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1
Aldarrak, K. A. "An evaluation of the Saudi referral system." Thesis, Swansea University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.635741.
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This thesis started with the assumption that there are major defects in the Saudi referral system between GPs and specialists in hospitals. An ideal referral system was created from different resources in order to compare it with the Saudi one. In a latter stage of this research, it became apparent that these defects were only symptoms of the defects in the whole Saudi PHC system. Four different research methods were used to measure how close the ideal the Saudi referral system was, namely; questionnaires, interviewees, field observation and triangulation (city, town and village). The data gathered from GP, specialists and MOH officials indicated that the Saudi referral system is very far from ideal, (only 33.86%). There is a lot of work to be done in areas like communication between GPs and specialists, but more particularly with the nature of the PHC system including the availability of financial resources allocated to the system. Some of these problems have nothing to do with the MOH, but rather with the basic infrastructure in Saudi Arabia.
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Mo, Wentao. "A Referral-Based Recommender System for E-commerce." NCSU, 2001. http://www.lib.ncsu.edu/theses/available/etd-20010621-231234.
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WENTAO MO. A Referral-Based Recommender System for E-Commerce (Under the direction of Dr. Munindar P. Singh).The thesis is intended to develop the technology and infrastructure to allow people to share knowledge with and learn from each other. A special kind of multiagent system, called multiagent referral system (MARS), is proposed. In MARS, each user is assigned a software agent, and software agents help automate the process of expertise location by a series of ?referral chains.? Unlike most previous approaches, our architecture is totally distributed and preserves the privacy and autonomy of their users. These agents learn models of each other in terms of expertise (ability to produce correct domain answers), and sociability (ability to produce accurate referrals).
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Cruz, Melissa M. "A statewide comparative study of enhanced referral services given to teenage mothers offered by the Illinois child care resource and referral system through the teen parent initiative program and the non-enhanced referral services given to teenage mothers offered by the Illinois child care resource and referral system /." View online, 1996. http://repository.eiu.edu/theses/docs/32211131391450.pdf.
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Olupot-Olupot, Peter. "Evaluation of Antiretroviral Therapy Information System In Mbale Regional Referral Hospital, Uganda." Thesis, University of the Western Cape, 2008. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7320_1272589584.
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HIV/AIDS is the largest and most serious global epidemic in the recent times. To date, the epidemic has affected approximately 40 million people (range 33 &ndash
46 million) of whom 67%, that is, an estimated 27 million people are in the Sub Saharan Africa. The Sub Saharan Africa is also reported to have the highest regional prevalence of 7.2% compared to an average of 2% in other regions. A medical cure for HIV/AIDS remains elusive but use of antiretroviral therapy (ART) has resulted in improvement of quality and quantity of life as evidenced by the reduction of mortality and morbidity associated with the infection, hence longer and good quality life for HIV/AIDS patients on ART.
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Khunga, Helen. "Factors affecting detection and referral of malnourished children to Primary Health Care (PHC) level in Kanchele community of Kalomo District, Zambia." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4508.
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Magister Public Health - MPHBackground: Malnutrition in children under the age of 5 years is a global public Health problem. The UNICEF report states that 10.9 million children under five die in developing countries each year due to malnutrition. According to the Zambia Demographic and Health Survey of 2008 malnutrition is one of the main childhood illnesses in Zambia with almost 50% of the under five children being stunted. The referral system in Zambia is organized in a way that starts at the Primary Health Care (PHC) level within the community and managed by the Community Health Workers (CHW). At this level, Community Health Workers screen and identify children that have childhood illnesses which require treatment and they refer them to the Rural Health Centre (RHC). When the problem cannot be handled at the RHC level the child is referred to the district hospital or provincial hospital level within a particular province. However, most children with malnutrition arrive late at the hospital for treatment. Some of them die soon after admission. It was not clear what prevent the mothers from bringing these children early to the hospital for treatment. Methods: The main aim of the study was to explore factors that are associated with detection and referral of malnourished children from Primary Health Care (PHC) at community level to the Health centres in Kalomo district. The study was conducted in Kanchele community of Kalomo in Southern Province of Zambia. Kanchele is a rural community with most basic services such as health facilities not being easily accessed. The study focused on two PHCs which had the highest prevalence of malnutrition. All participants were asked to sign a consent form after the purpose of study had been explained to them. They were informed that all information would be treated with confidentiality and that participation was voluntary and that they had the right to chose not to participate in the study. Furthermore each participant was asked if they agreed to maintain the confidentiality of the information discussed by participants and researchers during the focus group session. The study was qualitative in nature and focus group discussions were conducted with mothers or caregivers of children under five years, community members who have lived in the community for more than one year and community health workers who have also worked in the community for more than one year. Focus group discussions were used to collect data from mothers and community members. While in-depth interviews were used to collect data from CHWs and nutrition group leaders working at the PHC and community leaders. The data collected from the focus group discussions was analysed using thematic approach. Barriers or hindrances to rehabilitating a malnourished child mentioned by the respondents included lack of knowledge on malnutrition, failure to link malnutrition to poor feeding and bad health seeking habits, poor response to referral as a result of a system which is not supported with adequate resource such as transport, a system that does not support parents with food in-case of the child being hospitalised, the current hospital system only provides food to the patient. The failure by health staff to see that malnutrition is a key childhood disease. Data from this study will be used to develop interventions to improve the management of malnourished children. Conclusion: The study shows that mothers and community members are misinformed about the causes and treatment of malnutrition. It also clearly showed that traditional healers and grandparents played an important role in the diagnosis and treatment of malnourished children in this community. Interventions to improve identification and referral of these malnourished children needs to taken into consideration.
