of tribal trust funds? Upon... 25 Indians 1 2011-04-01 2011-04-01 false Will OTFM consult with tribes about investments of tribal trust funds? 115.807 Section 115.807 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR...

  12. More counselling for end-of-life decisions by GPs with own advance directives: A postal survey among German general practitioners.

    PubMed

    Schnakenberg, Rieke; Radbruch, Lukas; Kersting, Christine; Frank, Friederike; Wilm, Stefan; Becka, Denise; Weckbecker, Klaus; Bleckwenn, Markus; Just, Johannes M; Pentzek, Michael; Weltermann, Birgitta

    2018-12-01

    Although general practitioners (GPs) are among the preferred contact persons for discussing end-of-life issues including advance directives (ADs), there is little data on how GPs manage such consultations. This postal survey asked German GPs about their counselling for end-of-life decisions. In 2015, a two-sided questionnaire was mailed to 959 GPs. GPs were asked for details of their consultations on ADs: frequency, duration, template use, and whether they have own ADs. Statistical analysis evaluated physician characteristics associated with an above-average number of consultations on AD. The participation rate was 50.3% (n = 482), 70.5% of the GPs were male; the average age was 54 years. GPs had an average of 18 years of professional experience, and 61.4% serve more than 900 patients per three months. Most (96.9%) GPs perform consultations on living wills (LW) and/or powers of attorney (PA), mainly in selected patients (72.3%). More than 20 consultations each on LWs and PAs are performed by 60% and 50% of GPs, respectively. The estimated mean duration of consultations was 21 min for LWs and 16 min for PAs. Predefined templates were used in 72% of the GPs, 50% of GPs had their ADs. A statistical model showed that GPs with ADs and/or a qualification in palliative medicine were more likely to counsel ≥20 patients per year for each document. The study confirmed that nearly all German GPs surveyed provide counselling on ADs. Physicians with ADs counsel more frequently than those without such documents.

  13. Obstetric and Gynecologic Patients' Attitudes and Perceptions Toward Medical Students in Saudi Arabia

    PubMed Central

    Anfinan, Nisrin; Alghunaim, Nadine; Boker, Abdulaziz; Hussain, Amro; Almarstani, Ahmad; Basalamah, Hussain; Sait, Hesham; Arif, Rawan; Sait, Khalid

    2014-01-01

    Objective To identify patients’ attitudes, preferences and comfort levels regarding the presence and involvement of medical students during consultations and examinations. Methods A cross-sectional descriptive study was conducted from September 2011 to December 2011 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Participants were randomly selected from the outpatient and inpatient clinics at the Department of Obstetrics and Gynecology and the Emergency Department, provided they were admitted for obstetric or gynecology-related conditions. Data were collected using a structured questionnaire, and data analysis was performed using the Statistical Package for Social Sciences. Results Of the 327 patients who were recruited, 272 (83%) were elective patients who were seen at the outpatient and inpatient clinics of the Department of Obstetrics and Gynecology (group I). The other 55 (16.8%) were seen at the Emergency Department or the Labor and Delivery Ward (group II). One hundred seventy-nine participants (160 [58.8%] in group I and 19 [34.5%] in group II) reported positive attitudes about the presence of female medical students during consultations. Fewer participants (115 [42.3%] were in group I and 17 [30.9%] in group II) reported positive attitudes regarding the presence of male medical students during consultations (p=0.095). The gender of the medical student was the primary factor that influenced patients’ decision to accept or decline medical student involvement. No significant associations were observed between patients’ attitudes and perceptions toward medical students and the patients' age, educational level, nationality or the gender of the consultant. Conclusion Obstetrics and Gynecology patients are typically accepting of female medical student involvement during examinations. Student gender is the primary factor that influences patient attitudes regarding student involvement during physical examinations. PMID:24715936

  14. 31 CFR 561.803 - Consultations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Consultations. In implementing sections 104 and 104A of the Comprehensive Iran Sanctions, Accountability, and Divestment Act of 2010 (Pub. L. 111-195) (22 U.S.C. 8501-8551), as amended by the Iran Threat Reduction and...

  15. 31 CFR 561.803 - Consultations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Consultations. In implementing sections 104 and 104A of the Comprehensive Iran Sanctions, Accountability, and Divestment Act of 2010 (Pub. L. 111-195) (22 U.S.C. 8501-8551), as amended by the Iran Threat Reduction and...

  16. Patients' reflections on communication in the second-opinion hematology-oncology consultation.

    PubMed

    Goldman, Roberta E; Sullivan, Amy; Back, Anthony L; Alexander, Stewart C; Matsuyama, Robin K; Lee, Stephanie J

    2009-07-01

    The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients' perceptions of their second-opinion hematology-oncology consultation to investigate physician-patient communication in malignant disease at a critical juncture in cancer patients' care and decision-making. In-depth telephone interviews with a subset of 20 patients from a larger study, following their subspecialty hematology consultations. Most patients wanted to contribute to the consultation agenda, but were unable to do so. Patients sought expert and honest advice delivered with empathy, though most did not expect the consultant to directly address their emotions. They wanted the physician to apply his/her knowledge to the specifics of their individual cases, and were disappointed and distrustful when physicians cited only general prognostic statistics. In contrast, physicians' consideration of the unique elements of patients' cases, and demonstrations of empathy and respect made patients' feel positively about the encounter, regardless of the prognosis. Patients provided concrete recommendations for physician and patient behaviors to enhance the consultation. Consideration of these recommendations may result in more effective communication and increased patient satisfaction with medical visits.

  17. Self-Esteem Among the Elderly Visiting the Healthcare Centers in Kermanshah-Iran (2012)

    PubMed Central

    Franak, Jafari; Alireza, Khatony; Malek, Mehrdad

    2015-01-01

    Background and Objective: Self-esteem is viewed the most decisive factor in the psychological development of the elderly. This study was performed to assess self-esteem among the elderly referring to the elderly consulting unit of the healthcare centers in Kermanshah, Iran. Methods: A cross-sectional study was completed with 201 elderly respondents visiting the consulting unit of the healthcare services in Kermanshah, Iran. The samples were selected through convenience sampling. Rosenberg Self-esteem Scale (RSC) was used to gather the required data. Data were analyzed by using both descriptive (frequency, mean, median and standard deviation) and inferential statistics (chi-square and independent t-test). Results: The findings showed a mean of 35.63±5.25 for self-esteem, indicating a high level of self-esteem (66.2%) among the elderly. A statistically significant difference was reported between the mean of self-esteem and career (p<0.001), marital status (p<0.04), history of health problems (p<0.04), residence (p<0.001), education (p<0.001) and income (p<0.001). Conclusion: The findings of this study indicated that approximately one third of the elderly had a low self-esteem, which is indicative of the need to promote the self-esteem of the elderly in order to reduce their physical, psychological and social problems. Thus, it is necessary for the healthcare authorities to provide the elderly with financial, social and psychological support. PMID:26156932

  18. Day Care for All Children: Integrating Children with Special Needs into Community Child Care Settings. A Resource and Consultation Manual.

    ERIC Educational Resources Information Center

    Gaumer, Nancy; And Others

    This manual provides guidance on using the consultation method to help meet the needs of families of children with disabilities in integrated community-based day care settings. The introductory section provides an overview, a statement of philosophy, the history of the day care consultation program in Illinois, and instructions for using the…

  19. External Tank Liquid Hydrogen (LH2) Prepress Regression Analysis Independent Review Technical Consultation Report

    NASA Technical Reports Server (NTRS)

    Parsons, Vickie s.

    2009-01-01

    The request to conduct an independent review of regression models, developed for determining the expected Launch Commit Criteria (LCC) External Tank (ET)-04 cycle count for the Space Shuttle ET tanking process, was submitted to the NASA Engineering and Safety Center NESC on September 20, 2005. The NESC team performed an independent review of regression models documented in Prepress Regression Analysis, Tom Clark and Angela Krenn, 10/27/05. This consultation consisted of a peer review by statistical experts of the proposed regression models provided in the Prepress Regression Analysis. This document is the consultation's final report.

  20. A Field Study in the Application of CONSULT-I to the Problem of Inconsistency in Diagnosis and Treatment of Reading Difficulties. Proffitt Grant Final Report.

    ERIC Educational Resources Information Center

    Newman, Anabel P.; Metz, Elizabeth

    A field study tested the application of the CONSULT-I (R) program, which uses artificial intelligence with statistical pattern recognition in constructing a diagnosis and recommending treatment of reading difficulties. Participants in the field study came from 10 southern and central Indiana school districts, both public and parochial, and one…

  1. Data exploration of social client relationship management (CRM 2.0) adoption in the Nigerian construction business.

    PubMed

    Ojelabi, Rapheal A; Afolabi, Adedeji O; Oyeyipo, Opeyemi O; Tunji-Olayeni, Patience F; Adewale, Bukola A

    2018-06-01

    Integrating social client relationship management (CRM 2.0) in the built environment can enhance the relationship between construction organizations and client towards sustaining a long and lasting collaboration. The data exploration analyzed the e-readiness of contracting and consulting construction firms in the uptake of CRM 2.0 and the barriers encountered in the adoption of the modern business tool. The targeted organizations consist of seventy five (75) construction businesses operating in Lagos State which were selected from a pool of registered contracting and consulting construction firms using random sampling technique. Descriptive statistics of the e-readiness of contracting and consulting construction firms for CRM 2.0 adoption and barriers limiting its uptake were analyzed. Also, inferential analysis using Mann-Whitney U statistical and independent sample t-test was performed on the dataset obtained. The data generated will support construction firms on the necessity to engage in client social relationship management in ensuring sustainable client relationship management in the built environment.

  2. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial.

    PubMed

    Dziedzic, K S; Healey, E L; Porcheret, M; Afolabi, E K; Lewis, M; Morden, A; Jinks, C; McHugh, G A; Ryan, S; Finney, A; Main, C; Edwards, J J; Paskins, Z; Pushpa-Rajah, A; Hay, E M

    2018-01-01

    To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression. 525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3). Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months. ISRCTN06984617. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Knowledge, practice and utilization of dental services among pregnant women in the north of Jordan.

    PubMed

    Malkawi, Zain A; Tubaishat, Reem S

    2014-05-01

    The aim of this study was to evaluate women's oral hygiene knowledge, practice, and use of dental services during pregnancy in the north of Jordan. Voluntary sample of 154 pregnant women of 18 to 40 years old were invited to participate in the study. They were asked to read a self-designated questionnaire and a cover letter which explained the purpose of the study. The questionnaire addressed self-reported demographics, knowledge, practice and use of dental services during pregnancy. Data were statistically analyzed using Chi-square test to determine statistically significant differences across knowledge, practice and use of dental services during pregnancy. The sample included 29.3% aged 20 to 24 years old; 33.1% having bachelor degree; and 66.9% were housewives. The majority of study sample 68.2% knew they need dental consultation during pregnancy; however, 39.5% received dental consultation during pregnancy. Majority 62.4% brushed their teeth regularly; however, 73.2% does not use auxiliary dental hygiene devices. Majority 44.5% visited dentist, when they feel pain. Statistically significant association were found between educational level and knowledge about need to dental consultation during pregnancy (p = 0.012); educational level and knowledge about link between pregnancy and periodontal diseases (p = 0.01); and economic status and use of auxiliary dental hygiene devices during pregnancy (p = 0.040). Pregnant women brushed their teeth regularly and visited dentist occasionally. Income was significantly associated with increase use of auxiliary dental hygiene devices. Educational level was significantly associated with mothers' knowledge about the need for consultation and possible link between pregnancy and periodontal diseases.

  4. Are French general practitioners consulted before travel to developing countries? A cross-sectional study conducted in a French airport.

    PubMed

    Rovira, C; Buffel du Vaure, C; Partouche, H

    2015-08-01

    General practitioners (GPs) could play a central role in preventing travel-related health issues. The aim of this study was to assess, in travellers departing to developing countries from a French airport, the proportion of individuals having sought GP counseling before departure and to identify determinants for having consulted a GP. Cross-sectional study conducted between November 2012 and July 2013, in all adults living in France. Sociodemographic, health characteristics, type of travel and resources consulted before departure were collected. A descriptive analysis was performed. Determinants for having consulted a GP before departure were investigated using a logistic regression analysis. Of the 360 travellers included, 230 (64%) sought health counseling before departure. GPs were the main source of information for 134 (58%) travellers having sought health information and the only one for 49 (21%). Almost half of the travellers (48%) departing to sub-Saharan countries did not seek health counseling from a medical doctor (GP, non-GP specialist, specialist consulted in an international vaccination center or occupational physician). Individuals significantly more likely to travel without having consulted a GP were young and male, held foreign nationality, had travelled more than five times before, rarely consulted their GP and were travelling to a non-malarious area. GPs were the main but not the only source of information and counseling before traveling to a developing country. This study helps identify the characteristics of individuals likely to travel without having consulted a GP before departure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. 14 CFR 414.9 - Pre-application consultation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Pre-application consultation. 414.9 Section 414.9 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION... application process and the potential issues relevant to the FAA's safety approval decision. ...

  6. 14 CFR 414.9 - Pre-application consultation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Pre-application consultation. 414.9 Section 414.9 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION... application process and the potential issues relevant to the FAA's safety approval decision. ...

  7. 14 CFR 414.9 - Pre-application consultation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Pre-application consultation. 414.9 Section 414.9 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION... application process and the potential issues relevant to the FAA's safety approval decision. ...

  8. 14 CFR 414.9 - Pre-application consultation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Pre-application consultation. 414.9 Section 414.9 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION... application process and the potential issues relevant to the FAA's safety approval decision. ...

  9. 15 CFR 922.197 - Consultation with affected federally-recognized Indian tribes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...-recognized Indian tribes. 922.197 Section 922.197 Commerce and Foreign Trade Regulations Relating to Commerce... tribes. The Director shall regularly consult with the governing bodies of affected federally-recognized Indian tribes regarding areas of mutual concern. ...

  10. 15 CFR 922.197 - Consultation with affected federally-recognized Indian tribes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-recognized Indian tribes. 922.197 Section 922.197 Commerce and Foreign Trade Regulations Relating to Commerce... tribes. The Director shall regularly consult with the governing bodies of affected federally-recognized Indian tribes regarding areas of mutual concern. ...

  11. 15 CFR 922.197 - Consultation with affected federally-recognized Indian tribes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-recognized Indian tribes. 922.197 Section 922.197 Commerce and Foreign Trade Regulations Relating to Commerce... tribes. The Director shall regularly consult with the governing bodies of affected federally-recognized Indian tribes regarding areas of mutual concern. ...

  12. 15 CFR 922.197 - Consultation with affected federally-recognized Indian tribes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-recognized Indian tribes. 922.197 Section 922.197 Commerce and Foreign Trade Regulations Relating to Commerce... tribes. The Director shall regularly consult with the governing bodies of affected federally-recognized Indian tribes regarding areas of mutual concern. ...

  13. 15 CFR 922.197 - Consultation with affected federally-recognized Indian tribes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...-recognized Indian tribes. 922.197 Section 922.197 Commerce and Foreign Trade Regulations Relating to Commerce... tribes. The Director shall regularly consult with the governing bodies of affected federally-recognized Indian tribes regarding areas of mutual concern. ...

  14. 14 CFR 414.9 - Pre-application consultation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Pre-application consultation. 414.9 Section 414.9 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION LICENSING SAFETY APPROVALS Application Procedures § 414.9 Pre-application...

  15. Peer consultation on relationship between PAC profile and toxicity of petroleum substances.

    PubMed

    Patterson, Jacqueline; Maier, Andrew; Kohrman-Vincent, Melissa; Dourson, Michael L

    2013-11-01

    An expert peer consultation panel reviewed a report by the PAC Analysis Task Group, which hypothesized that systemic, developmental, and reproductive toxicity observed in repeated-dose dermal toxicity studies was related to polycyclic aromatic compound (PAC) content. Peer consultations seek to solicit scientific and technical input from experts on the scientific basis and merits of the subject report. This peer consultation panel included nine scientists with expertise in petroleum chemistry, biostatistics, toxicology, risk assessment, structure activity, and reproductive and developmental toxicology. The panel evaluated the technical quality of the PAC report and provided recommendations for improving the statistical and biological approaches. The PAC report authors revised their methods and documentation, which are published elsewhere in this supplement. A review of the post peer consultation manuscripts confirmed that many of the key suggestions from expert panel members were considered and incorporated. In cases where the PAC report authors did not fully incorporate panel suggestions from the peer consultation, they have provided an explanation and support for their decision. This peer consultation demonstrates the value of formal engagement of peers in development of new scientific methods and approaches. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Gender and Race in the Timing of Requests for Ethics Consultations: A Single-Center Study.

    PubMed

    Spielman, Bethany; Gorka, Christine; Miller, Keith; Pointer, Carolyn A; Hinze, Barbara

    2016-01-01

    Clinical ethics consultants are expected to "reduce disparities, discrimination, and inequities when providing consultations," but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them. The study was a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9. Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were strongly correlated with the intervals between admission to the hospital and request for an ethics consultation. Our findings suggest race and gender disparities in the timing of ethics consultations that consultants may have partially mitigated. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

  17. 24 CFR 91.110 - Consultation; states.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Consultation; states. 91.110 Section 91.110 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS Citizen Participation and...

  18. 42 CFR 493.1413 - Standard; Technical consultant responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Technical consultant responsibilities. 493.1413 Section 493.1413 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Nonwaived Testing Laboratories Performing Moderate Complexity Testing § 493.1413 Standard; Technical...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  20. 5 CFR 304.101 - Coverage.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 304.101 Section 304.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EXPERT AND CONSULTANT APPOINTMENTS § 304.101 Coverage. These regulations apply to the appointment of experts and consultants as...

  1. 5 CFR 304.101 - Coverage.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 304.101 Section 304.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EXPERT AND CONSULTANT APPOINTMENTS § 304.101 Coverage. These regulations apply to the appointment of experts and consultants as...

  2. 5 CFR 304.101 - Coverage.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 304.101 Section 304.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EXPERT AND CONSULTANT APPOINTMENTS § 304.101 Coverage. These regulations apply to the appointment of experts and consultants as...

  3. 5 CFR 304.101 - Coverage.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 304.101 Section 304.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EXPERT AND CONSULTANT APPOINTMENTS § 304.101 Coverage. These regulations apply to the appointment of experts and consultants as...

  4. 5 CFR 304.101 - Coverage.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 304.101 Section 304.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EXPERT AND CONSULTANT APPOINTMENTS § 304.101 Coverage. These regulations apply to the appointment of experts and consultants as...

  5. 23 CFR 450.316 - Interested parties, participation, and consultation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  6. Factors associated with consultation rates in general practice in England, 2013–2014: a cross-sectional study

    PubMed Central

    Mukhtar, Toqir K; Bankhead, Clare; Stevens, Sarah; Perera, Rafael; Holt, Tim A; Salisbury, Chris; Hobbs, FD Richard

    2018-01-01

    Background Workload in general practice has risen during the last decade, but the factors associated with this increase are unclear. Aim To examine factors associated with consultation rates in general practice. Design and setting A cross-sectional study examining a sample of 304 937 patients registered at 316 English practices between 2013 and 2014, drawn from the Clinical Practice Research Datalink. Method Age, sex, ethnicity, smoking status, and deprivation measures were linked with practice-level data on staffing, rurality, training practice status, and Quality and Outcomes Framework performance. Multilevel analyses of patient consultation rates were conducted. Results Consultations were grouped into three types: all (GP or nurse), GP, and nurse. Non-smokers consulted less than current smokers (all: rate ratio [RR] = 0.88, 95% CI = 0.87 to 0.89; GP: RR = 0.88, 95% CI = 0.87 to 0.89; nurse: RR = 0.91, 95% CI = 0.90 to 0.92). Consultation rates were higher for those in the most deprived quintile compared with the least deprived quintile (all: RR = 1.18, 95% CI = 1.16 to 1.19; GP: RR = 1.17, 95% CI = 1.15 to 1.19; nurse: RR = 1.13, 95% CI = 1.11 to 1.15). For all three consultation types, consultation rates increased with age and female sex, and varied by ethnicity. Rates in practices with >8 and ≤19 full-time equivalent (FTE) GPs were higher compared with those with ≤2 FTE GPs (all: RR = 1.26, 95% CI = 1.06 to 1.49; GP: RR = 1.36, 95% CI = 1.19 to 1.56). Conclusion The analyses show consistent trends in factors related to consultation rates in general practice across three types of consultation. These data can be used to inform the development of more sophisticated staffing models, and resource allocation formulae. PMID:29686130

  7. Bullying of junior doctors in Pakistan: a cross-sectional survey.

    PubMed

    Imran, N; Jawaid, M; Haider, I I; Masood, Z

    2010-07-01

    The aim of this study was to determine the prevalence of workplace bullying among junior doctors in Pakistan, identify the types and sources of bullying behaviours and investigate the perceived barriers to making complaints against bullying. We conducted a cross-sectional survey of junior doctors using convenience sampling in three tertiary care hospitals in two provinces of Pakistan. Demographic details and information about the different types of bullying behaviours experienced by junior doctors in the 12 months preceding the study were collected using a previously validated list of 20 such behaviours. Respondents were also asked to indicate the sources of bullying, any complaints made and if not, the reasons behind it. The data was analysed using the Statistical Package for the Social Sciences. A total of 654 doctors participated in the study. 417 (63.8 percent) of them reported experiencing one or more type of bullying in the past 12 months. 436 (66.7 percent) doctors had witnessed the bullying of others. The most common source of bullying was consultants (51.6 percent). 306 (73.4 percent) respondents did not make a complaint against the bullying. Bullying is faced by a fairly large proportion of junior doctors in Pakistan. The most frequent perpetrators of this bullying are consultants. Major changes are required at the national, organisational and individual levels in Pakistan to tackle the bullying problem and prevent its adverse consequences in an already vulnerable healthcare delivery system.

