WorldWideScience

Sample records for facilities including consulting

  1. 21 CFR 200.10 - Contract facilities (including consulting laboratories) utilized as extramural facilities by...

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Contract facilities (including consulting... GENERAL General Provisions § 200.10 Contract facilities (including consulting laboratories) utilized as... Cosmetic Act specifically authorizes inspection of consulting laboratories as well as any factory...

  2. 42 CFR 431.105 - Consultation to medical facilities.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... and child health and crippled children's program (title V of the Act), Medicaid or Medicare;...

  3. Using Consultants in the Design, Construction, and Occupancy of New Healthcare Facilities.

    Science.gov (United States)

    Stichler, Jaynelle F

    2015-11-01

    Nurse leaders are critical players in the design, construction, and occupancy of new healthcare facilities or renovation projects. While most hospitals and healthcare systems have internal resources needed to manage large projects, there is often a recognized need for expertise of external consultants during various phases of design and construction. The purpose of this article is to provide an overview of types of external consultants that can be contracted to ensure the success of the project from concept through initial occupancy.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  6. Relocation consequences on an ophthalmology consultation service from an inpatient to outpatient facility

    Directory of Open Access Journals (Sweden)

    Singh JS

    2015-10-01

    Full Text Available Jorawer S Singh,1 Vincent M Imbrogno,2 Mary K Howard,3 Amandip S Cheema,3 Ausra D Selvadurai,4 Surbhi Bansal5 1Department of Ophthalmology, George Washington University, Washington, DC, 2Contemporary Ophthalmology of Erie, Erie, PA, 3Department of Ophthalmology, University at Buffalo, Buffalo, NY, 4OcuSight Eye Care Center, Rochester, NY, 5Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA Importance: This study shows that relocation of an academic ophthalmology residency program from an inpatient to an outpatient setting in western New York does not affect the consult volume but affects management patterns and follow-up rates.Objective: To investigate the effects on the ophthalmology consultation service of an academic program with relocation from a Regional Level-1 Trauma center to an outpatient facility.Design: Consultation notes from 3 years before and 3 years after the University at Buffalo’s (UB Department of Ophthalmology relocation from a Regional Level-1 Trauma center (Erie County Medical Center to an outpatient facility (Ross Eye Institute were obtained from hospital electronic medical records and analyzed.Setting: Hospitalized care and institutional practice.Participants: All inpatient or Emergency Room Ophthalmology consultation patients from the Department of Ophthalmology at UB from 2004 to 2010 (1,379 patients.Exposures: None, this was a retrospective chart review.Main outcome measures: Patient demographics, reason for consult, diagnoses, and ophthalmic procedures performed by the UB Department of Ophthalmology before and after its relocation.Results: Relocation to the outpatient facility did not affect consult volume (P=0.15. The number of consults focusing on ophthalmic conditions, as a percentage of the yearly total, rose 460% (P=0.0001, while systemic condition consults with ocular manifestations fell 83% (P=0.0001. Consults for ocular trauma decreased 65% (P=0.0034. Consults ending with a

  7. [Gerodontology consultation in geriatric facilities: general health status (I)].

    Science.gov (United States)

    Katsoulis, Joannis; Huber, Sandra; Mericske-Stern, Regina

    2009-01-01

    people should undergo dental treatment regularly and in time. Training of nurses and doctors of geriatric hospitals in oral hygiene should improve the awareness. A multidisciplinary assessment of geriatric patients should include the oral and dental aspect if they enter the hospital.

  8. Managing misaligned paternity findings in research including sickle cell disease screening in Kenya: 'consulting communities' to inform policy.

    Science.gov (United States)

    Marsh, Vicki; Kombe, Francis; Fitzpatrick, Ray; Molyneux, Sassy; Parker, Michael

    2013-11-01

    The management of misaligned paternity findings raises important controversy worldwide. It has mainly, however, been discussed in the context of high-income countries. Genetic and genomics research, with the potential to show misaligned paternity, are becoming increasingly common in Africa. During a genomics study in Kenya, a dilemma arose over testing and sharing information on paternal sickle cell disease status. This dilemma may be paradigmatic of challenges in sharing misaligned paternity findings in many research and health care settings. Using a deliberative approach to community consultation to inform research practice, we explored residents' views on paternal testing and sharing misaligned paternity information. Between December 2009 and November 2010, 63 residents in Kilifi County were engaged in informed deliberative small group discussions, structured to support normative reflection within the groups, with purposive selection to explore diversity. Analysis was based on a modified framework analysis approach, drawing on relevant social science and bioethics literature. The methods generated in-depth individual and group reflection on morally important issues and uncovered wide diversity in views and values. Fundamental and conflicting values emerged around the importance of family interests and openness, underpinned by disagreement on the moral implications of marital infidelity and withholding truth. Wider consideration of ethical issues emerging in these debates supports locally-held reasoning that paternal sickle cell testing should not be undertaken in this context, in contrast to views that testing should be done with or without the disclosure of misaligned paternity information. The findings highlight the importance of facilitating wider testing of family members of affected children, contingent on the development and implementation of national policies for the management of this inherited disorder. Their richness also illustrates the potential for

  9. Implementation of Telemedicine Consultation to Assess Unplanned Transfers in Rural Long-Term Care Facilities, 2012-2015: A Pilot Study.

    Science.gov (United States)

    Hofmeyer, Joshua; Leider, Jonathon P; Satorius, Jennifer; Tanenbaum, Erin; Basel, David; Knudson, Alana

    2016-11-01

    Public and private entities in the United States spend billions of dollars each year on potentially avoidable hospitalizations. This is a common occurrence in long-term care (LTC) facilities, especially in rural jurisdictions. This article details the creation of a telemedicine approach to assess residents from rural LTC facilities for potential transfer to hospitals. An electronic LTC (eLTC) pilot was conducted in 20 pilot LTC facilities from 2012-2015. Each site underwent technologic assessment and upgrading to ensure that 2-way video communication was possible. A new central "hub" was staffed with advanced practice providers and registered nurses. Long-term care pilot sites were trained and rolled out over 3 years. This article reports development and implementation of the pilot, as well as descriptive statistics associated with provider assessments and averted transfers. Over 3 years, 736 eLTC consultations occurred in pilot sites. One-quarter of consultations occurred between 10 pm and 9 am. Overall, approximately 31% of cases were transferred. This decreased from 54% of cases in 2013 to 17% in 2015. Rural pilot facilities had an average of 23 eLTC consults per site per year. Averted transfers represent a dramatic benefit to the residents, as potentially avoidable hospitalizations cause undue stress and allow for nosocomial infections, among other risks. In addition, averting these unnecessary transfers likely saved the taxpayers of the United States over $5 million in admission-related charges to Centers for Medicare and Medicaid Services (511 avoided transfers × $11,000 per average hospitalization from a LTC facility). Overall, the eLTC pilot showed promise as a proof-of-concept. The pilot's implementation resulted in increasing utilization and promising reductions in unnecessary transfers to emergency departments and hospitalizations. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

  10. Biochemistry Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Biochemistry Facility provides expert services and consultation in biochemical enzyme assays and protein purification. The facility currently features 1) Liquid...

  11. 43 CFR 404.9 - What types of infrastructure and facilities may be included in an eligible rural water supply...

    Science.gov (United States)

    2010-10-01

    ... facilities may be included in an eligible rural water supply project? 404.9 Section 404.9 Public Lands... RURAL WATER SUPPLY PROGRAM Overview § 404.9 What types of infrastructure and facilities may be included in an eligible rural water supply project? A rural water supply project may include, but is...

  12. Bioethics Consultations and Resources

    OpenAIRE

    Thomas, Jennie

    2011-01-01

    Making difficult healthcare decisions is often helped by consultation with a bioethics committee. This article reviews the main bioethics principles, when it is appropriate and how to call a bioethics consult, ethical concerns, and members of the consult team. Bioethics resources are included.

  13. 25 CFR 170.807 - What must BIA include when it develops an IRR Transportation Facilities Maintenance Management...

    Science.gov (United States)

    2010-04-01

    ... Transportation Facilities Maintenance Management System? 170.807 Section 170.807 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN RESERVATION ROADS PROGRAM BIA Road Maintenance § 170.807 What must BIA include when it develops an IRR Transportation Facilities Maintenance Management...

  14. Making consultations run smoothly

    DEFF Research Database (Denmark)

    Jespersen, Astrid Pernille; Jensen, Torben Elgaard

    2012-01-01

    This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from...... the field of science and technology studies (STS), including notions of relationality, multiplicity and otherness. Through this lens, and based on extensive fieldwork, it describes the daily work of arranging time before, during and after consultations. In conclusion, it suggests that a STS...

  15. States and compacts: Issues and events affecting facility development efforts, including the Barnwell opening

    Energy Technology Data Exchange (ETDEWEB)

    Larson, G.S.

    1995-12-31

    Ten years have passed since the first regional low-level radioactive waste compacts received Congressional consent and initiated their efforts to develop new disposal capacity. During these 10 years, both significant achievements and serious setbacks have marked our efforts and affect our current outlook. Recent events in the waste marketplace, particularly in the operating status of the Barnwell disposal facility, have now raised legitimate questions about the continued rationale for the regional framework that grew out of the original legislation enacted by Congress in 1980. At the same time, licensing activities for new regional disposal facilities are under way in three states, and a fourth awaits the final go-ahead to begin construction. Uncertainty over the meaning and reliability of the marketplace events makes it difficult to gauge long-term implications. In addition, differences in the status of individual state and compact facility development efforts lead to varying assessments of the influence these events will, or should, have on such efforts.

  16. The Langley thermal protection system test facility: A description including design operating boundaries

    Science.gov (United States)

    Klich, G. F.

    1976-01-01

    A description of the Langley thermal protection system test facility is presented. This facility was designed to provide realistic environments and times for testing thermal protection systems proposed for use on high speed vehicles such as the space shuttle. Products from the combustion of methane-air-oxygen mixtures, having a maximum total enthalpy of 10.3 MJ/kg, are used as a test medium. Test panels with maximum dimensions of 61 cm x 91.4 cm are mounted in the side wall of the test region. Static pressures in the test region can range from .005 to .1 atm and calculated equilibrium temperatures of test panels range from 700 K to 1700 K. Test times can be as long as 1800 sec. Some experimental data obtained while using combustion products of methane-air mixtures are compared with theory, and calibration of the facility is being continued to verify calculated values of parameters which are within the design operating boundaries.

  17. Transition from Consultation to Monitoring-NRC's Increasingly Focused Review of Factors Important to F-Area Tank Farm Facility Performance - 13153

    Energy Technology Data Exchange (ETDEWEB)

    Barr, Cynthia; Grossman, Christopher; Alexander, George; Parks, Leah; Fuhrmann, Mark; Shaffner, James; McKenney, Christepher [U.S. NRC, Rockville, MD (United States); Pabalan, Roberto; Pickett, David [Center for Nuclear Waste Regulatory Analyses, Southwest Research Institute, San Antonio, TX (United States); Dinwiddie, Cynthia [Southwest Research Institute, San Antonio, TX (United States)

    2013-07-01

    In consultation with the NRC, DOE issued a waste determination for the F-Area Tank Farm (FTF) facility in March 2012. The FTF consists of 22 underground tanks, each 2.8 to 4.9 million liters in capacity, used to store liquid high-level waste generated as a result of spent fuel reprocessing. The waste determination concluded stabilized waste residuals and associated tanks and auxiliary components at the time of closure are not high-level and can be disposed of as LLW. Prior to issuance of the final waste determination, during the consultation phase, NRC staff reviewed and provided comments on DOE's revision 0 and revision 1 FTF PAs that supported the waste determination and produced a technical evaluation report documenting the results of its multi-year review in October 2011. Following issuance of the waste determination, NRC began to monitor DOE disposal actions to assess compliance with the performance objectives in 10 CFR Part 61, Subpart C. To facilitate its monitoring responsibilities, NRC developed a plan to monitor DOE disposal actions. NRC staff was challenged in developing a focused monitoring plan to ensure limited resources are spent in the most cost-effective manner practical. To address this challenge, NRC prioritized monitoring areas and factors in terms of risk significance and timing. This prioritization was informed by NRC staff's review of DOE's PA documentation, independent probabilistic modeling conducted by NRC staff, and NRC-sponsored research conducted by the Center for Nuclear Waste Regulatory Analyses in San Antonio, TX. (authors)

  18. The Contemporary Consultant

    DEFF Research Database (Denmark)

    Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

    This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...

  19. Situational Consultation

    Science.gov (United States)

    Rimehaug, Tormod; Helmersberg, Ingunn

    2010-01-01

    Situational Consultation (SC) is presented as a framework for flexible integration of several models and methodologies in consultation practice by choosing an approach adapted to the specific situation. In SC, models and their characteristic role positions are considered interchangeable tools with qualitative differences in strengths and…

  20. Management Consulting: Planning, Entry, Performance.

    Science.gov (United States)

    Cosier, Richard A.; Dalton, Dan R.

    1993-01-01

    Contends that counseling has much in common with organizational consulting. Provides overview of consulting practices that counselors might find useful should they decide to investigate organizational consulting. Includes aspects of market research, gauging competition, and target markets. Considers promotion, networking, and elements of…

  1. [Bioclimatic consultation].

    Science.gov (United States)

    Cordes, H; Reinke, R

    1975-01-23

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

  2. OHS consultants as facilitators of learning processes in client enterprises

    DEFF Research Database (Denmark)

    Broberg, Ole

    2004-01-01

    In carrying out consultancy the Danish occupational health services (OHS) are supposed to support and develop the capabilities of enterprises to manage work environment issues. This may be interpreted in a learning perspective: As part of the process consultancy the OHS consultants have to put...... processes in client enter-prises. Specifically the learning perspective will be touched upon. The research programme included four cases in different client enterprises: 1) New tech-nology in a logistic department of a brewery, 2) new pharmaceutical process facility, 3) design of a new catering centre...... on reduc-ing the work loads of delivery and warehouse personnel. In facilitating learning processes, deliberately or by incidence, the OHS consultants used different boundary objects. An example: In order to involve users in the design process it was better making a walk-through in a new catering centre...

  3. Individual Consultations

    Directory of Open Access Journals (Sweden)

    Ian Walkinshaw

    2015-09-01

    Full Text Available Responding to calls for research into measurable English language outcomes from individual language support consultations at universities, this study investigated the effect of individual consultations (ICs on the academic writing skills and lexico-grammatical competence of students who speak English as an additional language (EAL. Attendance by 31 EAL students at ICs was recorded, and samples of their academic writing texts before and after a 9-month interval were compared. Participants’ academic writing skills were rated, and lexico-grammatical irregularities were quantified. No statistically significant positive shifts manifested, due to the relatively short research period and limited participant uptake, but there were encouraging predictors of future shifts given continued utilization of the service. First, although a Wilcoxon signed-rank test showed no association between attendance at ICs and shifts in academic writing ability, a Spearman’s rho calculation suggested a tentative relationship to positive pre–post shifts in three academic writing sub-skills: Task Fulfillment, Grammar, and Vocabulary. Second, instances of four common lexico-grammatical irregularities (subject/verb, wrong word, plural/singular, and punctuation declined at post-testing. Although only regular, sustained attendance would produce statistically significant shifts, there is a potential association between participants’ use of ICs and improved academic writing skills/lexico-grammatical competence.

  4. Consulting by Business College Academics: Lessons for Business Communication Courses

    Science.gov (United States)

    Dave, Anish

    2009-01-01

    Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

  5. Consulting by Business College Academics: Lessons for Business Communication Courses

    Science.gov (United States)

    Dave, Anish

    2009-01-01

    Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

  6. Universities, LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the locations and building footprints of schools, churches, government buildings, law enforcement and emergency response offices, pha, Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Universities dataset current as of 2011. LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including...

  7. Libraries, LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the locations and building footprints of schools, churches, government buildings, law enforcement and emergency response offices, pha, Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Libraries dataset current as of 2011. LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the...

  8. Schools K-12, LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the locations and building footprints of schools, churches, government buildings, law enforcement and emergency response offices, pha, Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Schools K-12 dataset current as of 2011. LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including...

  9. Grocery Stores, LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the locations and building footprints of schools, churches, government buildings, law enforcement and emergency response offices, pha, Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Grocery Stores dataset current as of 2011. LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including...

  10. Court Buildings, LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the locations and building footprints of schools, churches, government buildings, law enforcement and emergency response offices, pha, Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Court Buildings dataset current as of 2011. LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including...

  11. Fire Stations, LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including the locations and building footprints of schools, churches, government buildings, law enforcement and emergency response offices, pha, Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Fire Stations dataset current as of 2011. LAGIC is consulting with local parish GIS departments to create spatially accurate point and polygons data sets including...

  12. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study

    Directory of Open Access Journals (Sweden)

    Bradley H. Wagenaar

    2016-08-01

    Full Text Available Background: We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design: We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results: Mean wait times (in minutes were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248 of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion: The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.

  13. Perceived incivility during emergency department phone consultations.

    Science.gov (United States)

    Shetty, Amith L; Vaghasiya, Milan; Boddy, Rachel; Byth, Karen; Unwin, Danielle

    2016-06-01

    Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P  4 (9.1% vs 3.8%, P incivility during ED phone consultations. Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  14. The Economy's Influence on Environmental Sustainability and Energy: Including the Top Ten Facilities Issues. APPA Thought Leaders Series, 2009

    Science.gov (United States)

    Lunday, Elizabeth

    2009-01-01

    Since 2006, the APPA (Association of Higher Education Facilities Officers) Thought Leaders Series has brought together experts in higher education for two days of discussion about the challenges facing colleges and universities in North America. Energy and the environment were the focal points for the 2009 Thought Leaders Symposium, and the result…

  15. Consulting in Collection Development.

    Science.gov (United States)

    Ash, Lee

    1980-01-01

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

  16. Full Service Included

    Institute of Scientific and Technical Information of China (English)

    ISABELDING

    2005-01-01

    At the beginning of the 1990s, with the opening of the market, foreign real estate consultants began to enter China. At that time, they mainly provided services such as facility management to the local clients, with their other functions seldom noticed and utilized. However, with the booming development of China's real estate market, foreign real estate consultants have become more and more important to the local developers.

  17. Post-test thermal-hydraulic analysis of two intermediate LOCA tests at the ROSA facility including uncertainty evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Freixa, J., E-mail: jordi@freixa.net [Paul Scherrer Institut (PSI) 5232 Villigen PSI (Switzerland); Kim, T.-W. [Paul Scherrer Institut (PSI) 5232 Villigen PSI (Switzerland); Manera, A. [University of Michigan, Ann Arbor, MI 48109 (United States)

    2013-11-15

    The OECD/NEA ROSA-2 project aims at addressing thermal-hydraulic safety issues relevant for light water reactors by building up an experimental database at the ROSA Large Scale Test Facility (LSTF). The ROSA facility simulates a PWR Westinghouse design with a four-loop configuration and a nominal power of 3423 MWth. Two intermediate break loss-of-coolant-accident (LOCA) experiments (Tests 1 and 2) have been carried out during 2010. The two tests were analyzed by using the US-NRC TRACE best estimate code, employing the same nodalization previously used for the simulation of small-break LOCA experiments of the ROSA-1 programme. A post-test calculation was performed for each test along with uncertainty analysis providing uncertainty bands for each relevant time trend. Uncertainties in the code modelling capabilities as well as in the initial and boundary conditions were taken into account, following the guidelines and lessons learnt through participation in the OECD/NEA BEMUSE programme. Two different versions of the TRACE code were used in the analysis, providing a qualitatively good prediction of the tests. However, the uncertainty analysis revealed differences between the performances of some models in the two versions. The most relevant parameters of the two experimental tests were falling within the computed uncertainty bands.

  18. Post-test thermal-hydraulic analysis of two intermediate LOCA tests at the ROSA facility including uncertainty evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Freixa, J.; Kim, T-W.; Manera, A. [Paul Scherrer Inst., Villigen (Switzerland)

    2011-07-01

    The OECD/NEA ROSA-2 project aims at addressing thermal-hydraulic safety issues relevant for light water reactors by building up an experimental database at the ROSA Large Scale Test Facility (LSTF). The ROSA facility simulates a PWR Westinghouse design with a four-loop configuration and a nominal power of 3423 MWth. Two intermediate break loss-of-coolant-accident (LOCA) experiments (Test 1 and 2) have been carried out during 2010. The two tests were analyzed by using the US-NRC TRACE best estimate code, employing the same nodalization previously used for the simulation of small-break LOCA experiments of the ROSA-1 program. A post-test calculation was performed for each test along with uncertainty analysis providing uncertainty bands for each relevant time trend. Uncertainties in the code modeling capabilities as well as in the initial and boundary conditions were taken into account, following the guidelines and lessons learnt through participation in the OECD/NEA BEMUSE program. Two different versions of the TRACE code were used in the analysis, providing a qualitatively good prediction of the tests. However, both versions showed deficiencies that need to be addressed. The most relevant parameters of the two experimental tests were falling within the computed uncertainty bands. (author)

  19. Tennessee Valley region study: potential year 2000 radiological dose to population resulting from nuclear facility operations. [Includes glossary

    Energy Technology Data Exchange (ETDEWEB)

    None

    1978-06-01

    A companion report, DOE/ET-0064/1, presents a geographic, cultural, and demographic profile of the Tennessee Valley Region study area. This report describes the calculations of radionuclide release and transport and of the resultant dose to the regional population, assuming a projected installed capacity of 220,000 MW in the year 2000, of which 144,000 MW would be nuclear. All elements of the fuel cycle were assumed to be in operation. The radiological dose was calculated as a one-year dose based on ingestion of 35 different food types as well as for nine non-food pathways, and was reported as dose to the total body and for six specific organs for each of four age groups (infant, child, teen, and adult). Results indicate that the average individual would receive an incremental dose of 7 x 10/sup -4/ millirems in the year 2000 from the operation of nuclear facilities within and adjacent to the region, five orders of magnitude smaller than the dose from naturally occurring radiation in the area. The major contributor to dose was found to be tritium, and the most significant pathways were immersion in air, inhalation of air, transpiration of tritium (absorption through the skin), and exposure radionuclide-containing soil. 60 references.

  20. 77 FR 12081 - Comscope, Inc., Catawba Facility, A Subsidiary of the Carlyle Group Including On-Site Leased...

    Science.gov (United States)

    2012-02-28

    ... Carolina. The workers are engaged in activities related to the production of coaxial cable and coax products for the cable television industry. The notice was published in the Federal Register on October 26... Including On-Site Leased Workers From Staffmasters, Including On- Site Workers from Cable Transport,...

  1. Method for assessment of stormwater treatment facilities – Synthetic road runoff addition including micro-pollutants and tracer

    DEFF Research Database (Denmark)

    Cederkvist, Karin; Jensen, Marina Bergen; Holm, Peter Engelund

    2017-01-01

    representative of runoff from roads is suggested, as well as relevant concentration ranges. The method was used for adding contaminants to three different STFs including a curbstone extension with filter soil, a dual porosity filter, and six different permeable pavements. Evaluation of the method showed......% in the dual porosity filter, stressing the importance of including a conservative tracer for correction of contaminant retention values. The method is considered useful in future treatment performance testing of STFs. The observed performance of the STFs is presented in coming papers....

  2. Tribal Consultation Tracking System

    Data.gov (United States)

    U.S. Environmental Protection Agency — The consultation-related information the AIEO Consultation Team working with our Tribal Portal contractors has developed a Lotus Notes Database that is capable of...

  3. Campaign Consultants - Client Payments

    Data.gov (United States)

    City of San Francisco — Campaign Consultants are required to report ���economic consideration�۝ promised by or received from clients in exchange for campaign consulting services during the...

  4. Optimizing Consulting Delivery Systems.

    Science.gov (United States)

    Spottswood, Curran

    1980-01-01

    Summarizes a study of several types of consulting groups in the Bell System and describes characteristics which are associated with high-impact consulting. A strategy which is designed for internal consulting organizations to maximize the likelihood of both initial success and long-term survival of the group is proposed. (Author/MER)

  5. Tips for telephone and electronic medical consultation.

    Science.gov (United States)

    Gupta, Sailesh G

    2013-11-01

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

  6. Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

    Science.gov (United States)

    Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

    2016-05-13

    Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

  7. Consulting on Academic Library Buildings.

    Science.gov (United States)

    Mason, Ellsworth

    1980-01-01

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

  8. Designing consultancy on energy

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Lene [Danish Energy Authority, Copenhagen (Denmark)

    2005-07-01

    There is a wide tradition for using energy consultancy in all end-using sectors and in various models. A lot of aspects have to be taken into consideration when a consultant scheme is to be launched. This paper will contribute to the discussion of the role of the consultant in the different energy end-use sectors: Energy consultancy is defined. The process for energy consulting is related to the eight fundamental objectives for effective management consulting (Arthur N. Turner): responding to a client's request for information; providing solutions to specific problems; giving an in-depth, accurate diagnosis; presenting a program of recommended corrective actions; implementing changes; building consensus and commitment; facilitating client learning; and enhancing organizational effectiveness. The role of the consultant is divided into 4 categories (expert, diagnostician, sparring partner, process consultant) depending on the consultant's focus (process or cases) and methodology (analysis or dialogue). Designing energy consultancy should reflect the end-use sector (household, industry etc.)

  9. Teaching CONSULT: Consultation with Novel methods & Simulation for UME Longitudinal Training.

    Directory of Open Access Journals (Sweden)

    Keme Carter

    2015-10-01

    consultation process (0% vs. 69%, p<0.001. Post- curriculum, fourth-year students scored higher in all criteria measuring consultation effectiveness (p<0.001 for all and included more necessary items in simulated consultations (62% vs. 77%, p<0.001. Conclusion: While third-year medical students reported calling consultations, few felt comfortable and formal training was lacking. A curriculum in consult communication for different levels of learners can improve knowledge and comfort prior to clinical clerkships and improve consultation skills prior to residency training.

  10. The Legal Structure of Ring-Fenced Bodies in the United Kingdom - A Response to Consultation Paper CP19/14 on the Implementation of Ring-fencing: on Legal Structure, Governance and the continuity of Services and Facilities

    NARCIS (Netherlands)

    K. Heine (Klaus); V.L.E. Cedeno-Brea (Enmanuel)

    2015-01-01

    markdownabstract__Abstract__ This paper is submitted by Prof. Dr. Klaus Heine1 and Enmanuel Cedeño-Brea2, in response to the Prudential Regulatory Authority’s (PRA) Consultation Paper CP19/14 on “The Implementation of Ring-fencing: consultation on legal structure, governance and the continuity of s

  11. ARL/OMS Consultant Training Program.

    Science.gov (United States)

    Euster, Joanne R.

    1982-01-01

    Describes Academic Library Consultant Training Program begun in 1979, sponsored by Office of Management Studies (OMS) and designed to provide 80 consultants to aid academic libraries in improving performance. Viewpoints are included from OMS Director and participants concerning program objectives, trainee selection, workshops, internships, and the…

  12. Consultants and organization concepts; tracing routes of reception

    NARCIS (Netherlands)

    Heusinkveld, Stefan; Benders, Jos

    2001-01-01

    The aim of this paper is to explore how organization concepts evolve within consulting organizations. These companies are characterized by specific historical backgrounds, organization forms, particular services and include consultants with their own professional interests and competencies. As a con

  13. Exploring employment in consultation reports of patients with neuromuscular diseases

    NARCIS (Netherlands)

    Heerkens, Yvonne; Kuyk-Minis, Marie Antoinette van; Cup, Edith; Engels, Josephine; Engelen, Baziel van; Oostendorp, Rob

    2012-01-01

    To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients with neuromuscular diseases (NMDs). Eighty percent of the included consultation reports contained information on employment. Less than half the patients with NMD were emplo

  14. The Dream Consultant

    DEFF Research Database (Denmark)

    Muhr, Sara Louise; Kirkegaard, Line

    2013-01-01

    for work. We draw on Lacan's notion of desire as the Other's desire and analyze the consultants' desire as controlled by a need for recognition at work. We show how consultants need off-work fantasies to maintain the illusion of wholeness – of being more than work. Only with this illusion of wholeness can...

  15. Family Practice Consultation.

    African Journals Online (AJOL)

    gauge the patients' opin:on on the family doctors' role regardirg prayer ... family practice consultation arc presented. ... patients' expectation of prayer and ..... New developments and frequently asked questions covering - high and low BMI, ...

  16. Consultancy and innovation the business service revolution in Europe

    CERN Document Server

    Wood, Peter

    2003-01-01

    Consultancy and Innovation links two important aspects of European economic development in the past thirty years: the pace of technical and management innovation, and the growing significance of technical and business consultancy. This book includes detailed studies of consultancy activities or 'knowledge intensive services' (KIS) in eight EU countries, written by national experts in the field.

  17. Solving the competitive facility location problem considering the reactions of competitor with a hybrid algorithm including Tabu Search and exact method

    Science.gov (United States)

    Bagherinejad, Jafar; Niknam, Azar

    2017-06-01

    In this paper, a leader-follower competitive facility location problem considering the reactions of the competitors is studied. A model for locating new facilities and determining levels of quality for the facilities of the leader firm is proposed. Moreover, changes in the location and quality of existing facilities in a competitive market where a competitor offers the same goods or services are taken into account. The competitor could react by opening new facilities, closing existing ones, and adjusting the quality levels of its existing facilities. The market share, captured by each facility, depends on its distance to customer and its quality that is calculated based on the probabilistic Huff's model. Each firm aims to maximize its profit subject to constraints on quality levels and budget of setting up new facilities. This problem is formulated as a bi-level mixed integer non-linear model. The model is solved using a combination of Tabu Search with an exact method. The performance of the proposed algorithm is compared with an upper bound that is achieved by applying Karush-Kuhn-Tucker conditions. Computational results show that our algorithm finds near the upper bound solutions in a reasonable time.

  18. Factors affecting consultation length in a Japanese diabetes practice.

    Science.gov (United States)

    Kabeya, Yusuke; Uchida, Junko; Toyoda, Masao; Katsuki, Takeshi; Oikawa, Yoichi; Kato, Kiyoe; Kawai, Toshihide; Shimada, Akira; Atsumi, Yoshihito; Higaki, Megumu

    2017-04-01

    Sufficient consultation time is important for establishing good doctor-patient relationship. We examined the factors that affect consultation length in Japanese diabetes practice. This was a cross-sectional study performed at a diabetes clinic in central Tokyo, Japan. Regular diabetes consultations of 1197 patients with 22 physicians were analyzed. Consultation time and clinical characteristics were obtained from the electronic records. A negative binomial model, which included patient and physician characteristics, was constructed to examine the association of the variables with consultation length. Of the 1197 patients (mean age, 66; women, 25%; type 1 diabetes, 10%), the mean consultation time was 10.1min. In the multivariate model, longer consultation time was recorded in patients with type 1 diabetes, higher glycated hemoglobin (HbA1c), use of insulin injections, and use of hypnotics/anxiolytics. The consultation time was longer in patients with HbA1c of ⩾7.0 to consultation. Older and female physicians provided longer consultation. Clinical consultation length in diabetes practice was associated with certain patient and physician characteristics. The findings can be used for making diabetes consultation more efficacious, which could eventually lead to the provision of the most appropriate consultation time for individual patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening.

    Science.gov (United States)

    O'Connell, Meghan; Wonodi, Chizoba

    2016-03-01

    Since 2002, the Nigerian government has deployed consultants to states to provide technical assistance for routine immunization (RI). RI consultants are expected to play a role in supportive supervision of health facility staff, capacity building, advocacy, and monitoring and evaluation. We conducted a retrospective review of the RI consultant program's strengths and weaknesses in 7 states and at the national level from June to September 2014 using semi-structured interviews and online surveys. Participants included RI consultants, RI program leaders, and implementers purposively drawn from national, state, and local government levels. Thematic analysis was used to analyze qualitative data from the interviews, which were triangulated with results from the quantitative surveys. At the time of data collection, 23 of 36 states and the federal capital territory had an RI consultant. Of the 7 states visited during the study, only 3 states had present and visibly working consultants. We conducted 84 interviews with 101 participants across the 7 states and conducted data analysis on 70 interviews (with 82 individuals) that had complete data. Among the full sample of interview respondents (N = 101), most (66%) were men with an average age of 49 years (±5.6), and the majority were technical officers (63%) but a range of other roles were also represented, including consultants (22%), directors (13%), and health workers (2%). Fifteen consultants and 44 program leaders completed the online surveys. Interview data from the 3 states with active RI consultants indicated that the consultants' main contribution was supportive supervision at the local level, particularly for collecting and using RI data for decision making. They also acted as effective advocates for RI funding. In states without an RI consultant, gaps were highlighted in data management capacity and in monitoring of RI funds. Program design strengths: the broad terms of reference and autonomy of the consultants

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

    Science.gov (United States)

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

    2012-01-01

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

  1. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  2. Park Land and Nature Preserves, Park facilities are maintained by Johnson County Parks and Recreation Department and includes all parks with in Johnson County, Published in Not Provided, Johnson County Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Park Land and Nature Preserves dataset current as of unknown. Park facilities are maintained by Johnson County Parks and Recreation Department and includes all parks...

  3. Practical guidance for charting ethics consultations.

    Science.gov (United States)

    Bruce, Courtenay R; Smith, Martin L; Tawose, Olubukunola Mary; Sharp, Richard R

    2014-03-01

    It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients' medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation.

  4. INTEGRATING CORPUS CONSULTATION IN LANGUAGE STUDIES

    Directory of Open Access Journals (Sweden)

    Angela Chambers

    2005-05-01

    Full Text Available Alongside developments in language research, the potential of corpora as a resource in language learning and teaching has been evident to researchers and teachers since the late 1960s. Despite publications which emphasise the benefits of corpus consultation for language learners (Bernardini, 2002; Kennedy & Miceli, 2001, there is little evidence to suggest that direct corpus consultation is coming to be seen as a complement or alternative to consultation of a dictionary, course book, or grammar by the majority of learners. There is thus a need for research to underpin the integration of corpora and concordancing in the language-learning environment.This study begins with an account of published research relating to course design and structure in the area of corpus consultation by language learners. The focus then narrows to the initial training of learners in corpus consultation, using as an example a course involving undergraduate students on several language degree programmes. The results of the students' consultation of the corpora are examined, including choice of search word(s, analytical skills, the problems encountered, and their evaluation of the activity. The results reveal how corpus consultation can complement traditional language-learning resources, while also raising questions concerning its integration in the language-learning environment.

  5. Postpartum consultation: Occurrence, requirements and expectations

    Directory of Open Access Journals (Sweden)

    Carlgren Ingrid

    2008-07-01

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

  6. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition......Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature......, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed since the last consultation 4 years previously. Where...

  7. Sharing Expertise: Consulting

    Science.gov (United States)

    Graves, Bill

    2011-01-01

    A special breed of superintendents who have developed expertise in a particular area find ways of sharing it in other venues as outside consultants. They pull extra duty to put their special skills into practice, to give back to their communities, to stay current and grounded in the field, or to enhance their professional reputations. They teach…

  8. Improving consultations in oncology: the development of a novel consultation aid

    Science.gov (United States)

    Furber, L; Murtagh, G M; Bonas, S A; Bankart, J G; Thomas, A L

    2014-01-01

    Background: The way in which patients receive bad news in a consultation can have a profound effect in terms of anxiety, depression and subsequent adjustment. Despite investment in well-researched communication skills training and availability of decision-making aids, communication problems in oncology continue to be encountered. Methods: We conducted a mixed-methods study in a large UK Cancer Centre to develop a novel consultation aid that could be used jointly by patients and doctors. Consultations were audio-recorded and both the doctors and the patients were interviewed. We used conversation analysis to analyse the consultation encounter and interpretative phenomenological analysis to analyse the interviews. Key themes were generated to inform the design of the aid. Results: A total of 16 doctors were recruited into the study along with 77 patients. Detailed analysis from 36 consultations identified key themes (including preparation, information exchange, question-asking and decision making), which were subsequently addressed in the design of the paper-based aid. Conclusions: Using detailed analysis and observation of oncology consultations, we have designed a novel consultation aid that can be used jointly by doctors and patients. It is not tumour-site specific and can potentially be utilised by new and follow-up consultations. PMID:24548856

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

    Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H.

    2017-01-01

    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners. PMID:28096715

  11. Radiology consultation in the era of precision oncology: A review of consultation models and services in the tertiary setting

    Energy Technology Data Exchange (ETDEWEB)

    DiPiro, Pamela J.; Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H. [Dept. of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States)

    2017-01-15

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

  12. [Genetic analysis of multidrug-resistant Streptococcus pneumoniae including meropenem resistance that was isolated from elderly residents with pneumonia in nursing-care facilities].