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Lim, Jung-Eun Jane. "THE EFFECTIVENESS OF THE MATERNAL REFERRAL SYSTEM IN DECREASING MATERNAL MORTALITY: A CROSS-CULTURAL ANALYSIS." Thesis, The University of Arizona, 2009. http://hdl.handle.net/10150/192533.
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Lemon, Stephen C. "Developing a school-based referral system: comparison of factors cited by school counselors and therapists." Thesis, Virginia Tech, 1987. http://hdl.handle.net/10919/45781.
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When school-based behavior problems are not solvable in short-term school
counseling, referrals are often made to community therapists. The school-based
referral process is described in the literature as an informal process aimed at
matching clientsâ needs with therapist skills but the literature also suggests that
the referral process is based even more so on the relationship of the school
counselor to the therapist. A survey of 19 school counselors was conducted to
measure the importance of six factors identified in a pilot study that are used in
selecting a referral source; Therapist Accessibility, Therapist Commitment to
School, Therapist Philosophy and Belief System, Therapist Reputation, and
Therapist Credentials. In addition, 19 community-based therapists were
surveyed to measure their ranking of these same factors. When the scores were
analyzed it was found that school counselors rated two scales, Therapist
Accessibility and Therapist Reputation, significantly higher than did therapists.
Surprisingly, Therapist Reputation was rated least important by both groups.
This research has the potential to help strengthen the engagement between the
school system and the mental health system by first identifying the factors used
for school-based referrals and then identifying the differences in how the two
systems perceive the importance of these factors.
Master of Science
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Campbell, Erica Basora. "The nurse's role in postpartum depression assessment, education and referral for women and their support system." Honors in the Major Thesis, University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1376.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
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Mwondela, Malala. "An exploration of the strengths and weaknesses of the referral and counter-referral system for maternal and neonatal health services between primary level health facilities and a tertiary hospital in Lusaka, Zambia." University of the Western Cape, 2017. http://hdl.handle.net/11394/5476.
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Master of Public Health - MPHIntroduction: Despite the progress that Zambia has made in reducing its maternal mortality ratio from 649 to 398 per 100,000 live births between 1996 and 2013/14, the country did not meet the Millennium Development Goal 5a target, of reducing the maternal mortality ratio by 75% (i.e. to a ratio of 162 per 100,000 live births) by the end of 2015. Thus, as is the case with many other countries, considerable challenges still remain in relation to reducing maternal mortality in Zambia. According to Zambia's Roadmap for Accelerating Reduction of Maternal, Newborn and Child Mortality (2013-2016), the continuum of care for reproductive and maternal, newborn, and child health includes integrated service delivery for mothers and children across these various time periods, and also across place: within the home, the community, and in health facilities. In this regard, a referral system plays a key role in linking the various levels at which care is provided, and the different types of services offered at these levels. In the urban district of Lusaka, Zambia, all complicated pregnancy-related cases received by health centres or clinics are referred to either Levy Mwanawasa General Hospital, or the University Teaching Hospital. However, it appears that at present those working at the primary level of care, who make such referrals up to these higher levels of care, receive no feedback on the outcome of their referrals; there are also few counter-referrals to the respective clinics in the district. With limited communication to the primary level of care, and with no formal handover of patients back to the clinics by the tertiary level institutions, it is difficult to ensure that the required continuum of care for the referred mothers and their children, post-delivery, has been established within the district. This explorative study aimed therefore to identify the strengths and weaknesses of the maternity-related referral system currently operating between primary and tertiary levels of health care in the district, and to consider how the system might be strengthened so as to support a stronger continuum of care with respect to maternal and neonatal health. Methods: Using a descriptive qualitative research approach, stakeholders involved in the planning, delivery and/or oversight of maternal and neonatal health services in the district were purposively sampled and asked to voluntarily participate in the study. Prior to all the interviews, after being informed about the study, and receiving information sheets to read through, participants were required to give informed consent. Their experiences and opinions regarding referrals and counter-referrals were collected through a series of 23 individual, semi-structured interviews. A Thematic Analysis approach was used to analyse data in this