  8. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes.

    PubMed

    Levetan, C S; Salas, J R; Wilets, I F; Zumoff, B

    1995-07-01

    To determine whether consultation by an individual endocrinologist or by a multidisciplinary diabetes team (endocrinologist, diabetes nurse educator, and registered dietitian) can impact length of hospital stay of patients with diabetes. Hospital stays of consecutive patients with a principal diagnosis of diabetes were compared. Forty-three patients were seen by an individual endocrine consultant and 27 were managed by the internist alone. Thirty-four patients were seen in consultation by the diabetes team. All consultations were performed at the request of the primary physician. There were no statistically significant differences among groups with respect to age, duration of diabetes, admitting diagnosis, glucose levels, or concomitant acute or chronic illness. Average length of stay of diabetes-team patients was 3.6 +/- 1.7 days, 56% shorter than the value, 8.2 +/- 6.2 days, of patients in the no-consultation group (P < 0.0001), and 35% shorter than the value, 5.5 +/- 3.4 days, of patients who received a traditional individual endocrine consultation (P < 0.05). The length of stay correlated with time from admission to consultation (regression equation: y = 3.92 + [1.09 x time to consultation]; r = .55; P < 0.0001). The slope (1.09) indicates that each 1-day delay in consultation resulted in a 1-day increase in length of stay. Length of stay was lowest in patients who received diabetes-team consultation. Three million Americans are hospitalized annually with diabetes at a cost of $65 billion. A team approach to their inpatient care may reduce their hospital stays, resulting in considerable health and economic benefits.

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

    PubMed Central

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

    2007-01-01

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

  10. Factors related to failure to attend the consultation to receive the results of the Pap smear test1

    PubMed Central

    Vasconcelos, Camila Teixeira Moreira; Cunha, Denise de Fátima Fernandes; Coelho, Cássia Fernandes; Pinheiro, Ana Karina Bezerra; Sawada, Namie Okino

    2014-01-01

    Objective to identify the factors related to the failure of women to attend the follow-up consultation to receive the results of the Pap smear test. Method a cross-sectional study, carried out with 775 patients who underwent the Pap smear test in the Centro de Saúde da Família of Fortaleza, between September 2010 and February 2011. Results the majority of the women studied were young (≤35 years), had low levels of education (≤7 years of study), and commenced sexual activity early (≤20 years), with 17.0% of them failing to return to receive the test results. Statistically significant results for the failure to return were related to: young women (p=0.001); early onset of sexual activity (p=0.047); and inadequate knowledge about the Pap smear test (p=0.029). Conclusion the fact that the women failed to return for the result is a problem for the control of cervical cancer and must be addressed through educational strategies that reinforce the importance of the return for the early detection of this cancer. PMID:25029050

  11. NATIONAL 304(A) AQUATIC LIFE CRITERIA CONSULTATIONS METHODOLOGY AND PROTOTYPE

    EPA Science Inventory

    When consulting with the Services under Section of the Endangered Species Act (ESA), federal agencies are to prepare a biological evaluation which evaluates the potential effects of its action on listed species and critical habitat, and determine whether such species or habitat ...

  12. 29 CFR 1908.4 - Offsite consultation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... on occupational safety and health issues by telephone and correspondence, and at locations other than... 29 Labor 5 2010-07-01 2010-07-01 false Offsite consultation. 1908.4 Section 1908.4 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR...

  13. 29 CFR 1908.4 - Offsite consultation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... on occupational safety and health issues by telephone and correspondence, and at locations other than... 29 Labor 5 2011-07-01 2011-07-01 false Offsite consultation. 1908.4 Section 1908.4 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR...

  14. 30 CFR 33.3 - Consultation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Consultation. 33.3 Section 33.3 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS DUST COLLECTORS FOR USE IN CONNECTION WITH ROCK DRILLING IN COAL MINES General Provisions...

  15. 30 CFR 33.3 - Consultation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Consultation. 33.3 Section 33.3 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS DUST COLLECTORS FOR USE IN CONNECTION WITH ROCK DRILLING IN COAL MINES General Provisions...

  16. 30 CFR 33.3 - Consultation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Consultation. 33.3 Section 33.3 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS DUST COLLECTORS FOR USE IN CONNECTION WITH ROCK DRILLING IN COAL MINES General Provisions...

  17. 30 CFR 33.3 - Consultation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Consultation. 33.3 Section 33.3 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS DUST COLLECTORS FOR USE IN CONNECTION WITH ROCK DRILLING IN COAL MINES General Provisions...

  18. 30 CFR 33.3 - Consultation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Consultation. 33.3 Section 33.3 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR TESTING, EVALUATION, AND APPROVAL OF MINING PRODUCTS DUST COLLECTORS FOR USE IN CONNECTION WITH ROCK DRILLING IN COAL MINES General Provisions...

  19. 42 CFR 493.1409 - Condition: Laboratories performing moderate complexity testing; technical consultant.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 42 CFR 493.1409 - Condition: Laboratories performing moderate complexity testing; technical consultant.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  1. 42 CFR 493.1415 - Condition: Laboratories performing moderate complexity testing; clinical consultant.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  2. 17 CFR 5.1 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... futures commission merchant as a partner, officer or employee (or any natural person occupying a similar... this section as a partner, officer, employee, consultant or agent (or any natural person occupying a... as a partner, officer, employee, consultant or agent (or any natural person occupying a similar...

  3. 10 CFR 1706.3 - Applicability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Applicability. 1706.3 Section 1706.3 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.3... to subcontractors and consultants proposed for, or working on, a Board contract, in each case where...

  4. 10 CFR 1706.3 - Applicability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Applicability. 1706.3 Section 1706.3 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.3... to subcontractors and consultants proposed for, or working on, a Board contract, in each case where...

  5. 10 CFR 1706.3 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Applicability. 1706.3 Section 1706.3 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.3... to subcontractors and consultants proposed for, or working on, a Board contract, in each case where...

  6. 10 CFR 1706.3 - Applicability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Applicability. 1706.3 Section 1706.3 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.3... to subcontractors and consultants proposed for, or working on, a Board contract, in each case where...

  7. 10 CFR 1706.3 - Applicability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Applicability. 1706.3 Section 1706.3 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.3... to subcontractors and consultants proposed for, or working on, a Board contract, in each case where...

  8. 10 CFR 1706.6 - Solicitation provisions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... organizational conflicts of interest certificate from any marketing consultants engaged by an offeror in support... 10 Energy 4 2010-01-01 2010-01-01 false Solicitation provisions. 1706.6 Section 1706.6 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.6...

  9. 23 CFR 450.210 - Interested parties, public involvement, and consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Interested parties, public involvement, and consultation. 450.210 Section 450.210 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Statewide Transportation Planning and Programming § 450...

  10. 7 CFR 1789.153 - Borrower funding.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  11. 7 CFR 1789.153 - Borrower funding.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  12. 7 CFR 1789.153 - Borrower funding.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  13. 7 CFR 1789.153 - Borrower funding.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  14. 7 CFR 1789.153 - Borrower funding.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  15. 23 CFR 450.210 - Interested parties, public involvement, and consultation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Interested parties, public involvement, and consultation. 450.210 Section 450.210 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Statewide Transportation Planning and Programming § 450...

  16. Dermatology discharge continuity clinic enhances resident autonomy and insight into transitions-of-care competencies: a cross-sectional survey study.

    PubMed

    Rana, Jasmine; Mostaghimi, Arash

    2017-05-15

    Dermatology residents perform consults on hospitalized patients, but are often limited in their ability to follow-up with these patients after discharge, leading to inadequate follow-up and understanding of post-discharge transitions of care. In 2013, a discharge continuity clinic (DCC) staffed by the inpatient consult dermatology resident and attending dermatologist was established at one of the four adult hospital sites residents rotate through in the Harvard Combined Dermatology Residency Program. Resident perceptions about the DCC and their educational experience on inpatient consult rotations with a DCC and without a DCC were obtained using a cross-sectional survey instrument in June 2016. Self-reported data from a multi-year cohort of dermatology residents (n = 14 of 20, 70% response rate) reveals that the DCC enabled resident autonomy and resident satisfaction in care of their patients,insight into the disease-related challenges and the broader social context during transitions of care from inpatient to outpatient settings, and more enriching learning experiences than inpatient consult rotations without a DCC. Dermatology residents self-report participation in an inpatient consult rotation with aDCC supports their autonomy and achievement of post-discharge transitions-of-care competencies.

  17. Analysis of Parent, Teacher, and Consultant Speech Exchanges and Educational Outcomes of Students With Autism During COMPASS Consultation.

    PubMed

    Ruble, Lisa; Birdwhistell, Jessie; Toland, Michael D; McGrew, John H

    2011-01-01

    The significant increase in the numbers of students with autism combined with the need for better trained teachers (National Research Council, 2001) call for research on the effectiveness of alternative methods, such as consultation, that have the potential to improve service delivery. Data from 2 randomized controlled single-blind trials indicate that an autism-specific consultation planning framework known as the collaborative model for promoting competence and success (COMPASS) is effective in increasing child Individual Education Programs (IEP) outcomes (Ruble, Dal-rymple, & McGrew, 2010; Ruble, McGrew, & Toland, 2011). In this study, we describe the verbal interactions, defined as speech acts and speech act exchanges that take place during COMPASS consultation, and examine the associations between speech exchanges and child outcomes. We applied the Psychosocial Processes Coding Scheme (Leaper, 1991) to code speech acts. Speech act exchanges were overwhelmingly affiliative, failed to show statistically significant relationships with child IEP outcomes and teacher adherence, but did correlate positively with IEP quality.

  18. Analysis of Parent, Teacher, and Consultant Speech Exchanges and Educational Outcomes of Students With Autism During COMPASS Consultation

    PubMed Central

    RUBLE, LISA; BIRDWHISTELL, JESSIE; TOLAND, MICHAEL D.; MCGREW, JOHN H.

    2011-01-01

    The significant increase in the numbers of students with autism combined with the need for better trained teachers (National Research Council, 2001) call for research on the effectiveness of alternative methods, such as consultation, that have the potential to improve service delivery. Data from 2 randomized controlled single-blind trials indicate that an autism-specific consultation planning framework known as the collaborative model for promoting competence and success (COMPASS) is effective in increasing child Individual Education Programs (IEP) outcomes (Ruble, Dal-rymple, & McGrew, 2010; Ruble, McGrew, & Toland, 2011). In this study, we describe the verbal interactions, defined as speech acts and speech act exchanges that take place during COMPASS consultation, and examine the associations between speech exchanges and child outcomes. We applied the Psychosocial Processes Coding Scheme (Leaper, 1991) to code speech acts. Speech act exchanges were overwhelmingly affiliative, failed to show statistically significant relationships with child IEP outcomes and teacher adherence, but did correlate positively with IEP quality. PMID:22639523

  19. Special Office Report for Warm Springs Dam and Lake Sonoma. Sonoma County, California. Section 7. Consultation on Endangered Species.

    DTIC Science & Technology

    1983-05-01

    REPORT, SECTION 7 CONSULTATION, FN WARM SPRINGS DAM AND LAKE SONOMA, SONOMA COUNTY , F P IN CALIFORNIA 6. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(s) 8...regarding the American Peregrine Falcon (Falco peregrInus anatum) and its critical habitat (about 13,300 acres in Sonoma County , California) in the 29 May...federally owned historic resources. Actions to be undertaken will not impair historic properties. e. Sonoma County General Plan. This County Plan is a

  20. A comparison of workload and morbidity recording by partners in a group practice

    PubMed Central

    Carney, T. A.

    1980-01-01

    A survey was carried out of one year's workload and morbidity recording by three partners in a semi-rural teaching practice. Despite an equal workload of patient contacts there were shown to be statistically significant differences between the partners in the number of return consultations, the sex and age of the patients seen, and in nine diagnostic groups. The statistically significant differences in the latter groups appear to have been caused by variations in policy for recalling patients and the different sex and age groups of the patients consulting the partners, not by diagnostic preferences. A lack of previous experience affected one group. The partners did not find the discussion of these differences to be threatening. PMID:7441620

  1. Risk factors and prescription patterns of gastroesophageal reflux disease: HEAL study in Pakistan.

    PubMed

    Butt, Arshad Kamal; Hashemy, Irfan

    2014-07-01

    To determine the frequency of the use of proton-pump inhibitor therapy in patients with typical symptoms of gastroesophageal reflux disease and evaluate its risk factors. The cross-sectional study was conducted between June 2010 and February 2011 across 10 cities of Pakistan. Adult patients giving a current history of typical gastroesophageal reflux disease symptoms were included. Information on patient demography, medical history, family history, prescription patterns, lifestyle factors and dietary habits were collected. SPSS 18 was used for statistical analysis and descriptive statistics were used for the analysis of categorical and continuous variables. Of the 1010 patients enrolled, 954 (94.45%) formed the study population. Of them, 520 (54.5%) were men. The overall mean age was 41.9 +/- 12.5 years, and 439 (46%) had body mass index > or = 25 kg/m2. Further, 805 (84.4%) reported history of dyspepsia while 692 (72.5%) had gastroesophageal reflux disease during the preceding year. Family history of acid peptic disease was reported by 231 (24.2%) patients. Prior to consultation, 505 (52.9%) patients were on proton-pump inhibitors. Following consultation, 923 (96.8%) patients were prescribed proton-pump inhibitors, with omeprazole being the preferred choice in 577 (60.5%). Associated risk factors included regular use of nonsteroidal anti-inflammatory drugs in 355 (37.2%) and current smoking in 210 (22.0%). Consuming spicy meals was reported by 666 (70.0%). Nearly half the patients with typical gastroesophageal reflux disease symptoms were overweight, and a majority consumed spicy meals. Proton-pump inhibitors were widely prescribed, and omeprazole was the preferred choice of drug.

  2. 41 CFR 101-1.107 - Agency consultation regarding FPMR.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Agency consultation regarding FPMR. 101-1.107 Section 101-1.107 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 1-INTRODUCTION 1.1-Regulation...

  3. 20 CFR 220.61 - Informing the examining physician or psychologist of examination scheduling, report content and...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... psychologist of examination scheduling, report content and signature requirements. 220.61 Section 220.61... examination scheduling, report content and signature requirements. Consulting physicians or psychologists will... needed), not every element is required. (d) Signature requirements. All consultative examination reports...

  4. 14 CFR 1261.403 - Consultation with appropriate officials; negotiation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Consultation with appropriate officials; negotiation. 1261.403 Section 1261.403 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... appropriate officials; negotiation. (a) The authority pursuant to § 1261.402 to determine to forego collection...

  5. 14 CFR 1261.403 - Consultation with appropriate officials; negotiation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Consultation with appropriate officials; negotiation. 1261.403 Section 1261.403 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... appropriate officials; negotiation. (a) The authority pursuant to § 1261.402 to determine to forego collection...

  6. 14 CFR 1261.403 - Consultation with appropriate officials; negotiation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Consultation with appropriate officials; negotiation. 1261.403 Section 1261.403 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... appropriate officials; negotiation. (a) The authority pursuant to § 1261.402 to determine to forego collection...

  7. 14 CFR 1261.403 - Consultation with appropriate officials; negotiation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Consultation with appropriate officials; negotiation. 1261.403 Section 1261.403 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... appropriate officials; negotiation. (a) The authority pursuant to § 1261.402 to determine to forego collection...

  8. 20 CFR 416.919s - Authorizing and monitoring the consultative examination.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... examination. 416.919s Section 416.919s Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Authorizing and... Social Security and Supplemental Security Income programs of at least $100,000; or (2) Any consultative...

  9. 42 CFR 493.1453 - Condition: Laboratories performing high complexity testing; clinical consultant.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  10. 20 CFR 410.472 - Consultative examinations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Consultative examinations. 410.472 Section 410.472 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Total Disability or Death Due to Pneumoconiosis § 410.472...

  11. 5 CFR 251.201 - Associations of management officials and/or supervisors.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    .../or supervisors. 251.201 Section 251.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... managers should be included in the decision-making process and notified of executive-level decisions on a... consultation with its supervisors and managers. Agencies must also establish consultative relationships with...

  12. 5 CFR 251.201 - Associations of management officials and/or supervisors.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    .../or supervisors. 251.201 Section 251.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... managers should be included in the decision-making process and notified of executive-level decisions on a... consultation with its supervisors and managers. Agencies must also establish consultative relationships with...

  13. 20 CFR 220.62 - Reviewing reports of consultative examinations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... decision-making in terms of the impairment it assesses. (2) Whether the report is internally consistent... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Reviewing reports of consultative examinations. 220.62 Section 220.62 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE...

  14. 5 CFR 9701.518 - Duty to bargain, confer, and consult.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Duty to bargain, confer, and consult. 9701.518 Section 9701.518 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES... SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Labor-Management Relations § 9701.518 Duty to bargain, confer...

  15. The Clinical Impact of Cardiology Consultation Prior to Major Vascular Surgery.

    PubMed

    Davis, Frank M; Park, Yeo June; Grey, Scott F; Boniakowski, Anna E; Mansour, M Ashraf; Jain, Krishna M; Nypaver, Timothy; Grossman, Michael; Gurm, Hitinder; Henke, Peter K

    2018-01-01

    To understand statewide variation in preoperative cardiology consultation prior to major vascular surgery and to determine whether consultation was associated with differences in perioperative myocardial infarction (poMI). Medical consultation prior to major vascular surgery is obtained to reduce perioperative risk. Despite perceived benefit of preoperative consultation, evidence is lacking specifically for major vascular surgery on the effect of preoperative cardiac consultation. Patient and clinical data were obtained from a statewide vascular surgery registry between January 2012 and December 2014. Patients were risk stratified by revised cardiac risk index category and compared poMI between patients who did or did not receive a preoperative cardiology consultation. We then used logistic regression analysis to compare the rate of poMI across hospitals grouped into quartiles by rate of preoperative cardiology consultation. Our study population comprised 5191 patients undergoing open peripheral arterial bypass (n = 3037), open abdominal aortic aneurysm repair (n = 332), or endovascular aneurysm repair (n = 1822) at 29 hospitals. At the patient level, after risk-stratification by revised cardiac risk index category, there was no association between cardiac consultation and poMI. At the hospital level, preoperative cardiac consultation varied substantially between hospitals (6.9%-87.5%, P <0.001). High preoperative consulting hospitals (rate >66%) had a reduction in poMI (OR, 0.52; confidence interval: 0.28-0.98; P <0.05) compared with all other hospitals. These hospitals also had a statistically greater consultation rate with a variety of medical specialties. Preoperative cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.

  16. Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.

    PubMed

    Zennaro, Floriana; Grosso, Daniele; Fascetta, Riccardo; Marini, Marta; Odoni, Luca; Di Carlo, Valentina; Dibello, Daniela; Vittoria, Francesca; Lazzerini, Marzia

    2014-07-28

    The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures. Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10). Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88). Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

  17. Pelvic floor muscle strength of women consulting at the gynecology outpatient clinics and its correlation with sexual dysfunction: A cross-sectional study.

    PubMed

    Ozdemir, Filiz Ciledag; Pehlivan, Erkan; Melekoglu, Rauf

    2017-01-01

    To investigate the pelvic floor muscle strength of the women andevaluateits possible correlation with sexual dysfunction. In this cross-sectional type study, stratified clusters were used for the sampling method. Index of Female Sexual Function (IFSF) worksheetwere used for questions on sexual function. The pelvic floor muscle strength of subjects was assessed byperineometer. The chi-squared test, logistic regression and Pearson's correlation analysis were used for the statistical analysis. Four hundred thirty primiparous women, mean age 38.5 participated in this study. The average pelvic floor muscle strength value was found 31.4±9.6 cm H 2 O and the average Index of Female Sexual Function (IFSF) score was found 26.5±6.9. Parity (odds ratio OR=5.546) and age 40 or higher (OR=3.484) were found correlated with pelvic floor muscle weakness (p<0.05). The factors directly correlated with sexual dysfunction were found being overweight (OR=2.105) and age 40 or higher (OR=2.451) (p<0.05). Pearson's correlation analysis showed that there was a statistically significantlinear correlation between the muscular strength of the pelvic floor and sexual function (p=0.001). The results suggested subjects with decreased pelvic floor muscle strength value had higher frequency of sexual dysfunction.