    Science.gov (United States)

    Ota, Kazuko; Chiba, Naoko; Sato, Kentaro; Nara, Syoetu; Kato, Satoko; Kanazawa, Hisao; Ikejima, Shin; Takahashi, Yoshihiro; Iwata, Satoshi; Ubukata, Kimiko

    2014-07-01

    From February to December 20XX, penicillin-resistant Streptococcus pneumoniae (PRSP) showing MICs of 16-32 microg/mL to cefotaxime (CTX) and 4-8 microg/mL to meropenem (MEPM) were isolated from 6 patients hospitalized at the general hospital S (2 cases) and hospital A (4 cases), close to the hospital S. Five elderly patients among these six cases came from nursing care facilities or nursing care-related medical facilities. All elderly persons (mean age: 81.7 years) were diagnosed as having pneumonia at the time of admission and the problematic PRSP was isolated from sputum samples collected on admission. Notably, all of these PRSP isolates simultaneously showed high resistance to macrolide agents mediated by an erm (B) gene and to fluoroquinolone agents via mutations in the gyrA and parC genes. Eventually, they were identified as multidrug-resistant S. pneumoniae (MDRSP) with high resistance to many agents. The capsule type of all strains was serotype 19F and multilocus sequence typing (MLST) revealed that they belonged to clonal complex (CC) 7993, which has not been reported before. It was thus concluded that the MDRSP that had spread within the nursing facilities was transmitted to the general hospitals via the elderly inpatients with pneumonia caused by these agents. Although one case finally had a poor outcome, the pneumococcal infection was not the direct trigger of the event. The current ratio of MDRSP is concluded to be very low. However, general hospitals that accept patients for therapeutic purposes from nursing-care facilities have to share epidemiological information in a timely manner with the nursing homes to prevent nosocomial infections.

  13. Mentoring for new consultants.

    Science.gov (United States)

    Ackroyd, R; Adamson, K A

    2015-01-01

    There is increasing evidence of the benefits of having a mentor during the early years as a consultant. Mentoring encourages and provides support to an individual in their professional development. Although there are different forms of mentoring there is recognition that developing a formal mentoring scheme can provide a consistent approach and support within a framework. The Royal College of Physicians of Edinburgh has introduced a mentoring scheme for new consultants that provides a forum for supporting them in their ongoing professional wellbeing. There is potential that the process of mentoring can improve an individual's development, and motivate and encourage them to develop the skills needed to achieve their goals, thus having an impact on ultimately improving their ability to deliver an effective patient-centred service.

  14. Health Consultation in China

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    ONE Sunday morning, I noticed some people gathered at a clearing outside a school in which my family had an apartment. Feeling curious, I joined them to find that some young dentists, wearing their white coats, were offering free consultations for people. They were selling toothbrushes and dental floss at the same time. One of my teeth was bothering me. It always felt odd when I bit something cold. I consulted with a young dentist, who was wearing a pair of glasses. He asked me many questions like when had it begun to hurt, if I felt the pain, how long it had been since I had it filled the previous time. He asked me to open my mouth and checked the tooth carefully. "You should have your

  15. The Process of Psychological Consultation

    Science.gov (United States)

    Nolan, Anna; Moreland, Neil

    2014-01-01

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

  16. Managing EMC within healthcare facilities.

    Science.gov (United States)

    High, Damon

    2011-01-01

    Damon High, a consultant at international testing, certification, qualification, training, and consultancy services provider TUV Product Service, examines the issue of electromagnetic interference in hospitals, highlighting the areas that equipment suppliers and estates and facilities managers/healthcare engineers need to consider to ensure both the continuing safe, reliable operation of equipment, and compliance with the latest legislation.

  17. Theme: Laboratory Facilities Improvement.

    Science.gov (United States)

    Miller, Glen M.; And Others

    1993-01-01

    Includes "Laboratory Facilities Improvement" (Miller); "Remodeling Laboratories for Agriscience Instruction" (Newman, Johnson); "Planning for Change" (Mulcahy); "Laboratory Facilities Improvement for Technology Transfer" (Harper); "Facilities for Agriscience Instruction" (Agnew et al.); "Laboratory Facility Improvement" (Boren, Dwyer); and…

  18. 7 CFR 1726.125 - Generating plant facilities.

    Science.gov (United States)

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Generation Facilities § 1726... design, RUS will, in consultation with the borrower and its consulting engineer, identify the specific... desulfurization system, particulate removal system, electric wiring and control systems, mechanical...

  19. Outreach surgical consulting services in North East Victoria.

    Science.gov (United States)

    Chittleborough, Timothy John; Lourensz, Kaleb; Elliott, Matthew; Thomas, Peter; Franzi, Stephen

    2013-12-01

    There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities. Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta. Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield. All patients seen in consultations over a 3-month period. Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure. Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre. Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach practice should be encouraged for surgeons in regional centres. © 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  20. Consulting in Electronic Commerce

    Directory of Open Access Journals (Sweden)

    Florentina Loredana Tache

    2010-10-01

    Full Text Available Economic development of electronic services provide advice and many agents of existingreferral systems to recommend and provide products, information and customized views of thecommunity through a personalized interaction in real time. Distributed systems of autonomous agentsare becoming increasingly important in electronic comet because the basic decisions of agents adviceon trust and reputation are taken in a similar way human society. If these decisions will be as a realconsumer protection, when new aspects of online consumer legislation will become usefulinformation in advice and consulting of electronic commerce.

  1. 76 FR 55678 - Tribal Consultation Policy

    Science.gov (United States)

    2011-09-08

    ... proposal, new rule adoption, and other policy changes) that cause ACF to consult with the tribes. ACF's..., including native americans, persons with developmental disabilities, refugees, and legal immigrants, to help... budget (OLAB). Office of planning, research and evaluation (opre). Office of refugee resettlement (ORR...

  2. Psychiatric consultations and the management of associated ...

    African Journals Online (AJOL)

    as delirium, dementia, psychotic disorders due to general medical ... comorbid medical conditions in a regional referral hospital ... (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, .... and Emergency Services (535; 89); Internal Medicine including.

  3. 34 CFR 200.63 - Consultation.

    Science.gov (United States)

    2010-07-01

    ... children from low-income families residing in participating public school attendance areas, including... to teachers and families of participating private school children. (c)(1) Consultation by the LEA... Programs Operated by Local Educational Agencies Participation of Eligible Children in Private Schools §...

  4. Wind power projects and Aboriginal consultation

    Energy Technology Data Exchange (ETDEWEB)

    Isaac, T. [McCarthy Tetrault LLP, Vancouver, BC (Canada)

    2006-07-01

    This presentation outlined some of the legal aspects related to Aboriginal involvement in wind power development consultation processes and disputes. Aboriginal rights are rights held by Aboriginal people that are an element of a practice, custom, or tradition integral to the culture of groups claiming such rights. Wind power developers should understand that Aboriginal rights claims may include fishing; whaling; transportation; and cultural and spiritual activities. Aboriginal title is a subcategory of Aboriginal rights, and is a right to land itself, and an encumbrance on the Crown's underlying title to land. Weak Aboriginal claims where potential infringement by energy developers is minor may only require notice and information. Strong prima facie cases for Aboriginal rights and title where the potential for infringement is of high significance may result in more extensive consultation involving interim solutions; formal Aboriginal participation in decision-making processes; and written responses demonstrating how Aboriginal concerns have been considered. There are a number of circumstances requiring a case-by-case approach, and the Crown may make decisions in the face of Aboriginal disagreement. However, energy developers should ensure that consultation processes are fair and reasonable. Conflicting interests can often be successfully resolved through consultation, and accommodation to Aboriginal rights may include mitigation, avoiding interference, and agreeing to as little infringement as possible. Aboriginal title may attach to private land but only to the Crown's underlying title. The Crown has no duty to consult respecting Aboriginal title on private land because title has already been infringed. In these cases, duty to consult and accommodate may be discharged through other regulatory processes such as environmental impact assessments. It was concluded that wind power project proponents should build a relationship with the Crown, as avoiding

  5. Epistemics in audiological consultations

    DEFF Research Database (Denmark)

    Egbert, Maria

    ' subjective descriptions of hearing experiences in different environments. In these consultations, the institutional conceptualization of hearing (and thus of hearing loss) is that of an objectively measurable functioning of the ear, categorized in an audiogram by decibels and hertz. In contrast, persons......, broad, and metaphorical. Compared to visual impairment, describing hearing seems to be more difficult, and frequently, persons with hearing impairment resort to visual metaphors. A CA examination of conversational order in the areas of turn-taking, sequence, repair, topic, multimodality, and linguistic...... at the micro-level of direct healthcare encounters to the macro-level and globel problems of the impact of untreated hearing loss. The social repercussions are stigmatization, miscommunication, loss of work, social isolation, depression, and suicide (Carmen 2001). The financial loss per person dropping out...

  6. Effects of a nurse practitioner on a multidisciplinary consultation team

    NARCIS (Netherlands)

    van der Sluis, Corry K.; Datema, Linetta; Saan, Ingrid; Stant, Dennis; Dijkstra, Pieter U.

    2009-01-01

    Effects of a nurse practitioner on a multidisciplinary consultation team. This paper is a report of a study to evaluate the impact on office hours capacity, patient satisfaction, quality of life and costs of including a nurse practitioner in a multidisciplinary consultation team for patients with ha

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

    Science.gov (United States)

    1995-01-01

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

  8. Colonial connections and consulting engineers 1850-1914

    DEFF Research Database (Denmark)

    Andersen, Casper

    2011-01-01

    The paper analyses colonial connections and networks of British consulting engineers. It unravels how consulting engineers operated within different imperial contexts, including settler colonies, Egypt and Crown colonies in West Africa in particular. The paper also examines the close and at times...

  9. Effects of a nurse practitioner on a multidisciplinary consultation team

    NARCIS (Netherlands)

    van der Sluis, Corry K.; Datema, Linetta; Saan, Ingrid; Stant, Dennis; Dijkstra, Pieter U.

    2009-01-01

    Effects of a nurse practitioner on a multidisciplinary consultation team. This paper is a report of a study to evaluate the impact on office hours capacity, patient satisfaction, quality of life and costs of including a nurse practitioner in a multidisciplinary consultation team for patients with ha

  10. Responsive Systems Consultation: A Model for Conjoint Consultation Preliminary Results.

    Science.gov (United States)

    Prasad-Gaur, Archna; And Others

    Responsive Systems Consultation (RSC) is an approach for enhancing children's developmental outcomes and involves a psychological or educational consultant working jointly with a child's parents and teachers. The impact of the RSC on parent and teacher consultees' attitudes toward home-school collaboration and their evaluation of the consultation…

  11. Educating Consultants for Multicultural Practice of Consultee-Centered Consultation

    Science.gov (United States)

    Ingraham, Colette L.

    2017-01-01

    Literature about educating consultants with knowledge, skills, and dispositions to work effectively within culturally and linguistically diverse schools is scarce. Research suggests that additional attention is needed on the preparation of consultants to practice with multicultural competence. This article reviews theories and research and…

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

    Science.gov (United States)

    van der

    2001-01-01

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

  13. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  14. Advanced training of tax consultants

    Directory of Open Access Journals (Sweden)

    Adigamova Farida F.

    2016-01-01

    Full Text Available The purpose of the research is to review and analyze the data on the necessity to provide an educational environment for training and advanced training of tax consultants in Russia. The article considers the types of tax consulting, the historical background of training financiers in Russia, as well as identifies conditions determining the significance of tax consulting. The research establishes the connection between the negative attitude to tax payment and tax evasion. The advanced training of tax consultants should be a continuous process as they need to take into account both external and internal taxpayers risks associated with the development of law and law-enforcement practice. Obviously, the training of tax consultants should take into account the experience of developed foreign countries, such as Germany, Austria, Czech Republic, Slovakia and other European countries as well. In Russia, it is necessary to open educational institutions, which will not only be involved in the certification of tax consultants, but also provide training courses. These courses should contribute to constant increase of tax consultants knowledge, consider the tax treatment of economic activities, as well changes in the legislation, economics, finance, accounting, manufacturing processes, which will improve the quality of services provided by tax consultants.

  15. The transition to hospital consultant

    DEFF Research Database (Denmark)

    Westerman, Michiel; Teunissen, Pim W.; Jorgensen, Rasmus Lundhus

    2013-01-01

    Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic comp...... competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored....

  16. An integrated occupational hygiene consultation model for the catering industry.

    Science.gov (United States)

    Lin, Yi-Kuei; Lee, Lien-Hsiung

    2010-07-01

    Vegetable oil used in food processing, during high-temperature exposure, will generate particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs), which are carcinogenic chemical compounds, with the potential to cause lung disease for restaurant kitchen staff. This study's design includes a three-stage consultation process with eight major consultation items, in order to build an integrated consultation model for occupational hygiene. This model combines inspection and consultation, targeting Chinese restaurants in the catering industry. Characteristics of the integrated consultation model include cooperation between different government departments and collaboration with nongovernmental, professional consulting organizations. An additional benefit of the model is the building of a good partnership relationship with the Catering Trade Association. The consultation model helps Chinese restaurants attain improvements in their work environments with minimal investment. Postconsultation, results show a 63.35% and 61.98% (P < 0.001) decrease in the mean time-weighted concentration of exposure to PM and PAHs, respectively. The overall regulation compliance rate of Chinese restaurants significantly increased from 34.3% to 89.6%. These results show that the integrated consultation model for occupational hygiene not only helps small and medium enterprises reduce exposure concentrations in the workplace but also has specific potential for successful implementation in Taiwan.

  17. Impact of Consultation on Hospital Outcomes and Resource Utilization for Patients with Acute Congestive Heart Failure.

    Science.gov (United States)

    Varga, Zoltan; Sabzwari, Syed Ali Rafay; Abusaada, Khalid

    2017-07-01

    Consultation is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consultation on hospital outcomes and resource utilization in CHF is unknown. The objectives of our study were to determine the effect of consultation on outcomes in CHF and to evaluate factors affecting the frequency of consultation. Our study was a retrospective cohort study of patients admitted to Florida Hospital Orlando for CHF between January 1, 2011 and December 31, 2013. Data on demographics, number of consultations, length of stay (LOS), readmissions within 30 days, cost of care, and mortality were compared according to the number of consultations. For statistical analysis, analysis of variance, the χ(2) test, and multivariate linear regression analysis were used. Risk-adjusted outcomes were reported as observed/expected. A total of 1554 patients were included; 103 (6.6%) patients received no consultation; 482 (31%) received 1; 365 (23.5%) received 2; 229 (14%) received 3; and 375 (24%) received ≥4. Teaching service, age, and African American race were associated with decreased consultation (P consultation (P consultations (P consultations (P = 0.35 and 0.98, respectively). Increased consultation with patients with CHF is associated with increased costs and LOS without improved mortality or readmission rate. Decreased utilization of consultations by the teaching service suggests that there is an opportunity to decrease utilization of healthcare resources by streamlining the utilization of consultations.

  18. The representations of adolescents about gynecological consultation

    Directory of Open Access Journals (Sweden)

    Vera Lúcia de Oliveira Gomes

    2014-06-01

    Full Text Available Objective: To analyze the social representation of adolescents about gynecological consultation and the influence of those in searching for consultations. Method: Qualitative descriptive study based on the Social Representations Theory, conducted with 50 adolescents in their last year of middle school. The data was collected between April and May of 2010 by Evocations and a Focal Group. The software EVOC and contextual analysis were used in the data treatment. Results: The elements fear and constraint, constant in the central nucleus, can justify the low frequency of adolescents in consultations. The term embarrassment in the peripheral system reinforce current sociocultural norms, while prevention, associated with learning about sex and clarifying doubts, allows to envision an educative function. Obtained testimonies in the focal groups exemplify and reinforce those findings. Conclusion: For an effective health education, professionals, including nurses, need to clarify the youth individually and collectively about their rights to privacy, secrecy, in addition to focus the gynecological consultation as a promotion measure to sexual and reproductive health.

  19. Health Facilities

    Science.gov (United States)

    Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care centers. When you ...

  20. Use of a histidine-rich protein 2-based rapid diagnostic test for malaria by health personnel during routine consultation of febrile outpatients in a peripheral health facility in Yaounde, Cameroon.

    Science.gov (United States)

    Sayang, Collins; Soula, Georges; Tahar, Rachida; Basco, Leonardo K; Gazin, Pierre; Moyou-Somo, Roger; Delmont, Jean

    2009-08-01

    The role of a rapid diagnostic test (RDT) in the case management of Plasmodium falciparum malaria infections has not been determined in Africa. Our study was conducted during November 2007-January 2008 to assess test accuracy of an RDT in the management of febrile outpatients in a peripheral urban health facility in Cameroon. We found the overall sensitivity to be 71.4% and a specificity of 82.2%; the positive predictive value and negative predictive value were 73.8% and 80.4%, respectively. False-negative and false-positive cases represented 11.8% and 10.5% of all febrile patients. Malaria alone (31.3%) was the first cause of fever; 33.5% of fever cases were of unknown origin. Acute respiratory infections were common among children 0-2 years of age (25.5%) and decreased with age. The risk of having a clinical failure with the presumptive treatment of febrile children was seven times greater than that of the RDT-oriented management (relative risk = 6.8, 95% confidence interval = 0.88-53.4, P = 0.03) because of the delay of appropriate treatment of non-malarial febrile illness. Our results suggest that the RDT may be of limited utility for children greater than five years of age and adults and that diagnosis based on microscopic examination of blood smears should be recommended for these patient populations, as well as in areas of low transmission.

  1. Simulated consultations: a sociolinguistic perspective

    National Research Council Canada - National Science Library

    Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha

    2016-01-01

    .... Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language...

  2. 40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

    Science.gov (United States)

    2010-07-01

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

  3. Notes: Public Consultation toward Ethiopia's Family Law Reform ...

    African Journals Online (AJOL)

    Notes: Public Consultation toward Ethiopia's Family Law Reform and the Revised Code's Response. ... Mizan Law Review ... inter alia, include the pros and cons of having a uniform family law, the various forms and impediments to marriage, ...

  4. Users enlist consultants to calculate costs, savings

    Energy Technology Data Exchange (ETDEWEB)

    1982-05-24

    Consultants who calculate payback provide expertise and a second opinion to back up energy managers' proposals. They can lower the costs of an energy-management investment by making complex comparisons of systems and recommending the best system for a specific application. Examples of payback calculations include simple payback for a school system, a university, and a Disneyland hotel, as well as internal rate of return for a corporate office building and a chain of clothing stores. (DCK)

  5. Development of a teledermatopathology consultation system using virtual slides

    Directory of Open Access Journals (Sweden)

    Nakayama Ikunori

    2012-12-01

    Full Text Available Abstract Background An online consultation system using virtual slides (whole slide images; WSI has been developed for pathological diagnosis, and could help compensate for the shortage of pathologists, especially in the field of dermatopathology and in other fields dealing with difficult cases. This study focused on the performance and future potential of the system. Method In our system, histological specimens on slide glasses are digitalized by a virtual slide instrument, converted into web data, and up-loaded to an open server. Using our own purpose-built online system, we then input patient details such as age, gender, affected region, clinical data, past history and other related items. We next select up to ten consultants. Finally we send an e-mail to all consultants simultaneously through a single command. The consultant receives an e-mail containing an ID and password which is used to access the open server and inspect the images and other data associated with the case. The consultant makes a diagnosis, which is sent to us along with comments. Because this was a pilot study, we also conducted several questionnaires with consultants concerning the quality of images, operability, usability, and other issues. Results We solicited consultations for 36 cases, including cases of tumor, and involving one to eight consultants in the field of dermatopathology. No problems were noted concerning the images or the functioning of the system on the sender or receiver sides. The quickest diagnosis was received only 18 minutes after sending our data. This is much faster than in conventional consultation using glass slides. There were no major problems relating to the diagnosis, although there were some minor differences of opinion between consultants. The results of questionnaires answered by many consultants confirmed the usability of this system for pathological consultation. (16 out of 23 consultants. Conclusion We have developed a novel

  6. Aspects of statistical consulting not taught by acedemia

    DEFF Research Database (Denmark)

    Kenett, R.; Thyregod, Poul

    2006-01-01

    Education in statistics is preparing for statistical analysis but not necessarily for statistical consulting. The objective of this paper is to explore the phases that precede and follow statistical analysis. Specifically these include: problem elicitation, data collection and, following statisti......Education in statistics is preparing for statistical analysis but not necessarily for statistical consulting. The objective of this paper is to explore the phases that precede and follow statistical analysis. Specifically these include: problem elicitation, data collection and, following...

  7. Environmental consulting in Niedersachsen. Umweltberatung in Niedersachsen; Entwicklung einer Konzeption zur umweltrelevanten Beratung und Information. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Michelsen, G.; Huntemann, K.; Mertineit, K.D.; Bonhaus, B.; Albrecht, F.; Bohne, K.; Wienhoefer, S.

    1989-09-01

    In order to receive a systematic survey about the present environment related consulting series and to strengthen or improve the existing advisory structure, the Minister for Environmental Affairs in Lower Saxony asked the central facility for further education of Hanover University in autumn 1988 - to carry out an inquiry of available consulting services regarding environmental questions in Lower Saxony; - to show possibilities of coordiation and cooperation between different consultants; - to provide proposals for a further education of staff members acting in environmental consulting; - to establish a guide by means of which the consulting services can be made more transparent and useable in Lower Saxony. On the basis of the information gained, a guide of environmental consultants is established and proposals for an improvement of cooperation, coordination and further education are provided. (orig./UA)

  8. CONSULTATION ON UPDATED METHODOLOGY FOR ...

    Science.gov (United States)

    The National Academy of Sciences (NAS) expects to publish the Biological Effects of Ionizing Radiation (BEIR) committee's report (BEIR VII) on risks from ionizing radiation exposures in calendar year 2005. The committee is expected to have analyzed the most recent epidemiology from the important exposed cohorts and to have factored in any changes resulting from the updated analysis of dosimetry for the Japanese atomic bomb survivors. To the extent practical, the Committee will also consider any relevant radiobiological data, including those from the Department of Energy's low dose effects research program. Based on their evaluation of relevant information, the Committee is then expected to propose a set of models for estimating risks from low-dose ionizing radiation. ORIA will review the BEIR VII report and consider revisions to the Agency's methodology for estimating cancer risks from exposure to ionizing radiation in light of this report and other relevant information. This will be the subject of the Consultation. This project supports a major risk management initiative to improve the basis on which radiation risk decisions are made. This project, funded by several Federal Agencies, reflects an attempt to characterize risks where there are substantial uncertainties. The outcome will improve our ability to assess risks well into the future and will strengthen EPAs overall capability for assessing and managing radiation risks. the BEIR VII report is funde

  9. Airports and Airfields, Airstrip locations within Sedgwick County. Primary attributes include site number, location ID, facility type, effective date, air strip name, city name, latitude, longitude, and elevation., Published in 2008, 1:1200 (1in=100ft) scale, Sedgwick County Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Airports and Airfields dataset current as of 2008. Airstrip locations within Sedgwick County. Primary attributes include site number, location ID, facility type,...

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

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

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

  11. Academic Development for Careers in Management Consulting

    Science.gov (United States)

    Adams, Susan M.; Zanzi, Alberto

    2004-01-01

    Explores the extent to which academic offerings are serving the consulting industry and identifies ways that academia can help. The numbers of management consulting courses, field experiences in consulting and consulting concentrations by graduate business schools were tracked over a three-year period to assess the current state of offerings. A…

  12. Communication Consulting as Persuasion: Issues and Implications.

    Science.gov (United States)

    Ross, Roseanna G.

    Focusing on the issue of the training and preparation of the communication specialist in communication consulting, an investigation of the persuasive elements in the client-consulting relationship suggests that more direct focus on consulting as persuasion can lead to more responsible and effective enactment of the role of both consultant and…

  13. Developing a model osteoarthritis consultation: a Delphi consensus exercise

    Directory of Open Access Journals (Sweden)

    Porcheret Mark

    2013-01-01

    Full Text Available Abstract Background Osteoarthritis (OA is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems. Methods A postal Delphi consensus exercise was undertaken with two expert groups: i general practitioners (GPs with expertise in OA management and ii patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%. Results The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i assessment of chronic joint pain, ii patient’s ideas and concerns, iii exclusion of red flags, iv examination, v provision of the diagnosis and written information, vi promotion of exercise and weight loss, vii initial pain management and viii arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence. Conclusions This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.

  14. Developing a model osteoarthritis consultation: a Delphi consensus exercise.

    Science.gov (United States)

    Porcheret, Mark; Grime, Janet; Main, Chris; Dziedzic, Krysia

    2013-01-16

    Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems. A postal Delphi consensus exercise was undertaken with two expert groups: i) general practitioners (GPs) with expertise in OA management and ii) patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%. The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient's ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence. This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.

  15. European Food Safety Authority; Outcome of the Public consultation on the Draft Opinion of the Scientific Panel on Dietetic products, Nutrition, and Allergies (NDA) on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol

    DEFF Research Database (Denmark)

    Tetens, Inge

    these were taken into account in the final opinion. EFSA had received contributions from 40 interested parties (individuals, non-governmental organisations, industry organisations, academia and national assessment bodies). The main comments which were received during the public consultation related to...

  16. The role of consulting psychiatrists for obstetric and gynecologic inpatients.

    Science.gov (United States)

    Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh

    2011-01-01

    The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

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

    Science.gov (United States)

    Afifi, Ladan; Shinkai, Kanade

    2017-03-01

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

  18. Multidisciplinary teams in consultation-liaison psychiatry: the Yale model.

    Science.gov (United States)

    Leigh, H

    1987-01-01

    The consultation-liaison service at Yale features integrated teams of psychiatrists, social workers, and clinical nurse specialists working together in both consultation and outpatient settings. The model is based on the tenets that (1) comprehensive evaluation of patients is essential for effective treatment; (2) role definition is necessary for specific disciplines, including the definition of overlapping and separate areas of expertise and practice. The multidisciplinary teams are coordinated by a psychiatric resident, who is supervised by an attending psychiatrist. The role of the resident is that of a diagnostician and coordinating physician. The social worker functions as an expert in family evaluation and treatment, and the nurse specialist functions as supportive therapist and liaison with the nursing staff. The structure of the division of consultation-liaison and ambulatory services at Yale is described and the advantages and disadvantages of the multidisciplinary team concept are discussed in comparison with other models of consultation-liaison psychiatry.

  19. Case consultation: ablatio penis.

    Science.gov (United States)

    Money, J

    1998-01-01

    In male infants, traumatic ablation of the penis, with or without loss of the testicles may occur as a sequel to mutilatory violence, accidental injury, or circumcision error. Post-traumatically, one program of case management is surgical sex reassignment to live as a girl, with female hormonal therapy at the age of puberty. The other program is genital reconstructive surgery to live as a boy, with male hormonal therapy at puberty if the testicles are missing. In both programs, the long term outcome is less than perfect and is contingent on intervening variables that include societal ideology; surgical technology; juvenile and adolescent timing and frequency of hospital admissions construed by the child as nosocomial abuse; development of body image; health and sex education; fertility versus sterility; coitus and orgasm; possible lesbian orientation if living as a girl; and long-term cost accounting, including the psychic cost of being a pawn in possible malpractice litigation on whose disability a very large fortune in compensation may devolve. There is, as yet, no unanimously endorsed set of guidelines for the treatment of genital trauma and mutilation in infancy, and no provision for a statistical depository for outcome data.

  20. Narrative and Structure in Consultation

    Science.gov (United States)

    Hadley, David

    2012-01-01

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

  1. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.

    2014-01-01

    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can re

  2. [Remote medical consultations in gerontology].

    Science.gov (United States)

    Mathieu-Fritz, Alexandre; Esterle, Laurence; Espinoza, Pierre

    2012-01-01

    Experimental teleconsultations have been set up between a university hospital and a public geriatric hospital in Paris in order to facilitate elderly patients' access to specialist consultations. Caregivers have had to accept major changes to their professional practices (delegation of tasks, sharing of knowledge, etc.). This new telemedecine scheme represents huge progress in patient care.

  3. Tianjin Architects & Consulting Engineers

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Tianjin Architects& Consulting Engineers (TACE), established in 1952,is the largest integrated architectural design institutein Tianjian. TACE has five A-Class certificates issued by the Ministry of Construction in areas such as engineering design, and it is rated as one of the top 100 exploration and design companies in China.

  4. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.

    2014-01-01

    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can re

  5. Corrective Action Investigation Plan for Corrective Action Unit 254: Area 25 R-MAD Decontamination Facility, Nevada Test Site, Nevada (includes ROTC No. 1, date 01/25/1999)

    Energy Technology Data Exchange (ETDEWEB)

    DOE/NV

    1999-07-29

    This Corrective Action Investigation Plan contains the US Department of Energy, Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 254 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 254 consists of Corrective Action Site (CAS) 25-23-06, Decontamination Facility. Located in Area 25 at the Nevada Test Site (NTS), CAU 254 was used between 1963 through 1973 for the decontamination of test-car hardware and tooling used in the Nuclear Rocket Development Station program. The CAS is composed of a fenced area measuring approximately 119 feet by 158 feet that includes Building 3126, an associated aboveground storage tank, a potential underground storage area, two concrete decontamination pads, a generator, two sumps, and a storage yard. Based on site history, the scope of this plan is to resolve the problem statement identified during the Data Quality Objectives process that decontamination activities at this CAU site may have resulted in the release of contaminants of concern (COCs) onto building surfaces, down building drains to associated leachfields, and to soils associated with two concrete decontamination pads located outside the building. Therefore, the scope of the corrective action field investigation will involve soil sampling at biased and random locations in the yard using a direct-push method, scanning and static radiological surveys, and laboratory analyses of all soil/building samples. Historical information provided by former NTS employees indicates that solvents and degreasers may have been used in the decontamination processes; therefore, potential COCs include volatile/semivolatile organic compounds, Resource Conservation and Recovery Act metals, petroleum hydrocarbons, polychlorinated biphenyls, pesticides, asbestos, gamma-emitting radionuclides, plutonium, uranium, and strontium-90. The results of this

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

    Science.gov (United States)

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

    2015-04-03

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

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

    Science.gov (United States)

    Thornberg, Robert

    2014-01-01

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

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

    Science.gov (United States)

    Thornberg, Robert

    2014-01-01

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

  9. Guide to research facilities

    Energy Technology Data Exchange (ETDEWEB)

    1993-06-01

    This Guide provides information on facilities at US Department of Energy (DOE) and other government laboratories that focus on research and development of energy efficiency and renewable energy technologies. These laboratories have opened these facilities to outside users within the scientific community to encourage cooperation between the laboratories and the private sector. The Guide features two types of facilities: designated user facilities and other research facilities. Designated user facilities are one-of-a-kind DOE facilities that are staffed by personnel with unparalleled expertise and that contain sophisticated equipment. Other research facilities are facilities at DOE and other government laboratories that provide sophisticated equipment, testing areas, or processes that may not be available at private facilities. Each facility listing includes the name and phone number of someone you can call for more information.

  10. [Teledermatology versus consultations--a comparative study of 120 consultations].

    Science.gov (United States)

    Herrmann, F E; Sönnichsen, K; Blum, A

    2005-10-01

    Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.

  11. The duty to consult and legal obligations

    Energy Technology Data Exchange (ETDEWEB)

    Carpenter, A.W. [Lawson Lundell Lawson and MacIntosh, Calgary, AB (Canada)

    2002-07-01

    Aboriginal law in Canada has been evolving and industry is beginning to engage in the change. This presentation describes the legal aspects regarding Aboriginal rights and the duty to consult First Nations regarding treaty rights. The implications for First Nations and industry are described. Aboriginal peoples of Canada include the Indian, Inuit and Metis populations. Aboriginal titles exist, therefore they are constitutionally protected. The paper describes recent decisions regarding the Mikisew Cree First Nation versus Canada, the Taku River Tlinget versus Ringstad, and the Haida Nation versus British Columbia and Weyerhaeuser.

  12. Asynchronous vascular consultation via electronic methods: A feasibility pilot.

    Science.gov (United States)

    Chittle, Melissa D; Rao, Sandhya K; Jaff, Michael R; Patel, Virendra I; Gallen, Kathleen M; Avadhani, Radhika; Ferris, Timothy G; Wasfy, Jason H

    2015-12-01

    Management of chronic disease often requires multidisciplinary clinical efforts and specialist care. With the emergence of Accountable Care Organizations (ACOs), health care systems are incentivized to evaluate methods of information exchange between generalists and specialists in order to provide value while preserving quality. Our objective was to evaluate patient and referring provider satisfaction and outcomes of asynchronous electronic consultations in vascular care in a large tertiary academic medical center. Referring providers were offered a vascular 'e-consult' option through an electronic referral management system. We conducted chart review to understand the downstream effects and surveyed patients and referring providers to assess satisfaction. From 24 March 2014 to 1 March 2015, 54 e-consults were completed. Additional testing and recommendations were made in 49/54 (90.7%) e-consults, including lower-extremity venous duplex ultrasonography with reflux testing, duplex ultrasonography of the carotid artery, computed tomography, magnetic resonance imaging, non-invasive physiology arterial studies, laboratory tests, medications, compression stockings, and sequential lymphedema compression therapy. Referring providers were compliant with recommendations in 40/49 (81.6%) of e-consults. A total of 17/54 (31.5%) patients were surveyed with a median patient satisfaction score of 13.7/15 (91.3%) (SD ± 6.4). The program was associated with high referring provider satisfaction, with 87.0% finding the e-consult very helpful and 80.0% stating it averted the need for a traditional visit. Our experience suggests that e-consults are an effective way to provide vascular care in some patients and are associated with high patient and provider satisfaction. E-consults may therefore be an efficient method of care delivery for vascular patients within an ACO.

  13. An Analysis of WhatsApp Usage for Communication Between Consulting and Emergency Physicians.

    Science.gov (United States)

    Gulacti, Umut; Lok, Ugur; Hatipoglu, Sinan; Polat, Haci

    2016-06-01

    The aim of this study was to evaluate WhatsApp messenger usage for communication between consulting and emergency physicians. A retrospective, observational study was conducted in the emergency department (ED) of a tertiary care university hospital between January 2014 and June 2014. A total of 614 consultations requested by using the WhatsApp application were evaluated, and 519 eligible consultations were included in the study. The WhatsApp messages that were transferred to consultant physicians consisted of 510 (98.3%) photographic images, 517 (99.6%) text messages, 59 (11.3%) videos, and 10 (1.9%) voice messages. Consultation was most frequently requested from the orthopedics clinic (n = 160, 30.8%). The majority of requested consultations were terminated only by evaluation via WhatsApp messages. (n = 311, 59.9%). Most of the consulting physicians were outside of the hospital or were mobile at the time of the consultation (n = 292, 56.3%). The outside consultation request rate was significantly higher for night shifts than for day shifts (p = .004), and the majority of outside consultation request were concluded by only WhatsApp application (p WhatsApp is useful a communication tool between physicians, especially for ED consultants who are outside the hospital, because of the ability to transfer large amounts of clinical and radiological data during a short period of time.

  14. THE IMPORTANCE OF CONSULTING IN CONTEMPORARY BUSINESS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Svetlana Vukotić

    2017-07-01

    Full Text Available Modern business is characterized by risk and uncertainty, and such an environment is reflected in the decisions taken by managers. On the other hand, management consulting is one of the most important management techniques developed over the last fifty years. The secondary effect of this invention is the rapid development of new frameworks, tools, and techniques improving the operations in a number of companies. Exposure of consulting organizations to varying combinations of business circumstances and experiences of different companies have allowed for the accumulation of valuable knowledge and business experience. From this coupling, or interaction of knowledge and experience of consulting companies, on the one hand and the needs of management companies to recognize their role and hire consultants, on the other hand, developed the importance of financial consulting and auditing. Rational management processes cannot be imagined without reliable information provided by the audit, especially as the strategic management includes the control phase. The importance and relationship between consulting and management in companies that do business according to modern principles is a central topic of consideration in this paper.

  15. Lactation Consultants' Perceived Barriers to Providing Professional Breastfeeding Support.

    Science.gov (United States)

    Anstey, Erica H; Coulter, Martha; Jevitt, Cecilia M; Perrin, Kay M; Dabrow, Sharon; Klasko-Foster, Lynne B; Daley, Ellen M

    2017-08-01

    Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems. This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.

  16. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    OpenAIRE

    Sporer, Scott M.; Bernard R. Bach, Jr

    2009-01-01

    DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Sc...