study. Ethics approval was first obtained from the Senate Research Committee, University of the Western Cape and thereafter from the Excellence in Research Ethics and Science Converge Ethical Review Board in Zambia, before proceeding with the study. Clearance was also obtained from the Ministry of Health, the Lusaka District Health Management Team and the University Teaching Hospital to facilitate entry into the health facilities. Findings: The study found that, in practice, the referral system for maternity and neonatal health does exist and is generally – but not optimally - functional in the Lusaka District. However, challenges were noted that included the fact that the district’s maternity referral system has not been revised since it was first developed in the 1980s and is not available in a comprehensive set of guidelines or standard operational procedures which explicitly outline the reasons for referral and the related referral steps and mechanisms. In addition, the referral forms currently in use in the district have not been standardised and appear to be inconsistently used by the different facilities. Interviewees reported that there were limitations in terms of the number of, and availability of ambulances, and that there was also an inadequate number of trained midwives. Limitations on the health service's infrastructure, namely, the physical space that is available, the number of delivery beds, and the limited supply of equipment place an additional burden on the staff working at both the primary and tertiary level. Conclusion: Overall, the study recommends that further research – possibly in the form of a baseline audit – be conducted so as to develop a more detailed and/or operational assessment of the actual rather than the reported level of functionality of the district's maternity referral system. Specific recommendations are also proposed for the various stakeholders who are critical role players in the referral system, namely, the clinics, the University Teaching Hospital, the Lusaka District Health Management Team, the Provincial Health Office, the Ministry of Health and Cooperating Partners.
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Isobell, Deborah Louise. "Referring agents’ perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape." University of the Western Cape, 2013. http://hdl.handle.net/11394/4060.
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Masters of ArtHigh rates of substance use and its associated problems afflict Cape Town, underscoring the need for easily accessible substance abuse treatment. Despite the substantial benefits for both individuals and society at large that substance abuse treatment confers, substance abusers often first have to negotiate considerable challenges in order to access treatment and accumulate these gains. That is, experiencing barriers to accessing treatment, together with the presence of socio-demographic features, rather than “need for treatment”, decides who accesses treatment. Referrals are the gateway to inpatient substance abuse treatment in the Western Cape. While several barriers to accessing treatment have been identified by prior studies, none examine these phenomena from the point of view of the agents responsible for referring substance users for treatment. Moreover, access barriers to inpatient substance abuse services are a neglected area in extant literature. To address this gap, this study explored the perceptions of referring agents‟ of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape. This enabled the researcher to compare existing access barriers to treatment as identified by prior research, to those elucidated in the study. Bronfenbrenner‟s Process-Person-Context-Time model was employed as the basis for understanding identified barriers. In accordance with the exploratory qualitative methodological framework of the study, six semi-structured individual in-depth interviews were conducted with referring agents‟ of differing professional titles who were purposefully selected and expressed a willingness to participate in the study. Interviews were audio-recorded, and transcripts were analysed and interpreted by means of Thematic Analysis. Two broad thematic categories of access barriers were identified: Person-related barriers (denial, motivation for treatment, gender considerations, disability, active TB disease, homelessness, psychiatric co-morbidity) and Context-related barriers to treatment (cultural and linguistic barriers, stigma, community beliefs about addiction and treatment, awareness of substance abuse treatment, affordability/ financial barriers, geographic locations of treatment facilities, waiting time, lack of collaboration within the treatment system, beliefs of service providers‟, lack of facilities/ resources within the treatment system, practices at inpatient facilities, referral protocol and uninformed staff). Results suggest that by targeting the aforementioned barriers, access to inpatient and outpatient treatment services can be improved, and recommendations for interventions are offered in this regard. Ethical principles such as obtaining informed consent and ensuring confidentiality were abided by throughout the study and thereafter.
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Buabbas, Ali. "Investigation of the adoption of telemedicine technology in the Kuwaiti health system : strategy and policy of implementation for overseas referral patients." Thesis, Brunel University, 2013. http://bura.brunel.ac.uk/handle/2438/7607.