  18. Consultants in nhs scotland: a survey of work commitments, remuneration, job satisfaction and retirement plans.

    PubMed

    French, F H; Andrew, J E; Awramenko, M; Coutts, H; Leighton-Beck, L; Mollison, J; Needham, G; Scott, A; Walker, K A

    2004-05-01

    UK consultants have reported working long hours, increased stress and reduced morale. This study set out to elicit consultants' views on flexible working and to gather data on consultants' workloads, remuneration, job satisfaction and retirement plans. As such it is the first comprehensive study of consultants in NHS Scotland. The Information and Statistics Division of the Scottish Executive Health Dept provided a list of consultants working in NHS Scotland Focus groups and interviews informed the design of a postal self-completion, questionnaire. The response ratewas 61%. Almost two-thirds (65%) of respondents felt their workloads were unreasonable and unsustainable and 67% were unable to provide their desired standards of patient care. Two-thirds (67%) did not normally take meal breaks, 63% had insufficient time for outside interests, whilst 44% felt their health was being adversely affected Many (84%) believed that some of their work could be delegated to someone less qualified but 79% agreed that there were insufficient staff to make this possible. The average planned retirement age was 60 years, with 23% describing their plans as definite and 70% as quite or very likely. When asked what might induce them to postpone retirement, 50% cited reduced workload/work intensity. In 2003, a majority of consultants in the UK voted in favour of the new consultant contract. This will improve consultant pay and introduce a standard 40-hour working week, including worked on-call. This should address tow of the main areas of consultant dissatisfaction in NHS Scotland. However, staff shortages will require to be addressed if the contract is to be successfully implemented.

  19. Quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia.

    PubMed

    Tafese, Fikru; Woldie, Mirkuzie; Megerssa, Berhane

    2013-11-01

    Good quality of care in family planning (FP) services help individuals and couples to meet their reproductive health needs safely and effectively. Therefore, assessment and improvement of the quality of family planning services could enhance family planning services utilization. This study was thus conducted to assess the quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia. A cross-sectional facility based study was conducted from March 1(st)-25(th), 2011 among family planning clients of government primary health care centers in southwest Ethiopia. Exit interview of 301 family planning clients identified through systematic random sampling technique was carried out using a pre-tested structured questionnaire. Availability of resources was checked using provider interview and inventory checklist. Moreover, a total of 150 consultation sessions were observed using checklist. Descriptive statistics and linear regression coefficients were generated to meet the objective of the study. There was a shortage of some medical equipment, trained staffs, and information education and communication materials (IEC) in all of the family planning clinics. The mean waiting time at the service delivery points and consultation duration were 16.4 and 10.5 minutes, respectively. The providers used at least one information education and communication material in 33.3% of the consultation sessions. The overall satisfaction score was 8.64. Clients' perception on adequacy of information during consultation (β=0.24; ( 95%CI=0.02-0.16) ease of getting the clinic site, short waiting time (β=0.17; 95%CI=0.15-029) and educational level (β=0.09; 95%CI =0.09-0.29) were significantly associated with overall satisfaction. The findings of this study showed that there was lack of critical resources for the provision of quality family planning services in all of the primary health care centers included in the study. This has affected important aspects of service provision including the use of IEC materials during consultations. Hence, it is advisable that health managers of the health facilities and the district health office ensure improved availability of trained personnel, IEC materials and other supplies at the clinics.

  20. Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study.

    PubMed

    Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Scott, John; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrie A; Davey, Andrew R; Catzikiris, Nigel F; Magin, Parker J

    2015-01-01

    Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel advice" were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being "travel-related" or "travel advice" were tested using simple logistic regression within the generalized estimating equations (GEE) framework. A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010-2014). Travel-related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel-related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in-consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non-travel advice problems. Significant positive associations of travel advice problems were seeking in-consultation information, generation of learning goals, longer consultation duration, and more problems managed. Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice setting. In addition, our findings have implications more broadly for the delivery of travel medicine in general practice. © 2015 International Society of Travel Medicine.

  1. Running R Statistical Computing Environment Software on the Peregrine

    Science.gov Websites

    for the development of new statistical methodologies and enjoys a large user base. Please consult the distribution details. Natural language support but running in an English locale R is a collaborative project programming paradigms to better leverage modern HPC systems. The CRAN task view for High Performance Computing

  2. Statistical Power of Psychological Research: What Have We Gained in 20 Years?

    ERIC Educational Resources Information Center

    Rossi, Joseph S.

    1990-01-01

    Calculated power for 6,155 statistical tests in 221 journal articles published in 1982 volumes of "Journal of Abnormal Psychology,""Journal of Consulting and Clinical Psychology," and "Journal of Personality and Social Psychology." Power to detect small, medium, and large effects was .17, .57, and .83, respectively. Concluded that power of…

  3. 75 FR 51240 - Pacific Fishery Management Council; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-19

    ... Remarks and Introductions 2. Council Member Appointments 3. Roll Call 4. Executive Director's Report 5... Technical Team/Salmon Amendment Committee Joint 8 a.m. Session Scientific and Statistical Committee 8 a.m.... Salmon Technical Team 8 a.m. Scientific and Statistical Committee 8 a.m. Enforcement Consultants 4:30 p.m...

  4. 24 CFR 3286.15 - Consultation with the Manufactured Housing Consensus Committee (MHCC).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Consultation with the Manufactured Housing Consensus Committee (MHCC). 3286.15 Section 3286.15 Housing and Urban Development Regulations... Consensus Committee (MHCC). The Secretary will seek input from the MHCC when revising the installation...

  5. 24 CFR 3288.305 - Consultation with the Manufactured Housing Consensus Committee.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Consultation with the Manufactured Housing Consensus Committee. 3288.305 Section 3288.305 Housing and Urban Development Regulations Relating... Housing Consensus Committee. HUD will seek input from the MHCC when revising the HUD Manufactured Home...

  6. 10 CFR 50.91 - Notice for public comment; State consultation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Notice for public comment; State consultation. 50.91 Section 50.91 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION... consideration if it determines that the licensee has abused the emergency provision by failing to make timely...

  7. 78 FR 33331 - Tribal Consultation and Coordination Policy for the U.S. Department of Commerce

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    .... Comment 4: Clarify the Department's role in coordinating with other federal agencies, and increase....'' Comments to Section 5: Roles and Responsibilities Comment 24: The tribal consultation official should.... Additionally, the policy should acknowledge that Tribes are more familiar with their local environment and...

  8. 24 CFR 586.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false HUD's negotiations and consultations with the LRA. 586.25 Section 586.25 Housing and Urban Development Regulations Relating to Housing... COMMUNITY ASSISTANCE-COMMUNITY REDEVELOPMENT AND HOMELESS ASSISTANCE § 586.25 HUD's negotiations and...

  9. 24 CFR 586.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false HUD's negotiations and consultations with the LRA. 586.25 Section 586.25 Housing and Urban Development Regulations Relating to Housing... COMMUNITY ASSISTANCE-COMMUNITY REDEVELOPMENT AND HOMELESS ASSISTANCE § 586.25 HUD's negotiations and...

  10. 24 CFR 586.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true HUD's negotiations and consultations with the LRA. 586.25 Section 586.25 Housing and Urban Development Regulations Relating to Housing and... COMMUNITY ASSISTANCE-COMMUNITY REDEVELOPMENT AND HOMELESS ASSISTANCE § 586.25 HUD's negotiations and...

  11. 24 CFR 586.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false HUD's negotiations and consultations with the LRA. 586.25 Section 586.25 Housing and Urban Development Regulations Relating to Housing... COMMUNITY ASSISTANCE-COMMUNITY REDEVELOPMENT AND HOMELESS ASSISTANCE § 586.25 HUD's negotiations and...

  12. 24 CFR 586.25 - HUD's negotiations and consultations with the LRA.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true HUD's negotiations and consultations with the LRA. 586.25 Section 586.25 Housing and Urban Development Regulations Relating to Housing and... COMMUNITY ASSISTANCE-COMMUNITY REDEVELOPMENT AND HOMELESS ASSISTANCE § 586.25 HUD's negotiations and...

  13. 25 CFR 224.58 - What is an application consultation meeting?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What is an application consultation meeting? 224.58 Section 224.58 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT...

  14. 7 CFR 1789.160 - Access to information.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Access to information. 1789.160 Section 1789.160... Consultant Services Funded by Borrowers-General § 1789.160 Access to information. The Borrower shall not have rights in nor right of access to the work product of the Consultant. All analyses, studies, opinions...

  15. 21 CFR 860.125 - Consultation with panels.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Consultation with panels. 860.125 Section 860.125 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... importance and complexity of the subject matter involved and the time available for action. When time and...

  16. 21 CFR 860.125 - Consultation with panels.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Consultation with panels. 860.125 Section 860.125 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... importance and complexity of the subject matter involved and the time available for action. When time and...

  17. 18 CFR 12.34 - Approval of independent consultant.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  18. 18 CFR 12.34 - Approval of independent consultant.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  19. 18 CFR 12.34 - Approval of independent consultant.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  20. 18 CFR 12.34 - Approval of independent consultant.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  1. 18 CFR 12.34 - Approval of independent consultant.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  2. 18 CFR 12.37 - Report of the independent consultant.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Report of the independent consultant. 12.37 Section 12.37 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER...

  3. 25 CFR 700.841 - Determination of loss or absence of archaeological interest.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... the Office Consulting Archaeologist review any final determination by the Federal land manager that... be sent to the Office Consulting Archaeologist, care of Land Use Manager, Office of Navajo and Hopi... interest. 700.841 Section 700.841 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION...

  4. 25 CFR 700.841 - Determination of loss or absence of archaeological interest.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... the Office Consulting Archaeologist review any final determination by the Federal land manager that... be sent to the Office Consulting Archaeologist, care of Land Use Manager, Office of Navajo and Hopi... interest. 700.841 Section 700.841 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION...

  5. 25 CFR 700.841 - Determination of loss or absence of archaeological interest.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... the Office Consulting Archaeologist review any final determination by the Federal land manager that... be sent to the Office Consulting Archaeologist, care of Land Use Manager, Office of Navajo and Hopi... interest. 700.841 Section 700.841 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION...

  6. 25 CFR 700.841 - Determination of loss or absence of archaeological interest.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... the Office Consulting Archaeologist review any final determination by the Federal land manager that... be sent to the Office Consulting Archaeologist, care of Land Use Manager, Office of Navajo and Hopi... interest. 700.841 Section 700.841 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION...

  7. 25 CFR 292.20 - What information must the consultation letter include?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What information must the consultation letter include? 292.20 Section 292.20 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ECONOMIC... impacts on the social structure, infrastructure, services, housing, community character, and land use...

  8. 36 CFR 800.3 - Initiation of the section 106 process.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Religious Freedom Act, the Archeological Resources Protection Act, and agency-specific legislation, such as... the next step in the process based on the finding or determination or consult with the Council in lieu... as the consulting parties and the public have an adequate opportunity to express their views as...

  9. 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 feasible...

  10. 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 feasible...

  11. 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 feasible...

  12. 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 feasible...

  13. 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 feasible...

  14. 29 CFR 1690.306 - Formal submission in absence of consultation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Section 1690.306 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION..., and on which there has been no consultation, the agency shall immediately notify the EEOC of the existence of such proposals and the following procedure shall apply: (a) EEOC shall confer with the...

  15. 29 CFR 1690.306 - Formal submission in absence of consultation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Section 1690.306 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION..., and on which there has been no consultation, the agency shall immediately notify the EEOC of the existence of such proposals and the following procedure shall apply: (a) EEOC shall confer with the...

  16. 29 CFR 1690.306 - Formal submission in absence of consultation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Section 1690.306 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION..., and on which there has been no consultation, the agency shall immediately notify the EEOC of the existence of such proposals and the following procedure shall apply: (a) EEOC shall confer with the...

  17. 29 CFR 1690.306 - Formal submission in absence of consultation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Section 1690.306 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION..., and on which there has been no consultation, the agency shall immediately notify the EEOC of the existence of such proposals and the following procedure shall apply: (a) EEOC shall confer with the...

  18. 29 CFR 1690.306 - Formal submission in absence of consultation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Section 1690.306 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION..., and on which there has been no consultation, the agency shall immediately notify the EEOC of the existence of such proposals and the following procedure shall apply: (a) EEOC shall confer with the...

  19. Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production.

    PubMed

    Farr, Michelle; Banks, Jonathan; Edwards, Hannah B; Northstone, Kate; Bernard, Elly; Salisbury, Chris; Horwood, Jeremy

    2018-03-19

    To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. Mixed-method evaluation of a primary care e-consultation system. Primary care practices in South West England. Qualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients' records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients' and staff touchpoints. We found different expectations between patients and staff on how to use e-consultations 'appropriately'. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation. Where both patients and staff interact with technology, it is in effect 'co-implemented'. How patients used e-consultations impacted on practice staff's experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. A profile of communication in primary care physician telephone consultations: application of the Roter Interaction Analysis System.

    PubMed

    Innes, Michael; Skelton, John; Greenfield, Sheila

    2006-05-01

    Telephone consultations are a part of everyday practice, there is surprisingly little research on the subject. To describe the variation of consulting skills within a body of telephone consultations in primary care, highlighting the performance of one method of assessing the process of the consultation-- the Roter Interaction Analysis System-- with telephone consultations. Cross sectional study of 43 recordings of telephone consultations with GPs. One rural county in the Midlands. Recordings were made of 8 GPs, purposively selected for maximum variance in one region of the UK. Forty-three consultations were coded using the Roter Interaction Analysis System. From the descriptive categories, six composite categories were compiled reflecting a number of domains of interaction in a consultation: rapport, data gathering, patient education and counselling, partnership building, doctor dominance and patient-centredness. Analysis of variance was undertaken to explain variations between consultations for the different domains. Comparison was made to findings from similar work for face-to-face consultations. These telephone consultations feature more biomedical information exchange than psychosocial or affective communication. Length of interaction accounts for much of the variation seen between consultations in the domains of rapport, data gathering, patient education and counselling and partnership. Male doctors are more patient centred in this study. There is the suggestion of more doctor dominance and a less patient-centred approach when comparisons are made with previous work on face-to-face consultations. Although the telephone is increasingly being used to provide care, this study highlights the fact that telephone consultations cannot be taken as equivalent to those conducted face to face. More work needs to be done to delineate the features of telephone consultations.

  1. Misuse of statistical methods: critical assessment of articles in BMJ from January to March 1976.

    PubMed Central

    Gore, S M; Jones, I G; Rytter, E C

    1977-01-01

    Sixty-two reports that appeared as Papers and Originals (excluding short reports) in 13 consecutive issues of the British Medical journal included statistical analysis. Thirty-two had statistical errors of one kind or another; in 18 fairly serious faults were discovered. The summaries of five reports made some claim that was unsupportable on re-examination of the data. Medical investigators should consult with people who have a real understanding of statistical methods throughout their projects. PMID:832023

  2. The transition to hospital consultant and the influence of preparedness, social support, and perception: A structural equation modelling approach.

    PubMed

    Westerman, Michiel; Teunissen, Pim W; Fokkema, Joanne P I; van der Vleuten, Cees P M; Scherpbier, Albert J J A; Siegert, Carl E H; Scheele, Fedde

    2013-04-01

    Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition. This study investigates whether preparedness regarding medical and generic competencies, perceived intensity, and social support are associated with burnout among new consultants. A population-based study among all 2643 new consultants in the Netherlands (all specialties) was conducted in June 2010. A questionnaire covering preparedness for practice, intensity of the transition, social support, and burnout was used. Structural equation modelling was used for statistical analysis. Data from a third of the population were available (32% n = 840) (43% male/57% female). Preparation in generic competencies received lower ratings than in medical competencies. A total of 10% met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Perceived lack of preparation in generic competencies correlated with burnout (r = 0.15, p < 0.001). No such relation was found for medical competencies. Furthermore, social support protected against burnout. These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.

  3. A descriptive study of access to services in a random sample of Canadian rural emergency departments.

    PubMed

    Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

    2013-11-27

    To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Cross-sectional study-mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Canadian rural EDs (rural small town (RST) definition-Statistics Canada). 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands.

  4. Comparing the nine-item Shared Decision-Making Questionnaire to the OPTION Scale - an attempt to establish convergent validity.

    PubMed

    Scholl, Isabelle; Kriston, Levente; Dirmaier, Jörg; Härter, Martin

    2015-02-01

    While there has been a clear move towards shared decision-making (SDM) in the last few years, the measurement of SDM-related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects. To test convergent validity of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) by comparing it to the OPTION Scale. Cross-sectional study. Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study. Consultations were evaluated using the OPTION Scale. Patients completed the SDM-Q-9 after the consultation. First, the internal consistency of both scales and the inter-rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM-Q-9, correlation between the patient (SDM-Q-9) and expert ratings (OPTION Scale) was calculated. A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM-Q-9 and limited internal consistency of the OPTION Scale. Inter-rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance. By the use of the OPTION Scale convergent validity of the SDM-Q-9 could not be established. Several possible explanations for this result are discussed. This study shows that the measurement of SDM remains challenging. © 2012 John Wiley & Sons Ltd.

  5. Advice and care for headaches: who seeks it, who gives it?

    PubMed

    Thomas, E; Boardman, H F; Ogden, H; Millson, D S; Croft, P R

    2004-09-01

    Using data from a cross-sectional survey and a prospective record linkage study the aims of this study were to: (i) determine sources of advice and care for headaches in a population survey of adults, and (ii) investigate prospectively the influences of headaches on general practice consultation in a 12-month follow-up of the responders to the population survey. A population based cross-sectional survey was mailed to 4885 adults (aged > or = 18 years) with an adjusted response rate of 56% (n = 2662). The main outcome measures of interest were (i) self-report advice and care-seeking in the survey (ii) consultation with general practitioner for headache and for other conditions in 12-month period subsequent to the survey. Reporting a recent GP consultation for headache was associated with younger age (mean: 46 vs 48 years), female gender (68% vs 60%), and greater headache severity as measured by frequency, pain, and associated disability. The commonest sources of advice and care in the past were GPs (27%), opticians (21%), and pharmacists (8%). Consultations for headache were not common in the 12-months following the survey (n = 144); however, those reporting a recent headache were almost 4 times more likely to consult subsequently with a headache than those not (relative risk; 95% CI: 3.7; 1.9, 7.0). Recent reporting of headache was also associated with an increased risk of consulting for mental disorders (1.7; 1.2, 2.6), diseases of the digestive (1.6; 1.1, 2.3) and respiratory system (1.4; 1.1, 1.8), and a decreased risk of consulting for circulatory diseases (0.8; 0.7, 1.0). Only a minority of headache sufferers consult their GP, regardless of severity, with opticians and pharmacists being other important sources of information. Headache appears to have an additional impact upon GP workload through increased rates of consultations for nonheadache conditions amongst headache sufferers. The interesting findings regarding rates of consultation for digestive and circulatory conditions amongst headache sufferers may be linked to the use of headache medication. Copyright 2004 Blackwell Publishing Ltd

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

    PubMed

    Clark, Thomas R

    2008-09-01

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

  7. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care.

    PubMed

    Elmore, Natasha; Burt, Jenni; Abel, Gary; Maratos, Frances A; Montague, Jane; Campbell, John; Roland, Martin

    2016-12-01

    Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction. Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England. Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length. There was no evidence that consultation length was associated with any of the three measures of patient experience (P >0.3 for all). Adjusted changes on a 0-100 scale per additional minute of consultation were: communication score 0.02 (95% confidence interval [CI] = -0.20 to 0.25), trust and confidence in the doctor 0.07 (95% CI = -0.27 to 0.41), and satisfaction -0.14 (95% CI = -0.46 to 0.18). The authors found no association between patient experience measures of communication and consultation length, and patients may sometimes report good experiences from very short consultations. However, longer consultations may be required to achieve clinical effectiveness and patient safety: aspects also important for achieving high quality of care. Future research should continue to study the benefits of longer consultations, particularly for patients with complex multiple conditions. © British Journal of General Practice 2016.