  17. The Hannover Consultation Liaison model: some empirical findings.

    Science.gov (United States)

    Freyberger, H; Künsebeck, H W; Lempa, W; Avenarius, H J; Liedtke, R; Plassman, R; Nordmeyer, J

    1985-01-01

    Starting from the definitions concerning the concepts 'Liaison medicine' and 'Consultative Psychiatry' we begin with remarks with regard to the Consultation Liaison-Situation in West Germany on the basis of the key-words 'Brief history', 'Independent university units with regard to Psychotherapy and Psychosomatics as well as the connected organization' and 'Teaching procedures'. Following it the Hannover Consultation Liaison model is presented particularly with regard to both the psychosomatic inpatient ward including the functional organization and psychotherapeutic processes as well as the so-called 'Innere Ambulanz' which includes the consultation liaison services in the clinico-medical departments outside Psychiatry and Psychosomatics. Within the 'Innere Ambulanz', which is closely connected to our psychosomatic inpatient ward, the consultation liaison activities and the resulting supportive psychotherapeutic strategies are performed by student auxiliary therapists who are interested in completing their 4-5 months internship-time in our department. We describe both the three supportive psychotherapeutic steps, which may last months to years including subsequent dynamically psychotherapeutic strategies as well as the reactions of the auxiliary therapist function on the students. Furthermore, we may state that there exists no one more optional education procedure of graduate students than the student's confrontation with his partial self-responsibility vis-à-vis a patient who is being supportive-psychotherapeutically treated by him. Specific empirical proofs concerning our patient oriented consultation liaison activities are demonstrated on the basis of previous psychotherapeutic findings in Crohn patients. Here we are able to demonstrate the effectivity of psychotherapy in the case of the supplementarily psychotherapeutically treated patients in comparison to the patients who received medical therapy only. Finally we are able to present quantitative clinico

  18. Core Competencies for Training Effective School Consultants

    Science.gov (United States)

    Burkhouse, Katie Lynn Sutton

    2012-01-01

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

  19. Core Competencies for Training Effective School Consultants

    Science.gov (United States)

    Burkhouse, Katie Lynn Sutton

    2012-01-01

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

  20. Special Education Teacher Consultant: Idealism versus Realism.

    Science.gov (United States)

    Haight, Sherrel Lee

    1984-01-01

    A review of literature on topics of teacher consultant roles, cross-categorical services, approval criteria, and caseloads suggests the position of teacher consultant as it is being implemented may be untenable. There is a critical lack of role definition at state and local levels and a dearth of professional preparation in consultation skills.…

  1. Observed Consultation: Confidence and Accuracy of Assessors

    Science.gov (United States)

    Tweed, Mike; Ingham, Christopher

    2010-01-01

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

  2. Observed Consultation: Confidence and Accuracy of Assessors

    Science.gov (United States)

    Tweed, Mike; Ingham, Christopher

    2010-01-01

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

  3. Nurse consultants 10 years on: an insight to the role for nurse managers.

    Science.gov (United States)

    Mullen, Chris; Gavin-Daley, Ann; Kilgannon, Helen; Swift, Juliette

    2011-09-01

    To evaluate the Non-Medical Consultant role in the North West of England. The objective was to identify the current number of Non-Medical Consultants, what they do and the impact of the role in practice. The Non-Medical Consultant role for nursing and midwifery was introduced in the UK in 2000 to provide better outcomes for patients by improving service and quality; strengthening clinical leadership; and providing a new career opportunity to help retain experienced and expert professionals in practice. A combined qualitative and quantitative design was adopted. This included desktop review of previous studies, a survey questionnaire to current consultants, focus group meetings with Non-Medical Consultants, sponsors and champions. The role is effective, flexible, responsive and outward facing both internal to the organization and externally on a local, regional and national basis. A key challenge for the Non-Medical Consultants was organizational understanding of the role. The small size of the Non-Medical Consultant workforce can limit individual organizations experience of establishing and supporting the role. Effective Non-Medical Consultants lead, drive and support quality improvement, increased productivity and service effectiveness. Other impacts include sharing and promoting best practice with colleagues, income generation and financial savings through service redesign and/or staff skill mix changes. Managerial issues identified may assist Nurse Managers seeking to introduce new consultant roles and/or support, and retain existing consultants to reach their full potential. 2011 Blackwell Publishing Ltd.

  4. Managing your engineering consultants: Steps for simultaneously improving operations, project implementation, and your bottom line

    Energy Technology Data Exchange (ETDEWEB)

    Kirchen, E.R.; Perilloux, B.L. [Albert-Garaudy and Associates, Inc., Metairie, LA (United States)

    1997-12-31

    The domestic oil and gas industry has responded to depleting reserves and increasing operating costs by downsizing the overhead required to maintain production and processing facilities. For many companies this downsizing has resulted in a reduced in-house engineering staff and a greater reliance on consulting engineering services. To get the most benefit from consulting engineering companies, the partnership between consultants and the oil and gas company needs to be carefully considered. Unfortunately, these partnerships are often developed at the home office with visionary goals in mind, only to be implemented reluctantly on a local level. A better strategy is to implement partnering tools on the local level and allow these partnerships to develop naturally, and at times, uniquely, at each location. The following such tools detailed in this paper are: manpower leveraging -- using field-trained consulting engineers to address project design/implementation and field/construction support so that the operating company`s engineers may focus on management and detailed development of high-return projects; enhanced project scope and design review -- developing and reviewing project scope(s) and preliminary engineering designs to minimize engineering/construction costs as well as optimize the operability and constructability of the project; and consulting rate standardization -- understanding and structuring the consultant`s rates so that neither side is exploited and so that the project is staffed in the interest of project execution and not maximum profits for the consultant.

  5. Facilities for US Radioastronomy.

    Science.gov (United States)

    Thaddeus, Patrick

    1982-01-01

    Discusses major developments in radioastronomy since 1945. Topics include proposed facilities, very-long-baseline interferometric array, millimeter-wave telescope, submillimeter-wave telescope, and funding for radioastronomy facilities and projects. (JN)

  6. Smoking cessation advice in consultations with health problems not related to smoking?

    DEFF Research Database (Denmark)

    Guassora, Ann Dorrit Kristiane; Baarts, Charlotte

    2010-01-01

    Objective. To identify frames of interaction that allow smoking cessation advice in general practice consultations. Design . Qualitative study based on individual in-depth interviews with GPs and their patients. Each of the GPs’ consultations were observed during a three-day period. Interviews...... primarily addressed the consultations that had been observed. The concept of “ frames ” described by Goffman was deployed as an analytic tool. Setting . Danish general practice. Subjects. Six GPs and 11 of their patients. Results . Both GPs and patients evaluated potential issues to be included during...... consultations by relevance criteria. Relevance criteria served the purpose of limiting the number of issues in individual consultations. Issues could be included if they connected to something already communicated in a consultation. Smoking cessation advice was subject to these relevance criteria...

  7. Survey of perceived stress and work demands of consultant doctors.

    Science.gov (United States)

    Agius, R M; Blenkin, H; Deary, I J; Zealley, H E; Wood, R A

    1996-01-01

    OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers. PMID:8664957

  8. Mechanisms for exchange of image data to support distant medical consultation.

    OpenAIRE

    Dayhoff, R. E.; Maloney, D. L.; Hirz, L.; Majurski, W. J.; Kuzmak, P. M.; Bradley, D.

    1993-01-01

    The VA has developed an integrated infrastructure to support the exchange of medical data, including images and text report data, between medical centers. This capability is expected to support teleconsulting and meet a variety of existing medical staffing and consultation needs. Consultation from distant locations requires at least the same complete integrated patient record available to onsite physicians. Several mechanisms are being explored to support distant medical consultation. Multime...

  9. Bus Yards and Repair Facilities, Local Buildings - Bus shop is included in local buildings layer, Published in 2008, 1:2400 (1in=200ft) scale, Effingham County Board Of Commissioners.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Bus Yards and Repair Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Orthoimagery information as of 2008. It is...

  10. Prisons and Correctional Facilities, Local Building - buiding footprint is included in the local building layer, Published in 2008, 1:2400 (1in=200ft) scale, Effingham County Board Of Commissioners.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Prisons and Correctional Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Orthoimagery information as of 2008. It is...

  11. The 'hidden work' of a hospital neurologist: 1000 consults later.

    LENUS (Irish Health Repository)

    Ali, E

    2012-02-01

    BACKGROUND: A new Web-based, internal neurology referral service was introduced in our department to expedite inpatient review for other departments and to allow assessment of the impact of neurology consults on patient care throughout the hospital, especially in the emergency department (ED). The results of the analysis of the first 1000 referrals using the new system are presented. Methods: An intranet referral system was designed by the consultant neurologists. The previous method of referral was by handwritten letter. The electronic template included \\'drop-down\\' menus and mandatory fields to help guide referring teams. An outcome section is completed by the neurology team. Results: An average of 17 referrals was seen weekly. Seventy-seven per cent were seen within 24 h of referral. A consultant neurologist saw 87% of the referrals directly; 13% were first seen by a registrar and later discussed with a consultant. Forty per cent were seen in the ED of which a one-third of the patients were discharged following assessment. The most common reason for referral was seizure(s) or an episode of collapse (28%). Patients presenting with stroke\\/transient ischaemic attack represented 13.5%, and 12.5% presented with headaches. The management of 79% of referred cases was deemed to have been significantly changed after neurology review. Discussion: The introduction of a neurology consultant-designed and consultant-led intranet referral service has greatly enhanced the delivery of the consult service to patients in our hospital. This referral system contributes significantly to hospital efficiency and to access for patients to specialist assessment.

  12. Acute surgical unit: The consultant experience

    Directory of Open Access Journals (Sweden)

    Patrick J Stokes

    2016-07-01

    Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.

  13. Consultation on urological specimens from referred cancer patients using real-time digital microscopy

    DEFF Research Database (Denmark)

    Holten-Rossing, Henrik; Larsen, Lise Grupe; Toft, Birgitte Grønkær

    2016-01-01

    digital consultation took place over the telephone using remote access software. Time of start and finish for each case was logged. For the physically referred cases, time from arrival to sign-out was logged in the national pathology information system, and time spent on microscopy and reporting was noted...... Finetek) was employed. The Pathology Department at Næstved Hospital was equipped with a digital microscope and three consultant pathologists were stationed at Rigshospitalet with workstations optimized for digital microscopy. Representative slides for each case were selected for consultation and live......, reporting and sign-out per case. For live digital consultations, a mean of 18 min 37 s was spent on each consultation with 4 min 43 s for each case, depending on the number of digital slides included. Only in two cases could a consensus regarding the diagnosis not be reached during live consultation...

  14. Harnessing competence and confidence: Dimensions in education and development for advanced and consultant practice

    Energy Technology Data Exchange (ETDEWEB)

    Price, Richard C. [School of Health and Emergency Professions, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB (United Kingdom)], E-mail: r.c.price@herts.ac.uk; Edwards, Hazel M. [School of Health and Emergency Professions, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB (United Kingdom)

    2008-12-15

    Consultant and advanced practice are relatively new concepts in radiography. There is evidence to show that as the career progression framework is being adopted the numbers of consultant and advanced practitioners in radiography are growing with the latter growing at a faster rate. The article considers the concept of advanced and consultant practice and the education requirements to support development. Preparation for an advanced practice role begins at the practitioner stage. Masters' level programmes are available to support the development of advanced practice. Education needs to be flexible as new advanced practice roles emerge. It is necessary to take practitioners beyond a defined modality to include leadership and people skills. These are essential for those aspiring to become consultants. Consultants require a high level of clinical knowledge for expert practice but also strategic vision and interpersonal intelligence to facilitate leadership and practice innovation. A model for developing leadership skills for consultants focussing on competence, confidence and capacity is proposed.

  15. Training interventions for improving telephone consultation skills in clinicians.

    Science.gov (United States)

    Vaona, Alberto; Pappas, Yannis; Grewal, Rumant S; Ajaz, Mubasshir; Majeed, Azeem; Car, Josip

    2017-01-05

    Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. We identified one very small controlled before-after study performed in 1989: this study used a

  16. Sports chronobiology consultation: from the lab to the arena.

    Science.gov (United States)

    Postolache, Teodor T; Hung, Tsung-Min; Rosenthal, Richard N; Soriano, Joseph J; Montes, Fernando; Stiller, John W

    2005-04-01

    This final article, coauthored by a chronobiology consultant, a sports psychologist who applied a chronobiology-based program to an Olympic national team, a clinical neurologist, a performance data analyst, a training-conditioning coach from a major league baseball team who applied chronobiology principles to major league pitchers, and a substance abuse expert, discusses practical aspects of a sports chronobiology consultation, including the goals and current arsenal of available interventions. Short vignettes of actual cases are presented for edification, and references are made to appropriate reviews found elsewhere in this issue.

  17. Development of a telepresence robot for medical consultation

    Science.gov (United States)

    Bugtai, Nilo T.; Ong, Aira Patrice R.; Angeles, Patrick Bryan C.; Cervera, John Keen P.; Ganzon, Rachel Ann E.; Villanueva, Carlos A. G.; Maniquis, Samuel Nazirite F.

    2017-02-01

    There are numerous efforts to add value for telehealth applications in the country. In this study, the design of a telepresence doctor to facilitate remote medical consultations in the wards of Philippine General Hospital is proposed. This includes the design of a robot capable of performing a medical consultation with clear audio and video information for both ends. It also provides the operating doctor full control of the telepresence robot and gives a user-friendly interface for the controlling doctor. The results have shown that it provides a stable and reliable mobile medical service through the use of the telepresence robot.

  18. The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

    Science.gov (United States)

    Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

    2017-08-01

    Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

  19. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation which is crucial knowledge in regards of patient compliance, decision making and general patient satisfaction. Despite good communication skills among clinicians...... the communication is challenged by the fact that patients tend to forget or misunderstand a great deal of the information given. The primary objective of this study is to investigate the effects of providing patients with an audio recording of the consultation. Methods A randomized controlled trial involving four...

  20. The uses and implications of standards in general practice consultations

    DEFF Research Database (Denmark)

    Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm

    2017-01-01

    was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic...... standards for the ‘softer’ aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development...... disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor–patient dialogues and to divert general practitioners’ attention from patients’ personal concerns. Similar consequences of quality standards have previously been framed...

  1. Colonial connections and consulting engineers 1850-1914

    DEFF Research Database (Denmark)

    Andersen, Casper

    2011-01-01

    The paper analyses colonial connections and networks of British consulting engineers. It unravels how consulting engineers operated within different imperial contexts, including settler colonies, Egypt and Crown colonies in West Africa in particular. The paper also examines the close and at times...... strained connections that existed between London's consulting engineers and British engineers stationed overseas in colonial public works departments. By examining the colonial connections of metropolitan engineers, the paper sheds light on a hitherto ignored factor that tied Britain and the colonies...... together during the diaspora of British engineering. It argues that personal connections and relations remained of paramount importance during this period, which has traditionally been described as characterised by growing professionalisation and a subsequent loss of the personal element in British...

  2. Incidence and outcomes of intraoperative vascular surgery consultations.

    Science.gov (United States)

    Danczyk, Rachel C; Coleman, Jake; Allensworth, Jordan; Azarbal, Amir F; Mitchell, Erica L; Liem, Timothy K; Landry, Gregory J; Moneta, Gregory L

    2015-07-01

    Vascular surgeons may aid in primarily nonvascular procedures. Such activity has not been quantified, and hospital administrators may be unaware of the importance of vascular surgeons to support other hospital-based surgical programs. This study reviewed intraoperative consultations by vascular surgeons to support other surgical services. Intraoperative vascular consultations were reviewed from January 2006 to January 2014 for consulting service, indication, and whether consultation occurred with advanced notice. Patient demographics, operative times, estimated blood loss, length of stay, and relative value units (RVUs) assigned for each consultation were also assessed. Consultations for trauma and iatrogenic injuries occurring outside the operating theater were excluded. Vascular surgeons performed 225 intraoperative consultations in support of procedures by nonvascular surgeons. Requesting services were surgical oncology (46%), orthopedics (17%), urology (11%), otolaryngology (7%), and others (19%). Reasons for consultation overlapped and included vascular reconstruction (53%), control of hemorrhage (39%), and assistance with difficult dissections (43%). Seventy-four percent were for intra-abdominal procedures, and venous (53%) and arterial (50%) problems were encountered equally with some overlap. Most patients were male (59%), overweight (56%; body mass index ≥25 kg/m(2)), had previous surgery (72%) and were undergoing elective procedures (89%). Mean total procedural anesthesia time was 9.4 hours, mean procedural operating time was 7.9 hours, and mean total and vascular-related estimated blood loss was 1702 mL and 327 mL, respectively. Mean length of stay was 14.7 days, mean intensive care unit stay was 2.9 days, and 30-day mortality was 6.2%. Mean nonvascular RVUs per operation were 46.0, and mean vascular RVUs per operation were 30.9. Unexpected intraoperative need for vascular surgical expertise occurs often enough that vascular surgeons should be regarded

  3. The facilities management market in Denmark

    DEFF Research Database (Denmark)

    Jensen, Per Anker

    2010-01-01

    for researching the market but particular the definition of space including acquisition as well as development, administration, operation, maintenance and utilities in the same main product is problematic. Research limitations/implications: The market research is limited to the Danish market, but the results......Purpose: To present the results of market surveys in Denmark, which have been based on and used to test a proposal for a new European standard for a taxonomy of Facilities Management (FM). Design/methodology: The market research included surveys of both the client side and the provider side...... and was carried out by a management consultant company by telephone interviews based on definitions developed from drafts for the European FM taxonomy standard by a university researcher, who is a member of the standardisation work group. Findings: The proposed taxonomy for FM is in general a good basis...

  4. Hanging Out My Shingle: From Librarian to Consultant.

    Science.gov (United States)

    DeCandido, Graceanne A.

    2000-01-01

    Discusses the transition from being a full-time librarian to a consultant working out of a home office. Topics include workspace; the need for an accountant; how to get work; marketing; support networks; work schedules; and how to charge clients. (LRW)

  5. Integrating corpus consultation in language studies

    OpenAIRE

    Angela Chambers

    2005-01-01

    peer-reviewed Alongside developments in language research, the potential of corpora as a resource in language learning and teaching has been evident to researchers and teachers since the late 1960s. Despite publications which emphasise the benefits of corpus consultation for language learners (Bernardini, 2002; Kennedy & Miceli, 2001), there is little evidence to suggest that direct corpus consultation is coming to be seen as a complement or alternative to consultation of a dictionary, cou...

  6. Asynchronous Remote Medical Consultation for Ghana

    CERN Document Server

    Luk, Rowena; Aoki, Paul M

    2008-01-01

    Computer-mediated communication systems can be used to bridge the gap between doctors in underserved regions with local shortages of medical expertise and medical specialists worldwide. To this end, we describe the design of a prototype remote consultation system intended to provide the social, institutional and infrastructural context for sustained, self-organizing growth of a globally-distributed Ghanaian medical community. The design is grounded in an iterative design process that included two rounds of extended design fieldwork throughout Ghana and draws on three key design principles (social networks as a framework on which to build incentives within a self-organizing network; optional and incremental integration with existing referral mechanisms; and a weakly-connected, distributed architecture that allows for a highly interactive, responsive system despite failures in connectivity). We discuss initial experiences from an ongoing trial deployment in southern Ghana.

  7. Cap and trade offsets regulation - consultation paper

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    Due to increasing concerns about the environment, British Columbia has committed to reducing its 2007 greenhouse gas emissions levels by 33% in 2020 and 80% in 2050. To reach those objectives, emissions trading and offset regulations are being developed by the Climate Action Secretariat. The aim of this document is to present a first draft of the regulations to the various stakeholders, including First Nations and the general public, together with the proposed offset eligibility criteria and related process, and to get their feedback. This document is itself part of the 5-phase process of developing the regulations. Following the 45 days during which comments on the proposed regulation were sought, the climate action secretariat will complete legal drafting of the regulations, drawing on help from this stakeholder input, and the regulation will subsequently be implemented. An accompanying response form was attached to this consultation paper.

  8. The Likelihood of Use of Social Power Strategies by School Psychologists when Consulting with Teachers

    Science.gov (United States)

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

    2008-01-01

    The Interpersonal Power Inventory (IPI) has been applied previously to investigate school psychologists engaged in problem-solving consultation with teachers concerning students having various learning and adjustment problems. Relevant prior findings include (a) consultants and teachers both perceive soft power strategies as more effective than…

  9. The Role of Nonphysician Consultants as Health-Care Educators in Postgraduate Programs of Anesthesiology.

    Science.gov (United States)

    Rosenberg, Henry; Polonsky, Binnie

    1990-01-01

    Advantages of using non-physician consultants in postgraduate anesthesiology training programs are presented, including using their expertise in teaching, training, curriculum design, evaluation, program planning, and interpersonal communications. Successful use of a nonphysician consultant by the Department of Anesthesiology at Hahnemann…

  10. Consulting--Part 2. The art and science of using consultants.

    Science.gov (United States)

    Lister, E D; Pirrotta, S

    1996-11-01

    Part I of this series described a research project--a survey of more than 300 physician executives. Asked to share their personal experiences of unsuccessful consultations, our correspondents painted a clear picture of what can go wrong when organizational consultants enter health care systems, and described the lasting destructive sequelae to failed consultations. The two issues responsible for most failed consultations were the intrusion of internal politics into the process and the failure to clearly establish and maintain consensual goals. In Part 2, the consultation process is explored from a very different perspective. What are the issues that often trigger requests for consultation services, as well as the dynamics that can foreshadow success or failure before consultants are even engaged? What are the pitfalls and pointers for the successful use of consultation services?

  11. Facilities & Leadership

    Data.gov (United States)

    Department of Veterans Affairs — The facilities web service provides VA facility information. The VA facilities locator is a feature that is available across the enterprise, on any webpage, for the...

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

    Science.gov (United States)

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

    2009-11-01

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

  13. E-consulting in a medical specialist setting: Medicine of the future?

    Science.gov (United States)

    Zandbelt, Linda C; de Kanter, Froukje E C; Ubbink, Dirk T

    2016-05-01

    Today's technology provides new ways of consulting between patients and medical specialists in health care, such as videoconferencing and web-messaging. In this systematic review we assessed the effects of e-consulting between medical specialists and patients. We searched MEDLINE, EMBASE, Psychlit and Cochrane Library for randomized clinical trials assessing the use of e-consulting methods (videoconferencing (VC) or web-messaging (WM)), as compared to conventional care (face-to-face (FF) or telephone consultations (TC)) in a medical specialist setting. We extracted patient-related, physician-related, cost, time and follow-up outcomes. We included 21 trials, of which 17 addressed VC compared to FF, two compared WM with FF, one VC with TC, and one WM with TC. Physicians appeared to prefer face-to-face consultations over videoconferencing. Patients appeared to be as satisfied with videoconferencing as with face-to-face contacts, but preferred videoconferencing and web-messaging over telephone consultations. Videoconferencing was more expensive regarding equipment, but saved patient-related costs in terms of time, transportation, and missed work. Variable results were found for consult time and follow-up visits. We cautiously conclude that e-consulting seems a feasible alternative to medical specialists' face-to-face follow-up or telephone appointments, but may be less suitable for initial consultations requiring physical examination. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Geodynamics Research Facility

    Data.gov (United States)

    Federal Laboratory Consortium — This GSL facility has evolved over the last three decades to support survivability and protective structures research. Experimental devices include three gas-driven...

  15. Web-Based Requesting and Scheduling Use of Facilities

    Science.gov (United States)

    Yeager, Carolyn M.

    2010-01-01

    Automated User's Training Operations Facility Utilization Request (AutoFUR) is prototype software that administers a Web-based system for requesting and allocating facilities and equipment for astronaut-training classes in conjunction with scheduling the classes. AutoFUR also has potential for similar use in such applications as scheduling flight-simulation equipment and instructors in commercial airplane-pilot training, managing preventive- maintenance facilities, and scheduling operating rooms, doctors, nurses, and medical equipment for surgery. Whereas requesting and allocation of facilities was previously a manual process that entailed examination of documents (including paper drawings) from different sources, AutoFUR partly automates the process and makes all of the relevant information available via the requester s computer. By use of AutoFUR, an instructor can fill out a facility-utilization request (FUR) form on line, consult the applicable flight manifest(s) to determine what equipment is needed and where it should be placed in the training facility, reserve the corresponding hardware listed in a training-hardware inventory database, search for alternative hardware if necessary, submit the FUR for processing, and cause paper forms to be printed. Auto-FUR also maintains a searchable archive of prior FURs.

  16. 75 FR 76997 - Public Consultation on Personnel Reliability and Culture of Responsibility Issues

    Science.gov (United States)

    2010-12-10

    ... Responsibility Issues AGENCY: National Institutes of Health, HHS. ACTION: Notice of Public Consultation on Guidance for Enhancing Personnel Reliability and Strengthening the Culture of Responsibility at the Local... culture of responsibility at facilities that conduct research with dangerous pathogens. The discussion...

  17. The effect of parallel consulting on the quality of consultations in regional general practice.

    Science.gov (United States)

    Tran, Peter Duy; Laurence, Jerome Martin; Weston, Kathryn M; McLennan, Peter L

    2012-05-01

    The sustainability of community-based medical education relies on maintaining consultation quality as perceived by patients. This study aims to investigate the effect of an alternative model (parallel consultation) of teaching on patients' views of consultation quality as compared to the conventional consultation model in a general practice setting. A cross-sectional questionnaire study. Patients attending a regional general practice in the Southern Highlands of New South Wales between February and May 2010, who consented to student involvement in their consultation. Instruments to measure 'empathy' (CARE score) and 'enablement' (PEI score) as markers for consultation quality were administered after patient consultations. There was no difference in consultation length between the two groups. There was a small increase in the level of empathy experienced by patients attending parallel consultations compared to conventional consultations (Pconsultation group (Pconsultation quality, as experienced by the patient, when using the parallel consulting model. Parallel consulting does not change the length of time a patient spends with their doctor, and patients have a positive perception of the students involved in this model of clinical teaching.

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

    Science.gov (United States)

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

    2004-01-01

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

  19. A report on small team clinical ethics consultation programmes in Japan.

    Science.gov (United States)

    Fukuyama, M; Asai, A; Itai, K; Bito, S

    2008-12-01

    Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan's first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006-December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.

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

    Science.gov (United States)

    Spencer, Gregory P.

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

  1. Consulting Careers: A Profile of Three Occupations

    Science.gov (United States)

    Mullins, John

    2011-01-01

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

  2. The Consulting Challenge: A Case Competition

    Science.gov (United States)

    Sachau, Daniel A.; Naas, Patricia A.

    2010-01-01

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

  3. Capturing the Competence of Management Consulting Work

    Science.gov (United States)

    Visscher, Klaasjan

    2006-01-01

    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. Design/methodology/approach: A survey was conducted among Dutch management…

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

    Science.gov (United States)

    Spencer, Gregory P.

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

  5. How to Hire a Search Consultant.

    Science.gov (United States)

    Lester, Virginia L.

    1993-01-01

    Increasingly, colleges and universities are using consultants to help search committees find the right president for the institution. Search consultants bring experience, historical and national perspectives, objectivity, personal knowledge of candidates, and a professional approach. Energy, enthusiasm, and style are important consultant…

  6. Patient expectations from consultation with family physician.

    NARCIS (Netherlands)

    Tähepöld, H.; Brink-Muinen, A. van den; Maaroos, H.I.

    2006-01-01

    Aim: To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. Method: We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped

  7. Capturing the competence of management consulting work

    NARCIS (Netherlands)

    Visscher, Klaasjan

    2006-01-01

    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. - Design/methodology/approach: A su

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

    Science.gov (United States)

    Iltis, Ana S; Sheehan, Mark

    2016-08-01

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

  9. Timer: a new objective measure of consultation content and its application to computer assisted consultations.

    Science.gov (United States)

    Pringle, M; Robins, S; Brown, G

    1986-01-01

    As part of the research into the effect in the consultation of the use of a computer to prompt opportunistic preventive care a valid, objective, and practical measure of the consultation process was required. After a review of the alternative methods the Time Interval Medical Event Recorder (Timer) was developed, its reliability tested, and applied to 93 control consultations and 49 computer assisted consultations. Timer records, every five seconds, four consultation events: the problems being dealt with, the physical activity, the verbal activity, and the secondary tasks being attempted. Timer showed that control consultations lasted an average of 6 minutes 58 seconds. The doctors spent 35% of their time on administration, and patients and doctors were both conversational for just 33% of the consultation. Giving information was the most common verbal activity (48% of the duration of the consultation) with silence accounting for 21% of the time. When the computer was used the average consultation was longer, at 7 minutes and 46 seconds. The doctor's contribution to the consultation appeared to have increased. Patient centred speech fell from 36% in controls to 28% of the duration of the consultation when the computer was used, while doctor centred speech rose from 30% to 34.5%. Secondary tasks (exploring patient concepts, education, management sharing, and prevention) were attempted during 28% of the control consultations and 40% of the computer consultations. This was accounted for by the increase in prevention (p less than 0.001). Timer is a reliable and practical tool for researching the consultation, and though it has shown validity in detecting differences between consultations that use a computer and those that do not, further applications are required to establish its full value. PMID:3089391

  10. The Consultation of the Puericulture.

    Directory of Open Access Journals (Sweden)

    Rotardo Rafael Navarro Ruíz

    2010-06-01

    Full Text Available He/she was carried out a bibliographical revision related with the topic Puericulture with the objective of deepening in the knowledge related with the topic, keeping in mind that it is the consultation, par excellence, of the Primary Attention that takes charge of the care and the minor cultivation from a lot before the conception. The visit of the children and young to their doctor, without problems of health mediate they allow to evaluate the integral operation of these and to guide the parents on as acting before possible situations that are presented we Also insist in the different subespecialitys that compose the Puericulture like they are: Puericulture Preconcepcional, Intra-uterine Puericulture and or Prenatal, Puericulture Neonatal, Puericulture of the Infant, Puericulture of the Naive one, Puericulture of the Scholar, the adolescent's Puericulture and that of the boy handicapped. We stand out that this realized activity with quality guarantees the full health of the children, through the clinical exam and other observations we can identify and to diagnose some situation of health that can arise precociously and to diminish future problems.

  11. From Solution Shop to Boutique Consulting? Capturing Recent Developments on the German Consulting Marke

    Directory of Open Access Journals (Sweden)

    Jörg Jasper DÖTSCH

    2016-12-01

    Full Text Available Digitalization, globalization, new technologies and shorter product life cycles are only a few keywords underlining the fact that companies are under increasing pressure for faster adaptation, innovation and hence applying a higher knowledge intensity. We assume that these conditions require an increasingly important role of consulting companies, because they seem to be the intermediaries needed to bridge the faster growing gaps between existing business models, organizational structures and accelerating market change. Market pressure is growing on the market for consultant companies as well. New technologies and digitalization should influence both the structure of the consultancy market and the business models of consultancies. Christensen suggested a trend from Dzsolution shop” to Dzboutique consulting.” To track current developments, we concentrate on the German consulting market as one of the most important consultant markets worldwide and explore changes of the last two years based on various studies. Processes of change seem to be both substantially driven by digitalization and to reflect change on the non-consultancy markets. A high willingness to switch among providers documents a high pressure on performance. The impact of digitalisation seem• to be observable in structural and qualitative change. With regard to the German consulting market and the latest available data we cannot validate a tendency from a dominance of “solution shop” consultancies to “boutique” consultancy services.

  12. Personalized Antenatal Consultations for Preterm Labor: Responding to Mothers' Expectations.

    Science.gov (United States)

    Gaucher, Nathalie; Nadeau, Sophie; Barbier, Alexandre; Janvier, Annie; Payot, Antoine

    2016-11-01

    To explore prospective mothers' perspectives regarding antenatal consultations by neonatology teams for threatened preterm delivery. In a prospective multicenter study, women at risk of preterm delivery between 26 and 32 weeks of gestational age were surveyed during the 72 hours following their antenatal consultation. The questionnaire used was developed and validated during a single-center study. Over 18 months, 229 mothers completed the survey (73% response rate), at a median gestational age of 30 weeks. Spouses/partners were present for 49% of consultations. Most women (90%) reported a positive experience. They found it important to discuss the outcomes of prematurity (96%), but 39% of them reported receiving too much information. Women wanted their spouse/partner to be present (71%) and wished to discuss parental concerns: their roles as mother of a premature baby (82%), their integration in their baby's care (83%), and a better understanding of the neonatal intensive care unit (NICU) environment, including antenatal NICU visits (69%). The majority (56%) wanted a follow-up consultation: this was less likely if a NICU visit had been offered (P child-centered information. Although clinicians follow these guidelines, mothers want personalized information focusing on their individual concerns and questions, such as what they can do for their baby, how NICUs work, and the integration of their family. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The Concept of Body Language in the Medical Consultation.

    Science.gov (United States)

    Lindsley, Isabella; Woodhead, Sophie; Micallef, Claranne; Agius, Mark

    2015-09-01

    In this paper we wish to argue that the human body is an instrument of communication that can be used by the individual. This can be shown by the use of phenomenology, as described by Husserl, and that indeed empathy, as described by phenomenology, can be seen as a link enabling two human bodies/persons to communicate. We then wish to show from neuroscience that empathy can itself be seen as a bodily function. We then will describe how the doctor-patient relationship in the consultation is an extremely important type of communication between two persons, and how teaching of consultation skills has developed. We will show that, once consultation skills teaching was established, then study of body language became an essential part of this teaching, as soon as the technology was developed, and finally we will demonstrate that it is now possible to confirm by observational and controlled trials that appropriate use of body language does indeed enhance the effectiveness of the consultation, including, we would suggest, by appropriate communication of empathy and understanding.

  14. Consultation with Aboriginal peoples : impacts on the petroleum industry

    Energy Technology Data Exchange (ETDEWEB)

    Fogarassy, A. [Clark Wilson, Vancouver, BC (Canada); Litton, K. [Macleod Dixon LLP, Calgary, AB (Canada)

    2003-07-01

    Two recent rulings by the British Columbia Court of Appeal have placed the onus for consultation and accommodation with Aboriginal peoples affected by resource development on the shoulders of industry. The authors discussed this new responsibility for the petroleum industry from a legal perspective. The first part of the document consists of an overview of Aboriginal and treaty rights. The Supreme Court of Canada's justification test of infringement of Aboriginal and treaty rights were reviewed in the second part. In part three, the authors reviewed the scope and nature of consultation, as well as the various sources for duty of consultation. These sources include administrative law, legislation, and potential new sources of the law of fiduciaries, and the 1982 Constitution Act between Aboriginal peoples and industry. Part four reviewed the Haida decisions and the duty of consultation with Aboriginal peoples as formulated by the British Columbia Court of Appeal. The impact of this decision on the petroleum industry was then discussed. refs.

  15. Vascular Neurology Nurse Practitioner Provision of Telemedicine Consultations

    Directory of Open Access Journals (Sweden)

    Bart M. Demaerschalk

    2010-01-01

    Full Text Available Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2±9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0±9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.

  16. Longer-term impact of cardiology e-consults.

    Science.gov (United States)

    Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G

    2016-03-01

    Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Web-based system for radiological protection programs: a repository for research, consultation and information

    Energy Technology Data Exchange (ETDEWEB)

    Levy, Denise S.; Sordi, Gian Maria A.A., E-mail: gmsordi@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2014-07-01

    In order to establish a Radiation Protection Plan or a Radiation Emergency Plan, Brazilian facilities should take into account all procedures based on national and international guidelines and recommendations. This information can be found in several documents published by different organizations over the past decades: the International Commission on Radiological Protection (ICRP), International Atomic Energy Agency (IAEA) and Comissao Nacional de Energia Nuclear (CNEN). Therefore, this project aims the informatization of the radiological protection programs in a single system in order to offer unified programs and inter-related information in Portuguese, providing Brazilian facilities a complete repository for research, consultation and information, combining computer technology and radiological protection in order to enhance the best benefits from information technology. This research work includes programs about: (1) Monitoring of Workplace (Monitoring for External Radiation, Monitoring for Surface Contamination, Monitoring for Air Contamination) and (2) Individual Monitoring (Monitoring of External Exposure and Monitoring of Internal Exposure, Monitoring for Skin and Clothing). WEB platform tools and functionalities were developed according to target public needs, regarding new possibilities of media, mobile access, and information sharing. The servers processing power added to the technology of relational databases allow to integrate information from different sources, enabling complex queries with reduced response time. Moreover, taking into account this is a pioneer project with the prospect of long-term use, the challenge involves the combination of multiple computer technologies that allows a robust, effective and flexible system, which can be easily adapted to future technological innovations. (author)

  18. Reliability and accuracy of dermatologists' clinic-based and digital image consultations.

    Science.gov (United States)

    Whited, J D; Hall, R P; Simel, D L; Foy, M E; Stechuchak, K M; Drugge, R J; Grichnik, J M; Myers, S A; Horner, R D

    1999-11-01

    Telemedicine technology holds great promise for dermatologic health care delivery. However, the clinical outcomes of digital image consultations (teledermatology) must be compared with traditional clinic-based consultations. Our purpose was to assess and compare the reliability and accuracy of dermatologists' diagnoses and management recommendations for clinic-based and digital image consultations. One hundred sixty-eight lesions found among 129 patients were independently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the examiners' diagnoses and the reliability of their management recommendations were compared. Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0. 54 (95% confidence interval [CI], 0.46-0.61) and was 0.92 (95% CI, 0. 88-0.96) when ratings included differential diagnoses. Digital image consultants provided diagnoses that were comparably reliable to the clinic-based examiners. Agreement on management recommendations was variable. Digital image and clinic-based consultants displayed similar diagnostic accuracy. Digital image consultations result in reliable and accurate diagnostic outcomes when compared with traditional clinic-based consultations.

  19. Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery.

    Science.gov (United States)

    Pettersson, Monica E; Öhlén, Joakim; Friberg, Febe; Hydén, Lars-Christer; Carlsson, Eva

    2016-11-08

    The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse. The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer. The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis RESULTS: The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns. There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing

  20. Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service.

    Science.gov (United States)

    Lee, Richard H; Lyles, Kenneth W; Pearson, Megan; Barnard, Karen; Colón-Emeric, Cathleen

    2014-06-01

    Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients' medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient's primary provider with specific recommendations for further management. Recommendations were initiated at the provider's discretion. Between 2011 and 2013, the E-consult service identified 444 eligible patients with a low-trauma fracture who were not already on treatment. One hundred twenty-nine (29.1%) consults recommended immediate bisphosphonate treatment, and 258 (58.1%) recommended bone density assessments. Primary providers responded by prescribing bisphosphonates in 74 patients (57.4%) and by ordering bone density testing in 183 (70.9%) patients. At the facility level, prior to implementation of the E-consult service, the rate of osteoporosis treatment following a fracture was 4.8% for bisphosphonates and 21.3% for calcium/vitamin D. After implementation, the treatment rate increased to 7.3% for bisphosphonates (p = 0.02) and 35.2% for calcium/vitamin D (p E-consult service modestly improved the rate of osteoporosis treatment among patients with a recent fracture. These results suggest that a program with direct patient interaction is probably required to substantially improve treatment rates.