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The cost of health care services is rising and the number of patients requesting overseas treatment from the Kuwait Government continues to increase; this is becoming an unsustainable financial burden. A telemedicine system has the potential to support the Kuwaiti health system to provide medical consultations from global medical centres, and thereby reduce the number of Kuwaiti patients being sent abroad for treatment, and so reduce costs. This research investigates the readiness of the key stakeholders in regard to adoption of telemedicine systems in the Kuwaiti healthcare system. This is achieved by assessing the readiness of individuals (physicians and patients), the organisation (policy makers) and the technical infrastructure (IT managers). Moreover, the lack of research on this topic, particularly in the Arabian Gulf Region, was the reason behind carrying out this study. An in-depth study was conducted by using a quantitative and qualitative approach. A questionnaire was used to explore the attitudes of specialised physicians and patients by obtaining their opinions based on specific criteria. Next, semi-structured interviews were conducted: (1) with IT managers to assess the technical infrastructure of the health system; and (2) with policy makers to assess the organisation in regard to its readiness towards telemedicine adoption. The study shows that the overseas referral patients are ready to use telemedicine systems, as a consequence of their need to receive medical consultations from global experts. However, they expressed some concerns, such as privacy and confidentiality of their data. The specialised physicians also showed readiness towards adoption of telemedicine in the Kuwaiti health system, and their responses indicated that they are willing to use such systems. However, the findings of the interviews reveal that the current technical infrastructure for ICT in the Kuwaiti healthcare system is not ready for telemedicine adoption and there are needs to be change in the way management is organized in order to improve and enhance trust among departments. The qualitative approach identified factors that would inhibit and hinder the adoption of telemedicine in Kuwait, as well as the supportive factors in the organisation. Using the results, a strategy was developed to demonstrate how the Kuwaiti health system could be made ready to receive a telemedicine system, together with policies for the use of telemedicine systems by overseas referral patients. A comparison with Jordan and Syria shows that the Kuwaiti healthcare system is more ready to adopt a telemedicine system with respect to the individuals, technical infrastructure and governmental support. Finally, an economic analysis was performed in order to investigate the cost effectiveness of the proposed system.
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Ncana, Lundi. "Evaluating the referral system between Cecelia Makhiwane Hospital ART unit and its feeder sites, (Zone 2, 8 and 13 clinics)." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5386.
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Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Purpose of the study. The primary purpose of the study was to evaluate the referral system between CMH ART unit and its feeder sites, and assess the staff perception and patient.s satisfaction about the latter with the intention of improving and shaping it. Research design A non-experimental descriptive type of quantitative research was used in conducting a cross sectional survey to evaluate the referral system between CMH ART unit and its feeder sites. Data was collected through open and closed ended questionnaires handed to the respondents to fill and return back to the researcher. Findings The results revealed lack of management support and supervision of the system; absence of standard operative procedure to follow when down referring patients; insufficient staffing; congested waiting rooms and long waiting hours. Conclusion The down referral process began without the completion of planning with all involved stakeholders because of the pressure to implement the decision to down refer, staff at the feeder clinics although trained on ART care, but not experienced enough to manage the large influx of patients on ART were left alone to manage patients on HAART. Simple measures like communication between facility staff and patient education should be adopted to improve the system.
AFRIKAANSE OPSOMMING: Doel van die studie Die primêre doel van die studie was om die verwysing stelsel tussen die CMH ART eenheid en sy voeder werwe te evalueer, asook om die personeel se persepsie en pasiënte se tevredenheid oor die laasgenoemde te evalueer met die voorneme om dit te verbeter en verwerk. Navorsingsontwerp 'n Nie-eksperimentele beskrywende aard van kwantitatiewe navorsing is gebruik in die uitvoering van' n kruis deursnee-opname om die verwysing stelsel tussen CMH ART eenheid en sy voeder werwe te evalueer Data is ingesamel deur middel van oop en geslote geëindig vraelyste uitgedeel aan die respondente om in te vul en terug te keer na die navorser. Bevindings Die resultate blyk 'n gebrek aan ondersteuning van die bestuur en beheer van die stelsel; die afwesigheid van standaard operatiewe prosedure om te volg wanneer pasiënte af verwys word; „n tekort aan personeel; oorgelaaide wagkamers en lang wag ure. Gevolgtrekking Die af verwysing proses het sonder die voltooiing van die beplanning met alle betrokke belanghebbendes begin as gevolg van die druk om die uitvoering van die besluit om af te verwys te implementeer. Personeel by die voeder klinieke, alhoewel opgelei in ART sorg, maar sonder die nodige onderving om die groot instroming van ART pasiënte te behandel, was alleen gelos om die pasiënte op HAART te behandel. Eenvoudige maatreëls soos die kommunikasie tussen die fasiliteit personeel en die opvoeding van pasiente sal moet goedgekeur word om die stelsel te verbeter.