  8. Providing cell phone numbers and e-mail addresses to patients: The patient’s perspective, a cross sectional study

    PubMed Central

    2012-01-01

    Background Today patients can consult with their treating physician by cell phone or e-mail. These means of communication enhance the quality of medical care and increase patient satisfaction, but they can also impinge on physicians’ free time and their patient schedule while at work. The objective of this study is to assess the attitudes and practice of patients on obtaining the cell phone number or e-mail address of their physician for the purpose of medical consultation. Methods Personal interviews with patients, 18 years of age or above, selected by random sampling from the roster of adults insured by Clalit Health Services, Southern Division. The total response rate was 41%. The questionnaire included questions on the attitude and practice of patients towards obtaining their physician’s cell phone number or e-mail address. Comparisons were performed using Chi-square tests to analyze statistically significant differences of categorical variables. Two-tailed p values less than 0.05 were considered statistically significant, with a power of 0.8. Results The study sample included 200 patients with a mean age of 46.6 ± 17.1, of whom 110 were women (55%). Ninety-three (46.5%) responded that they would be very interested in obtaining their physician’s cell phone number, and an additional 83 (41.5%) would not object to obtaining it. Of the 171 patients (85.5%) who had e-mail addresses, 25 (14.6%) said they would be very interested in obtaining their physician’s e-mail address, 85 (49.7%) said they would not object to getting it, and 61 (35.7%) were not interested. In practice only one patient had requested the physician’s e-mail address and none actually had it. Conclusions Patients favored cell phones over e-mail for consulting with their treating physicians. With new technologies such as cell phones and e-mail in common use, it is important to determine how they can be best used and how they should be integrated into the flow of clinical practice. PMID:22929801

  9. Providing cell phone numbers and e-mail addresses to patients: The patient's perspective, a cross sectional study.

    PubMed

    Peleg, Roni; Nazarenko, Elena

    2012-08-28

    Today patients can consult with their treating physician by cell phone or e-mail. These means of communication enhance the quality of medical care and increase patient satisfaction, but they can also impinge on physicians' free time and their patient schedule while at work. The objective of this study is to assess the attitudes and practice of patients on obtaining the cell phone number or e-mail address of their physician for the purpose of medical consultation. Personal interviews with patients, 18 years of age or above, selected by random sampling from the roster of adults insured by Clalit Health Services, Southern Division. The total response rate was 41%. The questionnaire included questions on the attitude and practice of patients towards obtaining their physician's cell phone number or e-mail address. Comparisons were performed using Chi-square tests to analyze statistically significant differences of categorical variables. Two-tailed p values less than 0.05 were considered statistically significant, with a power of 0.8. The study sample included 200 patients with a mean age of 46.6 ± 17.1, of whom 110 were women (55%). Ninety-three (46.5%) responded that they would be very interested in obtaining their physician's cell phone number, and an additional 83 (41.5%) would not object to obtaining it. Of the 171 patients (85.5%) who had e-mail addresses, 25 (14.6%) said they would be very interested in obtaining their physician's e-mail address, 85 (49.7%) said they would not object to getting it, and 61 (35.7%) were not interested. In practice only one patient had requested the physician's e-mail address and none actually had it. Patients favored cell phones over e-mail for consulting with their treating physicians. With new technologies such as cell phones and e-mail in common use, it is important to determine how they can be best used and how they should be integrated into the flow of clinical practice.

  10. The diagnostic yield of ultrasound of the head in healthy infants presenting with the clinical diagnosis of benign macrocrania.

    PubMed

    Naffaa, L; Rubin, M; Stamler, A C; Haddad, M; Saade, C

    2017-01-01

    To investigate the frequency of sonographic findings that required neurosurgical consultation for all referred outpatients suspected to have benign macrocrania (BMC). A retrospective review was performed from September 2011 until June 2015 for all outpatients referred to the ultrasound (US) department for BMC. Electronic medical records, US images, and reports were reviewed in conjunction with follow-up imaging. Each review consisted of gender, specialty of referring physician, first head circumference, head circumference at or closest to the time of the head US, the last head circumference, and any neurological issue prior to the US, at the time of US, or following the US, and clinical outcomes. Statistical analysis employed the Kruskal-Wallis rank sum test and Fischer's exact test (chi square test of independence) that compared normal/BMC patients from the patients requiring a neurosurgical consultation. One hundred and thirty (40.9%) had a normal head US, 181 patients (56.9%) had sonographic findings of BMC, and seven (2.2%) patients had an abnormal head US that required a neurosurgical consultation. Of the 181 patients with BMC, 23 underwent follow-up imaging with 22 patients having unchanged BMC or a normal head US and one patient developing mild ventriculomegaly that was stable on follow-up imaging. Three of the seven patients (1%) aged 1.8, 2.3, and 13.1 months with abnormal head US requiring neurosurgical consultation, had mild ventriculomegaly that was stable on follow-up imaging. Four of the seven patients (1.2%) that required neurosurgical consultation needed a neurosurgical procedure. Between the two US subgroups (normal and BMC), no statistical significance was noted regarding age of patient at US, head circumference at clinical and radiological presentation (p>0.05) except for the first head circumference clinically documented which demonstrated statistical significance (p<0.03). Short interval surveillance including head circumference and assessment for the development of bulging anterior fontanelle and neurological abnormalities may be more cost effective than US in the initial evaluation of patients clinically suspected to have BMC. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., among other statutes, the Endangered Species Act of 1973, as amended, the Marine Mammal Protection Act of 1972, as amended, and the Fish and Wildlife Coordination Act. He also will consult, prior to any... Council established pursuant to section 302 of the Fishery Conservation and Management Act of 1976 (16 U.S...

  12. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., among other statutes, the Endangered Species Act of 1973, as amended, the Marine Mammal Protection Act of 1972, as amended, and the Fish and Wildlife Coordination Act. He also will consult, prior to any... Council established pursuant to section 302 of the Fishery Conservation and Management Act of 1976 (16 U.S...

  13. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., among other statutes, the Endangered Species Act of 1973, as amended, the Marine Mammal Protection Act of 1972, as amended, and the Fish and Wildlife Coordination Act. He also will consult, prior to any... Council established pursuant to section 302 of the Fishery Conservation and Management Act of 1976 (16 U.S...

  14. 15 CFR 970.502 - Consultation and cooperation with Federal agencies.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., among other statutes, the Endangered Species Act of 1973, as amended, the Marine Mammal Protection Act of 1972, as amended, and the Fish and Wildlife Coordination Act. He also will consult, prior to any... Council established pursuant to section 302 of the Fishery Conservation and Management Act of 1976 (16 U.S...

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

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., among other statutes, the Endangered Species Act of 1973, as amended, the Marine Mammal Protection Act of 1972, as amended, and the Fish and Wildlife Coordination Act. He also will consult, prior to any... Council established pursuant to section 302 of the Fishery Conservation and Management Act of 1976 (16 U.S...

  16. 49 CFR 23.43 - What are the consultation requirements in the development of recipients' overall goals?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 1 2014-10-01 2014-10-01 false What are the consultation requirements in the development of recipients' overall goals? 23.43 Section 23.43 Transportation Office of the Secretary of Transportation PARTICIPATION OF DISADVANTAGED BUSINESS ENTERPRISE IN AIRPORT CONCESSIONS Goals, Good Faith...

  17. 49 CFR 23.43 - What are the consultation requirements in the development of recipients' overall goals?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 1 2013-10-01 2013-10-01 false What are the consultation requirements in the development of recipients' overall goals? 23.43 Section 23.43 Transportation Office of the Secretary of Transportation PARTICIPATION OF DISADVANTAGED BUSINESS ENTERPRISE IN AIRPORT CONCESSIONS Goals, Good Faith...

  18. 49 CFR 23.43 - What are the consultation requirements in the development of recipients' overall goals?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 1 2012-10-01 2012-10-01 false What are the consultation requirements in the development of recipients' overall goals? 23.43 Section 23.43 Transportation Office of the Secretary of Transportation PARTICIPATION OF DISADVANTAGED BUSINESS ENTERPRISE IN AIRPORT CONCESSIONS Goals, Good Faith...

  19. 49 CFR 23.43 - What are the consultation requirements in the development of recipients' overall goals?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 1 2011-10-01 2011-10-01 false What are the consultation requirements in the development of recipients' overall goals? 23.43 Section 23.43 Transportation Office of the Secretary of Transportation PARTICIPATION OF DISADVANTAGED BUSINESS ENTERPRISE IN AIRPORT CONCESSIONS Goals, Good Faith...

  20. 36 CFR 271.8 - Consultation with Association of State Foresters and the Advertising Council.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Consultation with Association of State Foresters and the Advertising Council. 271.8 Section 271.8 Parks, Forests, and Public... Association of State Foresters and the Advertising Council. These regulations in this part have been issued...

  1. 42 CFR 414.506 - Procedures for public consultation for payment for a new clinical diagnostic laboratory test.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... a new clinical diagnostic laboratory test. 414.506 Section 414.506 Public Health CENTERS FOR... FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for New Clinical Diagnostic Laboratory Tests § 414.506 Procedures for public consultation for payment for a new clinical diagnostic laboratory test...

  2. 6 CFR 27.120 - Designation of a coordinating official; Consultations and technical assistance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 6 Domestic Security 1 2014-01-01 2014-01-01 false Designation of a coordinating official; Consultations and technical assistance. 27.120 Section 27.120 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.120 Designation of a...

  3. 6 CFR 27.120 - Designation of a coordinating official; Consultations and technical assistance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 6 Domestic Security 1 2012-01-01 2012-01-01 false Designation of a coordinating official; Consultations and technical assistance. 27.120 Section 27.120 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.120 Designation of a...

  4. 6 CFR 27.120 - Designation of a coordinating official; Consultations and technical assistance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 6 Domestic Security 1 2013-01-01 2013-01-01 false Designation of a coordinating official; Consultations and technical assistance. 27.120 Section 27.120 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.120 Designation of a...

  5. 6 CFR 27.120 - Designation of a coordinating official; Consultations and technical assistance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 6 Domestic Security 1 2011-01-01 2011-01-01 false Designation of a coordinating official; Consultations and technical assistance. 27.120 Section 27.120 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS General § 27.120 Designation of a...

  6. 45 CFR 73.735-1006 - Reporting financial interests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting financial interests. 73.735-1006 Section... Reporting financial interests. (a) Consultants who will work more than 60 days in a calendar year are... equal to or greater than the basic rate for GS-16, Step 1. Such consultants are covered by the reporting...

  7. 23 CFR 172.7 - Audits.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Audits. 172.7 Section 172.7 Highways FEDERAL HIGHWAY... 23 U.S.C. 112 and this part provided that the consultant is given notice of each use and transfer... subrecpient's acceptance of a consultant's overhead rates pursuant to 23 U.S.C. 112 and this part without the...

  8. 23 CFR 172.7 - Audits.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Audits. 172.7 Section 172.7 Highways FEDERAL HIGHWAY... 23 U.S.C. 112 and this part provided that the consultant is given notice of each use and transfer... subrecpient's acceptance of a consultant's overhead rates pursuant to 23 U.S.C. 112 and this part without the...

  9. 23 CFR 172.7 - Audits.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Audits. 172.7 Section 172.7 Highways FEDERAL HIGHWAY... 23 U.S.C. 112 and this part provided that the consultant is given notice of each use and transfer... subrecpient's acceptance of a consultant's overhead rates pursuant to 23 U.S.C. 112 and this part without the...

  10. 42 CFR 414.506 - Procedures for public consultation for payment for a new clinical diagnostic laboratory test.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... a new clinical diagnostic laboratory test. 414.506 Section 414.506 Public Health CENTERS FOR... FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for New Clinical Diagnostic Laboratory Tests § 414.506 Procedures for public consultation for payment for a new clinical diagnostic laboratory test...

  11. ACHP | News | ACHP Issues Program Comment to Streamline Communication

    Science.gov Websites

    regulations (36 CFR Part 800). An agency can meet its Section 106 responsibilities for considering the effects organizations, local governments, and other consulting parties consult about the effects of these undertakings . However, RUS, NTIA, or FEMA will not have to consider the effects of the telecommunication facilities

  12. 20 CFR 645.510 - What is the required consultation with the Governor?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What is the required consultation with the Governor? 645.510 Section 645.510 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROVISIONS GOVERNING WELFARE-TO-WORK GRANTS Welfare-To-Work Competitive Grants § 645.510 What is...

  13. 24 CFR 972.133 - Public and resident consultation process for developing a conversion plan.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Public and resident consultation process for developing a conversion plan. 972.133 Section 972.133 Housing and Urban Development... ASSISTANCE Required Conversion of Public Housing Developments Conversion Plans § 972.133 Public and resident...

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

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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 the National Institute for Occupational Safety and Health with regard to plans submitted by the States under...

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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 the National Institute for Occupational Safety and Health with regard to plans submitted by the States under...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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 the National Institute for Occupational Safety and Health with regard to plans submitted by the States under...

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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 the National Institute for Occupational Safety and Health with regard to plans submitted by the States under...

  18. 34 CFR 75.516 - Compensation of consultants-employees of institutions of higher education.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Compensation of consultants-employees of institutions of higher education. 75.516 Section 75.516 Education Office of the Secretary, Department of Education... consultants—employees of institutions of higher education. If an institution of higher education receives a...

  19. 18 CFR 401.116 - Disclosure to consultants, advisory committees, State and local government officials, and other...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Disclosure to consultants, advisory committees, State and local government officials, and other special government employees. 401.116 Section 401.116 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION...

  20. 21 CFR 312.82 - Early consultation.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... meeting is to review and reach agreement on the design of animal studies needed to initiate human testing... goal that such testing will be adequate to provide sufficient data on the drug's safety and... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Early consultation. 312.82 Section 312.82 Food and...

  1. 21 CFR 312.82 - Early consultation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... meeting is to review and reach agreement on the design of animal studies needed to initiate human testing... goal that such testing will be adequate to provide sufficient data on the drug's safety and... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Early consultation. 312.82 Section 312.82 Food and...

  2. 21 CFR 312.82 - Early consultation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... meeting is to review and reach agreement on the design of animal studies needed to initiate human testing... goal that such testing will be adequate to provide sufficient data on the drug's safety and... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Early consultation. 312.82 Section 312.82 Food and...

  3. 21 CFR 312.82 - Early consultation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... meeting is to review and reach agreement on the design of animal studies needed to initiate human testing... goal that such testing will be adequate to provide sufficient data on the drug's safety and... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Early consultation. 312.82 Section 312.82 Food and...

  4. 21 CFR 312.82 - Early consultation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... meeting is to review and reach agreement on the design of animal studies needed to initiate human testing... goal that such testing will be adequate to provide sufficient data on the drug's safety and... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Early consultation. 312.82 Section 312.82 Food and...

  5. 29 CFR 1902.6 - Consultation with the National Institute for Occupational Safety and Health.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 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 the National Institute for Occupational Safety and Health with regard to plans submitted by the States under...

  6. Genetic consultation embedded in a gynecologic oncology clinic improves compliance with guideline-based care.

    PubMed

    Senter, Leigha; O'Malley, David M; Backes, Floor J; Copeland, Larry J; Fowler, Jeffery M; Salani, Ritu; Cohn, David E

    2017-10-01

    Analyze the impact of embedding genetic counseling services in gynecologic oncology on clinician referral and patient uptake of cancer genetics services. Data were reviewed for a total of 737 newly diagnosed epithelial ovarian cancer patients seen in gynecologic oncology at a large academic medical center including 401 from 11/2011-7/2014 (a time when cancer genetics services were provided as an off-site consultation). These data were compared to data from 8/2014-9/2016 (n=336), when the model changed to the genetics embedded model (GEM), incorporating a cancer genetic counselor on-site in the gynecologic oncology clinic. A statistically significant difference in proportion of patients referred pre- and post-GEM was observed (21% vs. 44%, p<0.0001). Pre-GEM, only 38% of referred patients were actually scheduled for genetics consultation and post-GEM 82% were scheduled (p<0.00001). The difference in the time from referral to scheduling in genetics was also statistically significant (3.92months pre-GEM vs. 0.79months post-GEM, p<0.00001) as was the time from referral to completion of genetics consultation (2.52months pre-GEM vs. 1.67months post-GEM, p<0.01). Twenty-five percent of patients referred post GEM were seen by the genetic counselor on the same day as the referral. Providing cancer genetics services on-site in gynecologic oncology and modifying the process by which patients are referred and scheduled significantly increases referral to cancer genetics and timely completion of genetics consultation, improving compliance with guideline-based care. Practice changes are critical given the impact of genetic test results on treatment and familial cancer risks. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Is There a Role for Publication Consultants and How Should Their Contribution be Recognized?

    PubMed

    Kendall, Graham; Yee, Angelina; McCollum, Barry

    2016-10-01

    When a scientific paper, dissertation or thesis is published the author(s) have a duty to report who has contributed to the work. This recognition can take several forms such as authorship, relevant acknowledgments and by citing previous work. There is a growing industry where publication consultants will work with authors, research groups or even institutions to help get their work published, or help submit their dissertation/thesis. This help can range from proof reading, data collection, analysis (including statistics), helping with the literature review and identifying suitable journals/conferences. In this opinion article we question whether these external services are required, given that institutions should provide this support and that experienced researchers should be qualified to carry out these activities. If these services are used, we argue that their use should at least be made transparent either by the consultant being an author on the paper, or by being acknowledged on the paper, dissertation or thesis. We also argue that publication consultants should provide an annual return that details the papers, dissertations and thesis that they have consulted on.

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

    PubMed

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

    2003-01-01

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

  9. Community pharmacists' knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): a cross-sectional survey in Makkah Province, Saudi Arabia.

    PubMed

    Hadi, Muhammad Abdul; Karami, Nedaa Ali; Al-Muwalid, Anhar S; Al-Otabi, Areej; Al-Subahi, Eshtyaq; Bamomen, Asmaa; Mohamed, Mahmoud M A; Elrggal, Mahmoud E

    2016-06-01

    To evaluate knowledge, attitude, and practices of community pharmacists towards dispensing antibiotics without prescription (DAwP) in Makkah Province, Saudi Arabia. A cross-sectional survey was conducted between January and February 2016 using a structured, validated, and pilot-tested questionnaire. A four-step systematic approach was used to recruit community pharmacists who completed a 28-item questionnaire either in English or Arabic language based on their personal preference. Of the 200 community pharmacists approached, 189 completed the questionnaire. More than two-thirds (70.5%) of the pharmacists were not aware that DAwP is illegal practice. Lack of patient willingness to consult a physician for a non-serious infection (69.9%) and an inability to afford a consultation with a physician (65.3%) were the most common reasons cited for DAwP. A statistically significant association was found between the number of antibiotics dispensed and educating patients about the importance of adherence and completion of the full course of antibiotics (p=0.007). In general, community pharmacists have a poor understanding of the regulations prohibiting the over-the-counter sale of antibiotics in Saudi Arabia, explaining the high rate of DAwP in the country. A multifaceted approach consisting of educational interventions and improving the access to and affordability of healthcare facilities for the general public is required to effectively reduce DAwP and its negative consequences on public health. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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

    PubMed

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

    2018-03-20

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

  11. 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

  12. Family practice obstetrics in a teaching hospital. Does a tertiary care environment make a difference?

    PubMed Central

    Jordan, J. M.; Gaspar, D.

    1995-01-01

    OBJECTIVE: To determine referral rates, to study the nature of consultations with obstetricians, and to examine how both patient and physician characteristics affect referrals. DESIGN: Case series. Retrospective review of hospital records. SETTING: Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. PARTICIPANTS: Five hundred forty-two women admitted consecutively for delivery under the care of family physicians from October 1, 1990, to September 31, 1991. OUTCOME MEASURE: The number and types of obstetrical consultations obtained for the study population. RESULTS: Of the 50.7% of cases requiring consultation, half were delivered by obstetricians. The most common reasons for consultation were failure to progress in labour, induction of labour, posterior presentation, fetal distress, and pregnancy-induced hypertension. The most common reasons for obstetricians to attend delivery were to perform forceps rotations and cesarean sections. CONCLUSIONS: Parity and risk classification were the two most important factors for predicting whether consultation would occur. The high rate of consultation in this study might relate to ease of access to consultation in a tertiary care environment. More study is needed to examine the reasons for consultation because it seems that some of the situations for which obstetricians were consulted could have been safely managed by family physicians. PMID:7787491

  13. Communication with patients and the duration of family medicine consultations.

    PubMed

    Valverde Bolívar, Francisco Javier; Pedregal González, Miguel; Moreno Martos, Herminia; Cózar García, Inmaculada; Torío Durántez, Jesús

    2017-10-17

    To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. Cross-sectional multicentre study. Primary Healthcare Centres in Andalusia, Spain. A total of 119 tutors and family medicine physician residents. Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r 2 =0.32). There was no correlation between physician or patient gender, or problem type. A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  14. Is three a crowd? Impact of the presence of a medical student in the general practice consultation.

    PubMed

    Partanen, Riitta; Ranmuthugala, Geetha; Kondalsamy-Chennakesavan, Srinivas; van Driel, Mieke

    2016-02-01

    To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times. Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p = 0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2%; p = 0.6) and overall satisfaction with the consultation (99.2% versus 99.1%; p = 0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6%; p < 0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20 minutes consultation; p = 0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0%; p = 0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning. The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present. © 2016 John Wiley & Sons Ltd.

  15. Application procedures for hydropower licenses, exemptions, and preliminary permits

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

    Not Available

    1982-04-01

    This document provides essential information regarding the FERC's regulations and procedures for filing an application with the Commission for hydropower licenses, exemptions and preliminary permits. Each section is page numbered with a roman numeral followed by consecutive arabic numbering. The appendices are page numbered with an alphabetical prefix and consecutve page numbering within each section. The first section of this book contains background descriptions of the Commission's authority and regulations and serves as an introduction to the Commission's hydropower licensing program. Two general tables follow this introductory text and provide a quick reference to the types of applications and themore » relationship between the Commission's orders and regulations. Following the introduction are sections which include the Commission's regulations by application type: preliminary permits; licenses; and exemptions. Each section contains an introduction describing application procedures by type of action requested. There are two appendices provided contain information on the consultation process and lists of agencies to be consulted and a section by section analyses of the Commission's orders.« less

  16. A two-component rain model for the prediction of attenuation statistics

    NASA Technical Reports Server (NTRS)

    Crane, R. K.