  1. 24 CFR 91.100 - Consultation; local governments.

    Science.gov (United States)

    2010-04-01

    ... Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS Citizen Participation and Consultation § 91.100 Consultation; local governments. (a) General. (1) When preparing...

  2. Consulting Informs Best Practice in Academia

    Directory of Open Access Journals (Sweden)

    Risa Blair

    2015-10-01

    Full Text Available The Conversational Plenary Session began with a clear agenda of describing the process and challenge of developing eLearning and eTraining. After a brief discussion of the benefits and challenges of the modality, the conversation quickly segued to a highly spirited conversation related to consulting and the negative implications when one calls oneself a consultant. In fact, this became an integral theme of multiple discussions throughout the rest of the conference. This author strives to identify a selection of literature which supports the viewpoint that consulting does indeed inform best practices in academia. Those professors with up-to-the-minute consultancies in their fields offer an enriched experience for their students.

  3. Three Obstacles to Improving Academic Consultation.

    Science.gov (United States)

    Kremer, John F.

    1980-01-01

    Notes three obstacles to improving academic consultation to students: (1) lack of knowledge of techniques to improve student performance; (2) reduction of barriers between students and professors; and (3) needed reinforcements for professors. Suggests strategies for overcoming those problems. (CK)

  4. [A nurse consultation in victimology for minors].

    Science.gov (United States)

    Soudan, Corinne

    2014-10-01

    The nurse consultation is an integral part of the treatment of children and adolescents experiencing psychological distress following traumatic events. Specific support is therefore offered to young patients, in particular through the intervention of a clinical nurse specialist.

  5. Ethics consultation: a dangerous, antidemocratic charlatanry?

    Science.gov (United States)

    Lilje, Christian

    1993-01-01

    Giles Scofield's argument indicates ethics consultants may need to better clarify what in fact they are and what they are not doing, claiming, and striving for. But we must not step back too far. We must neither engage in putting in envious professional claims for exclusive rights in the area of difficult and momentous decisions in healthcare nor get stuck in discussing normative ethics at the level of metaphysics, ontology, and dogmatics (as has happened in Germany for decades). We must not do so especially in view of the achievements of ethics consultation and the growing demand for it by all parties involved, conceded even by sceptics. Ethics consultation, according to Scofield, appears to be dangerous....Let us look more closely at the logic of the argument by discussing the presumed "antidemocratic" nature. The "new tyranny" of thoughts, and the "proper" role of bioethics consultation. Some considerations about the possibility of ethics expertise shall be left for the end.

  6. 265 Statistical Consulting and the African Universities

    African Journals Online (AJOL)

    User

    2011-07-21

    Jul 21, 2011 ... Indexed African Journals Online. An International Multidisciplinary Journal, Ethiopia ... engineering, medicine, public health, psychology, marketing, ..... method and the role of statistics; Statistical Consulting Environments (Life ... intelligible reports, makes presentations using PowerPoint and persuasive.

  7. ACF 2012 Reponse to Tribal Consultation Testimony

    Data.gov (United States)

    U.S. Department of Health & Human Services — On March 5 and 6, 2012, the Administration for Children and Families (ACF) held its annual tribal consultation session in Washington, D.C. This session marked the...

  8. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    cytology and cystoscopy are recommended if clinically indicated. Treatment progresses from conservative management through various oral and intravesical therapies, with most surgical therapies reserved for unresponsive cases. Pain management is critical throughout the treatment process. The consultation...

  9. 77 FR 43106 - Tribal Consultation Sessions-Department of the Interior Information Technology Infrastructure...

    Science.gov (United States)

    2012-07-23

    ... Office of the Special Trustee in Albuquerque, NM. This amendment includes additional tribal consultation... 254, Albuquerque, NM 87104. August 21, 2012 1:30 p.m.-3:30 Hilton Sacramento p.m.. Arden West,...

  10. Organizational cultural competence consultation to a mental health institution.

    Science.gov (United States)

    Fung, Kenneth; Lo, Hung-Tat Ted; Srivastava, Rani; Andermann, Lisa

    2012-04-01

    Cultural competence is increasingly recognized as an essential component of effective mental health care delivery to address diversity and equity issues. Drawing from the literature and our experience in providing cultural competence consultation and training, the paper will discuss our perspective on the foundational concepts of cultural competence and how it applies to a health care organization, including its programs and services. Based on a recent consultation project, we present a methodology for assessing cultural competence in health care organizations, involving mixed quantitative and qualitative methods. Key findings and recommendations from the resulting cultural competence plan are discussed, including core principles, change strategies, and an Organizational Cultural Competence Framework, which may be applicable to other health care institutions seeking such changes. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental health care service to the diverse patients, families, and communities.

  11. Supporting Group Communication Among UX Consultants

    OpenAIRE

    Feldt, Tommy

    2015-01-01

    Professional User Experience (UX) practitioners have an inherent need for effective group communication practices. If they work as external consultants, the need is arguably even greater. Enterprise Social Media (ESM) technologies have affordances that make them seem promising for this domain. The aim of this thesis is thus to identify the domain-specific communicative needs of UX consultants, and discuss how these might be supported using ESM. A case study was conducted, examining how the ES...

  12. Using Language Consultants in Communicative Language Teaching

    OpenAIRE

    Hiroki, Yamamoto; Makoto, Izumisawa; Graduate School, Meiji University

    2016-01-01

    The purpose of the present study is to introduce a teaching technique using language consultants in communicative language teaching. Language consultant is a role in which a student pays attention to a group member's language use during activities, and provides him/her with corrective and positive feedback after the activities, referring to dictionaries. Its effectiveness in terms of second language (L2) learning and motivation was investigated by using it with 42 English learners at a Japane...

  13. Synchrotron radiation facilities

    CERN Multimedia

    1972-01-01

    Particularly in the past few years, interest in using the synchrotron radiation emanating from high energy, circular electron machines has grown considerably. In our February issue we included an article on the synchrotron radiation facility at Frascati. This month we are spreading the net wider — saying something about the properties of the radiation, listing the centres where synchrotron radiation facilities exist, adding a brief description of three of them and mentioning areas of physics in which the facilities are used.

  14. Fabrication Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — The Fabrication Facilities are a direct result of years of testing support. Through years of experience, the three fabrication facilities (Fort Hood, Fort Lewis, and...

  15. Facility Microgrids

    Energy Technology Data Exchange (ETDEWEB)

    Ye, Z.; Walling, R.; Miller, N.; Du, P.; Nelson, K.

    2005-05-01

    Microgrids are receiving a considerable interest from the power industry, partly because their business and technical structure shows promise as a means of taking full advantage of distributed generation. This report investigates three issues associated with facility microgrids: (1) Multiple-distributed generation facility microgrids' unintentional islanding protection, (2) Facility microgrids' response to bulk grid disturbances, and (3) Facility microgrids' intentional islanding.

  16. Diagnoses, Requests and Timing of 503 Psychiatric Consultations in Two General Hospitals

    Directory of Open Access Journals (Sweden)

    Elahe Sahimi Izadian

    2012-01-01

    Full Text Available The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time. This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%, adjustment disorder (10.9% and cognitive disorder (7.6%. In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13. Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.

  17. Using an open source observational tool to measure the influence of the doctor's consulting style and the computer system on the outcomes of the clinical consultation.

    Science.gov (United States)

    De Lusignan, Simon; Kumarapeli, Pushpa; Debar, Safia; Kushniruk, Andre W; Pearce, Chris

    2009-01-01

    Computerization of general practice is an international phenomenon. Many of the Electronic Patient Record (EPR) systems have developed organically with considerable variation in their interface and functionality. Consequently they have differing impact on the clinical consultation. There is a dearth of tools available to study their impact on the consultation. The objective is to use ALFA to film and analyze a simulated clinical consultation. We used the ALFA (Activity Log File Aggregation) open source toolkit, to make video based observation and analysis of the computer mediated consultation. ALFA enables precise comparison of core elements of EPR systems. It allows multiple video channels including screen capture, data about computer use, and verbal interactions to be synchronized, timed and navigated through for analysis. The toolkit is free and can be downloaded under an open source license from www.biomedicalinformatics.info/alfa/. Its outputs, which include Unified Modelling Language (UML), provide the evidence-base for assessing the impact of the computer on the consultation the designing of EPR systems. ALFA has been used to compare different brands of primary care computer systems; nurse case-load selection and consultation in psychiatry.

  18. Clinical supervision by consultants in teaching hospitals.

    Science.gov (United States)

    Hore, Craig T; Lancashire, William; Fassett, Robert G

    2009-08-17

    Clinical supervision is a vital part of postgraduate medical education. Without it, trainees may not learn effectively from their experiences; this may lead to acceptance by registrars and junior doctors of lower standards of care. Currently, supervision is provided by consultants to registrars and junior doctors, and by registrars to junior doctors. Evidence suggests that the clinical supervision provided to postgraduate doctors is inadequate. Registrars and juniors doctors have the right to expect supervision in the workplace. Impediments to the provision of clinical supervision include competing demands of hospital service provision on trainees and supervisors, lack of clarity of job descriptions, private versus public commitments of supervisors and lack of interest. Supervisors should be trained in the process of supervision and provided with the time and resources to conduct it. Those being supervised should be provided with clear expectations of the process. We need to create and develop systems, environments and cultures that support high standards of conduct and effective clinical supervision. These systems must ensure the right to supervision, feedback, support, decent working conditions and respect for both trainees and their supervisors.

  19. Concertation rather than Consultation or Negotiation!

    CERN Multimedia

    Staff Association

    2017-01-01

    At CERN, the Concertation between the Management and the Personnel has been in effect since 1983, the year in which the Standing Concertation Committee (SCC) came to replace the Standing Consultation Committee. Since then, the concertation process has been enshrined in the Staff Rules and Regulations, which define its scope of application: “Any proposed measures of a general nature regarding the conditions of employment or association of members of the personnel shall be the subject of discussion within the SCC” (S VII 1.08). More generally, all questions relating to the employment and working conditions of the members of personnel are discussed in the SCC, including in particular issues of remuneration, social protection (CHIS and Pension Fund), career evolution... In Article S VII 1.07 of the Staff Rules and Regulations it is also stated that: “Discussion shall mean a procedure whereby the Director-General and the Staff Association concert together to try to reach a common po...

  20. Nurse consultants: organizational influences on role achievement.

    Science.gov (United States)

    Woodward, Valerie A; Webb, Christine; Prowse, Morag

    2006-03-01

    This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper. Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives. A cross-sectional design, using a convenience sample, was adopted. Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. Support systems were important influences on nurse consultants' role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture. The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation. The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences.

  1. Benchmarking 2010: measuring long-term care and consultant pharmacy practice.

    Science.gov (United States)

    Martin, Caren McHenry

    2011-07-01

    The American Society of Consultant Pharmacists, with support from the pharmacy management software company QS/1, has completed its 2010 survey to determine industry standards for long-term care pharmacy operations, consultant pharmacist practice, and the use of health information technology in the long-term care setting. The report presents data collected in this annual business benchmarking survey. Examples of data include gross profit margins of long-term care/closed-door pharmacies, pharmacists' salaries, prescription payer mix, consultant pharmacist productivity and contracting, and implementation of technology solutions such as ePrescribing, electronic medication administration records, electronic medical records, and automated dispensing.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

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

  4. Consultation and cooperation in NATO: nuclear planning, 1975-1987

    Energy Technology Data Exchange (ETDEWEB)

    Chernoff, F.B.

    1987-01-01

    This study looks at three types of explanation of international cooperation, which deal in different ways with communication and consultation. Themost-general theoretical explanation contrasts recent realist theories, like those of Waltz and Gilpin, with Keohane's functional theory of regimes. Secondly, the study looks at theories of information flow and processing (an element of consultation) within the alliance, like those of Deutsch and Steinbruner. Such theories explain governmental behavior using concepts like equilibrium of systems and feedback loop. Third, the study considers hypotheses that deal specifically with NATO and military alliances. The hypotheses relate alliance consultation processes to the cooperativeness of the cases' outcomes. Evidence is drawn from case studies of NATO decision-making. The cases include politically sensitive deployment issues, like the enhanced radiation warhead controversy in 1977-78 and the intermediate-range nuclear force deployment decision in 1979, and important, but less politically volatile arms-control decisions, including the 1975 option three proposal, the French plan for a conference on disarmament in Europe, approved in 1980, and the 1987 American zero-zero proposal on short- and intermediate-range nuclear forces in Europe.

  5. Air Defense Radar Operations Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Facility consists of laboratories, experimental test equipment including state-of-theart test bed radar, and test ranges. The facilities are used to design, develop,...

  6. Air Defense Radar Operations Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Facility consists of laboratories, experimental test equipment including state-of-theart test bed radar, and test ranges. The facilities are used to design, develop,...

  7. Solid Waste Management Facilities with Permits by the Iowa DNR

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — All types of facilities that handle solid waste, including: sanitary landfills, appliance demanufacturing facilities, transfer stations, land application sites,...

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

    Science.gov (United States)

    Burdette, Paula J.; Crockett, Jean B.

    1999-01-01

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

  9. 41 CFR 102-78.30 - Who are consulting parties?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Who are consulting... Preservation § 102-78.30 Who are consulting parties? As more particularly described in 36 CFR 800.2(c), consulting parties are those parties having consultative roles in the Section 106 process (i.e., Section 106...

  10. A3 Altitude Test Facility

    Science.gov (United States)

    Dulreix, Lionel J.

    2009-01-01

    This slide presentation shows drawings, diagrams and photographs of the A3 Altitude Test Facility. It includes a review of the A3 Facility requirements, and drawings of the various sections of the facility including Engine Deck and Superstructure, Test Cell and Thrust Takeout, Structure and Altitude Support Systems, Chemical Steam generators, and the subscale diffuser. There are also pictures of the construction site, and the facility under construction. A Diagram of the A3 Steam system schematic is also shown

  11. The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times.

    Science.gov (United States)

    Furler, John S; Harris, Elizabeth; Chondros, Patty; Powell Davies, P Gawaine; Harris, Mark F; Young, Doris Y L

    2002-07-15

    To compare the rate of provision of longer consultations per head of population across practice locations categorised by socioeconomic status. Retrospective analysis of Medicare data for all consultations for all general practitioners in Australia for the 1998-99 and 1999-2000 financial years, grouped by postcode of practice location. Postcodes were categorised by the Socio-Economic Indexes for Areas, Index of Relative Socio-Economic Disadvantage score. Number of consultations and number of brief, standard, long and prolonged consultations per capita in each postcode grouping. The absolute number of long plus prolonged consultations showed no trend across postcode groups, but the rate ratio per person was significantly higher in more advantaged postcode areas. This represents an example of care provision in inverse relationship to need. Despite higher rates of chronic disease and lower rates of preventive care uptake, patients in low socioeconomic status areas receive longer GP consultations at a lower rate than patients in more advantaged areas. Possible strategies to overcome this inverse care provision include increased numbers of GPs in disadvantaged communities, removal of financial disincentives to longer consultations, and strengthening health promotion and community health services in disadvantaged areas.

  12. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities.

    Science.gov (United States)

    Kirsh, Susan R; Ho, P Michael; Aron, David C

    2014-10-01

    In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.

  13. Understanding the impact of residents' interpersonal relationships during emergency department referrals and consultations.

    Science.gov (United States)

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

    2013-12-01

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

  14. [Adolescents consulting at the pediatric emergency room for psychological or psychiatric reasons].

    Science.gov (United States)

    Podlipski, M-A; Peuch, A-C; Belloncle, V; Rigal, S; Grall-Lerosay, M; Castanet, M; Mallet, E; Marguet, C; Gérardin, P

    2014-01-01

    The number of pediatric emergency consultations for psychological or psychiatric reasons continues to rise, raising the question of the adequacy of existing facilities. Our aim was therefore to identify and characterize a population of adolescents consulting at the pediatric emergency unit at Rouen university hospital. This study was conducted from 1 January to 31 December 2006. We distinguished three types of variables in adolescents consulting at the pediatric emergency unit. The main objective was to describe the profile and requirements of these young patients and their subsequent care management as compared to that of other studies. Of the 400 patients consulting over 12years of age, 69% were female and the average age was 13.8years. These cases were mainly attempted suicide in girls and conduct disorder in boys; hospitalization was at the request of the family. These consultations were directly linked to the school calendar and 70% required hospitalization. We both analyzed and compared the results of this study to those of other studies to propose solutions to improve the care of these young patients. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Criteria in consultant selection: public procurement of architectural and engineering services

    Directory of Open Access Journals (Sweden)

    Josefin Sporrong

    2011-12-01

    Full Text Available The competence, commitment and attitudes of design consultants strongly influence the quality and costs of built facilities. However, in the selection of professional services it is often difficult to specify and assess non-price criteria related to both firms and individual consultants. Therefore, clients traditionally rely on long term relations or recommendations from clients or colleagues. Public procurement regulation, however, restricts the use of such informal data. This study seeks to understand how procurers act to reconcile these conflicting demands.An explorative questionnaire survey distributed to Swedish municipalities investigates which selection criteria and information sources are used, as well as perceived difficulties and shortcomings related to consultancy procurement. Results show a high focus on price or more easily measured non-price criteria. This might limit the ability of municipal officials to evaluate consultant competence, especially aspects related to design and execution of projects. Furthermore, personal information sources are widely used, indicating a conflict between procurement practice and existing regulation. Unexpectedly, procurement officials were generally satisfied with their procurement practice. However, managers and more experienced procurers tend to be more satisfied than other officials. Satisfaction also appears to be connected to the existence of a procurement policy and more advanced selection methods. Keywords: public procurement, selection, consultants, Sweden

  16. Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology

    Science.gov (United States)

    American Psychologist, 2007

    2007-01-01

    The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The…

  17. Consulting as a Strategy for Knowledge Transfer

    Science.gov (United States)

    Jacobson, Nora; Butterill, Dale; Goering, Paula

    2005-01-01

    Academic researchers who work on health policy and health services are expected to transfer knowledge to decision makers. Decision makers often do not, however, regard academics’ traditional ways of doing research and disseminating their findings as relevant or useful. This article argues that consulting can be a strategy for transferring knowledge between researchers and decision makers and is effective at promoting the “enlightenment” and “interactive” models of knowledge use. Based on three case studies, it develops a model of knowledge transfer–focused consulting that consists of six stages and four types of work. Finally, the article explores how knowledge is generated in consulting and identifies several classes of factors facilitating its use by decision makers. PMID:15960773

  18. Online parenting support: Guiding parents towards empowerment through single session email consultation

    OpenAIRE

    Nieuwboer, C.C.

    2014-01-01

    Internet technology offers a lot of new opportunities for the dissemination of information, sharing of support and consultation of professionals. Innovating professionals from multiple disciplines have begun to exploit the new opportunities for parenting support. The studies presented in this book are meant to deepen our insights in the subject of online parenting support and investigate the feasibility to use single session email consultation to empower parents. This publication includes: - ...

  19. Moral mediation in interpreted health care consultations.

    Science.gov (United States)

    Seale, Clive; Rivas, Carol; Al-Sarraj, Hela; Webb, Sarah; Kelly, Moira

    2013-12-01

    This paper reports on the moral work done in routine diabetes review consultations in primary care with nurses. Consultations with fluent English speakers are compared with consultations where an interpreter was present, largely involving patients of Bangladeshi origin. The study setting was Tower Hamlets in London, where type 2 diabetes is particularly common. Existing research has shown some dissatisfaction with diabetes care amongst Bangladeshi patients, and studies of care providers in other locations suggest that they at times experience the care of this group as particularly challenging. Through analysis of video-recorded consultations recorded in 2010-2011 we shed light on possible reasons for these difficulties. The 12 non-English speakers often experienced difficulties in raising issues that concerned them, particularly if their interpreter did not translate their utterance because it was deemed to be unrelated to diabetes. These difficulties were not shared by the 24 fluent English speakers, who also found it easier to convey a positive moral reputation and to excuse behaviour that deviated from recommended self-management practices. Interpreters at times also acted as moral mediators. For example, where a participant in the consultation made statements that appeared to convey a negative moral judgement of an other participant, these would often go untranslated. Probably, neither health care providers nor patients are fully aware of the nature of their communication difficulties. Given this, interpreters possess considerable power to influence matters. Understanding the moral work of consultations is important in explaining the findings of other studies showing difficulties in the provision of diabetes care to people with limited English language skills.

  20. Airborne & Field Sensors Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — RTTC facilities include an 800' x 60' paved UAV operational area, clearapproach/departure zone, concrete pads furnished with 208VAC, 3 phase,200 amp power, 20,000 sq...

  1. Urban Test Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — RTTC has access to various facilities for use in urban testing applications,including an agreement with the Hazardous Devices School (HDS): a restrictedaccess Urban...

  2. Pittsburgh City Facilities

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Pittsburgh City FacilitiesIncludes: City Administrative Buildings, Police Stations, Fire Stations, EMS Stations, DPW Sites, Senior Centers, Recreation Centers, Pool...

  3. Pittsburgh City Facilities

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Pittsburgh City FacilitiesIncludes: City Administrative Buildings, Police Stations, Fire Stations, EMS Stations, DPW Sites, Senior Centers, Recreation Centers,...

  4. IT Consultants in Acquisition IT Integration

    DEFF Research Database (Denmark)

    Henningsson, Stefan; Øhrgaard, Christian

    2016-01-01

    ’s IT following a corporate acquisition, presents a difficult but crucial IT challenge for the many acquiring organizations. Through a comparative case study of four acquirers, theoretically grounded in the resource-based view of the firm, it is analyzed how acquirers draw on external consultants to realize...... model, depicting the use of external consultants in acquisition IT integration, contributes to the literature on acquisition IT integration by providing an explanation for IT-based value creation in acquisition that is rooted in the external of the acquirer. In addition to adding to the limited...

  5. Standardization Versus Innovation In Management Consultancy

    Directory of Open Access Journals (Sweden)

    Ciumara Tudor

    2011-12-01

    Full Text Available This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD, financed from the European Social Fund and by the Romanian Government under the contract number SOP HRD/89/1.5/S/62988. In this paper we propose some perspectives on the relationship between standardization and innovation in the management consulting business. Most of the consulting services are situated somewhere between absolute standardization and absolute innovation. Approaching any of these poles brings some advantages and disadvantages, both to the service providers and to their customers. It is important to find a balance between innovation and standardization to maximize the results of all agents involved.

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

    Science.gov (United States)

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

    2015-05-01

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

  7. Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

    Science.gov (United States)

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

    2015-01-01

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

  8. TRANSPORTATION CASK RECEIPT AND RETURN FACILITY WORKER DOSE ASSESSMENT

    Energy Technology Data Exchange (ETDEWEB)

    V. Arakali

    2005-02-24

    The purpose of this design calculation is to estimate radiation doses received by personnel working in the Transportation Cask Receipt and Return Facility (TCRRF) of the repository including the personnel at the security gate and cask staging areas. This calculation is required to support the preclosure safety analysis (PCSA) to ensure that the predicted doses are within the regulatory limits prescribed by the U.S. Nuclear Regulatory Commission (NRC). The Cask Receipt and Return Facility receives NRC licensed transportation casks loaded with spent nuclear fuel (SNF) and high-level radioactive waste (HLW). The TCRRF operation starts with the receipt, inspection, and survey of the casks at the security gate and the staging areas, and proceeds to the process facilities. The transportation casks arrive at the site via rail cars or trucks under the guidance of the national transportation system. This calculation was developed by the Environmental and Nuclear Engineering organization and is intended solely for the use of Design and Engineering in work regarding facility design. Environmental and Nuclear Engineering personnel should be consulted before using this calculation for purposes other than those stated herein or for use by individuals other than authorized personnel in the Environmental and Nuclear Engineering organization.

  9. Systemic consultation and goal setting

    OpenAIRE

    Carr, Alan

    1993-01-01

    Over two decades of empirical research conducted within a positivist framework has shown that goal setting is a particularly useful method for influencing task performance in occupational and industrial contexts. The conditions under which goal setting is maximally effective are now clearly established. These include situations where there is a high level of acceptance and commitment, where goals are specific and challenging, where the task is relatively simple rather than ...

  10. Framing the consultation: the role of the referral in surgeon-patient consultations.

    Science.gov (United States)

    White, Sarah J; Stubbe, Maria H; Macdonald, Lindsay M; Dowell, Anthony C; Dew, Kevin P; Gardner, Rod

    2014-01-01

    This study describes and analyzes the impact of the referral process on communication at the beginning of surgeon-patient consultations. We used conversation analysis to analyze the opening interactional activities of surgeon-patient consultations in New Zealand. This study focuses on 20 video-recorded consultations recorded between 2004 and 2006. Participants in surgeon-patient consultations began referred consultations by discussing the referral letter in what we have termed "referral recognition sequences." These sequences are coconstructed activities that can be implicit or explicit and address the minimized epistemic distance between surgeons and patients that is caused by the referral process. These sequences can be simple or complex, and this complexity may be determined by the quality of the referral letter received. Acknowledgment of the referral letter assists in achieving alignment between surgeon, patient, and referring doctor regarding the presenting problem. If this alignment is not achieved, progressivity of the consultation is affected, as there is disagreement as to why the patient is seeing the surgeon. This research shows that to assist in the progressivity of surgeon-patient consultations, referral letters should be clear and patients made aware of the reason for referral. Surgeons should also overtly address the minimized epistemic distance caused by the referral letter to ensure patients present their problems in full.

  11. Principles of effective consultation: an update for the 21st-century consultant.

    Science.gov (United States)

    Salerno, Stephen M; Hurst, Frank P; Halvorson, Stephanie; Mercado, Donna L

    2007-02-12

    Little information in the literature exists to guide consult interactions between different medical specialties. A total of 323 general internists, family medicine physicians, general surgeons, orthopedic surgeons, and obstetricians/gynecologists (OB/GYNs) from 3 academic medical centers completed a survey addressing their ideal relationship with consultants. Differences between surgeons and nonsurgeons were calculated using logistic regression, adjusting for location and trainee status. Differences between different specialties of surgeons were calculated using analysis of variance with Scheffe post hoc analysis There was a 72% response rate. About half of respondents were surgeons and the rest were general internists and family medicine physicians. More nonsurgeons (69%) desired the consultant to focus on a narrow question than did surgeons (41%). Over half (59%) of family medicine physicians and internists preferred to retain order-writing authority on their patients compared with 37% of surgeons (Pinternal medicine input, preferring to consult medicine subspecialists directly. Specialty-dependent differences exist in consult preferences of physicians. These differences vary from the extremes of orthopedic surgeons desiring a comprehensive co-management approach with the consultant to general internists and family medicine physicians desiring to retain control over order writing and have a more focused consultant approach.

  12. Quality Management in Project Management Consulting. A Case Study in an International Consulting Company

    Directory of Open Access Journals (Sweden)

    Eduard-Gabriel Ceptureanu

    2017-02-01

    Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. The negotiation of writer identity in engineering faculty - writing consultant collaborations

    Directory of Open Access Journals (Sweden)

    Sarah Read

    2011-12-01

    Full Text Available Negotiating faculty-writing consultant collaborations in engineering contexts can be challenging when the writing consultant originates in the humanities. The author found that one of the sites of negotiation in the formation of working relationships is that of writer identity, and disciplinary writer identity in particular. In order to confirm her experiential knowledge, the author interviewed her faculty collaborators to further investigate their attitudes and experiences about writing. Analysis of two excerpts of these interviews makes visible "clashes" between the faculty engineers' and the writing consultant's autobiographical and disciplinary writer identities. Implications of the role of writer identity in faculty-writing consultant collaborations include considering the value of extending this negotiation explicitly to students and the question of how writing curriculum can explicitly engage students in the formation of positive disciplinary writer identities

  15. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    Science.gov (United States)

    Langley, G R; Till, J E

    1989-08-15

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relationship with patients, availability, family physician-consultant relationship and a fifth category that included organizational ability and personality attributes. The family physicians and the consultants placed different values on these categories and indicated that these values might change under different clinical circumstances. Their concepts appear to be compatible with, but not restricted to, a model of contemporary medical practice based on an ethic specific to medicine.

  16. Daytime Running Lights. Public Consultation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-12-15

    The Road Safety Authority is considering the policy options available to promote the use of Daytime Running Lights (DRL), including the possibility of mandating the use of DRL on all vehicles. An EC Directive would make DRL mandatory for new vehicles from 2011 onwards and by 2024 it is predicted that due to the natural replacement of the national fleet, almost all vehicles would be equipped with DRL. The RSA is inviting views on introducing DRL measures earlier, whereby all road vehicles would be required to use either dipped head lights during hours of daylight or dedicated DRL from next year onwards. The use of DRL has been found to enhance the visibility of vehicles, thereby increasing road safety by reducing the number and severity of collisions. This paper explores the benefits of DRL and the implications for all road users including pedestrians, cyclists and motorcyclists. In order to ensure a comprehensive consideration of all the issues, the Road Safety Authority is seeking the views and advice of interested parties.

  17. Negotiating the Dance: Consulting with Adoptive Systems.

    Science.gov (United States)

    Becker, Kent W.; Carson, David K.; Seto, Atsuko; Becker, Carol A.

    2002-01-01

    For marriage and family therapists and educators who train future marriage and family therapists, families formed by means of adoption offer an abundance of learning opportunities in both the areas of assessment and intervention. The following consultation case represents a composite family designed to highlight the unique features of adoptive…

  18. Delivering an MBA Management Consulting Experience

    Science.gov (United States)

    LeMaire, Ryan; Fisher, Kirk; Watson, Edward F., III

    2017-01-01

    This article reports on an innovative MBA elective consulting course that attempts to address how to better prepare inexperienced MBA students for a competitive job market. This article is a best practice paper designed to provide insights and encouragement to educators.

  19. School Neuropsychology Consultation in Neurodevelopmental Disorders

    Science.gov (United States)

    Decker, Scott L.

    2008-01-01

    The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

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

    Science.gov (United States)

    Kirby, David A.

    2003-01-01

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

  1. Individualizing Language Strategies Using CONSULT-I.

    Science.gov (United States)

    Newman, Anabel P.; Metz, Elizabeth

    This handbook offers suggestions for implementing actions (termed variously in other settings as treatments, interventions, methods, techniques, strategies or activities) recommended for individual learners by CONSULT-I (R), a computer program created by James Fattu and Edward Patrick. Application of the program described in the handbook was under…

  2. The Writing Consultation: Developing Academic Writing Practices

    Science.gov (United States)

    Murray, Rowena; Thow, Morag; Moore, Sarah; Murphy, Maura

    2008-01-01

    This article describes and analyses a specific mechanism, the writing consultation, designed to help academics to prioritise, reconceptualise and improve their writing practices. It makes the case for its potential to stimulate consideration of writing practices and motivations, a possible precondition for creating time for writing in academic…

  3. IT Consultants in Acquisition IT Integration

    DEFF Research Database (Denmark)

    Henningsson, Stefan; Øhrgaard, Christian

    2016-01-01

    model, depicting the use of external consultants in acquisition IT integration, contributes to the literature on acquisition IT integration by providing an explanation for IT-based value creation in acquisition that is rooted in the external of the acquirer. In addition to adding to the limited...

  4. Service Learning In Physics: The Consultant Model

    Science.gov (United States)

    Guerra, David

    2005-04-01

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

  5. 77 FR 19020 - Tribal Consultation Meeting

    Science.gov (United States)

    2012-03-29

    ... Act of 2007, Public Law 110-134, notice is hereby given of a one-day Tribal Consultation Session to be... into consideration funding allocations, distribution formulas, and other issues affecting the delivery... children and families, taking into consideration funding allocations, distribution formulas, and...

  6. 29 CFR 1691.12 - Interagency consultation.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Interagency consultation. 1691.12 Section 1691.12 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION PROCEDURES FOR COMPLAINTS OF...) Prior to the initiation of any legal action against a recipient of Federal financial assistance alleging...

  7. Teacher Utilization of Instructional Consultation Teams

    Science.gov (United States)

    Berger, Jill; Yiu, Ho Lam; Nelson, Deborah; Vaganek, Megan; Rosenfield, Sylvia; Gravois, Todd; Gottfredson, Gary; Vu, Phuong; Shanahan, Kate; Hong, Vanessa

    2014-01-01

    Data regarding intervention utilization among the target population are critical to interpret evidence from efficacy trials for school-based interventions. When use of the intervention is voluntary, intervention diffusion becomes a particularly critical variable. We examined the use of Instructional Consultation Teams (IC Teams), a voluntary…

  8. The Role of the Organisational Development Consultant

    Science.gov (United States)

    Simmons, Mike

    1972-01-01

    The consultant's concern is to increase an organization's capacity to initiate and manage change through an integrated approach to the company's social, economic, technical, and organizational systems, and to improve the performance and value of its human resources, using measurable criteria whenever possible. (Author/JB)

  9. Viburnum “terugloopziekte” : Consultancy onderzoek

    NARCIS (Netherlands)

    Ludeking, D.J.W.; Kromwijk, J.A.M.; Boer-Tersteeg, de P.M.; Bosch, C.

    2012-01-01

    DUTCH Bij de teelt van Viburnum opulus komt het soms voor dat de groei pleksgewijs langzaam terugloopt. Het gewas lijkt niet ziek, maar het blad wordt stug en donker en de taklengte en bladgrootte worden elk jaar kleiner. In dit consultancy onderzoek is onderzocht wat de oorzaak is van deze

  10. The Writing Consultation: Developing Academic Writing Practices

    Science.gov (United States)

    Murray, Rowena; Thow, Morag; Moore, Sarah; Murphy, Maura

    2008-01-01

    This article describes and analyses a specific mechanism, the writing consultation, designed to help academics to prioritise, reconceptualise and improve their writing practices. It makes the case for its potential to stimulate consideration of writing practices and motivations, a possible precondition for creating time for writing in academic…

  11. School Neuropsychology Consultation in Neurodevelopmental Disorders

    Science.gov (United States)

    Decker, Scott L.

    2008-01-01

    The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

  12. Psychiatric consultation of patients with hyperemesis gravidarum.

    Science.gov (United States)

    Kim, Deborah R; Connolly, K R; Cristancho, Pilar; Zappone, Mark; Weinrieb, Robert M

    2009-04-01

    The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.

  13. Report of the Expert Consultation on Interactions between Sea Turtles and Fisheries within an Ecosystem Context, Rome, Italy, 9-12 March 2004

    National Research Council Canada - National Science Library

    2004-01-01

    This information paper provides a summary of the Consultation's outcomes and outputs, including overviews of sea turtle status, fisheries impacts, possible managerial solutions, socio-economic aspects...

  14. The Statistical Consulting Center for Astronomy (SCCA)

    Science.gov (United States)

    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

  15. Audit of the consultation process on general internal medicine services.

    Science.gov (United States)

    Conley, J; Jordan, M; Ghali, W A

    2009-02-01

    To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists. Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, kappa 0.85). Calgary, Alberta, Canada. A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004. The primary measure of interest was whether a "clear clinical question" was posed to the subspecialist, a binary variable. Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question. More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.

  16. Delayed consultation among pulmonary tuberculosis patients: a cross sectional study of 10 DOTS districts of Ethiopia

    Directory of Open Access Journals (Sweden)

    Gessessew Amanuel

    2009-02-01

    Full Text Available Abstract Background Delays seeking care increase transmission of pulmonary tuberculosis and hence the burden of tuberculosis, which remains high in developing countries. This study investigates patterns of health seeking behavior and determines risk factors for delayed patient consultation at public health facilities in 10 districts of Ethiopia. Methods New pulmonary TB patients ≥ 15 years old were recruited at 18 diagnostic centres. Patients were asked about their health care seeking behaviour and the time from onset of symptoms to first consultation at a public health facility. First consultation at a public health facility 30 days or longer after onset of symptoms was regarded as prolonged patient delay. Results Interviews were held with 924 pulmonary patients. Of these, 537 (58% were smear positive and 387 (42% were smear negative; 413 (45% were female; 451 (49% were rural residents; and the median age was 34 years. Prior to their first consultation at a public health facility, patients received treatment from a variety of informal sources: the Orthodox Church, where they were treated with holy water (24%; private practitioners (13%; rural drug vendors (7%; and traditional healers (3%. The overall median patient delay was 30 days (mean = 60 days. Fifty three percent [95% Confidence Intervals (CI (50%, 56%] of patients had delayed their first consultation for ≥ 30 days. Patient delay for women was 54%; 95% CI (54%, 58% and men 51%; 95% CI (47%, 55%. The delay was higher for patients who used informal treatment (median 31 days than those who did not (15 days. Prolonged patient delay (≥ 30 days was significantly associated with both patient-related and treatment-related factors. Significant patient-related factors were smear positive pulmonary disease [Adjusted Odds Ratio (AOR 1.4; 95% CI (1.1 to 1.9], rural residence [AOR 1.4; 95% CI (1.1 to 1.9], illiteracy [AOR 1.7; 95% CI (1.2 to 2.4], and lack of awareness/misperceptions of causes of

  17. Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement.