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Stewart, Tiffany Nicole, and Tiffany Nicole Stewart. "Palliative Care Education to Increase Outpatient Provider Knowledge and Palliative Care Referral Intent Within Veterans Healthcare System of the Ozarks." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624300.
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Purpose: Examine outpatient providers' perceptions of palliative care education in increasing their understanding, knowledge of resources, and intent to refer.
Research questions/goals: 1) Increase provider understanding about palliative care and the benefits that patients can receive as a result of early referral; 2) Increase provider knowledge of palliative care facilities and resources within VHSO; 3) Increase provider intent to use the referral process for patients in need of palliative care.
Setting: Veterans Healthcare System of the Ozarks, Fayetteville, Arkansas.
Participants: 14 outpatient providers within VHSO; 8 MDs, 4 NPs, and 2 PAs.
Methods: Descriptive research study consisting of an education session, discussion, and completion of a demographics form and evaluation questionnaire.
Results: Questionnaire scores: Goal 1) 4.9 (SD=1.27)/6; Goal 2) 5.07 (SD=1.1)/6; Goal 3) 5.1 (SD=1.1)/6. Open ended question themes: 1) 21.4%: palliative care was an "umbrella"; 35.7%: early referral improves outcomes; 21.4%: treatment plan can include curative therapies; 2) 28.6%: open group discussion; 14.3%: training opportunities; 21.4%: multidisciplinary team approach. 3) 35.7%: screenshots of the referral process; 14.3%: individual comments for the care plan; 21.4%: open discussion regarding referrals. 4) 14.3%: more about how to accommodate homebound Veterans; 28.6%: more about telehealth opportunities; 21.4%: more information on communication tactics.
Conclusions: There is a knowledge deficit among outpatient care providers in regards to palliative care. The providers found this education session informative, beneficial, and increased their intent to initiate palliative care referrals.
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Canavan, Caroline. "Using real world data to generate health economic models : a worked example assessing the cost-effectiveness of referral to gastroenterology for irritable bowel syndrome in the UK." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/32666/.
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Introduction: Irritable bowel syndrome (IBS) has substantial impact on Quality of Life (QoL) and patients have high healthcare utilization. Guidelines recommend diagnosis and management within primary care, yet around 25% of patients are referred to gastroenterology. These studies aimed to assess the incidence of organic gastrointestinal disease in patients diagnosed with IBS, the cost of healthcare utilization and the QoL in patients with IBS before and after seeing a gastroenterologist and to estimate the cost-effectiveness of a gastroenterology appointment. Methods: Patients with IBS were identified within the UK Clinical Practice Research Dataset. Incidence rates of coeliac disease, colorectal cancer (CRC) and inflammatory bowel disease (IBD) were calculated. Individual-level healthcare utilization data were extracted for IBS patients who first visited a gastroenterologist in 2008 or 2009. Mean costs of total healthcare utilization were calculated before and after gastroenterology attendance. A questionnaire study of patients with IBS attending a gastroenterology outpatient clinic for the first time measured QoL and utility before and after the appointment. Quality Adjusted Life Years (QALYs) were modeled from these utility values. Cost-effectiveness of a referral to gastroenterology in IBS was assessed using mean cost per QALY. Results: Fifteen years after IBS diagnosis, the combined cumulative excess incidence of coeliac disease, IBD and CRC in IBS is 3.7%. Over one year following gastroenterology appointment, the expected QALY gain compared to no appointment was 0.03 and the expected extra total healthcare costs were £657. The incremental cost-effectiveness ratio was £27865.64/QALY. Referral for patients younger than 30, men, and increasing the time horizon, reduces the expected cost effectiveness. Conclusions: My findings provide reassurance that non-specialists are unlikely to be missing an organic condition in the majority of IBS patients. Referral to a gastroenterologist for IBS might be cost-effective for the NHS but more data, especially on potential QALY gains, are needed.
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DeLong, Earl Eugene. "The Use of a Behavior Support Office Within a System of Positive Behavior Support as an Intervention for Disruptive Behavior in an Approved Private School Setting." Diss., Temple University Libraries, 2010. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/67413.
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School PsychologyPh.D.