    1982-01-01

    A two-component rain model has been developed for calculating attenuation statistics. In contrast to most other attenuation prediction models, the two-component model calculates the occurrence probability for volume cells or debris attenuation events. The model performed significantly better than the International Radio Consultative Committee model when used for predictions on earth-satellite paths. It is expected that the model will have applications in modeling the joint statistics required for space diversity system design, the statistics of interference due to rain scatter at attenuating frequencies, and the duration statistics for attenuation events.

  17. 25 CFR 224.113 - What must the tribe do after it completes petition consultation with the Director?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false What must the tribe do after it completes petition consultation with the Director? 224.113 Section 224.113 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT...

  18. 25 CFR 224.59 - How will the Director use the results of the application consultation meeting?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... consultation meeting? 224.59 Section 224.59 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF... information provided through §§ 224.53 and 224.63 to determine the energy resource development capacity of the...

  19. 77 FR 63763 - Regulatory Capital Rules: Standardized Approach for Risk-Weighted Assets; Market Discipline and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-17

    ... BCBS in 2006 and 2009, as well as other proposals set forth in consultative papers of the BCBS. Section... provided in this Federal Register document, which describes the economic impact of the Standardized... in recent consultative papers of the BCBS.\\2\\ In the Standardized Approach NPR, the agencies also...

  20. 76 FR 54535 - Designation of Three Individuals Pursuant to Executive Order 13224

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-01

    ... Order, as amended by Executive Order 13268 of July 2, 2002, 13 individuals and 16 entities as subject to... (4) except as provided in section 5 of the Order and after such consultation, if any, with foreign authorities as the Secretary of State, in consultation with the Secretary of the Treasury, the Secretary of...

  1. 25 CFR 170.108 - Should Indian tribes and BIA consult with States' planning organizations and local governments in...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...' planning organizations and local governments in the development of their IRRTIP? 170.108 Section 170.108... § 170.108 Should Indian tribes and BIA consult with States' planning organizations and local governments in the development of their IRRTIP? Yes. (a) All regionally significant IRR Program projects must be...

  2. 25 CFR 170.108 - Should Indian tribes and BIA consult with States' planning organizations and local governments in...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...' planning organizations and local governments in the development of their IRRTIP? 170.108 Section 170.108... § 170.108 Should Indian tribes and BIA consult with States' planning organizations and local governments in the development of their IRRTIP? Yes. (a) All regionally significant IRR Program projects must be...

  3. 25 CFR 170.108 - Should Indian tribes and BIA consult with States' planning organizations and local governments in...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...' planning organizations and local governments in the development of their IRRTIP? 170.108 Section 170.108... § 170.108 Should Indian tribes and BIA consult with States' planning organizations and local governments in the development of their IRRTIP? Yes. (a) All regionally significant IRR Program projects must be...

  4. 25 CFR 170.108 - Should Indian tribes and BIA consult with States' planning organizations and local governments in...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... organizations and local governments in the development of their IRRTIP? 170.108 Section 170.108 Indians BUREAU... Indian tribes and BIA consult with States' planning organizations and local governments in the development of their IRRTIP? Yes. (a) All regionally significant IRR Program projects must be: (1) Developed...

  5. 25 CFR 170.108 - Should Indian tribes and BIA consult with States' planning organizations and local governments in...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...' planning organizations and local governments in the development of their IRRTIP? 170.108 Section 170.108... § 170.108 Should Indian tribes and BIA consult with States' planning organizations and local governments in the development of their IRRTIP? Yes. (a) All regionally significant IRR Program projects must be...

  6. Aircrew team management program

    NASA Technical Reports Server (NTRS)

    Margerison, Charles; Mccann, Dick; Davies, Rod

    1987-01-01

    The key features of the Aircrew Team Management Workshop which was designed for and in consultation with Trans Australia Airlines are outlined. Five major sections are presented dealing with: (1) A profile of the airline and the designers; (2) Aircrew consultation and involvement; (3) Educational design and development; (4) Implementation and instruction; and (5) Evaluation and assessment. These areas are detailed.

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

    ERIC Educational Resources Information Center

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

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

  8. Factors related to consultation time: Experience in Slovenia

    PubMed Central

    Petek Šter, Marija; Švab, Igor; Živčec Kalan, Gordana

    2008-01-01

    Objective Consultation time has a serious impact on physicians’ work and patient satisfaction. No systematic study of consultation time in general practice in Slovenia has yet been carried out. The aim of the present study was to measure consultation time, to identify the factors influencing it, and to study the influence of the workload of general practitioners on consultation time. Design A total of 42 general practitioners participated in this cross-sectional study. Each physician collected data from 300 consecutive consultations and measured the length of the visit. Setting Forty-two randomly selected general practices in Slovenia. Subjects Patients of 42 general practices. Main outcome measures Average consultation time in general practice in Slovenia; factors influencing consultation time in Slovenia. Results Data from 12 501 visits to the surgery were collected. A quarter of all visits (25.5%) were administrative. The mean consultation time was 6.9 minutes (median 6.0 minutes, 5%–95% interval: 1.0–16.0 minutes). Longer consultation time was predicted by: patient-related factors (female gender, higher age, higher level of education, higher number of health problems, change of physician within the last year), physician-related factors (higher age), physicians’ workload (absence of high workload), and the type of visit (consultation and/or clinical examination). Conclusion Consultation time in general practice is short, and depends on the characteristics of the patient and the physician, the physician's workload, and the type of visit. A reduction of high workload in general practice should be one of the priorities of the healthcare system. PMID:18297560

  9. Sustainability of a Primary Care-Driven eConsult Service.

    PubMed

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

    2018-03-01

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

  10. Validation of use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for impairment rating: a transversal retrospective study of 120 patients.

    PubMed

    Timmermans, Luc; Falez, Freddy; Mélot, Christian; Wespes, Eric

    2013-09-01

    A urinary incontinence impairment rating must be a highly accurate, non-invasive exploration of the condition using International Classification of Functioning (ICF)-based assessment tools. The objective of this study was to identify the best evaluation test and to determine an impairment rating model of urinary incontinence. In performing a cross-sectional study comparing successive urodynamic tests using both the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the 1-hr pad-weighing test in 120 patients, we performed statistical likelihood ratio analysis and used logistic regression to calculate the probability of urodynamic incontinence using the most significant independent predictors. Subsequently, we created a template that was based on the significant predictors and the probability of urodynamic incontinence. The mean ICIQ-UI-SF score was 13.5 ± 4.6, and the median pad test value was 8 g. The discrimination statistic (receiver operating characteristic) described how well the urodynamic observations matched the ICIQ-UI-SF scores (under curve area (UDA):0.689) and the pad test data (UDA: 0.693). Using logistic regression analysis, we demonstrated that the best independent predictors of urodynamic incontinence were the patient's age and the ICIQ-UI-SF score. The logistic regression model permitted us to construct an equation to determine the probability of urodynamic incontinence. Using these tools, we created a template to generate a probability index of urodynamic urinary incontinence. Using this probability index, relative to the patient and to the maximum impairment of the whole person (MIWP) relative to urinary incontinence, we were able to calculate a patient's permanent impairment. Copyright © 2012 Wiley Periodicals, Inc.

  11. Validation of virtual-reality-based simulations for endoscopic sinus surgery.

    PubMed

    Dharmawardana, N; Ruthenbeck, G; Woods, C; Elmiyeh, B; Diment, L; Ooi, E H; Reynolds, K; Carney, A S

    2015-12-01

    Virtual reality (VR) simulators provide an alternative to real patients for practicing surgical skills but require validation to ensure accuracy. Here, we validate the use of a virtual reality sinus surgery simulator with haptic feedback for training in Otorhinolaryngology - Head & Neck Surgery (OHNS). Participants were recruited from final-year medical students, interns, resident medical officers (RMOs), OHNS registrars and consultants. All participants completed an online questionnaire after performing four separate simulation tasks. These were then used to assess face, content and construct validity. anova with post hoc correlation was used for statistical analysis. The following groups were compared: (i) medical students/interns, (ii) RMOs, (iii) registrars and (iv) consultants. Face validity results had a statistically significant (P < 0.05) difference between the consultant group and others, while there was no significant difference between medical student/intern and RMOs. Variability within groups was not significant. Content validity results based on consultant scoring and comments indicated that the simulations need further development in several areas to be effective for registrar-level teaching. However, students, interns and RMOs indicated that the simulations provide a useful tool for learning OHNS-related anatomy and as an introduction to ENT-specific procedures. The VR simulations have been validated for teaching sinus anatomy and nasendoscopy to medical students, interns and RMOs. However, they require further development before they can be regarded as a valid tool for more advanced surgical training. © 2015 John Wiley & Sons Ltd.

  12. Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment.

    PubMed

    Oláh, K S

    2005-02-01

    During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head. No comment was made about caput or moulding in the majority of cases (94%). The study findings suggest that vaginal examination, like instrumental delivery, is a skill that is being eroded and will require formal instruction to address this problem.

  13. [Present and prospects of telepathology].

    PubMed

    Takahashi, M; Mernyei, M; Shibuya, C; Toshima, S

    1999-01-01

    Nearly ten years have passed since telepathology was introduced and real-time pathology consultations were conducted. Long distance consultations in pathology, cytology, computed tomography and magnetic resonance imaging, which are referred to as telemedicine, clearly enhance the level of medical care in remote hospitals where no full-time specialists are employed. To transmit intraoperative frozen section images, we developed a unique hybrid system "Hi-SPEED". The imaging view through the CCD camera is controlled by a camera controller that provides NTSC composite video output for low resolution motion pictures and high resolution digital output for final interpretation on computer display. The results of intraoperative frozen section diagnosis between the Gihoku General Hospital 410 km from SRL showed a sensitivity of 97.6% for 82 cases of breast carcinoma and a false positive rate of 1.2%. This system can be used for second opinions as well as for consultations between cytologists and cytotechnologists.

  14. Advantages and disadvantages of interdisciplinary consultation in the prescription of assistive technologies for mobility limitations.

    PubMed

    de Laat, Fred A; van Heerebeek, Bart; van Netten, Jaap J

    2018-03-28

    To explore the advantages and disadvantages experienced by professionals in interdisciplinary consultation involving the user, prescriber and technician in the prescription of assistive technologies for mobility limitations. Cross-sectional study. Prescribers (N = 39) and orthopaedic technicians (N = 50), who were regularly involved in an interdisciplinary consultation completed a questionnaire about advantages and disadvantages of the interdisciplinary consultation. Advantages of the interdisciplinary consultation were mentioned within all CanMEDS areas of medical practice, including better and quicker prescription of the assistive technology, shared knowledge of medical diagnosis and device possibilities, shared decision making of the device prescription and clear communication rules. Disadvantages were mentioned in the CanMEDS areas management and collaboration, including planning problems (financial) reimbursement of this type of consultation, and time efficiency. On a 10-point scale, mean (standard deviation) rates of interdisciplinary consultations were 7.9 (0.6) according to prescribers, and 7.8 (0.9) by technicians. All participants wanted to continue the interdisciplinary consultation. Prescribers and technicians in the field of assistive technologies for walking mobility limitations appreciate an interdisciplinary consultation. Advantages are found in all CanMEDS areas, whereas disadvantages only concern coordination. It should be encouraged to realize this kind of consultation in all situations where such technologies are prescribed. Implications for rehabilitation Interdisciplinary consultation involving the user, prescriber and technician to prescribe assistive technologies for mobility limitations has many advantages in all CanMEDS areas of medical practice, and few disadvantages, related to management and collaboration only. The disadvantages of interdisciplinary consultation, such as (financial) reimbursement by health insurance companies, have to be taken into account. Professionals in the field of ankle-foot-orthoses and orthopaedic shoes (medical specialist as prescriber and orthopaedic technician) who are involved in interdisciplinary consultation appreciate it and want to continue.

  15. Global hospital bed utilization crisis. A different approach.

    PubMed

    Waness, Abdelkarim; Akbar, Jalal U; Kharal, Mubashar; BinSalih, Salih; Harakati, Mohammed

    2010-04-01

    To test the effect of improved physician availability on hospital bed utilization. A prospective cohort study was conducted from 1st January 2009 to 31st March 2009 in the Division of Internal Medicine (DIM), King Abdul-Aziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia. Two clinical teaching units (CTU) were compared head-to-head. Each CTU has 3 consultants. The CTU-control provides standard care, while the CTU-intervention was designed to provide better physician-consultant availability. Three outcomes were evaluated: patient outsourcing to another hospital, patient discharge during weekends, and overall admissions. Statistical analysis was carried out by electronic statistics calculator from the Center for Evidence-Based Medicine. Three hundred and thirty-four patients were evaluated for admission at the Emergency Room by both CTU's. One hundred and eighty-three patients were seen by the CTU-control, 6 patients were outsourced, and 177 were admitted. One hundred fifty-one patients were seen by the CTU-intervention: 39 of them were outsourced, and 112 were admitted. Forty-eight weekend patient discharges occurred during this period of time: 21 by CTU-control, and 27 by CTU-intervention. Analysis for odds ratio in both the rate of outsourcing, and weekend discharges, showed statistical significance in favor of the intervention group. The continuous availability of a physician-consultant for patient admission evaluation, outsourcing, or discharge during regular weekdays and weekends at DIM, KAMC proved to have a positive impact on bed utilization.

  16. Access to and utilisation of GP services among Burmese migrants in London: a cross-sectional descriptive study.

    PubMed

    Aung, Nyein Chan; Rechel, Bernd; Odermatt, Peter

    2010-10-12

    An estimated 10,000 Burmese migrants are currently living in London. No studies have been conducted on their access to health services. Furthermore, most studies on migrants in the United Kingdom (UK) have been conducted at the point of service provision, carrying the risk of selection bias. Our cross-sectional study explored access to and utilisation of General Practice (GP) services by Burmese migrants residing in London. We used a mixed-method approach: a quantitative survey using self-administered questionnaires was complemented by qualitative in-depth interviews for developing the questionnaire and triangulating the findings of the survey. Overall, 137 questionnaires were received (a response rate of 57%) and 11 in-depth interviews conducted. The main outcome variables of the study included GP registration, barriers towards registration, GP consultations, barriers towards consultations, and knowledge on entitlements to health care. Quantitative data were analysed using descriptive statistics, association tests, and a multivariate analysis using logistic regression. The qualitative information was analysed using content analysis. The respondents were young, of roughly equal gender (51.5% female), well educated, and had a fair level of knowledge on health services in the UK. Although the GP registration rate was relatively high (80%, 109 out of 136), GP service utilisation during the last episode of illness, at 56.8% (54 out of 95), was low. The statistical analysis showed that age being younger than 35 years, lacking prior overseas experience, having an unstable immigration status, having a shorter duration of stay, and resorting to self-medication were the main barriers hindering Burmese migrants from accessing primary health care services. These findings were corroborated by the in-depth interviews. Our study found that having formal access to primary health care was not sufficient to ensure GP registration and health care utilisation. Some respondents faced difficulties in registering with GP practices. Many of those who have registered prefer to forego GP services in favour of self-medication, partly due to long waiting times and language barriers. To ensure that migrants enjoy the health services they need and to which they are entitled, more proactive steps are required, including those that make health services culturally responsive.

  17. Physician-to-physician consultation via electronic mail: the Walter Reed Army Medical Center Ask a Doc system.

    PubMed

    Abbott, Kevin C; Mann, Scott; DeWitt, Daisy; Sales, Linda Youngblood; Kennedy, Sean; Poropatich, Ron K

    2002-03-01

    Physician-to-physician consultation and discussion have traditionally been conducted by telephone, paper, and "curbside" (face to face meetings). The implementation and use of physician-to-physician consultation via electronic mail in a military health care system has not been reported previously. The group mail function of the Composite Health Care System, the main outpatient medical automation system for the Department of Defense, was modified to create mailgroups for every specialty of the Walter Reed Army Medical Center to facilitate ease of physician-to-physician consultation. This modification was called the "Ask a Doc" system. The system was deployed to a 21-state health care network among triservice participants. There were 3,121 consultations logged from April 22, 1998, to December 31, 2000. Growth in use expanded initially and was sustained during a 3-year period. Average response time to consultations was less than 1 day (11.93 hours). Additional training and maintenance requirements were minimal. In general, the use of electronic consultation mirrored that of clinical practice. Most specialty consultations involved the disciplines of internal medicine. Use of the Ask a Doc system was representative of total clinical workload and increased access to specialty medical care over a wide geographic area. The distribution of use indicated that user statistics were legitimate, and quality improvement programs could easily troubleshoot the system. Ask a Doc was inserted into a regional health care network with minimal cost to support and implement and was sustained with very little effort for 3 years. Barriers to even wider use currently include lack of secure communications and the difficulty in assigning workload credit for electronic consultations.

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

    PubMed

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

    2011-10-25

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

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

    PubMed Central

    2011-01-01

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

  20. What is the relation between number of sessions worked and productivity of radiologists-a pilot study?

    PubMed

    Khan, Shah H M; Hedges, William P

    2016-04-01

    Increasing workloads and the current austerity measures are putting UK radiology departments under considerable stress. We need to look at the most efficient ways to manage radiology departments in order to cope with increasing demand. Consequently, a system is needed that can compare productivity between radiologists with different jobs. We measured workload in a UK radiology department and compared the productivities of consultants working different numbers of sessions, which are called programmed activities (PAs), to identify the optimal job plan structure for reporting productivity. Reporting data was gathered from electronic records for 14 consultants working different numbers of PA during the period April 2010-March 2011. These were converted into relative value unit (RVU) scores using a modified RCSI RVU system. Crude and net workloads were calculated for each consultant by dividing their total RVU score by the number of PAs they were contracted for and how many they spent reporting. The consultants reported 118,001 imaging studies. There was statistically significant variation in productivity between consultants working different numbers of PAs on χ (2) analysis (p < 0.05). Consultants working 12 PAs were more productive than consultants working 11 PAs, with net workloads of 7636 RVU/PA/year versus net 6146 RVU/PA/year, p < 0.05. Although UK consultants working 12 PAs per week are more productive than their colleagues, the reasons why are unclear. We have identified a method that can be developed further to identify efficient working practices in UK radiology departments. However, a UK-specific RVU system would make this productivity analysis more accurate.

  1. Determining the key drivers and mitigating factors that influence the role of the Nurse and/or Midwife Consultant: a cross-sectional survey.

    PubMed

    Fernandez, Ritin S; Sheppard-Law, Suzanne; Manning, Vicki

    2017-06-01

    Globally, many nurses and midwives are working at an advanced practice level. The role of a Nurse and/or Midwife Consultant encompasses a diverse and complex interaction between five specified domains namely Clinical Service and Consultancy, Clinical Leadership, Research, Education, and Clinical Services Planning and Management. The objective of this replication study was to identify the key drivers and mitigating factors that impact the role of Australian Nurse and/or Midwife Consultants. Cross-sectional survey. The study was conducted in a large metropolitan health district in Sydney, Australia. Participants for this study consisted of all Nurse and/or Midwife Consultants working within a health district in New South Wales (NSW). Data were collected by an anonymous online survey. Key drivers and mitigating factors perceived to influence their role were identified using previously implemented instruments. Data were analysed using SPSS version 21. Responses were obtained from 122 Nurse and/or Midwife Consultants. The number of years of experience as a Nurse and/or Midwife Consultant ranged from 6 months to 25.5 years. Personal attributes which included personal motivation and own communication skills were identified as key drivers to role performance with a mean score of 7.7±0.6. Other key drivers included peer support, organisational culture, personal attributes, professional learning, Nurse and/or Midwife Consultant experience, and collaborative relationships. Of the 14 mitigating factors to the role, the most common factors were lack of resources to set up and develop the role (2.6 ± 0.9), lack of secretarial support (2.6 ± 1.1), lack of managerial support (2.45 ± 1.1), and lack of understanding of the role by other health professionals (2.40 ± 0.8). Understanding the key drivers and mitigating factors that influence the role of the Nurse and/or Midwife Consultant is important for healthcare managers. Given the changing landscape of nursing and midwifery practice, organisational strategies to provide ongoing support to address the mitigating factors are urgently needed. It is pivotal that nursing management implement strategies to empower Nurse and/or Midwife Consultants to perform and reach their potential to deliver advanced nursing care.

  2. A decision-analytic approach to the optimal allocation of resources for endangered species consultation

    USGS Publications Warehouse

    Converse, Sarah J.; Shelley, Kevin J.; Morey, Steve; Chan, Jeffrey; LaTier, Andrea; Scafidi, Carolyn; Crouse, Deborah T.; Runge, Michael C.