    Science.gov (United States)

    Pawlikowska, Teresa; Zhang, Wenjuan; Griffiths, Frances; van Dalen, Jan; van der Vleuten, Cees

    2012-01-01

    To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure). We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations. Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior. For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations. To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. AGING FACILITY CRITICALITY SAFETY CALCULATIONS

    Energy Technology Data Exchange (ETDEWEB)

    C.E. Sanders

    2004-09-10

    The purpose of this design calculation is to revise and update the previous criticality calculation for the Aging Facility (documented in BSC 2004a). This design calculation will also demonstrate and ensure that the storage and aging operations to be performed in the Aging Facility meet the criticality safety design criteria in the ''Project Design Criteria Document'' (Doraswamy 2004, Section 4.9.2.2), and the functional nuclear criticality safety requirement described in the ''SNF Aging System Description Document'' (BSC [Bechtel SAIC Company] 2004f, p. 3-12). The scope of this design calculation covers the systems and processes for aging commercial spent nuclear fuel (SNF) and staging Department of Energy (DOE) SNF/High-Level Waste (HLW) prior to its placement in the final waste package (WP) (BSC 2004f, p. 1-1). Aging commercial SNF is a thermal management strategy, while staging DOE SNF/HLW will make loading of WPs more efficient (note that aging DOE SNF/HLW is not needed since these wastes are not expected to exceed the thermal limits form emplacement) (BSC 2004f, p. 1-2). The description of the changes in this revised document is as follows: (1) Include DOE SNF/HLW in addition to commercial SNF per the current ''SNF Aging System Description Document'' (BSC 2004f). (2) Update the evaluation of Category 1 and 2 event sequences for the Aging Facility as identified in the ''Categorization of Event Sequences for License Application'' (BSC 2004c, Section 7). (3) Further evaluate the design and criticality controls required for a storage/aging cask, referred to as MGR Site-specific Cask (MSC), to accommodate commercial fuel outside the content specification in the Certificate of Compliance for the existing NRC-certified storage casks. In addition, evaluate the design required for the MSC that will accommodate DOE SNF/HLW. This design calculation will achieve the objective of providing the

  19. Mammography Facilities

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Mammography Facility Database is updated periodically based on information received from the four FDA-approved accreditation bodies: the American College of...

  20. Canyon Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — B Plant, T Plant, U Plant, PUREX, and REDOX (see their links) are the five facilities at Hanford where the original objective was plutonium removal from the uranium...

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

    Science.gov (United States)

    2016-01-01

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

  2. Otolaryngology Consult Carts: Maximizing Patient Care, Surgeon Efficiency, and Cost Containment.

    Science.gov (United States)

    Royer, Mark C; Royer, Allison K

    2015-11-01

    The objective of this study was to develop an otolaryngology consult cart system to ensure prompt delivery to the bedside of all the unique equipment and medications required for emergent and urgent otolaryngology consults. An otolaryngology practice responsible for emergency room and hospital consult coverage sought to create a cart containing all equipment, medications, and supplies for otolaryngology consults. Meetings with hospital administration and emergency room, nursing, pharmacy, central processing, and operating room staff were held to develop a system for the emergent delivery of the cart to the needed location, sterilization and restocking of equipment between uses, and appropriate billing of supplies. Two months were required from conception to implementation. All equipment was purchased new, including flexible scopes and headlights. The cart is sterilized, restocked, and maintained by central processing after each use. The equipment is available to handle all airway emergencies as well as all common otolaryngology consults and is delivered bedside in less than 5 minutes. The development of a self-contained otolaryngology consult cart requires coordination with a wide variety of hospital departments. This system, while requiring initial monetary and time investment, has resulted in improved patient care, cost containment, and surgeon convenience. © The Author(s) 2015.

  3. The "Commitment Model" for Clinical Ethics Consultations: Society's Involvement in the Solution of Individual Cases.

    Science.gov (United States)

    Fournier, Véronique; Spranzi, Marta; Foureur, Nicolas; Brunet, Laurence

    2015-01-01

    Several approaches to clinical ethics consultation (CEC) exist in medical practice and are widely discussed in the clinical ethics literature; different models of CECs are classified according to their methods, goals, and consultant's attitude. Although the "facilitation" model has been endorsed by the American Society for Bioethics and Humanities (ASBH) and is described in an influential manual, alternative approaches, such as advocacy, moral expertise, mediation, and engagement are practiced and defended in the clinical ethics field. Our Clinical Ethics Center in Paris was founded in 2002 in the wake of the Patients' Rights Act, and to date it is the largest center that provides consultation services in France. In this article we shall describe and defend our own approach to clinical ethics consultation, which we call the "Commitment Model," in comparison with other existing models. Indeed commitment implies, among other meanings, continuity through time, a series of coherent actions, and the realization of important social goals. By drawing on a recent consultation case, we shall describe the main steps of our consultation procedure: interviews with major stakeholders, including patients and proxies; case conferences; and follow up. We shall show why we have chosen the term "commitment" to represent our approach at three different but interrelated levels: commitment towards patients, within the case conference group, and towards society as a whole.

  4. Facilities | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  5. Can audio recording improve patients' recall of outpatient consultations?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... to replay their consultation. The intervention is evaluated in a randomised controlled trial with 5.460 patients in order to determine whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation. In addition to this primary...... objective we want to investigate if replay of the consultations improves the patients’ recall of the information given. Methods Interviews are carried out with 40 patients whose consultations have been audio recorded. Patients are divided into two groups, those who have listened to their consultation...

  6. How lead consultants approach educational change in postgraduate medical education.

    NARCIS (Netherlands)

    Fokkema, J.P.; Westerman, M.; Teunissen, P.W.; Lee, N.; Scherpbier, A.J.J.A.; Vleuten, C.P.M. van der; Dorr, P.J.; Scheele, F.

    2012-01-01

    CONTEXT: Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead

  7. 75 FR 72838 - Notice of Tribal Consultations; Schedule Update

    Science.gov (United States)

    2010-11-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Indian Gaming Commission Notice of Tribal Consultations; Schedule Update AGENCY: National Indian Gaming Commission, Department of Interior. ACTION: Notice of tribal consultations; schedule...

  8. The Role of Design Consultants in Innovation Strategy Decisionmaking

    NARCIS (Netherlands)

    Calabretta, G.; Gemser, G.; Wijnberg, N.M.; Hekkert, P.P.M.

    2013-01-01

    To contain risks and increase the profitability of innovation efforts, firms frequently engage in joint innovation activities with external sources of knowledge, like design consultancies. Innovation literature has given limited consideration to the strategic role that design consultancies can play

  9. Exploring employment in consultation reports of patients with neuromuscular diseases

    NARCIS (Netherlands)

    Minis, M.A.H; Cup, E.H.C.; Heerkens, Y.F.; Engels, J.A.; Engelen, B.G. van; Oostendorp, R.A.B.

    2012-01-01

    Minis MA, Cup EH, Heerkens YF, Engels JA, van Engelen BG, Oostendorp RA. Exploring employment in consultation reports of patients with neuromuscular diseases. OBJECTIVES: To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients

  10. The Application of Cognitive Dissonance Theory to Consultation.

    Science.gov (United States)

    Hughes, Jan N.

    1983-01-01

    Summarizes aspects of cognitive dissonance theory (theory that predicts when a particular persuasive attempt will be successful) that are most relevant to consultation. Reviews the corresponding experimental support and suggests practical applications of dissonance research and theory to consultation. (LLL)

  11. Trend of newspaper consultation by students of federal University of ...

    African Journals Online (AJOL)

    Trend of newspaper consultation by students of federal University of Technology, Owerri. ... Data was obtained from the University Library's Records of users' statistics for Newspaper consultation for ten years, 2004-2013. ... Article Metrics.

  12. Business Communication Consulting and Research in Multinational Companies.

    Science.gov (United States)

    Hildebrandt, Herbert W.

    1978-01-01

    Describes three issues involved in communication research and consulting for multinational companies, particularly those in Germany: qualifications for doing international consulting and research, problems of American scholar-researchers in those firms, and suggestions for dealing with those issues. (JMF)

  13. Peer assessment of outpatient consultation letters – feasibility and satisfaction

    Directory of Open Access Journals (Sweden)

    Dojeiji Suzan

    2007-05-01

    Full Text Available Abstract Background Written correspondence is one of the most important forms of communication between health care providers, yet there is little feedback provided to specialists. The objective of this study was to determine the feasibility and satisfaction of a peer assessment program on consultation letters and to determine inter-rater reliability between family physicians and specialists. Methods A rating scale of nine 5-point Likert scale items including specific content, style items, education value of the letter and an overall rating was developed from a previous validated tool. Nine Internal Medicine specialists/subspecialists from two tertiary care centres submitted 10 letters with patient and physician identifiers removed. Two Internal Medicine specialists, and 2 family physicians from the other centre rated each letter (to protect writer anonymity. A satisfaction survey was sent to each writer and rater after collation of the results. A follow-up survey was sent 6–8 months later. Results There was a high degree of satisfaction with the process and feedback. The rating scale information was felt to be useful and appropriate for evaluating the quality of consultation letters by 6/7 writers. 5/7 seven writers felt that the feedback they received resulted in immediate changes to their letters. Six months later, 6/9 writers indicated they had maintained changes in their letters. Raters rank ordered letters similarly (Cronbach's alpha 0.57–0.84 but mean scores were highly variant. At site 1 there were significant differences in scoring brevity (p Conclusion Most participants found peer assessment of letters feasible and beneficial and longstanding changes occurred in some individuals. Family physicians and specialists appear to have different expectations on some items. Further studies on reliability and validity, with a larger sample, are required before high stakes professional assessments include consultation letters.

  14. Asthma consultations with specialists: what do the pediatricians seek?

    Science.gov (United States)

    Poowuttikul, Pavadee; Kamat, Deepak; Thomas, Ronald; Pansare, Milind

    2011-01-01

    "Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma" includes guidelines for referral to an asthma specialist. Because most cases of asthma are managed by primary care physicians, we intended to explore the referral practices of pediatricians managing childhood asthma. This study was designed to identify important considerations by pediatricians while referring a child to an asthma specialist. An electronic survey was sent to 1200 graduated pediatricians enlisted in the Michigan Chapter, American Academy of Pediatrics directory. The questions explored asthma disease characteristics, physician preferences when referring children with asthma, and reasons and barriers for asthma consultations. All responses were collected anonymously. We received 240/1200 (20%) questionnaires. The majority of pediatricians considered referral to a specialist if a child had severe persistent asthma (201/236 [85.2%]) or had a single life-threatening asthma event (188/229 [82.1%]). The top two likely reasons of referral included poor asthma control (200/224 [89.3%]) and unclear diagnosis (139/224 [62.1%]). We found 74/219 (33.8%) preferred consultation to a pediatric pulmonologist when compared with 93/219 (42.5%) allergists. We found the minority of pediatricians "always" recommended referral to a specialist for the following reasons: allergy skin testing (30/222 [13.5%]), possible allergen immunotherapy (54/223 [24.2%]), and spirometry (26/221 [11.8%]). The major barrier for childhood asthma specialist consultations was issues with medical insurance coverage (137/205 [66.8%]). Allergists have to educate primary care providers about the importance of allergen control, role of allergen immunotherapy, and updating current asthma treatment guidelines when treating a child with allergic asthma.

  15. Consultant supported ERP implementation – a learning opportunity?

    OpenAIRE

    2005-01-01

    Management consultants are often described as accumulators, generators and disseminators of knowledge in the business world. Little research has however been devoted to the extent to which and the processes by which organizations hiring management consultants learn. This issue is addressed in the current paper based on a study of a consultant-supported ERP (Enterprise Resource Planning) implementation project. It is concluded, that projects in which consultants and employees of the hiring org...

  16. Innovation in consulting firms: what are the foundations?

    OpenAIRE

    Lemus Aguilar, Isaac; Hidalgo Nuchera, Antonio

    2015-01-01

    Innovation inside consulting firms has missed specific attention in academic research. Consulting firms usually are considered to be part of Knowledge-Intensive Business Services (KIBS), Professional Service Firms (PSF) or Project-based Firms (PbF). However, consultancies possess particular characteristics that might affect generalizations made in studies targeting all the categories stated before. Consulting firms usually help other companies to be innovative, but they also need to have inno...

  17. What to listen for in the consultation

    DEFF Research Database (Denmark)

    Jensen, Christian Gaden; Elsass, Peter; Neustrup, Line

    2014-01-01

    scale (CES-D). RESULTS: Among the qualitative themes, only the percentage of words spent on talking about 'Acceptance-based psychological coping' was related to symptoms. In regression models controlling for age, education and time since diagnosis, a stronger focus on acceptance-based coping predicted......OBJECTIVE: To analyze whether qualitative themes in breast cancer patients' self-presentations predicted symptoms of psychological distress and depression in order to improve the consultation process. METHODS: Ninety-seven breast cancer patients gave unstructured, 10-min self......-presentations at their first consultation in a clinical registered trial (CRT identifier: NCT00990977). Self-presentations were categorized thematically and the most prevalent themes investigated as predictors for scores on the symptom check-list 90-revised (SCL-90-R) and the center for epidemiological studies depression...

  18. Consulting as a Strategy for Knowledge Transfer

    OpenAIRE

    Jacobson, Nora; Butterill, Dale; Goering, Paula

    2005-01-01

    Academic researchers who work on health policy and health services are expected to transfer knowledge to decision makers. Decision makers often do not, however, regard academics’ traditional ways of doing research and disseminating their findings as relevant or useful. This article argues that consulting can be a strategy for transferring knowledge between researchers and decision makers and is effective at promoting the “enlightenment” and “interactive” models of knowledge use. Based on thre...

  19. ACCOUNTING A CONSULTANT IN THE MANAGEMENT PROCESS

    Directory of Open Access Journals (Sweden)

    VIRAG NICOLAE PAUL

    2012-05-01

    Full Text Available Management process is a continuous activity that requires the achievement of the essential objectives of the entity. This involves knowing and understanding how should be implemented major functions of management to ensure the desired performance. Accounting, as part of the management process, specifically contribute to the value of the entity. In this paper we want to present how accounting acts as a consultant to managers, helping them in decision making process.

  20. Republic of Kazakhstan; 2013 Article IV Consultation

    OpenAIRE

    International Monetary Fund

    2013-01-01

    This paper analyzes the Republic of Kazakhstan’s 2013 Article of Consultation. The IMF report focuses on vision of developing Kazakhstan into a leading emerging market economy requires concerted efforts to strengthen the policy architecture. It highlights the importance of enhancing the diversification strategy by strengthening institutions, the business environment, and human capital, while carefully managing the country’s oil wealth. It also discusses that the unification of the pension...

  1. Internship at Taylor Fry Consulting Actuaries

    OpenAIRE

    Kierkels, Bram Joseph Johannes

    2013-01-01

    Mestrado em Ciências Actuariais As the final part of the master degree, I started my internship on 25 Febru- ary 2013 at Taylor Fry Consulting Actuaries. During the internship my work mainly involved analyzing the outstanding workers compensation liabilities for self-insured clients. In this report I will describe the process of this anal- ysis. Throughout this report I will explain the procedures I used to value outstanding claims.

  2. Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review.

    Science.gov (United States)

    Chen, Kai Yang; Evans, Rebecca; Larkins, Sarah

    2016-11-09

    Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.

  3. Building a Central Repository for Research Ethics Consultation Data: A Proposal for a Standard Data Collection Tool.

    Science.gov (United States)

    Cho, Mildred K; Taylor, Holly; McCormick, Jennifer B; Anderson, Nick; Barnard, David; Boyle, Mary B; Capron, Alexander M; Dorfman, Elizabeth; Havard, Kathryn; Reider, Carson; Sadler, John; Schwartz, Peter; Sharp, Richard R; Danis, Marion; Wilfond, Benjamin S

    2015-08-01

    Clinical research ethics consultation services have been established across academic health centers over the past decade. This paper presents the results of collaboration within the CTSA consortium to develop a standard approach to the collection of research ethics consultation information to serve as a foundation for quality improvement, education, and research efforts. This approach includes categorizing and documenting descriptive information about the requestor, research project, the ethical question, the consult process, and describing the basic structure for a consult note. This paper also explores challenges in determining how to share some of this information between collaborating institutions related to concerns about confidentially, data quality, and informatics. While there is much still to be learned to improve the process of clinical research ethics consultation, these tools can advance these efforts, which, in turn, can facilitate the ethical conduct of research.

  4. Virtual slides: application in pulmonary pathology consultations.

    Directory of Open Access Journals (Sweden)

    Michał Wojciechowski

    2008-02-01

    Full Text Available The Virtual Slide (VS is an interactive microscope emulator that presents a complete digitized tissue section via the Internet. A successful implementation of VS has been observed for educational, research venues and quality control. VS acquisition for consultative pathology is not so common. The purpose of this study was to explore the efficacy and usability of VS in the consultative pulmonary telepathology. 20 lung tumors entered the study. The performance was programmed for 2 medical centers specialized in pulmonary pathology (beginner and advancer in telepathology. A high-quality VSs were prepared by Coolscope (Nikon, Eclipsnet VSL, Japan, and were evaluated via the Internet. The cases were reviewed for the second time with conventional light microscope. VS diagnostic accuracy and the interobserver variability were evaluated. Also the time taken by examiners to render the diagnoses and time needed to scan the microscopic slide were analyzed. Percentage concordance between original glass-slides diagnosis and diagnosis for VSs was very high. Pathologists found the download speed of VSs adequate; experience in telepathology reduced the time of VS diagnosis. VS implementation suggests advantages for teleconsulation and education but also indicate some technical limitations. This is the first Polish trial of VS implementation in telepathology consultative service.

  5. Multilocation teleradiology system for emergency triage consultation

    Science.gov (United States)

    Herron, John M.; Yonas, Howard

    1996-05-01

    A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Crisis Communication Consultation of the Federal Reserve Bank System

    Science.gov (United States)

    Chandler, Robert C.; Wallace, J. D.

    2008-01-01

    This article, designed for both consulting practitioners and academics, reveals what it is like to do a high-level and high-profile client consultancy. This consultancy was highly informed by and assumes a working knowledge of instructional communication theory, research, and methods as well as drawing upon contemporary communication scholarship…

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

    Science.gov (United States)

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

    2015-01-01

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

  9. Teaching Evaluation: A Student-Run Consulting Firm

    Science.gov (United States)

    Cundiff, Nicole; Nadler, Joel; Scribner, Shauna

    2011-01-01

    Applied Research Consultants (ARC) is a graduate student run consulting firm that provides experience to students in evaluation and consultation. An overview of this program has been compiled in order to serve as a model of a graduate training practicum that could be applied to similar programs or aid in the development of such programs. Key…

  10. 5 CFR 2426.13 - Obligation to consult.

    Science.gov (United States)

    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...

  11. 5 CFR 2426.3 - Obligation to consult.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Obligation to consult. 2426.3 Section 2426.3 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE FEDERAL LABOR... GOVERNMENT-WIDE RULES OR REGULATIONS National Consultation Rights § 2426.3 Obligation to consult. (a) When a...

  12. 29 CFR 779.515 - Regulations should be consulted.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Regulations should be consulted. 779.515 Section 779.515... Records to Be Kept by Employers § 779.515 Regulations should be consulted. This discussion in subpart F of... employer subject to any provision of the Act should consult the regulations to determine what records he...

  13. 15 CFR 200.103 - Consulting and advisory services.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Consulting and advisory services. 200..., SERVICES, PROCEDURES, AND FEES § 200.103 Consulting and advisory services. (a) In areas of its special competence, NIST offers consulting and advisory services on various problems related to measurement, e.g...

  14. 45 CFR 400.57 - Planning and consultation process.

    Science.gov (United States)

    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...

  15. Multicultural Counseling Competence Training: Adding Value with Multicultural Consultation

    Science.gov (United States)

    Jones, Janine M.; Kawena Begay, Kristin; Nakagawa, Yoko; Cevasco, Molly; Sit, Janelle

    2016-01-01

    This study addresses the culturally responsive training process and highlights the integration of multicultural competence building in counseling consultation. Consultation was structured as client-centered case consultation. Before and after the intervention, clinician competence was assessed with the California Brief Multicultural Counseling…

  16. Multicultural Counseling Competence Training: Adding Value with Multicultural Consultation

    Science.gov (United States)

    Jones, Janine M.; Kawena Begay, Kristin; Nakagawa, Yoko; Cevasco, Molly; Sit, Janelle

    2016-01-01

    This study addresses the culturally responsive training process and highlights the integration of multicultural competence building in counseling consultation. Consultation was structured as client-centered case consultation. Before and after the intervention, clinician competence was assessed with the California Brief Multicultural Counseling…

  17. A Rational-Emotive Therapy Approach to Consultation

    Science.gov (United States)

    Forman, Susan G.; Forman, Bruce D.

    1978-01-01

    The application of Rational-Emotive Therapy in the practice of consultee-centered consultation is discussed. The consultant's task is to identify those irrational beliefs which are impeding consultee job-effectiveness and to help modify these beliefs. Several common consultation problems and techniques for their management are presented. (Author)

  18. The Development of Behaviorally Based Public School Consultation Services

    Science.gov (United States)

    Putnam, Robert F.; Handler, Marcie W.; Rey, Jannette; McCarty, Joseph

    2005-01-01

    This article describes the development of behavioral school care consultation services to public schools within a not-for-profit community behavioral health organization. An overview of the process of behavior consultation is presented. A description of the growth of behavioral school consultation services is outlined in regard to (a) the types of…

  19. Locations and attributes of utility-scale solar power facilities in Colorado and New Mexico, 2011

    Science.gov (United States)

    Ignizio, Drew A.; Carr, Natasha B.

    2012-01-01

    The data series consists of polygonal boundaries for utility-scale solar power facilities (both photovoltaic and concentrating solar power) located within Colorado and New Mexico as of December 2011. Attributes captured for each facility include the following: facility name, size/production capacity (in MW), type of solar technology employed, location, state, operational status, year the facility came online, and source identification information. Facility locations and perimeters were derived from 1-meter true-color aerial photographs (2011) produced by the National Agriculture Imagery Program (NAIP); the photographs have a positional accuracy of about ±5 meters (accessed from the NAIP GIS service: http://gis.apfo.usda.gov/arcgis/services). Solar facility perimeters represent the full extent of each solar facility site, unless otherwise noted. When visible, linear features such as fences or road lines were used to delineate the full extent of the solar facility. All related equipment including buildings, power substations, and other associated infrastructure were included within the solar facility. If solar infrastructure was indistinguishable from adjacent infrastructure, or if solar panels were installed on existing building tops, only the solar collecting equipment was digitized. The "Polygon" field indicates whether the "equipment footprint" or the full "site outline" was digitized. The spatial accuracy of features that represent site perimeters or an equipment footprint is estimated at +/- 10 meters. Facilities under construction or not fully visible in the NAIP imagery at the time of digitization (December 2011) are represented by an approximate site outline based on the best available information and documenting materials. The spatial accuracy of these facilities cannot be estimated without more up-to-date imagery – users are advised to consult more recent imagery as it becomes available. The "Status" field provides information about the operational

  20. Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients / family: A descriptive study

    Directory of Open Access Journals (Sweden)

    Dendukuri Nandini

    2005-04-01

    Full Text Available Abstract Background Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Methods An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. Results 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. Conclusion Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

  1. “How long does it take?” A mixed methods evaluation of computer-related work in GP consultations

    Directory of Open Access Journals (Sweden)

    James Hayward

    2015-12-01

    Full Text Available Background Systematic reviews have suggested that time spent on computerrelated tasks increases consultation length. However, these reviews pre-date the current ubiquitous use of computers in U.K. general practice.Objective As part of a U.K. national study of the influence of information technology (IT on the interaction between patients and healthcare professionals during consultations, we explored how IT functions affected time allocation and styles of computer use during general practitioner (GP consultations.Methods We drew on multichannel video recording of consultations and measured consultation phases and the duration of computer-related tasks. We related measures of actual time to GP’s interpretation of computer use elicited in qualitative interviews.Results Our sample included recordings of 112 consultations from 6 GPs in three practices. The computer was used for about one-third of the greater consultation. However, its use was concentrated pre- and post- the patient consultation. The workflow of consultation was exemplified through six computer use cases. Most functionality was accepted and accommodated within the consultation, though disruptive and time-consuming tasks were generally delegated to administrative staff. Recognised styles of computer use (minimal, block and conversational were apparent, but applied very flexibly by GPs according to the nature of the consultation.Conclusions In contrast to earlier reports, contemporary computer use does not appear to have lengthened consultations. GPs adopted different styles of computer use in different consultations, challenging classifications that seek to stereotype GP computer use. Designing systems that support this versatility require an understanding of the fluid application of computer use within consultation structure.

  2. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  3. Child Care Reform Consultation Infopack = Consultation sur la reforme des services de garde d'enfants. Trousse d'information.

    Science.gov (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    This information packet presented here in both the English and French language versions, summarizes the results of a public consultation on the subject of child care reform in Ontario, Canada. The packet consists of: (1) a table that describes the six modes of consultation that were used in the consultation process (public meetings, round table…

  4. Consultation needs in perinatal HIV care: experience of the National Perinatal HIV Consultation Service.

    Science.gov (United States)

    Fogler, Jessica A; Weber, Shannon; Goldschmidt, Ronald H; Mahoney, Megan R; Cohan, Deborah

    2007-09-01

    This study evaluates the consultation needs of clinicians who provide perinatal human immunodeficiency virus (HIV) care in the United States. The Perinatal Hotline (1-888-448-8765) is a telephone consultation service for providers who treat HIV-infected pregnant women and their infants. Hotline calls were analyzed for demographics about callers and their patients and information about consultation topics. There were 430 calls to the hotline from January 1, 2005, through June 30, 2006. Most calls (59.5%) were related to pregnant patients; 5.1% of the calls pertained to women currently in labor. The most common topic was HIV care in pregnancy (49.1%), particularly antiretroviral drug use (42.1%). HIV testing was discussed in 21.9%, and intrapartum treatment was discussed in 24.0%. Callers most often requested help choosing antiretroviral drug regimens; many of the discussions were about drug toxicities and viral resistance. Although the hotline received few calls about women in labor, the need for these consultations is expected to increase with the expanding use of rapid HIV testing. Access to 24-hour consultation can help ensure that state-of-the-art care is provided.

  5. NIF conventional facilities construction health and safety plan

    Energy Technology Data Exchange (ETDEWEB)

    Benjamin, D W

    1998-05-14

    The purpose of this Plan is to outline the minimum health and safety requirements to which all participating Lawrence Livermore National Laboratory (LLNL) and non-LLNL employees (excluding National Ignition Facility [NIF] specific contractors and subcontractors covered under the construction subcontract packages (e.g., CSP-9)-see Construction Safety Program for the National Ignition Facility [CSP] Section I.B. ''NIF Construction Contractors and Subcontractors'' for specifics) shall adhere to for preventing job-related injuries and illnesses during Conventional Facilities construction activities at the NIF Project. For the purpose of this Plan, the term ''LLNL and non-LLNL employees'' includes LLNL employees, LLNL Plant Operations staff and their contractors, supplemental labor, contract labor, labor-only contractors, vendors, DOE representatives, personnel matrixed/assigned from other National Laboratories, participating guests, and others such as visitors, students, consultants etc., performing on-site work or services in support of the NIF Project. Based upon an activity level determination explained in Section 1.2.18, in this document, these organizations or individuals may be required by site management to prepare their own NIF site-specific safety plan. LLNL employees will normally not be expected to prepare a site-specific safety plan. This Plan also outlines job-specific exposures and construction site safety activities with which LLNL and non-LLNL employees shall comply.

  6. If You Could Read My Mind: The Role of Healthcare Providers’ Empathic and Communicative Competencies in Clients’ Satisfaction with Consultations

    NARCIS (Netherlands)

    Schrooten, Iete; Jong, de Menno D.T.

    2016-01-01

    This article investigates the relationship between healthcare providers’ empathic and communicative competencies and clients’ overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients’ perspective) and empathic skills (ability to est

  7. If You Could Read My Mind: The Role of Healthcare Providers’ Empathic and Communicative Competencies in Clients’ Satisfaction with Consultations

    NARCIS (Netherlands)

    Schrooten, Iete; de Jong, Menno D.T.

    2016-01-01

    This article investigates the relationship between healthcare providers’ empathic and communicative competencies and clients’ overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients’ perspective) and empathic skills (ability to

  8. [Tips for hosting a medical student in a PC consultation].

    Science.gov (United States)

    Félix, Sylvie; Bonvin, Raphaël; Bischoff, Thomas

    2010-05-19

    Hosting a medical student in one's primary care consultation challenges the practitioner to be a clinical teacher as well as providing high-quality patient care. A few tips can make this double task easier. Before the consultation it is possible to define the student's learning objectives and to plan the consultation. During the consultation itself some teaching models exist (One minute preceptor, SNAPP) that facilitate the teaching by maximising the teaching moments for each student-patient encounter. And finally after the consultation a time of reflection where both student and clinical teacher can think about what went well and what could be done better.

  9. The Vanderbilt Mass Spectrometry Shared Facilities

    Science.gov (United States)

    Friedman, D.B.; Reyzer, M.L.; Seeley, E.H.; Calcutt, M. Wade; Hachey, D.L.; Caprioli, R.M.; McDonald, W.H.

    2010-01-01

    CF-33 The Vanderbilt Mass Spectrometry Research Center (MSRC) provides an integrated bioanalytical service facility to Vanderbilt researchers coupled with a strong MS research component.The synergies achieved by merging research and service provide investigators with state-of-the-art proteomics, tissue profiling/imaging, and bioanalytical MS technologies. These cores are managed by a professional staff of six faculty members and five research assistants, bioinformatics specialists, and an instrument engineer. The Proteomics Laboratory supports multiple technology platforms, including HPLC peptide separations and 2D gel separations of intact proteins. Analysis can be performed by ESI-linear ion trap/orbitrap and MALDI-TOF/TOF MS with all of the necessary downstream bioinformatics for protein identification and characterization. We routinely utilize single- and multi-dimensional LC/MS/MS for protein cataloguing and differential-expression studies (using spectral counting), and Difference Gel Electrophoresis (DIGE) for large-scale expression studies on complex proteomes. The Tissue Imaging core provides tissue sectioning, staining, and MS directly from tissue sections via either high resolution imaging across an entire tissue section, or higher-throughput histology-directed profiling using specific tissue areas.As with the proteomics analysis, the necessary tools and infrastructure are available for downstream biostatistical analysis of the MS data. Both of these cores work closely with users at all stages of experiments including detailed informatics consultations and training. They generally operate as limited-access facilities where users prepare samples and core technical staff performs the analyses. The Bioanalytical MS Core provides instrumentation to perform a wide variety of analyses (e.g. identification and structural analysis of biological molecules, and qualitative and quantitative assays of drugs and metabolites). The MS Core operates in an open access

  10. SOME INDICATORS OF CONSULTATIVE SERVICES DEVELOPMENT IN SERBIA

    Directory of Open Access Journals (Sweden)

    Vesna PARAUSIC

    2012-01-01

    Full Text Available Transition process and Serbia's entering into the European Union is possible to hasten by adequate and timely consultative services, before all during the programs and methodologies creation for conducting the enterprises' restructuring processes. In such conditions, the consultative organizations help the enterprises in accomplishing their goals, solving problems in business and management, identifying and using new possibilities, increasing their knowledge and applying suggested changes in the practice. Consulting is a result of manager need for integrated and complex business information. To obtain the transfer of consultant knowledge and manager skills development, a certain conditions must be fulfilled. First of all, business integrity and consultant competence are the most important. Business integrity, i.e. consultant ethics contributes image and reputation and is important competitiveness factor on consultant services market. Regarding actual consulting trends in countries within our region, as well as developmental level of consulting in EU countries, the market of consultative services in Serbia has not significantly changed in previous period (as we saw, the acknowledgement of it was got also by empirical research. The owners and managers of enterprises still do not feel a need for external services, in order to solve business problems. Having in mind a level and quality of demand, neither a supply of consultative services had not reached satisfactory level.

  11. SOME REFLECTIONS UPON MANAGEMENT CONSULTING AS PROFESSIONAL SERVICES

    Directory of Open Access Journals (Sweden)

    Botezat Elena

    2008-05-01

    Full Text Available Management consulting helping organizations improve their performance, primarily through the thorough analysis of existing business problems and development of plans for improvement. There is probably no activity about which the opinions are so divided as management consulting. The purpose of this paper is to make some reflections upon what role play the consulting management services as professional service to the firms and how offering these services affects the offering and delivery of other services of the firms. The study is based on an office documentation research within consulting firms and resources. The approach tries to be critical and reflective, examines different consulting roles by developing a typology. The purpose is to aware of these professional services young business people. The FAQ of this service are: “How to choose the best consultant?” and “Why did fail consultant?”.

  12. 44 CFR 331.5 - Production facilities.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Production facilities. 331.5... AND FACILITIES IN LABOR SURPLUS AREAS § 331.5 Production facilities. All Federal departments and... production facilities, including expansion, to the extent that such selection is consistent with existing law...

  13. Asian Facilities

    Science.gov (United States)

    Nakahata, M.

    2011-04-01

    Asian underground facilities are reviewed. The YangYang underground Laboratory in Korea and the Kamioka observatory in Japan are operational and several astrophysical experiments are running. Indian Neutrino Observatory(INO) and China JinPing Underground Laboratory (CJPL) are under construction and underground experiments are being prepared. Current activities and future prospects at those underground sites are described.

  14. Mechanisms for exchange of image data to support distant medical consultation.

    Science.gov (United States)

    Dayhoff, R E; Maloney, D L; Hirz, L; Majurski, W J; Kuzmak, P M; Bradley, D

    1993-01-01

    The VA has developed an integrated infrastructure to support the exchange of medical data, including images and text report data, between medical centers. This capability is expected to support teleconsulting and meet a variety of existing medical staffing and consultation needs. Consultation from distant locations requires at least the same complete integrated patient record available to onsite physicians. Several mechanisms are being explored to support distant medical consultation. Multimedia extensions to the VA's electronic mail system have been developed to allow images and other data objects to be included in electronic mail messages. Another approach that has been prototyped is to extend existing local imaging networks to produce more widely distributed imaging systems. These approaches will be described and discussed.

  15. Lessons learned in pilot testing specialty consultations to benefit individuals with lower limb loss.

    Science.gov (United States)

    Elnitsky, Christine; Latlief, Gail; Gavin-Dreschnack, Deborah; Harris, Melanie; Campbell, Robert

    2012-01-01

    Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program. Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

  16. Lessons Learned in Pilot Testing Specialty Consultations to Benefit Individuals with Lower Limb Loss

    Directory of Open Access Journals (Sweden)

    Christine Elnitsky

    2012-12-01

    Full Text Available Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program.  Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

  17. Palliative treatment alternatives and euthanasia consultations: a qualitative interview study.

    Science.gov (United States)

    Buiting, Hilde M; Willems, Dick L; Pasman, H Roeline W; Rurup, Mette L; Onwuteaka-Philipsen, Bregje D

    2011-07-01

    There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated by the treating physician as well as an independent euthanasia consultant. To investigate 1) whether and how palliative treatment alternatives come up during or preceding euthanasia consultations and 2) how the availability of possible palliative treatment alternatives are assessed by the independent consultant. We interviewed 14 euthanasia consultants and 12 physicians who had requested a euthanasia consultation. We transcribed and analyzed the interviews and held consensus meetings about the interpretation. Treating physicians generally discuss the whole range of treatment options with the patient before the euthanasia consultation. Consultants actively start thinking about and proposing palliative treatment alternatives after consultations, when they have concluded that the criteria for careful practice have not been met. During the consultation, they take into account various aspects while assessing the criterion concerning the availability of reasonable alternatives, and they clearly distinguish between euthanasia and continuous deep sedation. Most consultants said that it was necessary to verify which forms of palliative care had previously been discussed. Advice concerning palliative care seemed to be related to the timing of the consultation ("early" or "late"). Euthanasia consultants were sometimes unsure whether or not to advise about palliative care, considering it not their task or inappropriate in view of the previous discussions. Two different roles of a euthanasia consultant were identified: a limited one, restricted to the evaluation of the criteria for careful practice, and a broad one, extended to actively providing advice about palliative care. Further

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

    OpenAIRE

    2016-01-01

    Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs include...

  19. Seismic risk analysis for the Atomics International Nuclear Materials Development Facility, Santa Susana California

    Energy Technology Data Exchange (ETDEWEB)

    1978-12-29

    This report presents the results of a detailed seismic risk analysis of the Nuclear Materials Development Facility (NMDF) operated by Atomics International at Santa Susana, California. The historical seismic record was established after a review of available literature, consultation with operators of local seismic arrays and examination of appropriate seismic data bases including the USGS, California Institute of Technology and NEIS data bases. The resulting seismic record, covering the period 1969 to 1977, was used to identify all possible sources of seismicity that could affect the site. The best estimate curve indicates that the facility will experience 30% g with a return period of 55 years and 60% g with a return period of 750 years.