The purpose of this study was to examine whether removing disruptive students to a behavior support office (BSO) is an effective intervention in reducing disruptive behaviors in a school exclusively serving students diagnosed with emotional disturbance. The study also examined the effect of the BSO on academic success and school attendance. Staff attitudes toward the BSO were also examined. Finally, demographic categories were evaluated. Archival data from two school years were collected. There were 35 students during the 2007-2008 school year when the BSO was in effect, and 65 students during the 2008-2009 school year when the BSO was not in effect. There was also an evaluation of the 23 students who were present during both years. It was hypothesized that use of the behavior support office would reduce the number and intensity of behavior incidents, and ultimately, reduce the amount of time spent out of class due to those behaviors. The data, however, demonstrated that students exhibited more behavior incidents and spent more time out of the classroom due to those behaviors with the BSO in place. It is believed that this increase was most likely due to the reinforcement of escape motivated behaviors. These behaviors in the BSO were, however, of a lower intensity. This researcher further hypothesized that students would demonstrate higher grade point averages and higher rates of attendance with the behavior support office in place. There was no significant difference in GPA or attendance. School staff were administered the Intervention Rating Profile - 15 to examine levels of staff acceptance for the behavior support office. Teaching staff had the highest level of acceptance for the BSO, while administrators had a lower level of acceptance, and behavior staff had the lowest level of acceptance. The higher level of teaching staff acceptance did not appear to impact the success of the intervention. Finally, demographic information was evaluated. There were no significant effects for age or gender. However, African American students demonstrated a significantly greater decrease than Caucasian students in time out of the classroom due to behavior incidents after the Behavior Support Office was discontinued.
Temple University--Theses
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Paillard, Alise M. Berg. "Validity and utility of a child-find system for the early identification and referral of young children at risk for mental health disabilities /." view abstract or download file of text, 2003. http://wwwlib.umi.com/cr/uoregon/fullcit?p3113021.
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Thesis (Ph. D.)--University of Oregon, 2003.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 215-234). Also available for download via the World Wide Web; free to University of Oregon users.
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Ndwandwe, Miriam. "Impact analysis of a down-referral chronic medication distribution system for stable chronic patients to primary health care facilities in an Eastern Cape District." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020644.
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The purpose of the study was to assess the level of patient satisfaction with service provided in the Buffalo City sub-district following the implementation of the down-referral chronic medication distribution system between the tertiary(ELHC) and primary (clinics) levels of health care. The intervention was aimed at improving accessibility and availability of medication to the chronic patients. Research Design: A non-experimental descriptive quantitative research methodology was used. The sampling method for the study was the non-probability purposive sampling. Data was collected using a self-administered questionnaire that was given to respondents as they arrived at the facilities, and who, after completing the questionnaire, gave it back to the researcher. Findings: The results of the study revealed that the patients were generally satisfied about the down-referral chronic medication distribution system. However the patients were not satisfied about the services that they receive from the primary health care facilities when they go to collect their down-referred medication. Lack of communication to the patients regarding their medication by the hospital staff (pharmacists in particular) was a concern for patients. Conclusion: The down-referral chronic medication distribution system can benefit both the patients and the hospitals. Patient will receive their medication closer to their homes and save on the cost of transport. The hospital will have less patient congestion in the outpatient dispensaries and queues and waiting times will be reduced. Some strategies must be sought to improve the services at the primary health care facilities. The hospital should explore various communication methods to put into place, that will save pharmacists time and satisfy the needs of the patients. This would require the health services management from both the hospitals and the primary health care facilities to work together to ensure continued support for the patients.
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Molepo, Edward R. "The effectiveness of the referral system in primary health care in the West Rand region : a normative-ethical study with special emphasis on traditional healers." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51964.
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Thesis (M.Phil.)--Stellenbosch University, 2000.ENGLISH ABSTRACT: The aim of this research is to identify the various levels of health care units, their relationships and the problems hindering an effective referral system. To achieve this goal, use is made of a case study of the West Rand area in Gauteng. The standpoint is that, to achieve Primary Health for all South Africans referral systems within health care units and levels must be reciprocal. It is argued that for Primary Health Care to be successful, it must satisfy the goal of affordability appropriateness and accessibility. Results from the research revealed that four health care levels, namely traditional healers, health NGOs, Clinics, and Hospitals. Though there is some degree of referral in the study area, it was observed that referrals in the study area were not reciprocal. Amongst the major problems identified as hindering an effective referral system in the study area, include lack of cooperation between health institutions, poor health infrastructure and communication network as well as lack of other health paraphernalia. The research also found that government policy towards some of the health institutions (Traditional healers) contributes to the inefficiency of proper referrals in the study area.