    2011-01-01

    The resources available to support conservation work, whether time or money, are limited. Decision makers need methods to help them identify the optimal allocation of limited resources to meet conservation goals, and decision analysis is uniquely suited to assist with the development of such methods. In recent years, a number of case studies have been described that examine optimal conservation decisions under fiscal constraints; here we develop methods to look at other types of constraints, including limited staff and regulatory deadlines. In the US, Section Seven consultation, an important component of protection under the federal Endangered Species Act, requires that federal agencies overseeing projects consult with federal biologists to avoid jeopardizing species. A benefit of consultation is negotiation of project modifications that lessen impacts on species, so staff time allocated to consultation supports conservation. However, some offices have experienced declining staff, potentially reducing the efficacy of consultation. This is true of the US Fish and Wildlife Service's Washington Fish and Wildlife Office (WFWO) and its consultation work on federally-threatened bull trout (Salvelinus confluentus). To improve effectiveness, WFWO managers needed a tool to help allocate this work to maximize conservation benefits. We used a decision-analytic approach to score projects based on the value of staff time investment, and then identified an optimal decision rule for how scored projects would be allocated across bins, where projects in different bins received different time investments. We found that, given current staff, the optimal decision rule placed 80% of informal consultations (those where expected effects are beneficial, insignificant, or discountable) in a short bin where they would be completed without negotiating changes. The remaining 20% would be placed in a long bin, warranting an investment of seven days, including time for negotiation. For formal consultations (those where expected effects are significant), 82% of projects would be placed in a long bin, with an average time investment of 15. days. The WFWO is using this decision-support tool to help allocate staff time. Because workload allocation decisions are iterative, we describe a monitoring plan designed to increase the tool's efficacy over time. This work has general application beyond Section Seven consultation, in that it provides a framework for efficient investment of staff time in conservation when such time is limited and when regulatory deadlines prevent an unconstrained approach. ?? 2010.

  3. Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland

    PubMed Central

    Busato, André; Künzi, Beat

    2008-01-01

    Background The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. Methods The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Results Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. Conclusion The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations. PMID:18190705

  4. Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland.

    PubMed

    Busato, André; Künzi, Beat

    2008-01-11

    The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations.

  5. Patients' use of digital audio recordings in four different outpatient clinics.

    PubMed

    Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René; Ammentorp, Jette

    2015-12-01

    To investigate a new technology of digital audio recording (DAR) of health consultations to provide knowledge about patients' use and evaluation of this recording method. A cross-sectional feasibility analysis of the intervention using log data from the recording platform and data from a patient-administered questionnaire. Four different outpatient clinics at a Danish hospital: Paediatrics, Orthopaedics, Internal Medicine and Urology. Two thousand seven hundred and eighty-four outpatients having their consultation audio recorded by one of 49 participating health professionals. DAR of outpatient consultations provided to patients permitting replay of their consultation either alone or together with their relatives. Replay of the consultation within 90 days from the consultation. In the adult outpatient clinics, one in every three consultations was replayed; however, the rates were significantly lower in the paediatric clinic where one in five consultations was replayed. The usage of the audio recordings was positively associated with increasing patient age and first time visits to the clinic. Patient gender influenced replays in different ways; for instance, relatives to male patients replayed recordings more often than relatives to female patients did. Approval of future recordings was high among the patients who replayed the consultation. Patients found that recording health consultations was an important information aid, and the digital recording technology was found to be feasible in routine practice. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  6. Effect of components of a workplace lactation program on breastfeeding duration among employees of a public-sector employer.

    PubMed

    Balkam, Jane A Johnston; Cadwell, Karin; Fein, Sara B

    2011-07-01

    The purpose of this study was to evaluate the impact of the individual services offered via a workplace lactation program of one large public-sector employer on the duration of any breastfeeding and exclusive breastfeeding. Exclusive breastfeeding was defined as exclusive feeding of human milk for the milk feeding. A cross-sectional mailed survey approach was used. The sample (n = 128) consisted of women who had used at least one component of the lactation program in the past 3 years and who were still employed at the same organization when data were collected. Descriptive statistics included frequency distributions and contingency table analysis. Chi-square analysis was used for comparison of groups, and both analysis of variance (ANOVA) and univariate analysis of variance from a general linear model were used for comparison of means. The survey respondents were primarily older, white, married, well-educated, high-income women. More of the women who received each lactation program service were exclusively breastfeeding at 6 months of infant age in all categories of services, with significant differences in the categories of telephone support and return to work consultation. After adjusting for race and work status, logistic regression analysis showed the number of services received was positively related to exclusive breastfeeding at 6 months and participation in a return to work consultation was positively related to any breastfeeding at 6 months. The study demonstrated that the workplace lactation program had a positive impact on duration of breastfeeding for the women who participated. Participation in the telephone support and return to work consultation services, and the total number of services used were related to longer duration of exclusive and/or any breastfeeding.

  7. A descriptive study of access to services in a random sample of Canadian rural emergency departments

    PubMed Central

    Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

    2013-01-01

    Objective To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Design Cross-sectional study—mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Setting Canadian rural EDs (rural small town (RST) definition—Statistics Canada). Participants 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. Main outcome measures General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Results Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. Conclusions This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands. PMID:24285633

  8. [Prevalence and duration of breast-feeding: its influences on the weight and the morbidity].

    PubMed

    Morán Rodríguez, M; Naveiro Rilo, J C; Blanco Fernández, E; Cabañeros Arias, I; Rodríguez Fernández, M; Peral Casado, A

    2009-01-01

    To estimate the prevalence and the average length of Lactation. To describe the development of the weight during the first year of life and the demand of paediatric consultations in relation to the type of lactation. A cross-sectional study was done using retrospective data. There was gathered a random sample of clinical histories of born children between years 2000 and 2005. There was estimated the prevalence of breast-feeding from the beginning until three and six months. An index of global desertion was elaborated. The average weight and the number of paediatric consultations were related to the type of lactation. The children initiate exclusive breastfeeding (MEL) in a 63.5% (CI 95%: 58.6-64.5). 22.6% amount them (IC 95%: 18.4-26.9) remained it until six months age. After three months of MEL 43.4% of the subjects gave up exclusively lactation. At the age of six months only 33.6% remained with MEL. Mixed form of lactation (MTL) was kept in 80.5% of the subjects (IC 95%: 75.4-84.6). Children included in the program of MTL (exclusive or mixed) have a minor index of desertion (26.5% and 54.4% up to three and six months, respectively). A higher weight was detected in children with mixed lactation. Those on the MEL up to six months consulted the paediatrician 4.5 times a year, whereas children with artificial lactation did it 6.5 times during their first year of life. There were statistically significant differences found (p < 0.007). Percentage of lactation in the group studied is far from recommended levels (WHO). Exclusive breastfeeding (MEL) entails a suitable weight development, as well as a minor morbidity in the first year of life.

  9. Accuracy of a Mobile App to Identify Suspect Asbestos-Containing Material in Australian Residential Settings.

    PubMed

    Govorko, Matthew H; Fritschi, Lin; Reid, Alison

    2018-05-14

    In situ asbestos in the built environment is a remaining source of exposure in countries that have prohibited the manufacture and use of asbestos. However, it is difficult to identify in situ asbestos-containing material in residential settings. The objective of this study was to evaluate the accuracy of the mobile phone application ("app"), ACM Check, in identifying in situ asbestos located inside and outside of homes compared with onsite inspections conducted by an experienced environmental consultant. A cross-sectional study was undertaken that involved participants completing ACM Check on their homes built pre-1990 and located throughout metropolitan Perth, Western Australia, and an onsite inspection conducted at each home by an environmental consultant. Cohen's kappa statistic was calculated to evaluate the strength of agreement between the two methods. The 40 houses sampled were built between 1898 and 1988 with a median year of 1966. Thirty eight (95%) homes had at least one type of material categorized as positive for asbestos by both ACM Check and the environmental consultant (κ = 1.00). Agreement between the two methods differed when categorizing specific materials as positive or negative for asbestos with substantial agreement for fencing (κ = 0.918), outbuilding walls (κ = 0.844), backing board to electrical meter box (κ = 0.826), exterior wall cladding (κ = 0.771), and interior walls (κ = 0.754), and fair agreement for outbuilding roofs (κ = 0.375), and interior flooring (κ = 0.304). ACM Check is a tool that can be used by tradespeople, home renovators, and householders to screen residential settings for the presence of in situ asbestos-containing material. Mobile phone apps have the potential to be developed or modified for use in other countries to help users identify asbestos and reduce their risk of asbestos exposure.

  10. Statistical literacy and sample survey results

    NASA Astrophysics Data System (ADS)

    McAlevey, Lynn; Sullivan, Charles

    2010-10-01

    Sample surveys are widely used in the social sciences and business. The news media almost daily quote from them, yet they are widely misused. Using students with prior managerial experience embarking on an MBA course, we show that common sample survey results are misunderstood even by those managers who have previously done a statistics course. In general, they fare no better than managers who have never studied statistics. There are implications for teaching, especially in business schools, as well as for consulting.

  11. 42 CFR 137.401 - What role does Tribal consultation play in the IHS annual budget request process?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  12. 77 FR 12370 - Designation of 3 Individuals Pursuant to Executive Order 13224 of September 23, 2001, “Blocking...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-29

    ... Order, as amended by Executive Order 13268 of July 2, 2002, 13 individuals and 16 entities as subject to... (4) except as provided in section 5 of the Order and after such consultation, if any, with foreign authorities as the Secretary of State, in consultation with the Secretary [[Page 12371

  13. Consultation Process on the European Commission's "Memorandum on Lifelong Learning": Analysis of National Reports. CEDEFOP Panorama Series.

    ERIC Educational Resources Information Center

    Ni Cheallaigh, Martina, Ed.

    This document presents outcomes of a review of the Memorandum on Lifelong Learning (LL) consultation reports from member states of the European Commission and EEA (European Economic Area) countries that collected all views on how best to make progress in implementing LL at local, regional, and national levels. Section 1 provides an overview of…

  14. 36 CFR 1281.10 - When does a foundation consult with NARA before offering a gift of a physical or material change...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... library? 1281.10 Section 1281.10 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NARA FACILITIES PRESIDENTIAL LIBRARY FACILITIES § 1281.10 When does a foundation consult with NARA before offering a gift of a physical or material change, or addition to an existing library? A foundation...

  15. 36 CFR 1281.10 - When does a foundation consult with NARA before offering a gift of a physical or material change...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... library? 1281.10 Section 1281.10 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NARA FACILITIES PRESIDENTIAL LIBRARY FACILITIES § 1281.10 When does a foundation consult with NARA before offering a gift of a physical or material change, or addition to an existing library? A foundation...

  16. 36 CFR 1281.10 - When does a foundation consult with NARA before offering a gift of a physical or material change...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... library? 1281.10 Section 1281.10 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NARA FACILITIES PRESIDENTIAL LIBRARY FACILITIES § 1281.10 When does a foundation consult with NARA before offering a gift of a physical or material change, or addition to an existing library? A foundation...

  17. 36 CFR 1281.10 - When does a foundation consult with NARA before offering a gift of a physical or material change...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... library? 1281.10 Section 1281.10 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NARA FACILITIES PRESIDENTIAL LIBRARY FACILITIES § 1281.10 When does a foundation consult with NARA before offering a gift of a physical or material change, or addition to an existing library? A foundation...

  18. 21 CFR 14.171 - Utilization of an advisory committee on the initiative of FDA.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... initiative of FDA. 14.171 Section 14.171 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... Human Prescription Drugs § 14.171 Utilization of an advisory committee on the initiative of FDA. (a) Any... monitoring of the matter and consultation with FDA on behalf of the committee. The member or consultant may...

  19. 21 CFR 14.171 - Utilization of an advisory committee on the initiative of FDA.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... initiative of FDA. 14.171 Section 14.171 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... Human Prescription Drugs § 14.171 Utilization of an advisory committee on the initiative of FDA. (a) Any... monitoring of the matter and consultation with FDA on behalf of the committee. The member or consultant may...

  20. 21 CFR 14.171 - Utilization of an advisory committee on the initiative of FDA.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... initiative of FDA. 14.171 Section 14.171 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... Human Prescription Drugs § 14.171 Utilization of an advisory committee on the initiative of FDA. (a) Any... monitoring of the matter and consultation with FDA on behalf of the committee. The member or consultant may...

  1. 21 CFR 14.171 - Utilization of an advisory committee on the initiative of FDA.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... initiative of FDA. 14.171 Section 14.171 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... Human Prescription Drugs § 14.171 Utilization of an advisory committee on the initiative of FDA. (a) Any... monitoring of the matter and consultation with FDA on behalf of the committee. The member or consultant may...

  2. Explaining Mendelian inheritance in genetic consultations: an IPR study of counselor and counselee experiences.

    PubMed

    Gale, Theodora; Pasalodos-Sanchez, Sara; Kerzin-Storrar, Lauren; Hall, Georgina; MacLeod, Rhona

    2010-02-01

    The explanation of Mendelian inheritance is a key component of most genetic counselling consultations, yet no evidence base exists for this area of practice. This qualitative study used Interpersonal Process Recall (IPR) to explore how information about X-linked inheritance is provided and received in genetic counseling. Twelve consultations involving two senior genetic counselors and 21 counselees were videotaped. Section(s) of videotape featuring the explanation were subsequently played back separately to both counselees and counselors and their responses and reflections recorded. All interviews were fully transcribed and analysed using the constant comparison method. A personalized diagram, drawn "live" by the counselor during the consultation was recalled by counselees as being central to their understanding of the "bottom line". This helped bridge the gap between scientific information and their family experience and did not appear to require a baseline understanding of genetic concepts such as genes or chromosomes. Counselors reflected on the diagram's positive impact on the way they sequenced, paced and tailored the explanation. A positive counselor-counselee relationship was vital even during this educative exchange: for counselees to feel at ease discussing complex genetic information and to help gauge counselee understanding.

  3. NESB patients.

    PubMed

    Charles, Janice; Britt, Helena; Fahridin, Salma

    2010-04-01

    General practitioner consultations with patients of non-English speaking background (NESB) account for one in 10 encounters recorded in the BEACH (Bettering the Evaluation and Care of Health) program (NESB is defined as patients who reported that their primary language spoken at home is not English). We present a descriptive comparison of consultations with NESB and English speaking patients recorded between April 2007 and March 2009. Indigenous persons were excluded from the analysis to give a clearer picture of NESB patients of non- Australian origin. Only statistically significant differences with nonoverlapping 95% confidence intervals are reported.

  4. Statistical Process Control for KSC Processing

    NASA Technical Reports Server (NTRS)

    Ford, Roger G.; Delgado, Hector; Tilley, Randy

    1996-01-01

    The 1996 Summer Faculty Fellowship Program and Kennedy Space Center (KSC) served as the basis for a research effort into statistical process control for KSC processing. The effort entailed several tasks and goals. The first was to develop a customized statistical process control (SPC) course for the Safety and Mission Assurance Trends Analysis Group. The actual teaching of this course took place over several weeks. In addition, an Internet version of the same course complete with animation and video excerpts from the course when it was taught at KSC was developed. The application of SPC to shuttle processing took up the rest of the summer research project. This effort entailed the evaluation of SPC use at KSC, both present and potential, due to the change in roles for NASA and the Single Flight Operations Contractor (SFOC). Individual consulting on SPC use was accomplished as well as an evaluation of SPC software for KSC use in the future. A final accomplishment of the orientation of the author to NASA changes, terminology, data format, and new NASA task definitions will allow future consultation when the needs arise.

  5. Statistics Clinic

    NASA Technical Reports Server (NTRS)

    Feiveson, Alan H.; Foy, Millennia; Ploutz-Snyder, Robert; Fiedler, James

    2014-01-01

    Do you have elevated p-values? Is the data analysis process getting you down? Do you experience anxiety when you need to respond to criticism of statistical methods in your manuscript? You may be suffering from Insufficient Statistical Support Syndrome (ISSS). For symptomatic relief of ISSS, come for a free consultation with JSC biostatisticians at our help desk during the poster sessions at the HRP Investigators Workshop. Get answers to common questions about sample size, missing data, multiple testing, when to trust the results of your analyses and more. Side effects may include sudden loss of statistics anxiety, improved interpretation of your data, and increased confidence in your results.

  6. Handbook of transport statistics in the UNECE region

    DOT National Transportation Integrated Search

    2006-07-26

    The purpose of this booklet is to provide transport : decision-makers and planners in Governments and : international organizations with selected transport : data in a manageable format, which can be : conveniently consulted at any time. : The bookle...

  7. Sick-listed employees with severe medically unexplained physical symptoms: burden or routine for the occupational health physician? A cross sectional study

    PubMed Central

    2010-01-01

    Background The two primary objectives of this study were to the assess consultation load of occupational health physicians (OHPs), and their difficulties and needs with regard to their sickness certification tasks in sick-listed employees with severe medical unexplained physical symptoms (MUPS). Third objective was to determine which disease-, patient-, doctor- and practice-related factors are associated with the difficulties and needs of the OHPs. Methods In this cross-sectional study, 43 participating OHPs from 5 group practices assessed 489 sick-listed employees with and without severe MUPS. The OHPs filled in a questionnaire about difficulties concerning sickness certification tasks, consultation time, their needs with regard to consultation with or referral to a psychiatrist or psychologist, and communication with GPs. The OHPs also completed a questionnaire about their personal characteristics. Results OHPs only experienced task difficulties in employees with severe MUPS in relation to their communication with the treating physician. This only occured in cases in which the OHP attributed the physical symptoms to somatoform causes. If they attributed the physical symptoms to mental causes, the OHPs reported a need to consultate a psychiatrist about the diagnosis and treatment. Conclusions OHPs experience few difficulties with their sickness certification tasks and consultation load concerning employees with severe MUPS. However, they encounter problems if the diagnostic uncertainties of the treating physician interfere with the return to work process. OHPs have a need for psychiatric expertise whenever they are uncertain about the psychiatric causes of a delayed return to work process. We recommend further training programs for OHPs. They should also have more opportunity for consultation and referral to a psychiatrist, and their communication with treating physicians should be improved. PMID:21059232

  8. Error, stress, and teamwork in medicine and aviation: cross sectional surveys

    NASA Technical Reports Server (NTRS)

    Sexton, J. B.; Thomas, E. J.; Helmreich, R. L.

    2000-01-01

    OBJECTIVES: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. DESIGN:: Cross sectional surveys. SETTING:: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. PARTICIPANTS:: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). MAIN OUTCOME MEASURES:: Perceptions of error, stress, and teamwork. RESULTS:: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. CONCLUSIONS: Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members.

  9. Error, stress, and teamwork in medicine and aviation: cross sectional surveys

    PubMed Central

    Sexton, J Bryan; Thomas, Eric J; Helmreich, Robert L

    2000-01-01

    Objectives: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. Design: Cross sectional surveys. Setting: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. Participants: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). Main outcome measures: Perceptions of error, stress, and teamwork. Results: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. Conclusions: Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members. PMID:10720356

  10. Can we rely on simulated patients' satisfaction with their consultation for assessing medical students' communication skills? A cross-sectional study.

    PubMed

    Gude, T; Grimstad, H; Holen, A; Anvik, T; Baerheim, A; Fasmer, O B; Hjortdahl, P; Vaglum, P

    2015-12-18

    In medical education, teaching methods offering intensive practice without high utilization of faculty resources are needed. We investigated whether simulated patients' (SPs') satisfaction with a consultation could predict professional observers' assessment of young doctors' communication skills. This was a comparative cross-sectional study of 62 videotaped consultations in a general practice setting with young doctors who were finishing their internship. The SPs played a female patient who had observed blood when using the toilet, which had prompted a fear of cancer. Immediately afterwards, the SP rated her level of satisfaction with the consultation, and the scores were dichotomized into satisfaction or dissatisfaction. Professional observers viewed the videotapes and assessed the doctors' communication skills using the Arizona Communication Interview Rating Scale (ACIR). Their ratings of communication skills were dichotomized into acceptable versus unacceptable levels of competence. The SPs' satisfaction showed a predictive power of 0.74 for the observers' assessment of the young doctors and whether they reached an acceptable level of communication skills. The SPs' dissatisfaction had a predictive power of 0.71 for the observers' assessment of an unacceptable communication level. The two assessment methods differed in 26% of the consultations. When SPs felt relief about their cancer concern after the consultation, they assessed the doctors' skills as satisfactory independent of the observers' assessment. Accordance between the dichotomized SPs' satisfaction score and communication skills assessed by observers (using the ACIR) was in the acceptable range. These findings suggest that SPs' satisfaction scores may provide a reliable source for assessing communication skills in educational programs for medical trainees (students and young doctors). Awareness of the patient's concerns seems to be of vital importance to patient satisfaction.

  11. 77 FR 64971 - Lock+ Hydro Friends Fund XLII, LLC; Notice of Waiver, in Part, of Prefiling Consultation Required...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-24

    ... Friends Fund XLII, LLC; Notice of Waiver, in Part, of Prefiling Consultation Required Under Section 4.38(C... License. b. Project No.: 13739-002. c. Date Filed: September 17, 2012. d. Applicant: Lock+ Hydro Friends.... 791(a)-825(r). h. Applicant Contact: Mr. Mark R. Stover, Lock+\\TM\\ Hydro Friends Fund XLII, c/o Hydro...

  12. 25 CFR 115.807 - Will OTFM consult with tribes about investments of tribal trust funds?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Will OTFM consult with tribes about investments of tribal trust funds? 115.807 Section 115.807 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS Tribal Accounts Investing and Managing Tribal Trust Funds § 115.807 Will OTFM...