  20. Nutritional recommendations of feedlot consulting nutritionists: The 2015 New Mexico State and Texas Tech University survey.

    Science.gov (United States)

    Samuelson, K L; Hubbert, M E; Galyean, M L; Löest, C A

    2016-06-01

    The 2015 feedlot consulting nutritionist survey is a collaborative project between New Mexico State University and Texas Tech University that focuses on summarizing the professional practices of consulting feedlot nutritionists and updates a 2007 survey. Forty-nine consulting feedlot nutritionists were asked to participate, of which 24 completed the survey. The nutritionists surveyed service over 14,000,000 cattle annually and were representatives from individual consulting practices (54.2%), corporate cattle feeding companies (20.8%), corporate feed manufacturing companies (20.8%), or a combination of consulting practices (4.2%). The survey was completed using a web-based survey tool and contained 101 questions that were divided into sections regarding general information about the consulting practice; general cattle management; receiving cattle management, diet adaption; mixers, feed mills, and feeding management; grains and grain processing; grain by-product use; roughage use; information about supplements and microingredients; liquid feed use; nutrient formulation; feed additive use; and information used as a basis for nutritional recommendations. In most cases, the results of the current survey were similar to those reported for the 2007 survey, with a few notable exceptions such as shifts in cattle numbers and preferences for specific feedstuffs. The present study introduced a number of new questions not included in the 2007 survey that focused on management strategies used in the receiving period. Data from this survey provide insight into current nutritional and management practices of consulting nutritionists and, as in past surveys, should be useful for informing national committees that make nutritional recommendations for cattle, as well as nutrition and management strategies employed within university research settings.

  1. Translating Evidence to Facilitate Shared Decision Making: Development and Usability of a Consult Decision Aid Prototype.

    Science.gov (United States)

    Stacey, Dawn; Légaré, France; Lyddiatt, Anne; Giguere, Anik M C; Yoganathan, Manosila; Saarimaki, Anton; Pardo, Jordi Pardo; Rader, Tamara; Tugwell, Peter

    2016-12-01

    The purpose of this study was to translate evidence from Cochrane Reviews into a format that can be used to facilitate shared decision making during the consultation, namely patient decision aids. A systematic development process (a) established a stakeholder committee; (b) developed a prototype according to the International Patient Decision Aid Standards; (c) applied the prototype to a Cochrane Review and used an interview-guided survey to evaluate acceptability/usability; (d) created 12 consult decision aids; and (e) used a Delphi process to reach consensus on considerations for creating a consult decision aid. The 1-page prototype includes (a) a title specifying the decision; (b) information on the health condition, options, benefits/harms with probabilities; (c) an explicit values clarification exercise; and (d) questions to screen for decisional conflict. Hyperlinks provide additional information on definitions, probabilities presented graphically, and references. Fourteen Cochrane Consumer Network members and Cochrane Editorial Unit staff participated. Thirteen reported that it would help patient/clinician discussions and were willing to use and/or recommend it. Seven indicated the right amount of information, six not enough, and one too much. Changes to the prototype were more links to definitions, more white space, and details on GRADE evidence ratings. Creating 12 consult decision aids took about 4 h each. We identified ten considerations when selecting Cochrane Reviews for creating consult decision aids. Using a systematic process, we developed a consult decision aid prototype to be populated with evidence from Cochrane Reviews. It was acceptable and easy to apply. Future studies will evaluate implementation of consult decision aids.

  2. Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial.

    Science.gov (United States)

    van Gelder, Vincent A; Scherpbier-de Haan, Nynke D; van Berkel, Saskia; Akkermans, Reinier P; de Grauw, Inge S; Adang, Eddy M; Assendelft, Pim J; de Grauw, Wim J C; Biermans, Marion C J; Wetzels, Jack F M

    2017-08-01

    Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead. This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology. Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKD patients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKD patients. The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology. The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.

  3. Two years of psychogeriatric consultations in a nursing home: reasons for referral compared to psychiatrists' assessment

    Directory of Open Access Journals (Sweden)

    Costantini Chiara

    2006-06-01

    Full Text Available Abstract Background In spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment. Methods Data were collected and analysed on consultation carried out over a two-year period in a RSA (Residenza Socio-Assistenziale in Northern-Italy. Data were catalogued with reference to: patients, consultation, diagnosis and recommended medications. Statistical correlation analysis by means of Spearman test and signification test was carried out. Results Residents referred to psychiatric consultation at least once were 112 (14.5% of all residents. Reason for referral were: depression (17.2%, delusions and hallucinations (14%, agitation (34.8%, aggressive behaviour (23.5% and disturbances of sleep (6.8%. Most frequent diagnoses were organic, including symptomatic, mental disorders (33.9%, mood disorders (22.3% and schizophrenia, schizotypal and delusional syndromes (18.8%. No psychiatric diagnosis was found only in 1.8% of cases, thus confirming high sensibility of referring physicians. A statistically significant correlation was found when comparing referrals for depression or delusions and allucinations or sleep disturbances and diagnostic confirmation of such symptoms by specialistic assessment (respectively 49.8%, 52.7% and 19.6%. Correlation between psychotic symptoms and the consequent prescription of antipsychotic drugs had a significant if somewhat modest value (24% while correlation between depression symptoms and prescription of antidepressant drugs was more noticeable (66.5%. Conclusion Main reason for referral to psychiatric consultation resulted to be the presence of agitation, a non-specific symptom often difficult to attribute. Data concerning depression confirm tendency to

  4. Risk communication in the clinical consultation.

    Science.gov (United States)

    Thomson, Richard; Edwards, Adrian; Grey, Jenny

    2005-01-01

    Modern healthcare and modern societies are facing up to the need for greater engagement of patients in treatment decisions. Shared and informed decision-making is replacing traditional paternalistic approaches to decisions; health policy both reflects and drives these changes. A critical contribution to better informed decisions by patients is the effective communication of risk in the clinical consultation. This is not straightforward, but there is a growing evidence base to improve performance in this area to the benefit of both patients and clinicians. The purpose of this review is to provide an accessible and practical guide to better communication of risk by clinicians.

  5. Pharmaceutical consultation in UAE community pharmacies

    Directory of Open Access Journals (Sweden)

    N M Hamoudi

    2011-01-01

    Full Text Available In recent years, the focus of pharmacists as traditional drug dispensers has shifted to more active and participative role in risk assessment, risk management, and other medication related consultation activities. Pharmacy profession is evolving steadily in the United Arab Emirates (UAE. Pharmacists in UAE are so much occupied in their administrative and managerial duties that dispensing is mostly attended to by pharmacy technicians. Pharmacist-led patient counseling is limited to the dosage and frequency of medications and rarely adverse reactions and drug interactions with other medications. Therefore we decided to perform quantitative questionnaires study to explore the role of pharmacist in patient counseling in UAE, the evaluation of pharmacist′s opinion on patient counseling and the potential determinants of personal consultation. Results show the frequency and nature of inquiries received by pharmacist. Five to twenty inquires per month are received from patient, most of them related to drug prescription and dose recommendation. Thirty nine percent of pharmacists received inquiries from doctors, most of them related to the dose and mode of action. Ninty two percent of the pharmacists agreed that patient counseling is their professional responsibility. About 82% of pharmacists agreed that counseling will increase their sales and enhance the reputation of their pharmacies. Seventy percent of pharmacists mentioned that they need to undergo training for effective counseling while 46% of pharmacists felt that more staff in the pharmacies would have a positive influence on patient compliance to medication therapies and patient safety. The potential determinants of personal consultation show that 52% of participants trusted pharmacist and 55% considered the pharmacist as a friend. Forty eight percent of participants visited the pharmacy for medical recommendation while 30% for drug compounding, 72% agreed that pharmacist conducts full

  6. Pharmaceutical Consultation in UAE Community Pharmacies.

    Science.gov (United States)

    Hamoudi, N M; Shirwaikar, A A; Ali, H S; Al Ayoubi, E I

    2011-07-01

    In recent years, the focus of pharmacists as traditional drug dispensers has shifted to more active and participative role in risk assessment, risk management, and other medication related consultation activities. Pharmacy profession is evolving steadily in the United Arab Emirates (UAE). Pharmacists in UAE are so much occupied in their administrative and managerial duties that dispensing is mostly attended to by pharmacy technicians. Pharmacist-led patient counseling is limited to the dosage and frequency of medications and rarely adverse reactions and drug interactions with other medications. Therefore we decided to perform quantitative questionnaires study to explore the role of pharmacist in patient counseling in UAE, the evaluation of pharmacist's opinion on patient counseling and the potential determinants of personal consultation. Results show the frequency and nature of inquiries received by pharmacist. Five to twenty inquires per month are received from patient, most of them related to drug prescription and dose recommendation. Thirty nine percent of pharmacists received inquiries from doctors, most of them related to the dose and mode of action. Ninty two percent of the pharmacists agreed that patient counseling is their professional responsibility. About 82% of pharmacists agreed that counseling will increase their sales and enhance the reputation of their pharmacies. Seventy percent of pharmacists mentioned that they need to undergo training for effective counseling while 46% of pharmacists felt that more staff in the pharmacies would have a positive influence on patient compliance to medication therapies and patient safety. The potential determinants of personal consultation show that 52% of participants trusted pharmacist and 55% considered the pharmacist as a friend. Forty eight percent of participants visited the pharmacy for medical recommendation while 30% for drug compounding, 72% agreed that pharmacist conducts full instruction while 31% agreed

  7. Client/consultant model services agreement

    CERN Document Server

    International Federation of Consulting Engineers

    2006-01-01

    The terms of the Client Consultant Model Services agreement (The White Book) have been prepared by the Fédération Internationale des Ingénieurs-Conseils (FIDIC) and are recommended for general use for the purposes of pre-investment and feasibility studies, designs and administration of construction and project management, where proposals for such services are invited on an international basis. They are equally adaptable for domestic agreements. - See more at: http://fidic.org/books/clientconsultant-model-services-agreement-4th-ed-2006-white-book#sthash.3Uxy5qT3.dpuf

  8. Mound facility physical characterization

    Energy Technology Data Exchange (ETDEWEB)

    Tonne, W.R.; Alexander, B.M.; Cage, M.R.; Hase, E.H.; Schmidt, M.J.; Schneider, J.E.; Slusher, W.; Todd, J.E.

    1993-12-01

    The purpose of this report is to provide a baseline physical characterization of Mound`s facilities as of September 1993. The baseline characterizations are to be used in the development of long-term future use strategy development for the Mound site. This document describes the current missions and alternative future use scenarios for each building. Current mission descriptions cover facility capabilities, physical resources required to support operations, current safety envelope and current status of facilities. Future use scenarios identify potential alternative future uses, facility modifications required for likely use, facility modifications of other uses, changes to safety envelope for the likely use, cleanup criteria for each future use scenario, and disposition of surplus equipment. This Introductory Chapter includes an Executive Summary that contains narrative on the Functional Unit Material Condition, Current Facility Status, Listing of Buildings, Space Plans, Summary of Maintenance Program and Repair Backlog, Environmental Restoration, and Decontamination and Decommissioning Programs. Under Section B, Site Description, is a brief listing of the Site PS Development, as well as Current Utility Sources. Section C contains Site Assumptions. A Maintenance Program Overview, as well as Current Deficiencies, is contained within the Maintenance Program Chapter.

  9. Current Status of the Cyber Threat Assessment for Nuclear Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Doo [KINAC, Daejeon (Korea, Republic of)

    2016-05-15

    In December 2014, unknown hackers hacked internal documents sourced from Korea Hydro and Nuclear Power (KHNP) and those electronic documents were posted five times on a Social Network Service (SNS). The data included personal profiles, flow charts, manuals and blueprints for installing pipes in the nuclear power plant. Although the data were not critical to operation or sabotage of the plant, it threatened people and caused social unrest in Korea and neighboring countries. In December 2015, cyber attack on power grid caused a blackout for hundreds of thousands of people in Ukraine. The power outage was caused by a sophisticated attack using destructive malware called 'BlackEnergy'. Cyber attacks are reality in today's world and critical infrastructures are increasingly targeted. Critical infrastructures, such as the nuclear power plant, need to be proactive and protect the nuclear materials, assets and facilities from potential cyber attacks. The threat assessment document and its detailed procedure are confidential for the State. Nevertheless, it is easy to find cooperation on assessing and evaluating the threats of nuclear materials and facilities with other government departments or agencies including the national police. The NSSC and KINAC also cooperated with the National Intelligence Service (NIS) and National Security Research Institute (NSR). However, robust cyber threat assessment system and regular consultative group should be established with domestic and overseas organization including NIS, NSR, the National Police Agency and the military force to protect and ensure to safety of people, public and environment from rapidly changing and upgrading cyber threats.

  10. Sustainability of a proactive geriatric trauma consultation service.

    Science.gov (United States)

    Wong, Camilla L; Al Atia, Raghda; McFarlan, Amanda; Lee, Holly Y; Valiaveettil, Christina; Haas, Barbara

    2017-02-01

    Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

  11. FACILITIES MANAGEMENT AT CERN

    CERN Multimedia

    2002-01-01

    Recently we have been confronted with difficulties concerning services which are part of a new contract for facilities management. Please see below for some information about this contract. Following competitive tendering and the Finance Committee decision, the contract was awarded to the Swiss firm 'Facilities Management Network (FMN)'. The owners of FMN are two companies 'M+W Zander' and 'Avireal', both very experienced in this field of facilities management. The contract entered into force on 1st July 2002. CERN has grouped together around 20 different activities into this one contract, which was previously covered by separate contracts. The new contract includes the management and execution of many activities, in particular: Guards and access control; cleaning; operation and maintenance of heating plants, cooling and ventilation equipment for buildings not related to the tunnel or the LHC; plumbing; sanitation; lifts; green areas and roads; waste disposal; and includes a centralised helpdesk for these act...

  12. A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy

    Science.gov (United States)

    Stirman, Shannon Wiltsey; Pontoski, Kristin; Creed, Torrey; Xhezo, Regina; Evans, Arthur C.; Beck, Aaron T.; Crits-Christoph, Paul

    2017-01-01

    Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A “gold standard” condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies. PMID:26577646

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

    Science.gov (United States)

    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

  14. Interpersonal Consulting Skills for Instructional Technology Consultants: A Multiple Case Study

    Science.gov (United States)

    van Leusen, Peter; Ottenbreit-Lefwich, Anne T.; Brush, Thomas

    2016-01-01

    Building a trust-based relationship with faculty is one of the most important attributes of effective Instructional Technology Consultants (ITC) in order to integrate emerging technologies into higher education. Utilizing a multiple case study research design, four experienced ITCs at a large urban research university located in the Midwest showed…

  15. The "Consulting-Your-Consultants Interview": A Final Narrative Conversation with Graduating Family Therapy Masters' Students.

    Science.gov (United States)

    Keiley, Margaret K.; Piercy, Fred P.

    1999-01-01

    Discusses a Master's program exit interview that used questions from narrative therapy to celebrate the transition of Masters students into the world of marital and family therapy professionals. This process helps to underling students' agency and competence, and elevates them to the level of consultant during the interview. (Author/MKA)

  16. Interpersonal Consulting Skills for Instructional Technology Consultants: A Multiple Case Study

    Science.gov (United States)

    van Leusen, Peter; Ottenbreit-Lefwich, Anne T.; Brush, Thomas

    2016-01-01

    Building a trust-based relationship with faculty is one of the most important attributes of effective Instructional Technology Consultants (ITC) in order to integrate emerging technologies into higher education. Utilizing a multiple case study research design, four experienced ITCs at a large urban research university located in the Midwest showed…

  17. Web-Based Depression Screening and Psychiatric Consultation for College Students: A Feasibility and Acceptability Study

    Directory of Open Access Journals (Sweden)

    Aya Williams

    2014-01-01

    Full Text Available Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9 online; those who screened positive (PHQ-9 ≥ 10 or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4% students found the interview useful in helping them understand their depression. Fifteen (88.2% students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality.

  18. Data Management Facility Operations Plan

    Energy Technology Data Exchange (ETDEWEB)

    Keck, Nicole N

    2014-06-30

    The Data Management Facility (DMF) is the data center that houses several critical Atmospheric Radiation Measurement (ARM) Climate Research Facility services, including first-level data processing for the ARM Mobile Facilities (AMFs), Eastern North Atlantic (ENA), North Slope of Alaska (NSA), Southern Great Plains (SGP), and Tropical Western Pacific (TWP) sites, as well as Value-Added Product (VAP) processing, development systems, and other network services.

  19. Impact of follow-up consultations for ICU survivors on post-ICU syndrome

    DEFF Research Database (Denmark)

    Jensen, J. F.; Thomsen, Thordis; Overgaard, D

    2015-01-01

    /unpublished trials. Randomized controlled trials investigating post-ICU consultations in adults with outcomes such as quality of life (QOL), anxiety, depression, posttraumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed...... ratio 0.49, 95 % CI 0.26-0.95). There was no effect on other outcomes. CONCLUSIONS: The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3-6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights...

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

    Science.gov (United States)

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

    2009-12-01

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

  1. Visualising conversation structure across time: insights into effective doctor-patient consultations.

    Science.gov (United States)

    Angus, Daniel; Watson, Bernadette; Smith, Andrew; Gallois, Cindy; Wiles, Janet

    2012-01-01

    Effective communication between healthcare professionals and patients is critical to patients' health outcomes. The doctor/patient dialogue has been extensively researched from different perspectives, with findings emphasising a range of behaviours that lead to effective communication. Much research involves self-reports, however, so that behavioural engagement cannot be disentangled from patients' ratings of effectiveness. In this study we used a highly efficient and time economic automated computer visualisation measurement technique called Discursis to analyse conversational behaviour in consultations. Discursis automatically builds an internal language model from a transcript, mines the transcript for its conceptual content, and generates an interactive visual account of the discourse. The resultant visual account of the whole consultation can be analysed for patterns of engagement between interactants. The findings from this study show that Discursis is effective at highlighting a range of consultation techniques, including communication accommodation, engagement and repetition.

  2. Mineral facilities of Europe

    Science.gov (United States)

    Almanzar, Francisco; Baker, Michael S.; Elias, Nurudeen; Guzman, Eric

    2010-01-01

    This map displays over 1,700 records of mineral facilities within the countries of Europe and western Eurasia. Each record represents one commodity and one facility type at a single geographic location. Facility types include mines, oil and gas fields, and plants, such as refineries, smelters, and mills. Common commodities of interest include aluminum, cement, coal, copper, gold, iron and steel, lead, nickel, petroleum, salt, silver, and zinc. Records include attributes, such as commodity, country, location, company name, facility type and capacity (if applicable), and latitude and longitude geographical coordinates (in both degrees-minutes-seconds and decimal degrees). The data shown on this map and in table 1 were compiled from multiple sources, including (1) the most recently available data from the U.S. Geological Survey (USGS) Minerals Yearbook (Europe and Central Eurasia volume), (2) mineral statistics and information from the USGS Minerals Information Web site (http://minerals.usgs.gov/minerals/pubs/country/europe.html), and (3) data collected by the USGS minerals information country specialists from sources, such as statistical publications of individual countries, annual reports and press releases of operating companies, and trade journals. Data reflect the most recently published table of industry structure for each country at the time of this publication. Additional information is available from the country specialists listed in table 2.

  3. Facilities: The Tech Edge.

    Science.gov (United States)

    Farmer, Lesley S. J.

    2002-01-01

    Examines the impact of technology on school library facilities and suggests some low-impact ways to optimize its use. Highlights include considering the role technology can play; educational goals; interior environmental factors; circulation desk needs; security; storage for hardware and software; handicapped accessibility; and future planning.…

  4. Facility effluent monitoring plan for the 327 Facility

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-11-01

    The 327 Facility [Post-Irradiation Testing Laboratory] provides office and laboratory space for Pacific Northwest Laboratory (PNL) scientific and engineering staff conducting multidisciplinary research in the areas of post-irradiated fuels and structural materials. The facility is designed to accommodate the use of radioactive and hazardous materials in the conduct of these activities. This report summarizes the airborne emissions and liquid effluents and the results of the Facility Effluent Monitoring Plan (FEMP) determination for the facility. The complete monitoring plan includes characterization of effluent streams, monitoring/sampling design criteria, a description of the monitoring systems and sample analysis, and quality assurance requirements.

  5. Eating Issues in Schools: Detection, Management, and Consultation with Allied Professionals

    Science.gov (United States)

    Carney, Jennifer Maskell; Scott, Heather Lewy

    2012-01-01

    School counselors play a crucial role in the prevention, assessment, treatment, and overall management of eating-related problems among children and adolescents. This article provides a framework for conceptualizing these difficulties on a continuum of severity and includes recommendations at each level for intervention and consultation.…

  6. School-Based Consultation: Training Challenges, Solutions and Building Cultural Competence

    Science.gov (United States)

    Sander, Janay B.; Hernández Finch, Maria E.; Pierson, Eric E.; Bishop, Jared A.; German, Rachel L.; Wilmoth, Claire E.

    2016-01-01

    This is a consensual qualitative research study of the perceptions of university faculty about methods and tools to teach students the professional competency area of school-based psychological consultation, with special attention to cultural competence. The participants (n = 7) included faculty of school psychology programs located in the…

  7. Constipation and Nonspecific Abdominal Pain in Teenage Girls Referred for Emergency Surgical Consultation

    NARCIS (Netherlands)

    Buddingh, K. Tim; Wieselmann, Eva; Heineman, Erik; Broens, Paul M. A.

    Objective: The aim of this study was to describe the discharge diagnoses of children receiving surgical consultation for acute abdominal pain according to age and sex. Methods: Retrospective chart review. Results: Nine hundred forty-one children were included. Appendicitis was confirmed in 31% of

  8. The Role of the Team in Managing Telephone Consultation in Dialectical Behavior Therapy: Three Case Examples

    Science.gov (United States)

    Koons, Cedar R.

    2011-01-01

    Standard, outpatient Dialectical Behavior Therapy (DBT) includes the provision of intersession telephone contact between the therapist and the client to reduce suicidal crisis behaviors, enhance skills generalization, and reduce alienation and conflict in the therapeutic relationship. Therapists providing telephone consultation need the help of…

  9. Cues and Concerns by Patients in Medical Consultations: A Literature Review

    Science.gov (United States)

    Zimmermann, Christa; Del Piccolo, Lidia; Finset, Arnstein

    2007-01-01

    The aim of the current article is to review the peer-reviewed research literature on cues and concerns published between 1975 and 2006. To be included, articles had to report observational studies based on patient-physician consultations and report findings on patient expressions of cues and/or concerns. Quantitative and qualitative studies from…

  10. The School Counselor as Consultant on Self-Esteem: An Example.

    Science.gov (United States)

    Braucht, Stephanie; Weime, Barbara

    1992-01-01

    Describes development of in-service workshop for teachers on self-esteem which included two videos, chamber theater, bibliographic review, discussion of the principles of Rational-Emotive Therapy, and reception. Encourages school counselors to consider consultation in the form of an in-service program. (ABL)

  11. Universities UK Response to "The Student Immigration System--A Consultation"

    Science.gov (United States)

    Universities UK, 2011

    2011-01-01

    This is Universities UK's submission to the Home Office consultation The Student Immigration System. It sets out UUK's concerns in relation to the potential impact of the Government's proposals on the university sector. These concerns include, but are not limited to, the economic, cultural, academic and reputational impact of reducing the numbers…

  12. Graduate Students' Self-Reported Perspectives regarding Peer Feedback and Feedback from Writing Consultants

    Science.gov (United States)

    Chen, Cheryl Wei-yu

    2010-01-01

    This study reported how ten Taiwanese Master's students perceived their experiences of receiving feedback given by their peers and writing consultants to revise a shortened version of their thesis proposals. Collected over the course of one semester, data included students' writing portfolios and interviews with them. Analysis of the data revealed…

  13. The Role of the Team in Managing Telephone Consultation in Dialectical Behavior Therapy: Three Case Examples

    Science.gov (United States)

    Koons, Cedar R.

    2011-01-01

    Standard, outpatient Dialectical Behavior Therapy (DBT) includes the provision of intersession telephone contact between the therapist and the client to reduce suicidal crisis behaviors, enhance skills generalization, and reduce alienation and conflict in the therapeutic relationship. Therapists providing telephone consultation need the help of…

  14. Skills and Knowledge Needed to Serve as Mobile Technology Consultants for Information Organizations

    Science.gov (United States)

    Potnis, Devendra; Regenstreif-Harms, Reynard; Deosthali, Kanchan; Cortez, Ed; Allard, Suzie

    2016-01-01

    Libraries often lack the in-house information technology (IT) expertise required to (1) implement mobile applications and related technologies (MAT); (2) attain maximum return on investment including patron satisfaction for using MAT; and (3) reduce reliance on expensive IT consultants. Based on secondary analysis of the experiences and advice…

  15. What Consultation and Freelance Writing Can Do for You and for Your Students.

    Science.gov (United States)

    Muller, John A.

    This paper advises teachers of technical writing to "practice what they preach" by occasionally doing field work in technical communication. The possibilities for off-campus work include consultation, perhaps for an in-house manual of technical writing procedures and skills, editing assignments for businesses and public agencies, and freelance…

  16. Skills and Knowledge Needed to Serve as Mobile Technology Consultants for Information Organizations

    Science.gov (United States)

    Potnis, Devendra; Regenstreif-Harms, Reynard; Deosthali, Kanchan; Cortez, Ed; Allard, Suzie

    2016-01-01

    Libraries often lack the in-house information technology (IT) expertise required to (1) implement mobile applications and related technologies (MAT); (2) attain maximum return on investment including patron satisfaction for using MAT; and (3) reduce reliance on expensive IT consultants. Based on secondary analysis of the experiences and advice…

  17. Psychoimmunology Consultation - A Study on Comorbidity

    Directory of Open Access Journals (Sweden)

    Mariana Marinho

    2017-03-01

    Full Text Available Introduction: In comparison to the general population, notified  HIV-positive patients have higher prevalence  rates for most mental disorders, with values reaching 30-60%. Objectives: To characterize the population that is referred to Psychiatry-Psychoimmunology consultation; to explore the possible relationship  between  psychiatric  diagnosis, antiretroviral treatment and HCV co-infection, with sociodemographic and clinical variables. Methods: We have selected HIV-positive patients referred for the first time to Psychiatry-Psychoimmunology consultation, between January 2012 and July 2015. Information was collected through the clinical process in electronic form. Statistical analy- sis was performed using the statistical analysis  program  Statistical  Package for Social Sciences, version 20. Results: The sample contained 209 patients, with a median age of 43 years, mostly men, with four years of schooling, single, professionally inactive, infected via heterosexual behavior. However, we found statistically significant differences between sexes for the last three variables. The majority was under antiretroviral treatment, with no significant differences between sexes. In the first consultation, 29.0% and 30.1% had, respectively, substance use and HCV co-infection, with a significant predominance in men. Depressive symptoms and adjustment disorder to the disease constituted, respectively, the referral reason and the most common psychiatric diagnosis, in both sexes. More than half had psychiatric history. HCV co-infection showed a statistical significant correlation between variables like sex, occupational status, infection transmission route,  psychiatric  history  and  use  of  alcohol and/or illicit drugs. The same was true between the psychiatric diagnosis and some variables like infection notification  time, alcohol and/or drugs and HCV co-infection. Conclusions: During the course of infection, these patients often face

  18. Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation

    OpenAIRE

    2015-01-01

    Background Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access. Objective The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceive...

  19. The nursing consultation to the carriers of hypertension: the practice

    OpenAIRE

    Francisca Bertilia Chaves Costa; Thelma Leite de Araújo

    2012-01-01

    The aim of this study was to investigate, in a specific group formed by nurses belonging to the teams of the Family Health Program of Ceará, the practice of the nursing consultation to the people with arterial hypertension. This study was characterized as exploratory-descriptive, developed from 2004 to 2005 with 17 nursing consultations professional promoters to assist the mentioned patients. Some topics inserted in the stages of the nursing consultation were described by the participants of ...

  20. Nursing consultation to the user with hypertension in primary attention

    OpenAIRE

    Gilvan Ferreira Felipe; Thereza Maria Magalhães Moreira; Lúcia de Fátima da Silva; Andressa Suelly Saturnino de Oliveira

    2012-01-01

    In primary care, the nursing care for hypertensive patients can be provided during the nursing consultation. The main aim of this research was to examine the activities developed by nurses during the nursing consultation for hypertensive patients followed in primary care. This descriptive study, developed in three Family Health Centers of the Regional IV Executive Secretary in Fortaleza, through monitoring of 39 consultations and completion of a checklist. It was found out that the consultati...

  1. Scientific decision-making and stakeholder consultations: the case of salt recommendations.

    Science.gov (United States)

    Timotijevic, Lada; Barnett, Julie; Brown, Kerry; Raats, Monique M; Shepherd, Richard

    2013-05-01

    Scientific advisory committees (SACs) are seen as "boundary organisations" working at the interface between science, policy and society. Although their narrowly defined remit of risk assessment is anchored in notions of rationality, objectivity, and reason, in reality, their sources for developing recommendations are not limited to scientific evidence. There is a growing expectation to involve non-scientific sources of information in the formation of knowledge, including the expectation of stakeholder consultation in forming recommendations. Such a move towards "democratisation" of scientific processes of decision-making within SACs has been described and often studied as "post-normal science" (PNS) (Funtowicz & Ravetz, 1993). In the current paper we examine the application of PNS in practice through a study of stakeholder consultations within the workings of the UK Scientific Advisory Committee for Nutrition (SACN). We use the theoretical insights from PNS-related studies to structure the analysis and examine the way in which PNS tenets resonate with the practices of SACN. We have selected a particular case of the SACN UK recommendations for salt as it is characterized by scientific controversy, uncertainty, vested interests and value conflict. We apply the tenets of PNS through documentary analysis of the SACN Salt Subgroup (SSG) consultation documents published in 2002/2003: the minutes of the 5 SACN SSG's meetings which included summary of the SACN SSG's stakeholder consultation and the SSG's responses to the consultation. The analysis suggests that the SACN consultation can be construed as a process of managing sources of risk to its organisation. Thus, rather than being an evidence of post-normal scientific practice, engagement became a mechanism for confirming the specific framing of science that is resonant with technocratic models of science holding authority over the facts. The implications for PNS theory are discussed.

  2. Emission Facilities - Erosion & Sediment Control Facilities

    Data.gov (United States)

    NSGIC Education | GIS Inventory — An Erosion and Sediment Control Facility is a DEP primary facility type related to the Water Pollution Control program. The following sub-facility types related to...

  3. Why are junior doctors reluctant to consult attending physicians?

    Science.gov (United States)

    Swank, Otto H

    2010-03-01

    A physician performs two tasks: making diagnoses and determining treatments. To reduce medical error, junior doctors are supposed to consult their supervisors when they face uncommon circumstances. However, recent research shows that junior doctors are reluctant to do so. This paper presents a model that explains (i) which junior doctors shy away from consulting; (ii) when junior doctors are reluctant; (iii) the importance of protocols in the medical sector; and (iv) when consulting is a sign of strength or a sign of weakness. Furthermore, I show that encouraging junior doctors to consult by investigating mishaps leads to another distortion: they will give too much weight to own assessments.

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

    Science.gov (United States)

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

    2014-12-01

    Children undergoing HSCT are at risk for complications due to immune system impairment, toxicity from prior therapies and conditioning regimens, and long-term use of indwelling catheters. These problems may require assessment by the surgical team. We sought to characterize the role of surgical consultation during primary hospital stay for HSCT. We retrospectively reviewed the records of consecutive patients undergoing HSCT between September 2010 and September 2012. One hundred and seventy-three patients underwent 189 HSCTs. General surgery consultations occurred during 33% (n = 62) of primary hospitalizations for HSCT, with a total of 85 consults. Sixty-three (73%) consults resulted in an intervention in the operating room or at the bedside. The majority of consults were for CVL issues (59%, n = 50), followed by abdominal complaints (16%, n = 14). Patients requiring surgical consultation had significantly higher in-hospital mortality (16% vs. 2%, p consultation. Patients undergoing HSCT often require surgical consultation, most commonly for line-related issues. Surgical consultation heralded an increased risk of in-hospital and 100-day TRM. Issues among this high-risk cohort of children who have undergone HSCT must be familiar to the general surgeon and oncologist alike. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Community nurses and their collaboration with clinical nurse consultants.

    Science.gov (United States)

    Jannings, W; Maynard, C

    A survey was undertaken of 129 community nurses who had chosen to utilise a clinical nurse consultant for education and/or patient care at home. Accessibility, efficiency, usefulness of the consultation and the educative role of the clinical nurse consultant were examined. The responses indicated that the community nurses had positive perceptions regarding their collaboration with the clinical nurse consultants. It is recommended that an objective tool be developed to demonstrate the effectiveness of the collaboration, for data collection purposes, when measuring patient outcomes and evaluating specialist resources.

  6. Structural analysis consultation using artificial intelligence

    Science.gov (United States)

    Melosh, R. J.; Marcal, P. V.; Berke, L.

    1978-01-01

    The primary goal of consultation is definition of the best strategy to deal with a structural engineering analysis objective. The knowledge base to meet the need is designed to identify the type of numerical analysis, the needed modeling detail, and specific analysis data required. Decisions are constructed on the basis of the data in the knowledge base - material behavior, relations between geometry and structural behavior, measures of the importance of time and temperature changes - and user supplied specifics characteristics of the spectrum of analysis types, the relation between accuracy and model detail on the structure, its mechanical loadings, and its temperature states. Existing software demonstrated the feasibility of the approach, encompassing the 36 analysis classes spanning nonlinear, temperature affected, incremental analyses which track the behavior of structural systems.

  7. Financial security for women -- Fem Consult congress.

    Science.gov (United States)

    1996-01-01

    The nongovernmental organization "Fem Consult," which seeks to strengthen the socioeconomic position of women by applying a gender perspective to programs and projects in developing countries, celebrated its 10th anniversary in 1996 by holding a conference in the Netherlands on financial security for women in the developing world. During the conference, the President of the WWF (Working Women's Forum) described her agency's 17 years of experience in lending to impoverished rural and urban women in India. By extending microcredit assistance through a network of cooperatives, the WWF has been the catalyst for lasting improvements in the economic and social status of impoverished women. Representatives of the Grameen Bank, Women's World Banking, the Ecumenical Development Cooperative Society, and other organizations also addressed the conference.

  8. [ICD diagnoses in university polyclinic naturopathy consultation].

    Science.gov (United States)

    Hentschel, C; Lindner, M; Brinkhaus, B; Nagel, M R; Hahn, E G; Kohnen, R

    1996-08-01

    In a special consulting office for complementary medicine, ambulatory patients interested in receiving adjuvant treatment with complementary medicine can obtain a relevant advice and critical information regarding non-evaluated therapies. Within the framework of a retrospective statistical analysis, the diagnosis documented over a period of 24 months in accordance with the 4-digit ICD code were evaluated. In particular patients with chronic and/or functional illnesses had additional treatment needs. The exponential growth in the numbers of patients during the course of the observation period illustrates the increasing importance of complementary medical measures. However, in view of the considerable political significance of the cost factor and the possible risks of the treatment, only properly evaluated complementary medical therapies should be employed.

  9. Establishing nuclear facility drill programs

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    The purpose of DOE Handbook, Establishing Nuclear Facility Drill Programs, is to provide DOE contractor organizations with guidance for development or modification of drill programs that both train on and evaluate facility training and procedures dealing with a variety of abnormal and emergency operating situations likely to occur at a facility. The handbook focuses on conducting drills as part of a training and qualification program (typically within a single facility), and is not intended to included responses of personnel beyond the site boundary, e.g. Local or State Emergency Management, Law Enforcement, etc. Each facility is expected to develop its own facility specific scenarios, and should not limit them to equipment failures but should include personnel injuries and other likely events. A well-developed and consistently administered drill program can effectively provide training and evaluation of facility operating personnel in controlling abnormal and emergency operating situations. To ensure the drills are meeting their intended purpose they should have evaluation criteria for evaluating the knowledge and skills of the facility operating personnel. Training and evaluation of staff skills and knowledge such as component and system interrelationship, reasoning and judgment, team interactions, and communications can be accomplished with drills. The appendices to this Handbook contain both models and additional guidance for establishing drill programs at the Department`s nuclear facilities.

  10. Doctor-patient dialogue--basic aspect of medical consultation.

    Science.gov (United States)

    Murariu-Brujbu, Isabella Cristina; Macovei, Luana Andreea

    2013-01-01

    Family medicine is the specialty that provides ongoing primary medical care and improves the health status of the individual, of the family and of the community through preventive, educational, therapeutic and rehabilitation measures. The family doctor often makes the interdisciplinary synthesis, in a flexible manner, either alone or in most cases with interdisciplinary consultation. In the latter case, the family doctor initiates the team work and makes the final evaluation by using the longitudinal follow-up of the disease. The doctor-patient encounter represents the "confrontation" with the greatest moral weight, due to the complexity of the values involved, the status of the doctor in a society, and patient's involvement in decision making. The patient is a person who should be treated with respect, honesty, professionalism and loyalty, whatever the clinical status, severity of illness, mental competence or incompetence. A focus, on an international scale, is represented by the characteristics of a good doctor, family physician included, as the latter is the first link in the network of health services. Each model of consultation varies in a more or less subtle way in priorities assignment, and suggests slight differences regarding the role played by doctor and patient in their collaboration. The qualities of a good family physician include not only the strictly professional competences, that also apply to other medical specialties, but also duties, such as, clearly explaining to patients issues concerning their health, informing them about all the possible preventive measures of diseases, making a diagnosis, initiating and supervising a therapy. Medical responsibility lies at the crossroads between medical science and the conscience of the doctor.