AFRIKAANSE OPSOMMING: Die oogmerk van hierdie ondersoek is om die verskillende vlakke van gesondheidsorgeenhede, hulonderlinge verbande en die probleme wat doeltreffende verwysings in die wiele ry, te identifiseer. Dit word gedoen aan die hand van 'n gevallestudie van die Wes-Randarea in Gauteng. Die uitgangspunt is dat doeltreffende Primêre Gesondheid vir alle Suid- Afrikaners afhang van resiprokale verwysingsisteme tussen gesondheidsorgeenhede en -vlakke. Suksesvolle Primêre Gesondheidsorg vereis bekostigbaarheid, toepaslikheid en toeganklikheid. Die ondersoek het vier gesondheidsorgvlakke aan die lig gebring: tradisionele genesers, gesondheids-nie-regerings-organisasies, klinieke en hospitale. Hoewel daar 'n mate van onderfinge verwysing in die studie-area bestaan, was dit nie wederkerig nie. Onder die vernaamste struikelblokke vir 'n doeltreffende verwysingsisteem tel swak samewerking tussen gesondheidsinstellings, gebrekkige gesondheidsinfrastruktuur en kommunikasienetwerk, en 'n skaarste aan ander gesondheidsmiddelle. Die ondersoek het ook bevind dat regeringsbeleid aangaande sommige van die gesondheidsinstellings (tradisionele genesers) bydra tot die ondoeltreffendheid van verwysings in die studie-area.
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Williams, Sarah E. "A qualitative investigation of the special education identification, referral, and placement process: its relationship to the over representation of African American males in high incidence programs in an urban school system." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2005. http://digitalcommons.auctr.edu/dissertations/586.
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This study examines the relationship between the special education identification, referral, and placement process and African-American males’ overrepresentation in high incidence programs in an urban school system. This study relied on perceptions of educators and parents regarding the special education process. This study was based on the premise that the special education placement phenomenon is influenced by teachers’ perceptions of behavior and teachers ‘perceptions that many African-American. male students lack fundamental academic capabilities. A qualitative approach which utilized focus groups and interviews was implemented. Data were analyzed literally, interpretively, and reflectively in order to address each of the four study domains. The researcher found that the overrepresentation of African-American males in high incidence programs was not a function of race, in the study district, but rather more related to gender and gender based issues. The conclusions drawn from the findings suggest that gender related issues impact the number of African-American males in high incidence programs. Additionally, teacher tolerance and teacher expectations dictate how each teacher will implement the process.
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Ranjit, Narendran. "Multiagent Referral Systems: Maintaining and Applying Trust and Expertise Mode." NCSU, 2007. http://www.lib.ncsu.edu/theses/available/etd-05112007-143631/.
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This thesis addresses the challenge of assisting people to solve a problem by helping locate other people who might have the expertise required to solve that problem. To this end, the proposed system assigns an agent to each user. Further, it models a social network as a multiagent system based on the user's existing online identity. It provides heuristics by which an agent can estimate the expertise and trust to be placed in a user with whom the agent's user interactis. Our approach seeks to reduce the problem of finding an answer to a query to the problem of finding a path to a trustworthy expert who can answer the query. To accomplish this, our system uses referrals from one agent to another in the same fashion that word-of-mouth is used when people are looking for an expert. Our models of trust help establish the authenticity and veracity of the referrals and replies. This thesis describes the architecture and implementation of such a system.
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Singh, S. "Referral systems and transport for emergency obstetric care in India." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4647889/.
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Background: Institutional delivery rates in India have improved in the past decade, but maternal mortality remains high. The aim of this study was to describe current referral pathways and transport services for pregnant women in the Indian public health sector to identify strategies for strengthening the referral system for emergency obstetric care. Methods: I conducted three literature reviews; a health provider’s KAP survey of staff in primary level public health facilities from two states; analyses of ‘108’ ambulance service data from six states; and telephone interviews of women who called this service in two states. Results: The reviews found no standard protocols or guidelines for referral of women with obstetric high-risk or complications in India, and over half of pregnant women attending primary level health facilities were referred. There was poor quality institution referral care and no studies on the effectiveness of transport interventions. The KAP study found staff had sub-optimal knowledge and practice for screening common high-risk conditions and complications, and low confidence and resources to manage emergency situations. Less than a quarter of pregnancies and institutional deliveries in the study populations used ‘108’ ambulances. Most women called the service for normal labour: only 4.3% had an obstetric emergency and 5.8% were inter-facility transfers. Of pregnant callers to the ‘108’ service, one third reported a high-risk condition or early complication in pregnancy. Women transported using other means were more likely to use private facilities than those transported by ‘108’. Conclusion: The quality of obstetric care at peripheral health centres is suboptimal and the high proportion of referrals could be avoided. The ‘108’ ambulance service is underused, especially in emergency situations. India’s health systems should improve the provision of obstetric care by standardising services at each level of health care. Strategies are required to increase the use of ‘108’ services for obstetric emergencies.