  13. 25 CFR 1000.211 - Will the bureau contact the Tribe/Consortium before initiating public consultation process for a...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Will the bureau contact the Tribe/Consortium before initiating public consultation process for a non-BIA AFA under negotiation? 1000.211 Section 1000.211 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMENT ACT...

  14. Application of the verona coding definitions of emotional sequences (VR-CoDES) on a pediatric data set.

    PubMed

    Vatne, Torun M; Finset, Arnstein; Ørnes, Knut; Ruland, Cornelia M

    2010-09-01

    Adult patients present concerns as defined in the Verona Coding Definitions of Emotional Sequences (VR-CoDES), but we do not know how children express their concerns during medical consultations. This study aimed to evaluate the applicability of VR-CoDES to pediatric oncology consultations. Twenty-eight pediatric consultations were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES), and the material was also qualitatively analyzed for descriptive purposes. Five consultations were randomly selected for reliability testing and descriptive statistics were computed. Perfect inter-rater reliability for concerns and moderate reliability for cues were obtained. Cues and/or concerns were present in over half of the consultations. Cues were more frequent than concerns, with the majority of cues being verbal hints to hidden concerns or non-verbal cues. Intensity of expressions, limitations in vocabulary, commonality of statements, and complexity of the setting complicated the use of VR-CoDES. Child-specific cues; use of the imperative, cues about past experiences, and use of onomatopoeia were observed. Children with cancer express concerns during medical consultations. VR-CoDES is a reliable tool for coding concerns in pediatric data sets. For future applications in pediatric settings an appendix should be developed to incorporate the child-specific traits. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Concerns voiced by patients and GPs' responses during psychosocial visits in primary care: a historical cross-sectional study.

    PubMed

    Butalid, Ligaya; Verhaak, Peter F M; van Dulmen, Sandra; Bensing, Jozien M

    2014-11-25

    In a recent study comparing psychosocial consultations prior to and after the implementation of national clinical guidelines in the Netherlands, we found that general practitioners (GPs) showed less empathy in the more recent consultations. As a consequence, patients possibly have less scope to express their worries. The objective is to investigate whether patients have become more reluctant to open up about their concerns during psychosocial consultations and how GPs respond. Consultations from previous study samples videotaped between 1977 and 2008 and categorized by GPs as 'completely psychosocial' were selected for the present study. These consultations were observed using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to capture cues and concerns expressed by patients and GPs' immediate responses. We compared consultations prior to (N = 121) and after (N = 391) introduction of national clinical guidelines in the 1990s. In 92% of the consultations, patients presented at least one worry. These were most often expressed implicitly. However, the proportion of consultations containing at least one explicit concern changed from 24% to 37% over time. The increased number of expressed cues and concerns was partly explained by a change in GP characteristics; the latter sample contained more female and more experienced GPs. Furthermore, cues and concerns were more often expressed during later phases of consultations in recent years. Our study shows that patients have become somewhat more explicit in expressing their worries. However, GPs need to be aware that, still, most worries are expressed implicitly and that new concerns may appear towards the end of consultations.

  16. eCONSULTS TO ENDOCRINOLOGISTS IMPROVE ACCESS AND CHANGE PRIMARY CARE PROVIDER BEHAVIOR.

    PubMed

    Tran, Christopher S; Liddy, Clare E; Liu, Dora M; Afkham, Amir; Keely, Erin J

    2016-10-01

    To describe the impact of an eConsult service on access to endocrinologists along with its influence on changing primary care provider (PCP) course of action and referral behaviors. Established in 2011, the Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to endocrinologists by PCPs between April 15, 2011 and January 31, 2015. Usage data and PCP responses to a mandatory closeout survey were analyzed to determine eConsult response times, PCP practice behavior, referral outcomes, and provider satisfaction. Each eConsult was coded according to clinical topic and question type based on established taxonomies. A total of 180 PCPs submitted 464 eConsults to endocrinology during the study period. Specialist median response time was 7 hours, with 90% of responses occurring within 3 days. PCPs received a new or additional course of action in 62% of submitted cases. An unnecessary face-to-face referral was avoided in 44% of all eConsults and in 67% of cases where the PCP initially contemplated requesting a referral. Over 95% of cases were rated at least 4 out of 5 in value for PCPs and their patients. The use of eConsult improves access to endocrinologists by providing timely, highly rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits. BASE = Building Access to Specialist Advice through eConsult PCP = primary care physician UCSF = University of California San Francisco.

  17. The Phenomenology of the Diagnostic Process: A Primary Care-Based Survey.

    PubMed

    Donner-Banzhoff, Norbert; Seidel, Judith; Sikeler, Anna Maria; Bösner, Stefan; Vogelmeier, Maria; Westram, Anja; Feufel, Markus; Gaissmaier, Wolfgang; Wegwarth, Odette; Gigerenzer, Gerd

    2017-01-01

    While dichotomous tasks and related cognitive strategies have been extensively researched in cognitive psychology, little is known about how primary care practitioners (general practitioners [GPs]) approach ill-defined or polychotomous tasks and how valid or useful their strategies are. To investigate cognitive strategies used by GPs for making a diagnosis. In a cross-sectional study, we videotaped 282 consultations, irrespective of presenting complaint or final diagnosis. Reflective interviews were performed with GPs after each consultation. Recordings of consultations and GP interviews were transcribed verbatim and analyzed using a coding system that was based on published literature and systematically checked for reliability. In total, 134 consultations included 163 diagnostic episodes. Inductive foraging (i.e., the initial, patient-guided search) could be identified in 91% of consultations. It contributed an average 31% of cues obtained by the GP in 1 consultation. Triggered routines and descriptive questions occurred in 38% and 84% of consultations, respectively. GPs resorted to hypothesis testing, the hallmark of the hypothetico-deductive method, in only 39% of consultations. Video recordings and interviews presumably interfered with GPs' behavior and accounts. GPs might have pursued more hypotheses and collected more information than usual. The testing of specific disease hypotheses seems to play a lesser role than previously thought. Our data from real consultations suggest that GPs organize their search for information in a skillfully adapted way. Inductive foraging, triggered routines, descriptive questions, and hypotheses testing are essential building blocks to make a diagnosis in the generalist setting. © The Author(s) 2016.

  18. Evaluation of hygiene habits: cross-sectional study.

    PubMed

    Campos, Manuel António; Sousa, Ana Cristina; Varela, Paulo; Baptista, Armando

    2016-09-01

    It is well known that adequate hygiene is important for health. Even though this topic has drawn the attention of the media, little or no scientific investigation has been done. We performed a comparative questionnaire-based cross-sectional study in three groups: patients attending a dermatology outpatient clinic, patients attending an internal medicine consultation, and community members. We analyzed a total of 446 questionnaires (249 from dermatology patients, 98 from internal medicine patients, and 99 from the community group). The three groups did not differ statistically in sex and age (p=0.070). The patients from the dermatology department had a higher education level. The number of weekly baths did not differ among the three groups (p=0.417). Hair hygiene did not differ between the three groups. The dermatology and internal medicine groups washed their hands more frequently than the community group (p=0.028). Comparing our results to the limited data available, we find that the population surveyed has better hygiene habits than those previously reported. We believe that hygiene habits should be discussed during office visits.

  19. Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis

    PubMed Central

    Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A.; Ward, David K.

    2013-01-01

    Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting. PMID:23613858

  20. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

    PubMed

    Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

    2013-01-01

    Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

  1. A randomised trial of photographic reinforcement during postoperative counselling after diagnostic laparoscopy for pelvic pain.

    PubMed

    Onwude, Joseph L; Thornton, Jim G; Morley, Stephen; Lilleyman, Janet; Currie, Ian; Lilford, Richard J

    2004-01-15

    To measure the effect of seeing a photograph of the pelvic findings at laparoscopy. Two university teaching hospitals. A randomised-controlled trial. Two hundred thirty-three women undergoing diagnostic laparoscopy for the investigation of chronic pelvic pain. At operation a Polaroid print was taken of the pelvis. If this was of satisfactory quality, the patient was randomly allocated to either see, or not see, the print during the postoperative consultation. Pain severity and pain belief scores at 3 and 6 months. By intention to treat. Postoperative consultations with photographs did not improve immediate understanding and satisfaction with the consultation. In addition, compared to controls, both patients and doctors did not perceive particular benefit for communication from the photograph. There was a consistent trend to more pain in the photographic reinforcement group and more negative pain beliefs. At 3 months, the average within person differences showed some benefit in visual analogue pain scores, McGill affect scores, 'permanence' and 'self-blame' scores. These benefits were not statistically significant. At 6 months, there was a consistent pattern of benefit from pain severity and pain beliefs, again these benefits were not statistically significant. No clear benefits result from showing patients photographs of their pelvis.

  2. [Health services utilization by the adult population in São Leopoldo, Rio Grande do Sul State, Brazil: a cross-sectional study].

    PubMed

    Dias-da-Costa, Juvenal Soares; Olinto, Maria Teresa Anselmo; Soares, Simoni Assunção; Nunes, Marcelo Felipe; Bagatini, Tatiane; Marques, Maximiliano das Chagas; Guimarães, Lisiane Kiefer; Müller, Letícia Possebon; Machado, Fátima Carina de Souza; Barcellos, Eduardo dos Santos; Pattussi, Marcos Pascoal

    2011-05-01

    The aim was to describe healthcare utilization by adults in a Brazilian city. The outcomes were medical appointments in the previous month and use of public (Unified National Health System - SUS) versus private healthcare services. A population-based cross-sectional study with 1,098 adults aged 20 years or over was carried out. No medical appointment in the previous month was reported by 623 persons (56.7%, 95%CI: 53.8-59.7). Of the 487 individuals who had consulted a physician, 51.2% used the public healthcare system, 26.9% private care, and 22% other services. Consultation was associated with female gender and older age. Individuals in the intermediate categories for income, schooling, and socioeconomic status consulted less than the corresponding high and low categories. The results suggest that the middle class in this city lacks the purchasing power to seek care in the private sector while also using public services less, thus generally seeking healthcare less frequently.

  3. Alternative health care consultations in Ontario, Canada: A geographic and socio-demographic analysis

    PubMed Central

    2011-01-01

    Background An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province. Methods Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005) for people aged 18 or over (n = 32,598) who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1) all consultations (2) massage therapy (3) acupuncture, and (4) homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use. Results In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met. Conclusions The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to alternative care use. The paper concludes that there is a need for more place-specific research that explores the reasons why people use specific types of alternative health care as tied to socio-economic status, health, place of residence, and knowledge of these treatments. PMID:21696621

  4. General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

    PubMed Central

    2012-01-01

    Background In most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic. Methods Statistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding. Results Most GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave. Conclusions The study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies. PMID:22375615

  5. NATO Standardization and Licensing Policy - Exploratory Phase. Volume 2. Main Report

    DTIC Science & Technology

    1976-11-30

    issued under this section, every person who engages in the business of manufacturing, exporting, or importing arms, ammunition, or implements of... Wiliiam C. Pettijohn, Consultant Arthur Tyler Port, Consultant George M. Sr.ead, Jr. and Hoagland, MacLachlan & Co., Inc., Subcontractor 8...support in obtaining interviews with busy officials. The views and judgments expressed in this report are those of the authors and do not

  6. Clinical Characteristic of the HIV/AIDS Patients with Cryptosporidiosis Referring to Behavioral Diseases Consultation Center, Imam Khomeini Hospital, Tehran in 2013.

    PubMed

    Gholami, Rashid; Gholami, Shirzad; Emadi-Kouchak, Hamid; Abdollahi, Alireza; Shahriari, Mona

    2016-01-01

    Cryptosporidium is known as an opportunist disease-causing agent in man in recent decades. It causes diarrhea and intestinal disorders in the immune deficit and immune competent individuals. This study was aimed to investigate the clinical characteristics of HIV/AIDS patients with cryptosporidiosis infection. This cross-sectional descriptive study was performed on 53 HIV/AIDS patients referred to the Behavior Disease Consultation Center of Imam Khomeini Hospital in Tehran, Iran in 2013. First, the patients were studied clinically and the context data were recorded in a questionnaire for parasitological examination and referred to the laboratory for eosinophil count, and CD4 count per ml of blood. Cryptosporidiosis was observed in 4 (7.6%) of the total 53 HIV/AIDS patients. The highest prevalence of infection was observed in the age range of 30-39 yr. It was observed in different sexes as 5.7% of male and 1.9% of female, but statistically was insignificant (P=0.163).75% of patients had no intestinal symptom, 11.4% with acute diarrhea and 3.8% with chronic diarrhea. Cryptosporidiosis cases were observed in 5.7% of patients without intestinal symptom. Practitioners in the clinical examination for the detection of the opportunistic intestinal protozoan infection should use clinical and paraclinical characteristics of the HIV/AIDS patients for the diagnostic of Cryptosporidium and other opportunistic parasitic diseases.

  7. Critical appraisal of fundamental items in approved clinical trial research proposals in Mashhad University of Medical Sciences

    PubMed Central

    Shakeri, Mohammad-Taghi; Taghipour, Ali; Sadeghi, Masoumeh; Nezami, Hossein; Amirabadizadeh, Ali-Reza; Bonakchi, Hossein

    2017-01-01

    Background: Writing, designing, and conducting a clinical trial research proposal has an important role in achieving valid and reliable findings. Thus, this study aimed at critically appraising fundamental information in approved clinical trial research proposals in Mashhad University of Medical Sciences (MUMS) from 2008 to 2014. Methods: This cross-sectional study was conducted on all 935 approved clinical trial research proposals in MUMS from 2008 to 2014. A valid and reliable as well as comprehensive, simple, and usable checklist in sessions with biostatisticians and methodologists, consisting of 11 main items as research tool, were used. Agreement rate between the reviewers of the proposals, who were responsible for data collection, was assessed during 3 sessions, and Kappa statistics was calculated at the last session as 97%. Results: More than 60% of the research proposals had a methodologist consultant, moreover, type of study or study design had been specified in almost all of them (98%). Appropriateness of study aims with hypotheses was not observed in a significant number of research proposals (585 proposals, 62.6%). The required sample size for 66.8% of the approved proposals was based on a sample size formula; however, in 25% of the proposals, sample size formula was not in accordance with the study design. Data collection tool was not selected appropriately in 55.2% of the approved research proposals. Type and method of randomization were unknown in 21% of the proposals and dealing with missing data had not been described in most of them (98%). Inclusion and exclusion criteria were (92%) fully and adequately explained. Moreover, 44% and 31% of the research proposals were moderate and weak in rank, respectively, with respect to the correctness of the statistical analysis methods. Conclusion: Findings of the present study revealed that a large portion of the approved proposals were highly biased or ambiguous with respect to randomization, blinding, dealing with missing data, data collection tool, sampling methods, and statistical analysis. Thus, it is essential to consult and collaborate with a methodologist in all parts of a proposal to control the possible and specific biases in clinical trials. PMID:29445703

  8. Critical appraisal of fundamental items in approved clinical trial research proposals in Mashhad University of Medical Sciences.

    PubMed

    Shakeri, Mohammad-Taghi; Taghipour, Ali; Sadeghi, Masoumeh; Nezami, Hossein; Amirabadizadeh, Ali-Reza; Bonakchi, Hossein

    2017-01-01

    Background: Writing, designing, and conducting a clinical trial research proposal has an important role in achieving valid and reliable findings. Thus, this study aimed at critically appraising fundamental information in approved clinical trial research proposals in Mashhad University of Medical Sciences (MUMS) from 2008 to 2014. Methods: This cross-sectional study was conducted on all 935 approved clinical trial research proposals in MUMS from 2008 to 2014. A valid and reliable as well as comprehensive, simple, and usable checklist in sessions with biostatisticians and methodologists, consisting of 11 main items as research tool, were used. Agreement rate between the reviewers of the proposals, who were responsible for data collection, was assessed during 3 sessions, and Kappa statistics was calculated at the last session as 97%. Results: More than 60% of the research proposals had a methodologist consultant, moreover, type of study or study design had been specified in almost all of them (98%). Appropriateness of study aims with hypotheses was not observed in a significant number of research proposals (585 proposals, 62.6%). The required sample size for 66.8% of the approved proposals was based on a sample size formula; however, in 25% of the proposals, sample size formula was not in accordance with the study design. Data collection tool was not selected appropriately in 55.2% of the approved research proposals. Type and method of randomization were unknown in 21% of the proposals and dealing with missing data had not been described in most of them (98%). Inclusion and exclusion criteria were (92%) fully and adequately explained. Moreover, 44% and 31% of the research proposals were moderate and weak in rank, respectively, with respect to the correctness of the statistical analysis methods. Conclusion: Findings of the present study revealed that a large portion of the approved proposals were highly biased or ambiguous with respect to randomization, blinding, dealing with missing data, data collection tool, sampling methods, and statistical analysis. Thus, it is essential to consult and collaborate with a methodologist in all parts of a proposal to control the possible and specific biases in clinical trials.

  9. Comparison of ethical judgments exhibited by clients and ethics consultants in Japan.

    PubMed

    Nagao, Noriko; Kadooka, Yasuhiro; Asai, Atsushi

    2014-03-04

    Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of "uncertain decisional capacity," and 23 cases (38.3%) of "withholding of decision-making." A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants' reasoning was based on "patient's preference was ambiguous," "validity of family as a surrogate," "estimation of patient preference," and "patient's best interest," whereas the CEC client's reasoning was based on "consistent family preference was shown/not shown" and "appropriate therapeutic methods to manage patient safety." Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic.

  10. [Nutrition consultation in small animal practice - a field for specialized veterinarians].

    PubMed

    Bergler, R; Wechsung, S; Kienzle, E; Hoff, T; Dobenecker, B

    2016-01-01

    The study aimed to identify barriers to the implementation of nutrition consultation in veterinary practice. Differences between individual veterinarians in their problem-solving strategies in nutrition consultation were investigated. Representative online survey of 214 veterinarians (female/male) using a standardized questionnaire. Statistical analysis by correlations, t-test, analysis of variance and factor analysis as well as cluster analysis of types of veterinarians. Over 90% of vets had seen an increase in owners' questions on feeding pets. Forty-one percent estimated the percentage of patients suffering from nutrition-related diseases in their practice to be 20-30%. At the same time, 70% of vets agreed that nutrition consultation was neglected in every-day practice. Vets estimated that only 30% of owners complied with recommendations on nutrition. Over 80% of vets presumed that pet owners gave false information on feeding. For other sensitive questions, including domestic and financial situations, the percentage of presumed false information was below 60%. Approximately 50% of the vets did not feel sufficiently competent with regard to nutrition consultation. Less than 50% asked for payment of nutrition consultation. Only 18% had taken part in continuing education in animal nutrition. The cluster analysis identified five different strategies to cope with nutrition consultation, four of which were based on a low priority for nutrition in their own practice. Some vets referred nutrition problems to specialized colleagues (7.2%), others consulted with representatives of pet food companies (28.2%), another group offered free, quick tips (23.4%), and a small percentage ignored nutrition (13.4%). There was one group with a strong interest in nutrition (27.8%). It is remarkable that this group felt the least competent in small-animal nutrition. Conclusion and practical relevance: The study demonstrates that sound nutrition consultation in small-animal practice requires a high degree of specialization. In addition, special coping strategies to obtain a sound nutrition history and a fair payment are necessary. Vets fulfilling these conditions may find a wide field of work.

  11. 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... group seminars on the precision measurement of specific types of physical quantities, offering the...

  12. 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... group seminars on the precision measurement of specific types of physical quantities, offering the...

  13. SUPPORT NEEDS AND ACCEPTABILITY OF PSYCHOLOGICAL CONSULTATION: ATTITUDES OF 108 WOMEN WHO HAD UNDERGONE OR WERE CONSIDERING PROPHYLACTIC MASTECTOMY

    PubMed Central

    Patenaude, Andrea F; Orozco, Sara; Li, Xiaochun; Kaelin, Carolyn M; Gadd, Michelle; Matory, Yvedt; Mayzel, Kathleen; Roche, Constance A; Smith, Barbara L; Farkas, Walden; Garber, Judy E

    2014-01-01

    Summary Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America has been low (0–36%). Most women report reduced cancer worry post-operatively, but up to 25–50% of women electing surgery also report psychological distress and/or difficulty adapting following PM. Psychological consultation to aid decision-making and improve post-surgical coping isn’t routinely offered. This retrospective, cross-sectional study explored, quantitatively and qualitatively, interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery. Of the 71 women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable and nearly 2/3 felt post-surgical psychological consultation would be helpful. All 37 women (100%) currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Narratives from the interviews illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for the integration of psychological services for women deciding about or adapting to PM. PMID:18636423

  14. Support Provided to the External Tank (ET) Project on the Use of Statistical Analysis for ET Certification Consultation Position Paper

    NASA Technical Reports Server (NTRS)

    Null, Cynthia H.

    2009-01-01

    In June 2004, the June Space Flight Leadership Council (SFLC) assigned an action to the NASA Engineering and Safety Center (NESC) and External Tank (ET) project jointly to characterize the available dataset [of defect sizes from dissections of foam], identify resultant limitations to statistical treatment of ET as-built foam as part of the overall thermal protection system (TPS) certification, and report to the Program Requirements Change Board (PRCB) and SFLC in September 2004. The NESC statistics team was formed to assist the ET statistics group in August 2004. The NESC's conclusions are presented in this report.