  11. Audit of an inpatient liaison psychiatry consultation service.

    LENUS (Irish Health Repository)

    Lyne, John

    2012-02-01

    PURPOSE: The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a baseline for demographics, type of referral, and management of referrals, with a view to introducing improved evidence-based treatments. It also aims to examine timeliness of response to referrals benchmarked against published standards. DESIGN\\/METHODOLOGY\\/APPROACH: All inpatient referrals to a liaison psychiatry service were recorded over a six-month period, including demographics, diagnosis, management and timeliness of response to referrals. The data were retrospectively analysed and compared against international standards. FINDINGS: A total of 172 referrals were received in the six months. Commonest referral reasons included assessments regarding depressive disorders (23.8 per cent), delirium\\/other cognitive disorders (19.2 per cent), alcohol-related disorders (18.6 per cent), anxiety disorders (14.5 per cent), and risk management (12.2 per cent). Evidence-based practices were not utilised effectively for a number of different types of presentations. A total of 40.1 per cent of referrals were seen on the same day, 75.4 per cent by the end of the next day, and 93.4 per cent by the end of the following day. PRACTICAL IMPLICATIONS: Use of a hospital protocol for management of delirium may improve outcomes for these patients. Evidence-based techniques, such as brief intervention therapies, may be beneficial for referrals involving alcohol dependence. Referrals were seen reasonably quickly, but there is room for improvement when compared with published standards. ORIGINALITY\\/VALUE: This paper provides valuable information for those involved in management of liaison psychiatry consultation services, providing ideas for development and implementation of evidence based practices.

  12. Consulting Communities When Patients Cannot Consent: A Multi-Center Study of Community Consultation for Research in Emergency Settings

    Science.gov (United States)

    Dickert, Neal W; Mah, Victoria A; Biros, Michelle H; Harney, Deneil M; Silbergleit, Robert; Sugarman, Jeremy; Veledar, Emir; Weinfurt, Kevin P; Wright, David W; Pentz, Rebecca D

    2013-01-01

    Objective To assess the range of responses to community consultation efforts conducted within a large network and the impact of different consultation methods on acceptance of exception from informed consent (EFIC) research and understanding of the proposed study. Design A cognitively pre-tested survey instrument was administered to 2,612 community consultation participants at 12 US centers participating in a multi-center trial of treatment for acute traumatic brain injury (TBI). Setting Survey nested within community consultation for a Phase III, randomized controlled trial of treatment for acute TBI conducted within a multi-center trial network and using EFIC. Subjects Adult participants in community consultation events. Interventions Community consultation efforts at participating sites. Measurements and Main Results Acceptance of EFIC in general, attitude toward personal EFIC enrollment, and understanding of the study content were assessed. 54% of participants agreed EFIC was acceptable in the proposed study; 71% were accepting of personal EFIC enrollment. Participants in interactive versus non-interactive community consultation events were more accepting of EFIC in general (63% vs. 49%) and personal EFIC inclusion (77% vs. 67%). Interactive community consultation participants had high-level recall of study content significantly more often than non-interactive consultation participants (77% vs. 67%). Participants of interactive consultation were more likely to recall possible study benefits (61% vs. 45%) but less likely to recall potential risks (56% vs. 69%). Conclusions Interactive community consultation methods were associated with increased acceptance of EFIC and greater overall recall of study information but lower recall of risks. There was also significant variability in EFIC acceptance among different interactive consultation events. These findings have important implications for IRBs and investigators conducting EFIC research and for community

  13. Consulting communities when patients cannot consent: a multicenter study of community consultation for research in emergency settings.

    Science.gov (United States)

    Dickert, Neal W; Mah, Victoria A; Biros, Michelle H; Harney, Deneil M; Silbergleit, Robert; Sugarman, Jeremy; Veledar, Emir; Weinfurt, Kevin P; Wright, David W; Pentz, Rebecca D

    2014-02-01

    To assess the range of responses to community consultation efforts conducted within a large network and the impact of different consultation methods on acceptance of exception from informed consent research and understanding of the proposed study. A cognitively pretested survey instrument was administered to 2,612 community consultation participants at 12 U.S. centers participating in a multicenter trial of treatment for acute traumatic brain injury. Survey nested within community consultation for a phase III randomized controlled trial of treatment for acute traumatic brain injury conducted within a multicenter trial network and using exception from informed consent. Adult participants in community consultation events. Community consultation efforts at participating sites. Acceptance of exception from informed consent in general, attitude toward personal exception from informed consent enrollment, and understanding of the study content were assessed. Fifty-four percent of participants agreed exception from informed consent enrollment was acceptable in general in the proposed study; 71% were accepting of personal exception from informed consent enrollment. Participants in interactive versus noninteractive community consultation events were more accepting of exception from informed consent in general (63% vs 49%) and personal exception from informed consent inclusion (77% vs 67%). Interactive community consultation participants had high-level recall of study content significantly more often than noninteractive consultation participants (77% vs 67%). Participants of interactive consultation were more likely to recall possible study benefits (61% vs 45%) but less likely to recall potential risks (56% vs 69%). Interactive community consultation methods were associated with increased acceptance of exception from informed consent and greater overall recall of study information but lower recall of risks. There was also significant variability in exception from informed

  14. How head and neck consultants manage patients' emotional distress during cancer follow-up consultations: a multilevel study.

    Science.gov (United States)

    Zhou, Yuefang; Humphris, Gerry; Ghazali, Naseem; Friderichs, Simon; Grosset, David; Rogers, Simon N

    2015-09-01

    Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant-reduced space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.

  15. National Cryo-Electron Microscopy Facility

    Science.gov (United States)

    Information about the National Cryo-EM Facility at NCI, created to provide researchers access to the latest cryo-EM technology for high resolution imaging. Includes timeline for installation and how to access the facility.

  16. Magnet facility credits communication for success.

    Science.gov (United States)

    2008-03-01

    Task forces include ancillary departments, so key messages can be spread to the entire facility. Dashboards display performance information on system, facility, and unit levels. Multiple publications reinforce education on key quality improvement goals.

  17. 18 CFR 4.38 - Consultation requirements.

    Science.gov (United States)

    2010-04-01

    ... increase the capacity of the project as defined in § 4.201(b), but that would involve: (A) The construction... belief, if any; (vii) Detailed descriptions of any proposed studies and the proposed methodologies to be... construction or operation of proposed facilities, would determine the success of protection, mitigation,...

  18. Air Quality Facilities

    Data.gov (United States)

    Iowa State University GIS Support and Research FacilityFacilities with operating permits for Title V of the Federal Clean Air Act, as well as facilities required to submit an air emissions inventory, and other facilities...

  19. Evaluation of the impact of a consultation in a secure setting.

    Science.gov (United States)

    Blumenthal, Stephen; Ruszczynski, Stanley; Richards, Rachel; Brown, Matthew

    2011-10-01

    Organisational consultation is widespread in the National Health Service (NHS), but little is known about its impact. To evaluate the impact of a psychodynamically informed consultation to a high-security hospital ward.  This prospective study compared measures before and after the consultation with similarly timed measures on a comparison ward in the hospital, matched for patient characteristics, but not exposed to the consultation. The intention was to compare the consultation with 'treatment as usual', but the study became a comparison of interventions after a programme to facilitate staff-patient communication was instituted by management on the comparison ward. Measures included the Ward Atmosphere Scale (WAS) and an index of burnout. Interactions between staff and patients were observed and rated for content and quality.  Most scales on two of three dimensions of the WAS improved on both wards, as did the quality of staff-patient contact. Change at the levels of behaviour and attitude strengthens confidence that a shift occurred in a positive direction.  The overall importance of professional supportive attention to staff in such settings was established. Although there was little evidence here for a distinct advantage of one intervention style, the results were encouraging for the consultation, because ward atmosphere and staff-patient interaction were not a direct target for change. Further study is needed to test the possibility that specific interventions may carry specific advantage in other settings or with other patient groups. The nature and quality of institutional support for such research itself needs strengthening. In this case, the institutions' intention to assist was robust, but real understanding and/or sustained ability to facilitate it is lacking. This problem is hardly unique to this setting. 2011 John Wiley & Sons, Ltd.

  20. Preliminary Data from an Advanced Dementia Consult Service: Integrating Research, Education, and Clinical Expertise

    Science.gov (United States)

    Catic, Angela G.; Mitchell, Susan L.

    2013-01-01

    Hospitalized patients with advanced dementia often receive care that is of limited clinical benefit and inconsistent with preferences. We designed an Advanced Dementia Consult Service and conducted a pre and post pilot study to evaluate it in a Boston hospital. Consults were conducted by geriatricians and palliative care nurse practitioner. They consisted of structured consultation, counseling and provision of an information booklet to the family, and post-discharge follow-up with the family and primary care providers. Patients > 65 admitted with advanced dementia were identified and consults were solicited using pop-ups programmed into the computerized provider order entry (POE) system. In the initial 3-month period, patients received usual care (N=24). In the subsequent 3-month period, consults were provided to patients for whom it was requested (N=5). Data were obtained from the electronic medical record and proxies interviews (admission, 1-month post-discharge). The patients’ mean age in the combined sample (N=29) was 85.4, 58.6% were from nursing homes, and 86.2% of their proxies stated comfort was the goal of care. Nonetheless, their hospitalizations were characterized by high rates of intravenous antibiotics (86.2%), > 5 venipunctures (44.8%), and radiological exams (96.6%). Acknowledging the small sample size, there were trends towards better outcomes in the intervention group including: higher proxy knowledge of the disease, greater communication between proxies and providers, more advance care planning, lower re-hospitalization rates, and fewer feeding tube insertions after discharge. Targeted consultation for advanced dementia is feasible and may promote greater engagement of proxies and goal-directed care for patients after discharge. PMID:24219202

  1. Consultation and remediation in the north: meeting international commitments to safeguard health and well-being

    Directory of Open Access Journals (Sweden)

    Laura Banfield

    2013-08-01

    Full Text Available Background . International commitments exist for the safeguarding of health and the prevention of ill health. One of the earliest commitments is the Declaration of Alma-Ata (1978, which provides 5 principles guiding primary health care: equity, community participation, health promotion, intersectoral collaboration and appropriate technology. These broadly applicable international commitments are premised on the World Health Organization's multifaceted definition of health. The environment is one sector in which these commitments to safeguarding health can be applied. Giant Mine, a contaminated former gold mine in the Northwest Territories, Canada, represents potential threats to all aspects of health. Strategies for managing such threats usually involve an obligation to engage the affected communities through consultation. Objective . To examine the remediation and consultation process associated with Giant Mine within the context of commitments to safeguard health and well-being through adapting and applying the principles of primary health care. Methods . Semi-structured interviews with purposively selected key informants representing government proponents and community members were conducted. Results . In reviewing themes which emerged from a series of interviews exploring the community consultation process for the remediation of Giant Mine, the principles guiding primary health were mapped to consultation in the North: (a “equity” is the capacity to fairly and meaningfully participate in the consultation; (b “community participation” is the right to engage in the process through reciprocal dialogue; (c “health promotion” represents the need for continued information sharing towards awareness; (d “intersectoral collaboration” signifies the importance of including all stakeholders; and (e “appropriate technology” is the need to employ the best remediation actions relevant to the site and the community. Conclusions . Within

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

    Directory of Open Access Journals (Sweden)

    Fairley Christopher K

    2011-10-01

    Full Text Available Abstract 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

  3. The Classroom Check-up: A Classwide Teacher Consultation Model for Increasing Praise and Decreasing Disruptive Behavior.

    Science.gov (United States)

    Reinke, Wendy M; Lewis-Palmer, Teri; Merrell, Kenneth

    2008-01-01

    School-based consultation typically focuses on individual student problems and on a small number of students rather than on changing the classroom system. The Classroom Check-up (CCU) was developed as a classwide consultation model to address the need for classroom level support while minimizing treatment integrity problems common to school-based consultation. The purpose of the study was to evaluate the effects of the CCU and Visual Performance Feedback on teacher and student behavior. Results indicated that implementation of the CCU plus Visual Performance Feedback increased teacher implementation of classroom management strategies, including increased use of praise, use of behavior specific praise, and decreased use of reprimands. Further, these changes in teacher behavior contributed to decreases in classroom disruptive behavior. The results are encouraging because they suggest that consultation at the classroom level can create meaningful teacher and student behavior change.

  4. Proceedings of the international workshop on hadron facility technology

    Energy Technology Data Exchange (ETDEWEB)

    Thiessen, H.A. (comp.)

    1987-12-01

    The conference included papers on facility plans, beam dynamics, accelerator hardware, and experimental facilities. Individual abstracts were prepared for 43 papers in the conference proceedings. (LEW)

  5. Facility effluent monitoring plan for the 325 Facility

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-31

    The Applied Chemistry Laboratory (325 Facility) houses radiochemistry research, radioanalytical service, radiochemical process development, and hazardous and mixed hazardous waste treatment activities. The laboratories and specialized facilities enable work ranging from that with nonradioactive materials to work with picogram to kilogram quantities of fissionable materials and up to megacurie quantities of other radionuclides. The special facilities include two shielded hot-cell areas that provide for process development or analytical chemistry work with highly radioactive materials, and a waste treatment facility for processing hazardous, mixed, low-level, and transuranic wastes generated by Pacific Northwest Laboratory. Radioactive material storage and usage occur throughout the facility and include a large number of isotopes. This material is in several forms, including solid, liquid, particulate, and gas. Some of these materials are also heated during testing which can produce vapors. The research activities have been assigned to the following activity designations: High-Level Hot Cell, Hazardous Waste Treatment Unit, Waste Form Development, Special Testing Projects, Chemical Process Development, Analytical Hot Cell, and Analytical Chemistry. The following summarizes the airborne and liquid effluents and the results of the Facility Effluent Monitoring Plan (FEMP) determination for the facility. The complete monitoring plan includes characterization of effluent streams, monitoring/sampling design criteria, a description of the monitoring systems and sample analysis, and quality assurance requirements.

  6. 45 CFR 98.12 - Coordination and consultation.

    Science.gov (United States)

    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 FUND General Application Procedures § 98.12 Coordination and consultation. The Lead Agency shall:...

  7. 48 CFR 3437.270 - Consulting services reporting clause.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Consulting services reporting clause. 3437.270 Section 3437.270 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING Consulting Services...

  8. 48 CFR 1552.211-78 - Management consulting services.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Management consulting services. 1552.211-78 Section 1552.211-78 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION... 1552.211-78 Management consulting services. As prescribed in 1511.011-78, insert the following...

  9. 48 CFR 3437.271 - Services of consultants clause.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Services of consultants clause. 3437.271 Section 3437.271 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING Consulting Services...

  10. The social identity of hospital consultants as managers.

    Science.gov (United States)

    Russell, Vincent; Wyness, Laura A; McAuliffe, Eilish; Fellenz, Martin

    2010-01-01

    This paper aims to explore hospital consultants' social identification, in terms of perceptions of their position in society, the salient targets for their social identification and how this appears to influence their perceptions of management activities and change. A purposeful sample of 15 hospital consultants from a wide range of specialities and work locations in Ireland were recruited. Semi-structured, in-depth interviews were undertaken and thematic analysis was used to interpret the interview data. The paper finds that all interviewees perceived public attitudes towards hospital consultants, as a group, to be negative. Twelve interviewees derived most sense of belonging from group membership within their immediate work area. These groups seemed to represent sources of validation and esteem and enabled consultants to exercise control over their work. Many consultants, however, described a sense of detachment from their employing health boards. Management, as a salient target for social group identification, was perceived as associated with powerlessness and lack of respect. Interviewees generally viewed involvement in management with little enthusiasm and considerable caution. This paper shows that management approaches to hospital consultants could benefit from awareness that their social identity may already be under threat. Assaults on core professional values in the communication surrounding change are likely to provoke resistance. Existing work groups, with which consultants identify, could serve as a less threatening means to engage them with issues of cost and quality than externally imposed structures. This paper informs ways in which hospital consultants could be more successfully involved in health service management.

  11. A Fish out of Water? Management Consultants in Academia

    Science.gov (United States)

    Serrano-Velarde, Kathia

    2010-01-01

    What happens when management consultants enter the academic arena and offer their services to universities? In the following article, we examine this question by drawing on findings from a qualitative study based on a series of 30 interviews with senior management consultants and academic managers in Germany. The aim of this explorative study is,…

  12. 76 FR 81527 - Notice of Tribal Consultations; Schedule Update

    Science.gov (United States)

    2011-12-28

    ... From the Federal Register Online via the Government Publishing Office NATIONAL INDIAN GAMING COMMISSION Notice of Tribal Consultations; Schedule Update AGENCY: National Indian Gaming Commission. ACTION: Notice of tribal consultations; schedule update. Authority: E.O. 13175. SUMMARY: On November 18,...

  13. Participation in Written Government Consultations in Denmark and the UK

    DEFF Research Database (Denmark)

    Rasmussen, Anne

    2015-01-01

    5,000 responses to consultations in Denmark and the UK in the first half of 2008. It shows that participation is highly conditional upon system-and actor-level characteristics in practice. Our findings indicate that, even if liberal democracies have adopted similar procedures for actor consultation...

  14. Consultation in Bullying Prevention: An Elementary School Case Study

    Science.gov (United States)

    Morrow, Michael T.; Hooker, Steven D.; Cate, Rebecca Lynne

    2015-01-01

    This manuscript outlines a consultation with a public elementary school that was aimed at assessing and strengthening the school's antibullying programs. We gathered consultation data through interviews and observations and also reviewed existing program evaluation data. We evaluated these data in light of current research on bullying prevention…

  15. Reliability of consultation skills assessments using standardised versus real patients.

    NARCIS (Netherlands)

    Reinders, M.E.; Blankenstein, A.H.; Marwijk, H.W.J. van; Knol, D.L.; Ram, P.; Horst, H.E. van der; Vet, H.C. de; Vleuten, C.P.M. van der

    2011-01-01

    OBJECTIVES: Training in and assessment of consultation skills are high on the agenda of vocational training institutes for postgraduate training. There is a need to establish valid and reliable instruments to assess consultation skills in authentic settings. We investigated the number of assessors a

  16. 22 CFR 61.6 - Consultation with subject matter specialists.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Consultation with subject matter specialists... FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The Department may, in its discretion, solicit the opinion of subject matter specialists for the purpose...

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

    Science.gov (United States)

    Ibrahim, Farah A.

    2015-01-01

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

  18. A Model for Psychiatric Consultation in Systemic Therapy.

    Science.gov (United States)

    Griffith, James L.; And Others

    1991-01-01

    Discusses metaphors used to describe problems when family therapy and psychopharmacology are employed together. Identifies coupling metaphors that support both therapies as valid treatments and exclusionary metaphors that invalidate one approach. Presents consultation model for psychiatrists consulting to family therapists wherein the psychiatrist…

  19. A Grounded Theory Study of Supervision of Preservice Consultation Training

    Science.gov (United States)

    Newman, Daniel S.

    2012-01-01

    The purpose of this study was to explore a university-based supervision process for consultants-in-training (CITs) engaged in a preservice level consultation course with applied practicum experience. The study was approached from a constructivist worldview using a grounded theory methodology. Data consisted of supervision session transcripts,…

  20. Characteristics of children consulting for cough, sore throat, or earache

    NARCIS (Netherlands)

    J.H.J.M. Uijen (Hans); H.J. van Duijn (Huug); M.M. Kuyvenhoven (Marijke); F.G. Schellevis (François); J.C. van der Wouden (Hans)

    2008-01-01

    textabstractAbstract BACKGROUND: GPs are often consulted for respiratory tract symptoms in children. AIM: To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. DESIGN OF STUDY: Second Dutch National Survey o

  1. Characteristics of children consulting for cough, sore throat, or earache.

    NARCIS (Netherlands)

    Uijen, H.J.M.; Duijn, H.J. van; Kuyvenhoven, M.M.; Schellevis, F.G.; Wouden, J.C. van der

    2008-01-01

    BACKGROUND: GPs are often consulted for respiratory tract symptoms in children. AIM: To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. DESIGN OF STUDY: Second Dutch National Survey of General Practice (DN

  2. Characteristics of children consulting for cough, sore throat, or earache

    NARCIS (Netherlands)

    Uijen, Johannes H. J. M.; van Duijn, Huug J.; Kuyvenhoven, Marijke M.; Schellevis, Francois G.; van der Wouden, Johannes C.

    2008-01-01

    Background GPs are often consulted for respiratory tract symptoms in children. Aim To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. Design of study Second Dutch National Survey of General Practice (DNSGP

  3. Adoption of an integrated radiology reading room within a urologic oncology clinic: initial experience in facilitating clinician consultations.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Lepor, Herbert; Taneja, Samir S; Recht, Michael P

    2014-05-01

    The authors describe their initial experience in implementing an integrated radiology reading room within a urologic oncology clinic, including the frequency and nature of clinician consultations and the perceived impact on patient management by clinicians. A radiology reading room was established within an office-based urologic oncology clinic in proximity to the surgeon's work area. A radiologist was present in this reading room for a 3-hour shift each day. The frequency and nature of consultations during these shifts were recorded. Also, the clinic's staff completed a survey assessing perceptions of the impact of the integrated reading room on patient management. One hundred two consultations occurred during 57 included dates (average, 1.8 consultations per shift): 52% for review of external cases brought in by patients on discs, 43% for review of internal cases, and 5% for direct review by the radiologist of imaging with patients. The maximum number of consultations during a single shift was 8. All of the clinic's urologists indicated that >90% of consultations benefited patient care. The clinicians indicated tendencies to view consultations as affecting management in the majority of cases, to be more likely to seek consultation for outside imaging when the radiologist was on site, and to be less likely to repeat outside imaging when the radiologist was on site. The integrated reading room within the clinic has potential to improve the quality of care, for instance by facilitating increased review of outside imaging studies and thereby potentially reducing duplicate ordering and by enabling occasional direct image review with patients by radiologists. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  4. Telemedicine in plastic surgery: E-consult the attending surgeon.

    Science.gov (United States)

    Pap, Stephen A; Lach, Elliot; Upton, Joseph

    2002-08-01

    Telemedicine has evolved into a valuable but underused resource for the delivery of health care to patients at a distance, particularly where patient transport is impractical, expensive, complicated, and/or urgent. Today, over 250,000 telemedicine consults are generated annually, involving various specialties in both military and civilian health delivery systems. The ability to evaluate and triage plastic surgery patients through the use of telemedicine has not been widely explored. We have designed, developed, and tested a "store-and-forward" solution at UMass Memorial Hospital and Beth Israel Deaconess Hospital whereby the plastic surgery residents who responded to a consult request transmitted digital photographs by means of the Internet to the attending physician on call. The customary telephone call between resident and attending physician benefited from the additional photographic data, and patient management resulted in a clear, concise, and unambiguous treatment plan. The initial management suggested by the resident was modified on some occasions, particularly with complex problems. The use of digital images was especially helpful for evaluation of radiographs and complex wounds of the hand and face. The solution proved to be very valuable for both attending physicians and residents in plastic surgery. The photographs provide rich detail and resolution comparable to high-quality prints. The mechanics of obtaining images and the process of sending them electronically was readily mastered. Images reached their destination in only a few minutes over standard telephone lines. No problems were encountered while sending or viewing images on Macintosh or Windows platforms. Determining course of action with a complete clinical history now includes a level of visual detail previously not available. As this application expands into wider use, data integrity and safety will have to be more formally secured and monitored. Our model of telemedicine has broad

  5. Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

    Directory of Open Access Journals (Sweden)

    Erdem Hakan

    2011-12-01

    Full Text Available Abstract 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.

  6. Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

    Science.gov (United States)

    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

  7. Striking variations in consultation rates with general practice reveal family influence

    Directory of Open Access Journals (Sweden)

    Spreeuwenberg Peter

    2007-01-01

    Full Text Available Abstract Background The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21. Methods Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families. Results In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background. Conclusion Family

  8. How are European birth-cohort studies engaging and consulting with young cohort members?

    Science.gov (United States)

    Lucas, Patricia J; Allnock, Debra; Jessiman, Tricia

    2013-04-11

    Birth cohort studies, where parents consent for their child to be enrolled in a longitudinal study prior to or soon after birth, are a powerful study design in epidemiology and developmental research. Participation often continues into adulthood. Where participants are enrolled as infants, provision should be made for consent, consultation and involvement in study design as they age. This study aims to audit and describe the extent and types of consultation and engagement currently used in birth cohorts in Europe. Seventy study groups (representing 84 cohorts) were contacted to ask about their practice in engaging and involving study members. Information was gathered from study websites and publications, 15 cohorts provided additional information via email and 17 cohorts were interviewed over the phone. The cohorts identified confirm the growth of this study design, with more than half beginning since 1990, and 4 since 2011. Most studies maintain a website open to the general public, although many are written for the scientific community only. Five studies have web pages specifically for young cohort members and one study provides a dedicated page for fathers. Cohorts send newsletters, cards, and summaries of findings to participants to stay in touch. Six cohorts use Facebook for this purpose. Five cohorts provide feedback opportunities for participants after completing a round of data collection. We know of just 8 cohorts who have a mechanism for consulting with parents and 3 a mechanism for consulting with young people themselves, although these were 'one off' consultations for some groups. Barriers to further consultation with cohort members were: concerns about impact on quality of research, ethical constraints, resource limitations, lack of importance, and previous adverse experiences. Although the children in some of the cohorts are still young (born in the last 10 years) many are old enough to include some element of consultation. Barriers to greater

  9. Are patients' and doctors' accounts of the first specialist consultation for chronic back pain in agreement?

    Directory of Open Access Journals (Sweden)

    White KB

    2016-11-01

    Full Text Available Kathy B White,1 John Lee,2 Amanda C de C Williams3 1Central and North West London NHS Foundation Trust, 2School of Life and Medical Sciences, University College London, 3Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK Introduction: The first consultation at a specialist pain clinic is potentially a pivotal event in a patient’s pain history, affecting treatment adherence and engagement with longer term self-management. What doctors communicate to patients about their chronic pain and how patients interpret doctors’ messages and explanations in pain consultations are under-investigated, particularly in specialist care. Yet, patients value personalized information about their pain problem.Patients and methods: Sixteen patients in their first specialist pain clinic consultation and the doctors they consulted were interviewed shortly after the consultation. Framework analysis, using patient themes, was used to identify full match, partial match, or mismatch of patient–doctor dyads’ understandings of the consultation messages.Results: Patients and doctors agreed, mainly implicitly, that medical treatment aiming at pain relief was primary and little time was devoted to discussion of self-management. Clinically relevant areas of mismatch included the explanation of pain, the likelihood of medical treatments providing relief, the long-term treatment plan, and the extent to which patients were expected to be active in achieving treatment goals.Discussion: Overall, there appears to be reasonable concordance between doctors and patients, and patients were generally satisfied with their first consultation with a specialist. Two topics showed substantial mismatch, the estimated likely outcome of the next planned intervention and, assuming (as doctors but not patients did that this was unsuccessful, the long-term treatment plan. It appeared that more complex issues

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

    Science.gov (United States)

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

    2014-05-01

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

  11. Liberia_WADC00004_OHDR_Health_Facilities2010

    Data.gov (United States)

    United Nations Cartographic Section — This data is based on the survey questionnaire, which are included in the table belowWhat county is this facility in?What is the facility name?Is this facility a...

  12. Experimenting with Science Facility Design.

    Science.gov (United States)

    Butterfield, Eric

    1999-01-01

    Discusses the modern school science facility and how computers and teaching methods are changing their design. Issues include power, lighting, and space requirements; funding for planning; architect assessment; materials requirements for work surfaces; and classroom flexibility. (GR)

  13. Environmental Protection Agency (EPA) Facilities

    Data.gov (United States)

    Department of Homeland Security — This SEGS layer shows the names, locations and biographical information of EPA facilities in the U.S. and its territories. Included in this layer are headquarters...

  14. Nurse and allied health professional consultants: perceptions and experiences of the role.

    Science.gov (United States)

    Stevenson, Kay; Ryan, Sarah; Masterson, Abigail

    2011-02-01

    To explore the perceptions and experiences of nurse and allied health professional consultants and key stakeholders. Nurse and allied health professional consultants' roles were introduced in the United Kingdom in 1999 with defined role criteria and a remit to improve patient outcomes. Although these roles have now existed for over a decade, there is a lack of research as to whether these roles have achieved their intended impact on clinical care. Through an exploration of the experiences of consultant nurses and allied health professionals and key stakeholders who work with these practitioners, a greater understanding of the consultant role can be achieved. Qualitative. A purposive sample of seven non-medical consultants (five nurses, one physiotherapist and a pharmacist) and eight stakeholders took part in focus group interviews. Each focus group was audio-taped and lasted between 1.5-2 hours. Content analysis was used to interpret the data. Four main themes were identified: (1) Role interpretation--core features include clinical practice, leadership, education and research. Debate surrounded the need to incorporate managerial responsibilities into the role. (2) Role implementation required political skills and emotional intelligence. (3) Role impact especially on clinical practice was a major priority for both groups. (4) Challenges included lack of organisational and administrative support. There was consensus amongst the two groups regarding the value of the role, key role functions and skills and the emerging impact on clinical practice. Both groups were able to identify the clinical impact of the role including helping patients manage chronic pain, reducing the need for follow-up appointments and managing emergency admissions. To capture the clinical diversity of the roles, a variety of evaluation strategies should be implemented. © 2011 Blackwell Publishing Ltd.

  15. Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

    Directory of Open Access Journals (Sweden)

    Baum Erika

    2007-12-01

    Full Text Available Abstract Background Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM therapies little is known on the extent patients are actually using CAM for back pain. Methods This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months Results A total of 691 (51% respectively 928 (69% out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. Conclusion The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

  16. Education, consultation, guidance, students, advisor, teacher

    Directory of Open Access Journals (Sweden)

    M Seyedmajidi

    2013-09-01

    Full Text Available Introduction: Student counseling and supervision play an important role to overcome learning problems and to achieve educational goals. The present study is intended to investigate viewpoints of students regarding educational guidance and advice studying at Babol University of Medical Sciences. Methods: In this descriptive cross-sectional survey, viewpoints of 480 students were collected by a questionnaire. The validity and reliability of the questionnaire had been approved before. Data were analyzed using SPSS version 17 software. Chi- square and ANOVA tests were administered. Results: 61.2% of all participants were female and 38.8% were males with mean age of 21.3±4.0. 37.2% of these students lacked sufficient knowledge and information on how to request from their advisors for help and guidance. Half of students (50.3% reported attendance of advisors and holding routine consultation is inappropriate. Advisors made more educational files for females compare to males (P=0.001. No difference observed regarding educational disciplines of the advisors regarding students were dissatisfied with help and guidance received from paramedics and dentistry students in most fields (87.3% and 81.5% respectively. Conclusion: It seems that either student has no sufficient information about tasks of advisors and/or advisors may not do their tasks properly. It is recommended the students to be acquainted with advisors’ tasks upon their entrance into the university. Training classes for new academics would be helpful.

  17. CRITERIA FOR CONSULTANT AND ADVISOR IN THE BRAZILIAN POSTGRADUATE SYSTEM.

    Science.gov (United States)

    Petroianu, Andy

    2015-01-01

    To review the rules, resolutions and existing documents relating to consultant and advisor to better target the actions of those who exercise these roles. The following documents were consulted: Statute of CAPES, through Decree No. 7692 of March 2, 2012; Ordinance No. 47 of 17/10/1995; Opinion 977 1965 Newton Sucupira; Area Document of Medicine III; Interministerial Ordinance 251 of 2012, based on Decree No. 7642 of 2011 of the Ministry of Science and Technology; CAPES Regiment. The Brazilian Postgraduate system is divided in two different fields, according to its aspects: the "lato sensu" postgraduate, defined as all professional studies performed after the high school graduation; and the "stricto sensu" postgraduate that includes the master degree and the doctorate, both of them different from what is known as MSc or MS and PhD. The Brazilian doctorate is recognized as academic because its purposes include to improve the scientific and the teaching levels of university docents. The master degree has two different objectives one is to be academic and similar to the doctorate; the other is to upgrade professionals to a higher level than specialist or MBA and is denominated professional master degree. The master degrees and the doctorate are designated as courses and may be put together in a structure known as stricto sensu postgraduate program. The complexity of these courses and programs in all the areas of the superior human knowledge requires a large number of professional directly involved with this system and other professionals that attend them, called consultants and advisors. The consultants are counselors, and the advisors are assistants, both of them legally established with the incumbency to aid the postgraduate staff in all their duties. Nothing prevents a person from being a consultant on the situation and advisor on another, even in the same institution. Have knowledge about what being a consultant and advisor is required to exercise the function

  18. Optical modulator including grapene

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  19. Performance specifications for proton medical facility

    Energy Technology Data Exchange (ETDEWEB)

    Chu, W.T.; Staples, J.W.; Ludewigt, B.A.; Renner, T.R.; Singh, R.P.; Nyman, M.A.; Collier, J.M.; Daftari, I.K.; Petti, P.L.; Alonso, J.R. [Lawrence Berkeley Lab., CA (United States); Kubo, H.; Verhey, L.J. [University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine; Castro, J.R. [Lawrence Berkeley Lab., CA (United States)]|[University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine

    1993-03-01

    Performance specifications of technical components of a modern proton radiotherapy facility are presented. The technical items specified include: the accelerator; the beam transport system including rotating gantry; the treatment beamline systems including beam scattering, beam scanning, and dosimetric instrumentation; and an integrated treatment and accelerator control system. Also included are treatment ancillary facilities such as diagnostic tools, patient positioning and alignment devices, and treatment planning systems. The facility specified will accommodate beam scanning enabling the three-dimensional conformal therapy deliver .

  20. Orientation to pollution prevention for facility design

    Energy Technology Data Exchange (ETDEWEB)

    Raney, E.A.; Whitehead, J.K.; Encke, D.B. [Westinghouse Hanford Co., Richland, WA (United States); Dorsey, J.A. [Kaiser Engineers Hanford Co., Richland, WA (United States)

    1994-01-01

    This material was developed to assist engineers in incorporating pollution prevention into the design of new or modified facilities within the U.S. Department of Energy (DOE). The material demonstrates how the design of a facility can affect the generation of waste throughout a facility`s entire life and it offers guidance on how to prevent the generation of waste during design. Contents include: Orientation to pollution prevention for facility design training course booklet; Pollution prevention design guideline; Orientation to pollution prevention for facility design lesson plan; Training participant survey and pretest; and Training facilitator`s guide and schedule.

  1. Visual Impairment, Including Blindness

    Science.gov (United States)

    ... Who Knows What? Survey Item Bank Search for: Visual Impairment, Including Blindness Links updated, April 2017 En ... doesn’t wear his glasses. Back to top Visual Impairments in Children Vision is one of our ...

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

    Science.gov (United States)

    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.

  3. Facility Safety Plan B360 Complex CMLS-411r0

    Energy Technology Data Exchange (ETDEWEB)

    Cooper, G

    2007-01-08

    Lawrence Livermore National Laboratory's (LLNL) Environmental, Safety and Health (ES&H) policy is that all operations must be planned and performed safely for the protection of workers, the public, the environment, and limit possible loss to property, facilities and equipment assigned to this directorate. In addition to observing LLNL policies contained in the ''Environment, Safety, and Health (ES&H) Manual'', LLNL workers will comply with applicable federal, state, and local regulations when conducting any activity that the Chemistry, Materials and Life Sciences (CMLS) Directorate has managerial control or oversight. Management has determined that the safety controls specified within this Facility Safety Plan (FSP) must also be followed to ensure that the operation is successfully performed efficiently and safely within this facility. Any operations conducted in this Complex that involve activities not commonly performed by the public require an Integration Work Sheet (IWS) or IWS/Safety Plan (IWS/SP) that specifically assesses the responsibilities, hazards and controls to conduct the operation safely. Everyone who enters this area (including students, workers, visitors, and consultants) must follow the applicable requirements in this FSP. Each person is expected to protect himself/herself and others from injury or illness. Regular facility occupants are expected to guide and govern visitors and assist new or temporary occupants in understanding and following this plan. When there are any doubts regarding the safety of any phase of work, workers and others will check with the facility manager. Changes to this FSP will be approved by the Facility Associate Director (AD). This will undergo triennial review to establish, at a minimum, that its contents are appropriate and adequate for current operations. The Hazards Control ES&H Team assists management in instituting and maintaining a minimum-risk and environmentally sound work environment

  4. SCIENTIFIC-PROJECT CONSULTING AS AN INNOVATIVE FORMAT OF POSTGRADUATE EDUCATION

    Directory of Open Access Journals (Sweden)

    G. A. Ignatieva

    2017-01-01

    characterized. Scientific-project consulting as a backbone concept of model is defined as a specific innovative format of preparation of pedagogical and academic-teaching personnel capable to conscious design and transformation of own professional activity and education in general acts. Projecttransformative approach to implementation of analytical, organizational-administrative and scientific-methodical support of teachers concludes in the mechanism of realization of such consulting. The value of this format of additional professional education from the point of view of the joint practice-focused scientific search organization of the solution of problems in education system is shown. The forms of post-degree training which are most demanded within scientific and design consulting are described. Scientific novelty. In the field of pedagogical post-degree education consulting has not become a full standard rule yet. In general, educational consulting including development of techniques of management and planning of educational activity is applied to methodical maintenance of functioning and development of educational structures. Perspective scientific and project types of consulting in post-industrial society still have remained out-of-sight of a scientific pedagogical research. The authors of the present article make one of the first attempts on completion of this gap in the Russian education.Practical significance. Introduction of scientific-project consulting in the field of post-degree training of the top skills for the sphere education offers new opportunities of scientific-organizational and expert-consulting maintenance of innovative activity of members of an educational process.

  5. Dry Well Storage Facility conceptual design study

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    The Dry Well Storage Facility described is assumed to be located adjacent to or near a Spent Fuel Receiving and Packaging Facility and/or a Packaged Fuel Transfer Facility. Performance requirements, quality levels and codes and standards, schedule and methods of performance, special requirements, quality assurance program, and cost estimate are discussed. Appendices on major mechanical equipment and electric power requirements are included.

  6. 7 CFR 51.57 - Facilities.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Facilities. 51.57 Section 51.57 Agriculture... Requirements for Plants Operating Under Continuous Inspection on A Contract Basis § 51.57 Facilities. Each packing plant shall be equipped with adequate sanitary facilities and accommodations, including but not...

  7. 50 CFR 260.100 - Facilities.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Facilities. 260.100 Section 260.100... Basis 1 § 260.100 Facilities. Each official establishment shall be equipped with adequate sanitary facilities and accommodations, including, but not being limited to, the following: (a) Containers approved...

  8. 24 CFR 891.315 - Prohibited facilities.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Prohibited facilities. 891.315... Housing for Persons With Disabilities § 891.315 Prohibited facilities. This section shall apply to capital... facilities may not include infirmaries, nursing stations, spaces dedicated to the delivery of...

  9. 24 CFR 891.220 - Prohibited facilities.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Prohibited facilities. 891.220 Section 891.220 Housing and Urban Development Regulations Relating to Housing and Urban Development... Housing for the Elderly § 891.220 Prohibited facilities. Projects may not include facilities...

  10. Breast-cancer patients' participation behavior and coping during presurgical consultations: a pilot study.

    Science.gov (United States)

    Venetis, Maria K; Robinson, Jeffrey D; Kearney, Thomas

    2015-01-01

    In the context of breast-cancer care, there is extremely little research on the association between observed (i.e., taped and coded) communication behaviors and patients' health outcomes, especially those other than satisfaction. In the context of presurgical consultations between female breast cancer patients and a surgeon, the aim of this exploratory study was to test the association between communication-based participation behaviors and pre-post consultation changes in aspects of patients' mental adjustment to cancer (i.e., coping). Participants included 51 women newly diagnosed with breast cancer and a surgical oncologist from a National Cancer Institute (NCI)-designated cancer center in the northeastern United States. Outcomes were changes in patients' fighting spirit, helplessness/hopelessness, anxious preoccupation, cognitive avoidance, and fatalism (measured immediately before and after consultations via survey), and the main predictors were three communication-based participation behaviors coded from videotapes of consultations: patient question asking, patient assertion of treatment preferences, and surgeon solicitation of patient question/concern/opinion. Patients who more frequently asserted their treatment preferences experienced increases in their fighting spirit (p = .01) and decreases in their anxious preoccupation (p = .02). When companions (e.g., sister, spouse) asked more questions, patients experienced decreases in their anxious preoccupation (p = .05). These findings suggest that, in the present context, there may be specific, trainable communication behaviors, such as patients asserting their treatment preferences and companions asking questions, that may improve patients' psychosocial health outcomes.

  11. Structuring a written examination to assess ASBH health care ethics consultation core knowledge competencies.

    Science.gov (United States)

    White, Bruce D; Jankowski, Jane B; Shelton, Wayne N

    2014-01-01

    As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities (ASBH) has published core knowledge competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models-both objective and written-must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization.

  12. Effective follow-up consultations: the importance of patient-centered communication and shared decision making.

    Science.gov (United States)

    Brand, Paul L P; Stiggelbout, Anne M

    2013-12-01

    Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice.

  13. The Functional Model Approach to the Consulting for Vertically - Integrated Construction Group

    Directory of Open Access Journals (Sweden)

    Pimenova Anna

    2016-01-01

    Full Text Available Managerial decision making in the framework of functional modeling of the consulting process have a direct effect on other business - processes of vertically - integrated group of construction companies. As a result, the experience of consulting companies tends to be used for the making managerial solutions. Consultancy is known as one of the most complicated types of buisiness process. It requires a huge and deep examines and researches of targeting area, therefore need to be provided with special methodology, included internal standards of the consulting companies. Correct methodological support, planning process and implementation of managerial solutions should be based on the survey of the direct and inverse connections and interdependence of all group’s business – processes. Functional - process modeling of the vertically - integrated construction group could be considered as an instrument of examination and analysis of the issue how the managerial solution impact on the business-process for the construction group functioning. The main result of the research is the formalized process-oriented model – prototype of the business - processes of vertically - integrated group of construction companies.

  14. Parental knowledge in pediatric otolaryngology surgical consultations: A qualitative content analysis.

    Science.gov (United States)

    Gorodzinsky, Ayala Y; Hong, Paul; Chorney, Jill MacLaren

    2015-07-01

    To understand the source of parents' knowledge prior to and desire for further information following pediatric otolaryngology surgical consultations. Mixed-methods approach using descriptive and qualitative content analysis of interviews with parents following otolaryngology consultations for children under the age of 6 years was performed. The children were being seen for either tonsillitis, obstructive sleep apnea, otitis media, and/or sinusitis/nasal obstruction. Forty-one parents completed a phone interview two weeks following their child's surgical consultation. The majority of parents indicated that their primary care physician referred their child for either: investigation of symptoms (50%), to have a specific discussion about surgery (27.5%), or because other treatment options were no longer working (20%). Many parents (56.5%) indicated that the Internet was their primary source of information prior to the appointment. Most parents (93%) wanted more information; majority of these parents noted that a technology-based mode of delivery of information available prior to the appointment would be most desirable. Desired information was most often regarding the surgical procedure, including risks and benefits, and symptoms of concern prior to surgery. This study provides a description of parental knowledge and information sources prior to their child's surgical consultation and continued desire for information. This information may lead to decreased knowledge barriers and increased communication to facilitate shared decision-making between the provider and parents. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Knowledge Management Systems: A Comparison of Law Firms and Consulting Firms

    Directory of Open Access Journals (Sweden)

    Petter Gottschalk

    2000-01-01

    Full Text Available This paper reports results from a survey of Norwegian law firms on the use of information technology to support inter-organizational knowledge management. Two predictors of IT support were significant: firm cooperation and knowledge cooperation. Inter-organizational trust was not a significant predictor. Software and systems most frequently used include word processing, electronic mail and legal databases. It has been argued that law firms are old fashioned and not ready for extensive use of information technology. An impression is created that other professional service firms such as consulting firms are much more advanced. To evaluate the relative performance of law firms in the area of IT support for knowledge trans-fer an identical survey was conducted among a limited number of consulting firms in Norway. Survey results indicate that the average IT use in consulting firms was slightly higher than in law firms, but the most interesting differences were found in the different systems and software used rather than the level of IT use. Consulting firms are high-level users of general information sources on the Internet, while law firms are high-level users of structured information in databases.

  16. Efficacy of a high-resolution consultation system in gastroenterology at an Andalusian hospital center

    Directory of Open Access Journals (Sweden)

    José Luis Zambrana-García

    2016-01-01

    Full Text Available Background: By high resolution consultation (HRC we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established and recorded. Objective: To assess to which extent patients with digestive conditions may benefit from a single consultation system. Material: A descriptive study of 179 first visit events, randomly selected as high-resolution consultations in gastroenterology. We discuss the percentage of patients who benefited from HRC and the complementary tests performed. Results: Most common conditions included dyspepsia (16%, a family history of colon cancer (16% and gastroesophageal reflux disease (GERD (16%. Seventy-nine (44% of all first visits became HRCs and 80 (45% required a diagnostic test (100% abdominal ultrasound that was reviewed on the same day. Performing a test on the same day significantly increased the percentage of HRCs (57% vs. 34%, p < 0.002. GERD, dyspepsia, cholelithiasis and chronic liver disease were the subjects most commonly leading to HRC. Conclusions: Gastroenterology consultations may largely benefit from an HRC system with only organizational changes and no additional costs.

  17. Canastota Renewable Energy Facility Project

    Energy Technology Data Exchange (ETDEWEB)

    Blake, Jillian; Hunt, Allen

    2013-12-13

    The project was implemented at the Madison County Landfill located in the Town of Lincoln, Madison County, New York. Madison County has owned and operated the solid waste and recycling facilities at the Buyea Road site since 1974. At the onset of the project, the County owned and operated facilities there to include three separate landfills, a residential solid waste disposal and recycled material drop-off facility, a recycling facility and associated administrative, support and environmental control facilities. This putrescible waste undergoes anaerobic decomposition within the waste mass and generates landfill gas, which is approximately 50% methane. In order to recover this gas, the landfill was equipped with gas collection systems on both the east and west sides of Buyea Road which bring the gas to a central point for destruction. In order to derive a beneficial use from the collected landfill gases, the County decided to issue a Request for Proposals (RFP) for the future use of the generated gas.

  18. Automating radiologist workflow part 1: the digital consultation.

    Science.gov (United States)

    Reiner, Bruce

    2008-10-01

    With the widespread adoption of picture archiving and communication systems and filmless imaging, ubiquitous and instantaneous access to imaging data has resulted in decreased radiologist-clinician consultations. It is therefore imperative that the radiology community develop new communication strategies to improve both the timeliness and the perceived value of the radiology report. One strategy to accomplish this goal is the creation of electronic consultation tools, which can effectively recreate radiologist workflow and the identification of key pathologic findings in an easy-to-use, well-organized, and timely fashion. This would be accomplished by recording radiologist-computer interactions using an electronic auditing tool, storing these interactions in an extensible markup language schema, which can subsequently be played back at a later point in time to recreate the radiologist consultation. This approach has the added benefits of allowing the radiologist to selectively edit content to the needs of different clinician users, index the comprehensive consultation into pathology-specific components, and perform asynchronous bidirectional consultations. This electronic consultation tool would result in the creation of context and user-specific consultation files, which can in turn be integrated with clinical data from electronic medical records.

  19. Implementation of an Arranged Preventive Consultation in Danish General Practice

    DEFF Research Database (Denmark)

    Junge, Anne Gram; Kirkegaard, Pia; Thomsen, Janus Laust

    Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences with the arra...... interaction between the GP/nurse and the patient, and therefore the GPs/nurses can in some respects experience it as difficult to apply the theoretical guidelines of the new consultation to their daily work with the patients.......Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences...... with the arranged preventive consultation with focus on facilitators and barriers in the implementation of the consultation. Material & Method: Semi-structured interviews with 10 GPs and nurses in general practice. Results & Conclusions: Economically lucrative services are not an isolated motivation for the GPs...

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

    Science.gov (United States)

    Long, Jennifer; Long, Airdrie

    2012-01-01

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

  1. [Gerontopsychiatric problems in a consultation-liaison practice].

    Science.gov (United States)

    Gazdag, Gábor; Sebestyén, Gábor

    2005-09-01

    The most effective way for the diagnosing and the treatment of psychopathological symptoms appearing in non-psychiatric hospitalized patients is the utilization of consultation-liaison psychiatry. With the increasing number of the elderly patients, number of appearing gerontopsychiatric problems in consultation work is also growing. We have studied among the patients of a consultation-liaison service the problems which led to the psychiatric consultations, the diagnoses which were set up, the concomitant somatic disorders and the treatment recommendations. We have retrospectively studied the data of the patients in the consultation-liaison service of St. László Hospital. 77% of the consultations were asked from internal medicine. Most frequent reason of the requests were the presence of any psychiatric symptom, but unexplained somatic complains were also common. Gerontopsychiatric problems were most frequently associated to cardiovascular disorders. Demencia and delirium were the most frequent diagnoses. The rate of affective disorders was higher than reported in the literature. Consultations were most frequently asked for non-compliance in patients with demencia, and for unexplained somatic complain in affective disorders. Most frequent reason of psychiatric referrals was symptoms of delirium. Authors try to explain these results in accordance with the literature.

  2. Joining the team: ethics consultation at the Cleveland Clinic.

    Science.gov (United States)

    Agich, George J

    2003-12-01

    In this paper, I describe the development of ethics consultation services and their operation at the Cleveland Clinic; my own educational experiences and background and how I came to see the importance of setting and collaboration for successfully doing clinical ethics; the unique culture of the Cleveland Clinic and its influence on the ethics consultation services provided there; and, finally, the place of personal commitments and values on the conduct of ethics consultations. I stress the point that although philosophers (and perhaps other bioethicists without health professions training) are socialized and educated to do solitary work, successfully conducting ethics consultations requires relatively high levels of collaboration and cooperation that have not been sufficiently discussed. Although this paper is more a description than an analysis of the influence of institutional setting on ethics consultation, I would claim that attention to setting, either as the local scene of the consultation or the institutional and social framework, deserves more attention by bioethicists intent on understanding ethics consultation.

  3. Preventive health screenings and health consultations in primary care increase life expectancy without increasing costs

    DEFF Research Database (Denmark)

    Rasmussen, Susanne R; Thomsen, Janus Laust; Kilsmark, Janni

    2007-01-01

    accepted were randomized. Both intervention groups were offered a broad (multiphasic) screening including cardiovascular risk and a personal letter including screening results and advice on healthy living. Individuals in group A could contact their family physician for a normal consultation whereas group B......AIMS: The intention was to investigate whether preventive health checks and health discussions are cost effective. METHODS: In a randomized trial the authors compared two intervention groups (A and B) and one control group. In 1991 2,000 30- to 49-year-old persons were invited and those who...... were given fixed appointments for health consultations. The follow-up period was six years. Analysis was carried out on the "intention to treat" principle. Outcome parameters were life years gained, and direct and total health costs (including productivity costs), discounted by 3% annually. Costs were...

  4. Characteristics of children consulting for cough, sore throat, or earache

    Science.gov (United States)

    Uijen, Johannes HJM; van Duijn, Huug J; Kuyvenhoven, Marijke M; Schellevis, François G; van der Wouden, Johannes C

    2008-01-01

    Background GPs are often consulted for respiratory tract symptoms in children. Aim To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. Design of study Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. Setting Children aged 0–17 years registered with 122 GPs in Dutch general practice. Method Characteristics of patients and their GPs were derived from the DNSGP-2 health interview and a questionnaire, respectively. Characteristics of the illness symptoms and GP consultation were acquired by means of an additional questionnaire. Data were analysed using multivariate logistic regression. Results Of all children who completed the questionnaire, 550 reported cough, sore throat, or earache in the 2 weeks preceding the interview with 147 of them consulting their GP. Young children more frequently consulted the GP for respiratory symptoms, as did children with fever, longer duration of symptoms, those reporting their health to be ‘poor to good’, and living in an urban area. When parents were worried, and when a child or their parents were cued by someone else, the GP was also consulted more often. GP-related determinants were not associated with GP consultation by children. Conclusion This study emphasises the importance of establishing the reasons behind children with respiratory tract symptoms consulting their GP. When GPs are aware of possible determinants of the decision to consult a GP, more appropriate advice and reassurance can be given regarding these respiratory symptoms, which are generally self-limiting. PMID:18387228

  5. The Necessity and Strategy of Psychological Consultation of Life%生活化心理咨询的必要性及其对策

    Institute of Scientific and Technical Information of China (English)

    吴疆

    2011-01-01

    在社会竞争日益加剧的背景下,人们面临的生活压力也越来越大.因而推进生活化的心理咨询有其必然性,其策略主要包括心理咨询目标现实化、心理咨询内容生活化、心理咨询方式人性化和心理咨询途径开放化四个方面.%Under the background of fierce social competition, people face the increasing pressure. Thus, promoting psychological consultation of life is inevitable. The strategy mainly includes four aspects: the reality objective of psychological consultation; the life content of psychological consultation; the humanistic manner of psychological consultation; the open channel of psychological consultation.

  6. The role of marketing in the modern local consulting

    Directory of Open Access Journals (Sweden)

    Bezpalova Anna

    2016-02-01

    Full Text Available Modern market conditions are so complex and unstable that the marketing activity of the local consulting companies becomes virtually unpredictable, difficult to plan and control. Most consulting firms previously hold claims against their marketing and the current state of the market actually triggered the rejection and the transition to spontaneous economic activity. In the framework of the article the role of the of marketing in the current activity of local consulting companies is identified and its potential perspectives for the target audience are proved

  7. Standardization In The Field Of Management Consulting Services

    Directory of Open Access Journals (Sweden)

    Ciumara Tudor

    2009-12-01

    Full Text Available The EU recognizes the importance of management consultancy, part of the services sector. To facilitate the matching of management consulting services at European level, work is carried out to develop an industry standard, which is meant to become a best practice guide for providers of these services. The proposed standard has both clear advantages and disadvantages. It represents essentially a solution for reducing information asymmetry between providers of consultancy services and their customers, an alternative to the implementation of legal regulations.

  8. Writing effective consultation letters: 12 tips for teachers.

    Science.gov (United States)

    Keely, Erin; Dojeiji, Suzan; Myers, Kathryn

    2002-11-01

    Written correspondence is the standard mode of communication between healthcare providers. Despite the importance of this skill and increased emphasis on ambulatory care, communication skills and professionalism in training programs, there has been very little written on the teaching and evaluation of consultation letter writing. Consultation letter writing is an essential skill that cannot be learned simply by reading others' letters and should be taught in a formal manner. This article describes the authors' experience in teaching the skill of writing effective consultation letters to residents and describes strategies for evaluating this skill.

  9. Ethics in independent nurse consulting: strategies for avoiding ethical quicksand.

    Science.gov (United States)

    Creel, Eileen L; Robinson, Jennifer C

    2010-11-01

    Changes in health care have created a variety of new roles and opportunities for nurses in advanced practice. One of these changes is the increasing number of advanced practice nurses carrying out independent consultation. Differences in goals between business and health care may create ethical dilemmas for nurse consultants. The purpose of this article is to describe possible ethical pitfalls that nurse consultants may encounter and strategies to prevent or solve these dilemmas. Three themes related to nursing codes of ethics will be discussed: the duty to uphold human rights, the duty to fulfill commitments, and the duty to practice the profession competently.

  10. Sport psychology group consultation using social networking web sites.

    Science.gov (United States)

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

    2012-08-01

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

  11. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

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

    2017-01-01

    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...

  12. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    2016-01-01

    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...

  13. Teaching medical students consultation skills using e-learning

    DEFF Research Database (Denmark)

    Jørgensen, Merete; Witt, Klaus; Fridorff-Jens, Peter Kindt

    2015-01-01

    Teaching consultation skills to medical students using e-learning. Introduction: We have been teaching Family Medicine at the University of Copenhagen for more than twenty years. We wish to develop a method to evaluate the current teaching of consultation skills and the effect of new interventions...... general practice consultations. 1. Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB. The patient-centred clinical method. A model for the doctor-patient interaction in family medicine. Fam Pract. 1986 Mar; 3(1):24-30. 2. Warnecke E, Pearson S. Medical students' perceptions of using e-learning...

  14. [Remote Slit Lamp Microscope Consultation System Based on Web].

    Science.gov (United States)

    Chen, Junfa; Zhuo, Yong; Liu, Zuguo; Chen, Yanping

    2015-11-01

    To realize the remote operation of the slit lamp microscope for department of ophthalmology consultation, and visual display the real-time status of remote slit lamp microscope, a remote slit lamp microscope consultation system based on B/S structure is designed and implemented. Through framing the slit lamp microscope on the website system, the realtime acquisition and transmission of remote control and image data is realized. The three dimensional model of the slit lamp microscope is established and rendered on the web by using WebGL technology. The practical application results can well show the real-time interactive of the remote consultation system.

  15. 76 FR 30396 - Deloitte Financial Advisory Services LLP, Real Estate Consulting, Houston, TX; Amended...

    Science.gov (United States)

    2011-05-25

    ... Financial Advisory Services LLP, Real Estate Consulting, Houston, TX; Amended Certification Regarding... of Deloitte Financial Advisory Services LLP, Real Estate Consulting, Houston, Texas (subject firm... Financial Advisory Services LLP, Real Estate Consulting, Houston, Texas who were adversely affected by a...

  16. Pressurized burner test facility

    Energy Technology Data Exchange (ETDEWEB)

    Maloney, D.J.; Norton, T.S.; Hadley, M.A.

    1993-09-01

    The US Department of Energy`s METC has recently completed construction and commissioning of a new high-pressure combustion research facility. Utilities servicing the facility enable combustion tests at scales up to 3 MW (10 MM Btu/h) and pressures in excess of 3000 kPa (30 atm). These include a preheated, high-pressure air supply that can deliver up to 1.7 kg/s (3.7 lbs/s) of combustion air, and a high-pressure, natural gas compressor that can deliver 0.8 kg/s (.19 lbs/s). In the summer of 1994 METC`s syngas generator is scheduled to come on line, at which time combustion tests on a range of fuel gases from low to medium to high heating values will be possible. The syngas generator will simulate a range of fuel gas compositions characteristic of coal gasification product streams. As part of the combustion facility, a high-pressure burner test facility is currently being constructed to support the development of gas turbine combustion systems fired on natural gas and coal-derived gaseous fuels containing fuel-bound nitrogen. The facility, illustrated in Figure 1, is a 61-centimeter (24-inch) diameter, refractory-lined vessel of modular construction, offering the flexibility to test a variety of NO{sub x} control concepts. Burner test modules are sandwiched between gas inlet and sampling plenums with a maximum combustion test zone of 2.2 m (90 inches) in length. Modules are custom designed for specific burners.

  17. Database for the registration of radiological surveillance in radioactive facilities of CIEMAT; Base de datos para el registro de vigilancias radiologicas en las instalaciones radiactivas del CIEMAT

    Energy Technology Data Exchange (ETDEWEB)

    Marquez Fernandez, J. L.; Carroza Garcia, J. A.; Perez-Cejuela, P.; Vico Ocon, A.; Alvarez Garcia, A.

    2013-07-01

    In the CIEMAT There are 21 Radiation Facilities in which according to the Radiation Protection Manual must considered radiation hazards and / or contamination. The Radiological Protection Service according to this risk It establishes the classification and marking of areas and a monitoring plan that includes the type and extent of radiological periodicity. The information derived from this monitoring be registered and properly stored. Therefore, it has been completed the design of an application that allows technical experts record their actions and also consult records radiation monitoring tasks performed. (Author)

  18. Test facilities for VINCI®

    Science.gov (United States)

    Greuel, Dirk; Schäfer, Klaus; Schlechtriem, Stefan

    2013-09-01

    With the replacement of the current upper-stage ESC-A of the Ariane 5 launcher by an enhanced cryogenic upper-stage, ESA's Ariane 5 Midterm Evolution (A5-ME) program aims to raise the launcher's payload capacity in geostationary transfer orbit from 10 to 12 tons, an increase of 20 %. Increasing the in-orbit delivery capability of the A5-ME launcher requires a versatile, high-performance, evolved cryogenic upper-stage engine suitable for delivering multiple payloads to all kinds of orbits, ranging from low earth orbit to geostationary transfer orbit with increased perigee. In order to meet these requirements the re-ignitable liquid oxygen/liquid hydrogen expander cycle engine VINCI® currently under development is designated to power the future upper stage, featuring a design performance of 180 kN of thrust and 464 s of specific impulse. Since 2010 development tests for the VINCI® engine have been conducted at the test benches P3.2 and P4.1 at DLR test site in Lampoldshausen under the ESA A5-ME program. For the VINCI® combustion chamber development the P3.2 test facility is used, which is the only European thrust chamber test facility. Originally erected for the development of the thrust chamber of the Vulcain engine, in 2003 the test facility was modified that today it is able to simulate vacuum conditions for the ignition and startup of the VINCI® combustion chamber. To maintain the test operations under vacuum conditions over an entire mission life of the VINCI® engine, including re-ignition following long and short coasting phases, between 2000 and 2005 the test facility P4.1 was completely rebuilt into a new high-altitude simulation facility. During the past two P4.1 test campaigns in 2010 and 2011 a series of important milestones were reached in the development of the VINCI® engine. In preparation for future activities within the frame of ESA's A5-ME program DLR has already started the engineering of a stage test facility for the prospective upper stage

  19. Prisons and Correctional Facilities, The featured data collection is the USGS-LAGIC Coastal Parishes Structures Project. This ongoing project was started in 2009 with the intent to map critical infrastructure in the Coastal Zone. The initial four parishes included Lafourche, Plaquemine, St. , Published in 2011, 1:24000 (1in=2000ft) scale, Louisiana Geographic Information Center.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Prisons and Correctional Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Orthoimagery information as of 2011. It...

  20. North Slope, Alaska ESI: FACILITY (Facility Points)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains data for oil field facilities for the North Slope of Alaska. Vector points in this data set represent oil field facility locations. This data...

  1. Analytic device including nanostructures

    KAUST Repository

    Di Fabrizio, Enzo M.

    2015-07-02

    A device for detecting an analyte in a sample comprising: an array including a plurality of pixels, each pixel including a nanochain comprising: a first nanostructure, a second nanostructure, and a third nanostructure, wherein size of the first nanostructure is larger than that of the second nanostructure, and size of the second nanostructure is larger than that of the third nanostructure, and wherein the first nanostructure, the second nanostructure, and the third nanostructure are positioned on a substrate such that when the nanochain is excited by an energy, an optical field between the second nanostructure and the third nanostructure is stronger than an optical field between the first nanostructure and the second nanostructure, wherein the array is configured to receive a sample; and a detector arranged to collect spectral data from a plurality of pixels of the array.

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

    Science.gov (United States)

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

    2014-04-01

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

  3. NRC Consultation and Monitoring at the Savannah River Site: Focusing Reviews of Two Different Disposal Actions - 12181

    Energy Technology Data Exchange (ETDEWEB)

    Ridge, A. Christianne; Barr, Cynthia S.; Pinkston, Karen E.; Parks, Leah S.; Grossman, Christopher J.; Alexander, George W. [U.S. Nuclear Regulatory Commission (United States)

    2012-07-01

    Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA) requires the U.S. Department of Energy (DOE) to consult with the U.S. Nuclear Regulatory Commission (NRC) for certain non-high level waste determinations. The NDAA also requires NRC to monitor DOE's disposal actions related to those determinations. In Fiscal Year 2011, the NRC staff reviewed DOE performance assessments for tank closure at the F-Tank Farm (FTF) Facility and salt waste disposal at the Saltstone Disposal Facility (SDF) at the Savannah River Site (SRS) as part of consultation and monitoring, respectively. Differences in inventories, waste forms, and key barriers led to different areas of focus in the NRC reviews of these two activities at the SRS. Because of the key role of chemically reducing grouts in both applications, the evaluation of chemical barriers was significant to both reviews. However, radionuclide solubility in precipitated metal oxides is expected to play a significant role in FTF performance whereas release of several key radionuclides from the SDF is controlled by sorption or precipitation within the cementitious wasteform itself. Similarly, both reviews included an evaluation of physical barriers to flow, but differences in the physical configurations of the waste led to differences in the reviews. For example, NRC's review of the FTF focused on the modeled degradation of carbon steel tank liners while the staff's review of the SDF performance included a detailed evaluation of the physical degradation of the saltstone wasteform and infiltration-limiting closure cap. Because of the long time periods considered (i.e., tens of thousands of years), the NRC reviews of both facilities included detailed evaluation of the engineered chemical and physical barriers. The NRC staff reviews of residual waste disposal in the FTF and salt waste disposal in the SDF focused on physical barriers to flow and chemical barriers to

  4. Hospital Palliative Care Teams and Post-Acute Care in Nursing Facilities: An Integrative Review.

    Science.gov (United States)

    Carpenter, Joan G

    2017-01-01

    Although palliative care consultation teams are common in U.S. hospitals, follow up and outcomes of consultations for frail older adults discharged to nursing facilities are unclear. To summarize and critique research on the care of patients discharged to nursing facilities following a hospital-based palliative care consult, a systematic search of PubMed, CINAHL, Ageline, and PsycINFO was conducted in February 2016. Data from the articles (N = 12) were abstracted and analyzed. The results of 12 articles reflecting research conducted in five countries are presented in narrative form. Two studies focused on nurse perceptions only, three described patient/family/caregiver experiences and needs, and seven described patient-focused outcomes. Collectively, these articles demonstrate that disruption in palliative care service on hospital discharge and nursing facility admission may result in high symptom burden, poor communication, and inadequate coordination of care. High mortality was also noted. [Res Gerontol Nurs. 2017; 10(1):25-34.].

  5. Saltstone studies using the scaled continuous processing facility

    Energy Technology Data Exchange (ETDEWEB)

    Fowley, M. D. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Cozzi, A. D. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Hansen, E. K. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2015-08-01

    The Savannah River National Laboratory (SRNL) has supported the Saltstone Facility since its conception with bench-scale laboratory experiments, mid-scale testing at vendor facilities, and consultations and testing at the Saltstone Facility. There have been minimal opportunities for the measurement of rheological properties of the grout slurry at the Saltstone Production Facility (SPF); thus, the Scaled Continuous Processing Facility (SCPF), constructed to provide processing data related to mixing, transfer, and other operations conducted in the SPF, is the most representative process data for determining the expected rheological properties in the SPF. These results can be used to verify the laboratory scale experiments that support the SPF using conventional mixing processes that appropriately represent the shear imparted to the slurry in the SPF.

  6. Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

    Directory of Open Access Journals (Sweden)

    Kemmy Julie

    2011-08-01

    Full Text Available Abstract Background Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences. Methods A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5. 2519 questionnaires were returned in total. Results Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session: • how to structure the consultation • importance of patient-centredness • aspects of professionalism (including recognising own limits, being prepared, generally acting professionally. All years also noted that the sessions had increased their confidence, particularly through practice. Conclusions Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism.

  7. The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

    Directory of Open Access Journals (Sweden)

    Gu NY

    2008-12-01

    Full Text Available There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010. However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010 after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus

  8. The purpose of the general practice consultation from the patients perspective - theoretical aspects

    DEFF Research Database (Denmark)

    Thorsen, Hanne; Witt, Klaus; Malterud, Kirsti

    2001-01-01

    Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness......Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness...

  9. Telehone consultations: At the emergency service, Copenhagen County: Analysis of doctor-patient communication patterns

    DEFF Research Database (Denmark)

    Larsen, Jan-Helge; Risør, Ole

    1997-01-01

    Communications patterns, emergency service, out-of-hours service, telehpone consultations, video-supervision......Communications patterns, emergency service, out-of-hours service, telehpone consultations, video-supervision...

  10. Jupiter Laser Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Jupiter Laser Facility is an institutional user facility in the Physical and Life Sciences Directorate at LLNL. The facility is designed to provide a high degree...

  11. Basic Research Firing Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Basic Research Firing Facility is an indoor ballistic test facility that has recently transitioned from a customer-based facility to a dedicated basic research...

  12. Inconsistency of residents' communication performance in challenging consultations

    NARCIS (Netherlands)

    Wouda, Jan C.; van de Wiel, Harry B. M.

    2013-01-01

    Objective: Communication performance inaonsistency between consultations is usually regarded as a measurement error that jeopardizes the reliability of assessments. However, inconsistency is an important phenomenon, since it indicates that physicians' communication may be below standard in some cons

  13. A Qualitative Study of Televideo Consultations for COPD Patients

    DEFF Research Database (Denmark)

    Mathar, Helle; Fastholm, Pernille; Sandholm Larsen, Niels

    2015-01-01

    . In public the expectations are high that digital mediation between clients' everyday lives and the health care system can strengthen patients' abilities regarding their self-management. Nonetheless, the study shows that patients have a number of reservations concerning televideo consultations at home......This article presents results from a small qualitative study investigating COPD patients' experiences with televideo consultations at home as a supplement to conventional control and treatment. The research question is: what are the experiences and preferences of COPD patients related to discharge...... from hospital with televideo consultations? The study shows that the patients' assessments of the effectiveness and value of the televideo consultations in their everyday lives are based on tough cost-benefit calculation of the extent to which the intervention makes their lives easier or more difficult...

  14. Mutual construction and reconstruction in client-consultant interaction

    DEFF Research Database (Denmark)

    Smith, Irene Skovgaard

    struggles over position, power and control. In the context of client-consultant interaction, it is thus not only ideas and solutions that are contested but also the power to define. Attention is paid to how ideas are brought into play and negotiated in the interaction between actors. The empirical material......Based on preliminary interviews with client representatives and a pilot case study, the pa-per explores collaboration and mutual construction in client-consultant relationships. Both consultants and client actors take part in an active construction and reconstruction of knowledge that involve...... presented in the paper illustrates how consultancy projects evolve through processes of negotiation over whose interpretation should count and who should be in control. In the process, client actors with different posi-tions and interests play an active role in creating what become valid and what ideas...

  15. The role of assessment packages for diagnostic consultations

    DEFF Research Database (Denmark)

    Rossen, Camilla B; Buus, Niels; Stenager, Egon

    2015-01-01

    and content. Assessment packages are widely used in an increasing number of medical specialities; however, there is a lack of knowledge about how packaged assessment influences the interaction between doctor and patient. In this study, we investigate the final consultation in assessment packages, which......This article reports a conversation analysis of assessment package consultations. Healthcare delivery packages belong to a highly structured mode of healthcare delivery, in which specific courses of healthcare interventions related to assessment and treatment are predefined, both as to timing...... is when the final clarification of the patient's symptoms takes place. The primary data of the study were eight audio recordings of consultations, and the secondary data were ethnographic field descriptions. In most consultations, packaged assessment was a resource as it provided fast and efficient...

  16. MARKETING CONSULTANCY IN AGROTOURISM ALONG THE ROMANIAN WEB SITES

    Directory of Open Access Journals (Sweden)

    NEGRUŢ CONSTANTIN

    2012-05-01

    Full Text Available This study assumed that the interest in agrotourism was increased in the last years of financial crisis. This paper is the result of Internet searches aimed at finding specialized companies and useful in agrotourism marketing and consulting.

  17. CERN's IT Consultancy Team: a new IT project support service

    CERN Multimedia

    Ignacio Reguero, IT Department

    2016-01-01

    Newly created IT Consultancy Team provides advice on IT matters to communities at CERN starting new projects or reviewing computing activities of old.   The members of CERN's IT Consultancy Team. The consultants share their knowledge and experience to improve awareness of the IT landscape at CERN and to advise on system architecture and design to ensure best usage of existing IT services and solutions that favour, and are compatible with, the infrastructure already in place. They also help to formalise requirements and assess impact on security, software licenses and cost, especially where contacts among different services are needed and questions go beyond the current computing service offerings. For instance, the IT consultants may help answering questions like the ones below: We are starting with project X – how could we make its computing aspects compatible with the CERN IT infrastructure? E.g. if you need a web content management system favour Drupal instead of Wor...

  18. Inpatient consultations to an orthopaedic service: the hidden workload.

    LENUS (Irish Health Repository)

    O'Malley, N T

    2011-12-01

    While the quality and efficiency of out-patient orthopaedic referrals are well documented in the literature, there is little on the standard and appropriateness of inpatient orthopaedic consultations.

  19. Contribution of respiratory pathogens to influenza-like illness consultations.

    Science.gov (United States)

    Bollaerts, K; Antoine, J; Van Casteren, V; Ducoffre, G; Hens, N; Quoilin, S

    2013-10-01

    Influenza-like illnesses (ILIs) are caused by several respiratory pathogens. These pathogens show weak to strong seasonal activity implying seasonality in ILI consultations. In this paper, the contribution of pathogens to seasonality of ILI consultations was statistically modelled. Virological count data were first smoothed using modulation models for seasonal time series. Second, Poisson regression was used regressing ILI consultation counts on the smoothed time series. Using ratios of the estimated regression parameters, relative measures of the underreporting of pathogens were obtained. Influenza viruses A and B, parainfluenza virus and respiratory syncytial virus (RSV) significantly contributed to explain the seasonal variation in ILI consultations. We also found that RSV was the least and influenza virus A is the most underreported pathogen in Belgian laboratory surveillance. The proposed methods and results are helpful in interpreting the data of clinical and laboratory surveillance, which are the essential parts of influenza surveillance.

  20. Consultation letters for medically unexplained physical symptoms in primary care

    NARCIS (Netherlands)

    Hoedeman, Rob; Blankenstein, Annette H.; van der Feltz-Cornelis, Christina M.; Krol, Boudien; Stewart, Roy; Groothoff, Johan W.; van der Feltz-Cornelis, CM

    2010-01-01

    Background In primary care between 10% and 35% of all visits concern patients with medically unexplained physical symptoms (MUPS). MUPS are associated with high medical consumption, significant disabilities and psychiatricmorbidity. Objectives To assess the effectiveness of consultation letters (CLs