  15. Feeling Heard & Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients with Advanced Cancer Before and After Palliative Care Consultation.

    PubMed

    Ingersoll, Luke T; Saeed, Fahad; Ladwig, Susan; Norton, Sally A; Anderson, Wendy; Alexander, Stewart C; Gramling, Robert

    2018-05-02

    Maximizing value in palliative care requires continued development and standardization of communication quality indicators. To describe the basic epidemiology of a newly-adopted patient-centered communication quality indicator for hospitalized palliative care patie9nts with advanced cancer. Cross-sectional analysis of 207 advanced cancer patients who received palliative care consultation at two medical centers in the United States. Participants completed the Heard & Understood quality indicator immediately before and the day following the initial palliative care consultation: "Over the past two days ["24 hours" for the post-consultation version], how much have you felt heard and understood by the doctors, nurses and hospital staff? Completely/Quite a Bit/Moderately/Slightly/Not at All". We categorized "Completely" as indicating ideal quality. Approximately one-third indicated ideal Heard & Understood quality before palliative care consultation. Age, financial security, emotional distress, preferences for comfort-longevity tradeoffs at end-of-life, and prognosis expectations were associated with pre-consultation quality. Among those with less-than-ideal quality at baseline, 56% rated feeling more Heard & Understood the day following palliative care consultation. The greatest pre-post improvement was among people who had unformed end-of-life treatment preferences or who reported having "no idea" about their prognosis at baseline. Most patients felt incompletely heard and understood at the time of referral to palliative care consultation and more than half improved following consultation. Feeling heard and understood is an important quality indicator sensitive to interventions to improve care and key variations in the patient experience. Copyright © 2018. Published by Elsevier Inc.

  16. Evaluation of telephone first approach to demand management in English general practice: observational study.

    PubMed

    Newbould, Jennifer; Abel, Gary; Ball, Sarah; Corbett, Jennie; Elliott, Marc; Exley, Josephine; Martin, Adam; Saunders, Catherine; Wilson, Edward; Winpenny, Eleanor; Yang, Miaoqing; Roland, Martin

    2017-09-27

    Objective  To evaluate a "telephone first" approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design  Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data. Participants  147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England. Intervention  Management support for workload planning and introduction of the telephone first approach provided by two commercial companies. Main outcome measures  Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies' protocols. Results  After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices -38%, 95% confidence interval -45% to -29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval -1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs. Conclusions  The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Evaluation of telephone first approach to demand management in English general practice: observational study

    PubMed Central

    Newbould, Jennifer; Abel, Gary; Ball, Sarah; Corbett, Jennie; Elliott, Marc; Exley, Josephine; Martin, Adam; Saunders, Catherine; Wilson, Edward; Winpenny, Eleanor; Yang, Miaoqing

    2017-01-01

    Objective To evaluate a “telephone first” approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data. Participants 147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England. Intervention Management support for workload planning and introduction of the telephone first approach provided by two commercial companies. Main outcome measures Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies’ protocols. Results After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices −38%, 95% confidence interval −45% to −29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval −1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs. Conclusions The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care. PMID:28954741

  18. Activities of the healthcare team for women who smoke during pregnancy and the puerperium1

    PubMed Central

    Teixeira, Carolina de Castilhos; Lucena, Amália de Fátima; Echer, Isabel Cristina

    2014-01-01

    OBJECTIVE: to identify activities developed by the healthcare team for pregnant and postpartum women who smoke. METHOD: cross-sectional study with a sample of 135 healthcare team members who assist pregnant and postpartum women in a university hospital located in southern Brazil. The data was collected using questionnaires and analyzed using the Statistical Package for Social Sciences software. RESULTS: 76 (56.3%) staff members reported that they always addressed smoking cessation; however, the approach occurred in only two periods of the hospitalization and/or prenatal consultations, not including family members. In regard to the effectiveness of their actions, the health team assessed it as fair or poor, and mentioned the need for updating knowledge regarding this issue. CONCLUSIONS: the health team did not perform the approach as recommended by the tobacco control guidelines, requiring training to offer a qualified and efficient intervention. PMID:25296146

  19. The empirical basis of substance use disorders diagnosis: research recommendations for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V).

    PubMed

    Schuckit, Marc A; Saunders, John B

    2006-09-01

    This paper presents the recommendations, developed from a 3-year consultation process, for a program of research to underpin the development of diagnostic concepts and criteria in the Substance Use Disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and potentially the relevant section of the next revision of the International Classification of Diseases (ICD). A preliminary list of research topics was developed at the DSM-V Launch Conference in 2004. This led to the presentation of articles on these topics at a specific Substance Use Disorders Conference in February 2005, at the end of which a preliminary list of research questions was developed. This was further refined through an iterative process involving conference participants over the following year. Research questions have been placed into four categories: (1) questions that could be addressed immediately through secondary analyses of existing data sets; (2) items likely to require position papers to propose criteria or more focused questions with a view to subsequent analyses of existing data sets; (3) issues that could be proposed for literature reviews, but with a lower probability that these might progress to a data analytic phase; and (4) suggestions or comments that might not require immediate action, but that could be considered by the DSM-V and ICD 11 revision committees as part of their deliberations. A broadly based research agenda for the development of diagnostic concepts and criteria for substance use disorders is presented.

  20. General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland.

    PubMed

    McLean, Gary; Guthrie, Bruce; Mercer, Stewart W; Watt, Graham C M

    2015-12-01

    Universal access to health care, as provided in the NHS, does not ensure that patients' needs are met. To explore the relationships between multimorbidity, general practice funding, and workload by deprivation in a national healthcare system. Cross-sectional study using routine data from 956 general practices in Scotland. Estimated numbers of patients with multimorbidity, estimated numbers of consultations per 1000 patients, and payments to practices per patient are presented and analysed by deprivation decile at practice level. Levels of multimorbidity rose with practice deprivation. Practices in the most deprived decile had 38% more patients with multimorbidity compared with the least deprived (222.8 per 1000 patients versus 161.1; P<0.001) and over 120% more patients with combined mental-physical multimorbidity (113.0 per 1000 patients versus 51.5; P<0.001). Practices in the most deprived decile had 20% more consultations per annum compared with the least deprived (4616 versus 3846, P<0.001). There was no association between total practice funding and deprivation (Spearman ρ -0.09; P = 0.03). Although consultation rates increased with deprivation, the social gradients in multimorbidity were much steeper. There was no association between consultation rates and levels of funding. No evidence was found that general practice funding matches clinical need, as estimated by different definitions of multimorbidity. Consultation rates provide only a partial estimate of the work involved in addressing clinical needs and are poorly related to the prevalence of multimorbidity. In these circumstances, general practice is unlikely to mitigate health inequalities and may increase them. © British Journal of General Practice 2015.

  1. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand.

    PubMed

    Daly, Barbara; Arroll, Bruce; Sheridan, Nicolette; Kenealy, Timothy; Stewart, Alistair; Scragg, Robert

    2014-07-01

    To identify factors associated with patients receiving foot examinations by primary health care nurses. A cross-sectional survey of 287 randomly sampled primary health care nurses, from a total of 1091 in Auckland, completed a postal self-administered questionnaire and telephone interview. Biographical and diabetes management details were collected for 265 diabetes patients consulted by the nurses on a randomly selected day. A response rate of 86% was achieved. Nurses examined patient's feet in 46% of consultations. Controlling for demographic variables, foot examinations were associated with age, odds ratio (1.25, 95% CI 0.57-2.74) for patients aged 51-65 years and >66 years (2.50, 1.08-5.75) compared with those ≤50 years, consultations by district compared with practice nurses (14.23, 95% CI 3.82-53.05), special programme consultations compared with usual follow-up consults (8.81, 95% CI 2.99-25.93) and length of consultation (1.89, 0.72-4.97) for 15-30 min and (4.45, 95% CI 1.48-13.41) >30 min compared with consultations ≤15 min, or for wound care (2.58, 1.01-6.61). Diabetes foot examinations by primary health care nurses varies greatly, and are associated with characteristics of the patient (age, need for wound care) and the consultation (district nurses, diabetes programme and duration). Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  2. Cataract surgery practices in the United States Veterans Health Administration.

    PubMed

    Havnaer, Annika G; Greenberg, Paul B; Cockerham, Glenn C; Clark, Melissa A; Chomsky, Amy

    2017-04-01

    To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). Veterans Health Administration hospitals in the U.S. Retrospective data analysis. An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  3. A comparison of performances of consultant surgeons, NCHDs and medical students in a modified HPAT examination.

    PubMed

    Quinn, A; Corrigan, M A; Broderick, J; McEntee, G; Hill, A D K

    2010-06-01

    Following the implementation of the Fottrell report, entry to medical school in Ireland has undergone significant change. Medical school studentship is now awarded based on a combination of points obtained from the final examination of Irish secondary schools (the leaving certificate) combined with HPAT scores (Health Professions Admissions Test). The HPAT is designed to test a candidate's knowledge in several different fields including problem solving skills, logical and non verbal reasoning. A sample HPAT was administered to a test group composed of consultant surgeons, non consultant hospital doctors, and medical students. Statistical analysis was performed and no significant difference was found between the performances of the groups. This is surprising as it was expected that groups with greater experience at medical problem solving would have translated to higher scores. This exposes a flaw within the HPAT system and a potential weakness in the process of doctor selection.

  4. Environmental Assessment, Glide Slope/Clear Zone Obstructions, Wright-Patterson Air Force Base, Ohio

    DTIC Science & Technology

    2013-06-01

    would be implemented. The Proposed Action would not pose any new risks; however, minor adverse effects on groundwater would continue to occur as a...consulted regarding potential effects on biological resources in the project areas. According to information obtained from the ODNR, the only federally...designated treatment sites. The USFWS concurred with the USAF determination that no adverse effects are likely and that consultation under Section 7(a

  5. 25 CFR 1000.210 - When does a non-BIA bureau use a public consultation process related to the negotiation of an AFA?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false When does a non-BIA bureau use a public consultation process related to the negotiation of an AFA? 1000.210 Section 1000.210 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMENT ACT AMENDMENTS TO THE INDIAN...

  6. Use of health-care services during chemotherapy for breast cancer.

    PubMed

    Baena-Cañada, José M; Estalella-Mendoza, Sara; Rosado-Varela, Petra; Expósito-Álvarez, Inmaculada; González-Guerrero, Macarena; Díaz-Blanco, María C; Cortés-Carmona, Cristina; Ramírez-Daffós, Patricia; Arriola-Arellano, Esperanza; Rueda-Ramos, Antonio; Solana-Grimaldi, Lourdes; Benítez-Rodríguez, Encarnación

    2012-12-01

    The authors analyse the effect of chemotherapy on the use of additional health-care resources and report the clinical and demographic factors associated with such use. In women with breast cancer, eligible to receive first-line (neo)-adjuvant or palliative chemotherapy, consultations with health-care practitioners (general practitioners [GPs] and specialists) and admissions to emergency department and to hospital were prospectively recorded. Differences were studied according to these clinical and demographic variables: age, tumour stage, performance status, weight, height, body mass index, surgery type, chemotherapy type, number of courses, comorbidity, marital status, educational level, social status and occupational status. Among 268 patients, 124 (42.2%) required one or more non-protocol health-care encounters. 180 visits were generated (GP 23.3%, specialist 35.5%, emergency department admission 21.1%, hospital admission 8.3%, others 3.3% and more than one resource 8.3%). Of total consultations 150 (83.3%) were chemotherapy-related. The number of visits was higher in the first courses. Fever and infection were the most frequent reasons for consultation in all resources. The dependent variable: 'need for non-protocol health-care encounter in any course' was statistically associated with age (p=0.002) and marital status (p=0.021); no association was found with other variables. In multivariate analysis, age (p=0.001) and marital status (p=0.009) remained statistically significant. Younger and married patients consumed less extra health resources. Many patients receiving chemotherapy consume health-care resources in addition to their routine visits, usually treatment-related. Patients consult less in the later courses. Older and unmarried women in particular need extra care during chemotherapy. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center.

    PubMed

    Kashef, Mohammad Amin; Friderici, Jennifer; Hernandez-Montfort, Jaime; Atreya, Auras R; Lindenauer, Peter; Lagu, Tara

    2017-06-01

    There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation. Journal of Hospital Medicine 2017;12:414-420. © 2017 Society of Hospital Medicine

  8. 76 FR 339 - Office of Special Education and Rehabilitative Services; Overview Information; National Institute...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-04

    ... making statistical and other methodological consultation available for research projects that use the TBI... Information; National Institute on Disability and Rehabilitation Research (NIDRR)--Disability and Rehabilitation Research Projects and Centers Program--Disability and Rehabilitation Research Projects (DRRPs...

  9. 76 FR 344 - Office of Special Education and Rehabilitative Services; Overview Information; National Institute...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-04

    ... making statistical and other methodological consultation available for research projects that use the SCI... Information; National Institute on Disability and Rehabilitation Research (NIDRR)--Disability and Rehabilitation Research Projects and Centers Program--Disability and Rehabilitation Research Projects (DRRPs...

  10. Mental health care and out-of-pocket expenditures in Europe: results from the ESEMeD project.

    PubMed

    Sevilla-Dedieu, Christine; Kovess-Masfety, Viviane; Gilbert, Fabien; Vilagut, Gemma; Koenig, Hans-Helmut; Bruffaerts, Ronny; Haro, Josep Maria; Alonso, Jordi

    2011-06-01

    Most published data on out-of-pocket spending on mental health originate from the United States, where insurance payments for mental health have traditionally been much less generous than benefits for other health care services. Given the difference in the structure of health care funding in Europe, it is clearly important to obtain similar information on out-of-pocket expenditure in different European countries. To estimate out-of-pocket costs paid by people who receive mental health care in six European countries (Belgium, France, Germany, Italy, the Netherlands, and Spain). Of the 8,796 participants in a cross-sectional survey conducted in these six European countries, 1,128 reported having consulted a professional for a mental health problem in the year preceding the interview and provided information on how many times in the past year they consulted each type of provider, and the money they and their family members had paid out-of-pocket for their mental health care. In addition to sociodemographic characteristics, information on mental health status was collected using the CIDI 3.0. Descriptive statistics on out-of-pocket expenditure and share of income across countries were generated. Two-part models were employed to identify the relationship between the different covariates, notably the types of providers consulted, and out-of-pocket expenditure. Overall, 41.0% of those who used services for a mental health problem paid something for the care they received. This represented a minority of respondents in all countries except Belgium (87.9%) and Italy (61.7%). The financial burden of these costs relative to income was found to be low (1.2%), ranging from 0.4% in Germany to 2.3% in France. Out-of-pocket expenditure differed according to the type of providers consulted, with non-physician health professionals and medical specialists being more often associated with significant expenditure. Although the study is limited principally by data collection from self-report, it is the first of its kind, to our knowledge, and suggests that out-of-pocket costs for mental health care in Europe are relatively low compared to the United States. However, differences between countries exist, which may be partially due to differences in coverage for specialized care. Consultations with non-physician mental health professionals such as psychologists are expensive for patients, since they are reimbursed to a lesser extent than consultations with physicians, or not reimbursed at all. This limits their role and increases the burden on psychiatrists. Monitoring out-of-pocket spending on mental health, preferably on the basis of administrative data when available, is essential in the current context of cost containment policy, where out-of-pocket spending may be expected to increase.

  11. Self-reported musculoskeletal pain predicts long-term increase in general health care use: a population-based cohort study with 20-year follow-up.

    PubMed

    Hartvigsen, Jan; Davidsen, Michael; Søgaard, Karen; Roos, Ewa M; Hestbaek, Lise

    2014-11-01

    Musculoskeletal pain and disability is a modern epidemic and a major reason for seeking health care. The aim of this study is to determine absolute and relative rates of care seeking over 20 years for adults reporting musculoskeletal complaints. Interview data on musculoskeletal pain reported during the past two weeks from the Danish National Cohort Study were merged with data from the Danish National Health Insurance Registry and the National Patient Registry containing information on consultations in the Danish primary and secondary care sector. Absolute and relative rates for all seeking of care with general practitioners, physiotherapists, chiropractors, outpatient hospital contacts and hospital admissions are reported for persons reporting no musculoskeletal pain and for persons reporting pain in the neck, shoulder, wrist/hands, mid back, low back, hips, knees and ankles/feet. Regardless of site, persons experiencing a musculoskeletal complaint had a statistically increased risk of consulting a general practitioner when compared with persons reporting no musculoskeletal complaint. For physiotherapists and chiropractors, only persons complaining of neck pain and back pain had an increased risk of seeking care. Regardless of pain site, except for shoulder pain, persons reporting musculoskeletal pain had a statistically significant increased risk of outpatient hospital consultations and hospital admissions. Few differences were found between pain sites in relation to any of the outcomes. Self-report of musculoskeletal pain reported within the past two weeks predicts a statistically significant long-term increase in general use of health care services in both the primary and the secondary health care sector. © 2014 the Nordic Societies of Public Health.

  12. Handbook for School Health Nursing. Fourth Edition.

    ERIC Educational Resources Information Center

    Putnam City Public Schools, OK.

    The purpose of this handbook is to assist Putnam City schools (Oklahoma) in implementing a comprehensive school health nursing program. Four substantive sections describe the school health program. Section 1, an overview, outlines the health responsibilities of parents, administrators, professional consultants, teachers, and nurses, and describes…

  13. Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

    PubMed Central

    2011-01-01

    Background Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole. PMID:22177310

  14. IFLA General Conference, 1990. Division of Special Libraries: Section of Administrative Libraries; Section of Social Science Libraries; Section of Science and Technology Libraries; Section of Biological and Medical Sciences Libraries; Section of Art Libraries. Booklet 2.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    The 23 papers in this collection were presented at 5 sections of the Division of Special Libraries: (1) "Principles of Government Librarianship" (Hans H. van der Neut); (2) "Strategic Planning as an Instrument of Improving Library Quality" (Maurice B. Line); (3) "Library Staff Development Consultancy: A Means to Achieve a…

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

    PubMed Central

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

    2018-01-01

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

  16. Associations of gender and age groups on the knowledge and use of drug information resources by American pharmacists.

    PubMed

    Carvajal, Manuel J; Clauson, Kevin A; Gershman, Jennifer; Polen, Hyla H

    2013-04-01

    To explore knowledge and use of drug information resources by pharmacists and identify patterns influenced by gender and age-group classification. A survey questionnaire was mailed nationwide to 1,000 practitioners working in community (n = 500) and hospital (n = 500) settings who answer drug information questions as part of their expected job responsibilities. Responses pertaining to drug information resource use and knowledge of different types of drug-related queries, resource media preferences, and perceived adequacy of resources maintained in the pharmacy were analyzed by gender and age group. The t statistic was used to test for significant differences of means and percentages between genders and between age groups. Descriptive statistics were used to characterize other findings. Gender and age group classification influenced patterns of knowledge and use of drug information resources by pharmacists. They also affected pharmacists' perceptions of the most common types of questions prompting them to consult a drug information reference, as well as the resources consulted. Micromedex, exclusively available in electronic format, was the most commonly consulted resource overall by pharmacists. Lexi-Comp Online was the leading choice by women, preferred over Micromedex, but was not one of the top two resources selected by men. This study successfully identified the influence of gender and age-group classification in assessing drug information resource knowledge and use of general and specific types of drug-related queries.

  17. Novel Therapeutic Targets to Treat Social Behavior Deficits in Autism and Related Disorders

    DTIC Science & Technology

    2015-10-01

    studies and statistical consultation and other intellectual contributions as needed. W81XWH-12-1-0506 (Gould, PI) 09/30/12 – 09/29/2015 Gould et al., 13...report shall include negative as well as positive findings. Include problems in accomplishing any of the tasks. Statistical tests of significance...Release. DO NOT USE THE WORD " WHEN MARKING DOCUMENTS. DELINQUENT REPORTS If the recipient is delinquent on reporting requirements for other USAMRAA

  18. An Illustration to Assist in Comparing and Remembering Several Multiplicity Adjustment Methods

    ERIC Educational Resources Information Center

    Hasler, Mario

    2017-01-01

    There are many well-known or new methods to adjust statistical tests for multiplicity. This article provides an illustration helping lecturers or consultants to remember the differences of three important multiplicity adjustment methods and to explain them to non-statisticians.

  19. University Safety Culture: A Work-in-Progress?

    ERIC Educational Resources Information Center

    Lyons, Michael

    2016-01-01

    Safety management systems in Australian higher education organisations are under-researched. Limited workplace safety information can be found in the various reports on university human resources benchmarking programs, and typically they show only descriptive statistics. With the commencement of new consultation-focused regulations applying to…

  20. 77 FR 8804 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-15

    ..., is frequently used to monitor the business cycle. This survey provides an essential component of the... planning and analysis to business firms, trade associations, research and consulting agencies, and academia... project future movements in manufacturing activity. These statistics are valuable for analysts of business...

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