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Cassidy, Karma Bryan. "HEALTH SYSTEM PROCESSES, CLINICIAN ATTITUDES, AND REFERRALS TO TOBACCO TREATMENT PROGRAMS." UKnowledge, 2010. http://uknowledge.uky.edu/gradschool_diss/67.
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Assisting smokers to quit and stay quit is the most important intervention clinicians can undertake to improve the length and quality of life of patients who use tobacco. The chronic, relapsing nature of tobacco dependence complicates tobacco treatment. Tobacco treatment counseling programs provide on-going support to help patients avoid relapse. Assistance with a referral increases the likelihood that patients will participate in counseling, but few clinicians regularly assist with referrals to tobacco treatment programs. This dissertation examined health system processes and clinician attitudes that influence the likelihood that clinicians will refer their patients for tobacco treatment counseling.
Three papers examined health system processes, clinician attitudes, and frequency of referrals. A systematic review of the literature was conducted to evaluate strategies to increase the frequency of clinician referrals and effects on quit rates in primary care. The most effective strategies were those that combined clinician education with integrated referral systems. Integrated referral systems include non-clinician staff and clinician and staff prompts with algorithms or protocols for referrals. The second paper reports the findings of a pilot study using qualitative methods to explore experiences and strategies used for tobacco treatment by clinician champions practicing in independent primary care practices. Tobacco champions (N = 11) described experiences counseling patients but not assistance with referrals. Themes identified were: sources of knowledge and experience, understanding dependence, role perception, and treatment strategies. The final paper reports the findings of a cross- sectional, non-experimental study to examine clinician attitudes toward counseling, health system processes that facilitate referrals, and referrals to tobacco treatment counseling. Attitudes about the efficacy of tobacco counseling and the presence of processes that facilitate referrals predicted referrals.
Clinicians sampled in these studies held favorable attitudes toward tobacco treatment but lacked confidence in the efficacy of community-based counseling for tobacco treatment. These findings have implications for health care policies to improve integration of processes that facilitate referrals and clinician education that includes information about counseling resources to improve chronic care for the treatment of tobacco dependence.
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Lofego, Léa. "Organização da atenção pré-natal na rede regional /." Araçatuba, 2019. http://hdl.handle.net/11449/180993.
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Orientador: Nemre Adas SalibaBanca: Doris Hissako Sumida
Banca: Symone Cristina Teixeira
Resumo: Introdução: A rede de atenção à saúde maternoinfantil foi instituída em 2011 com a finalidade de promover melhorias na eficiência da gestão dos serviços, porém ainda se apresenta como um grande desafio para os gestores. Objetivo: Analisar a rede regional de atenção à saúde da gestante no SUS. Método: Trata-se de pesquisa de caráter transversal, quanti-qualitativa, tipo inquérito. Foram realizadas entrevistas com gestores de 28 municípios, do Ambulatório de Especialidades Médicas (AME) e do Departamento Regional de Saúde (DRS) II do estado de SP, totalizando 86 entrevistados. As variáveis pesquisadas foram: realização de atividade educativa no pré-natal, existência de protocolo de atendimento e encaminhamento, organização da atenção à saúde bucal e geral à gestante, pactuação das referências e funcionalidade do sistema de referência e contrarreferência. Realizou-se análise de conteúdo para as questões discursivas e triangulação entre as respostas obtidas nos municípios, AME e DRS. Resultado: Observou-se que 78,57% dos municípios realizam atividade educativa com gestantes; 42,86% não possuíam protocolo de atendimento implantado e em 57,14% não havia critérios de encaminhamento estabelecidos. Do total de gestores municipais, 53,57% afirmaram realizar testes rápidos para detecção de HIV, Sífilis e Hepatite B e C; 46,43% teste rápido de gravidez e 39,28% relataram avaliar a situação vacinal. Quanto à atenção odontológica primária, não havia protocolo instituído em 71,43% dos munic... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: The maternal and child health care network was established in 2011 with the purpose of promoting improvements in the efficiency of service management, but still presents a great challenge for managers. Objective: To analyze the regional health care network of pregnant women in SUS. Method: This is a cross-sectional, quantitative-qualitative research type survey. Interviews were carried out with managers from 28 municipalities, from the Ambulatory of Medical Specialties (AME) and from the Regional Department of Health (DRS) II of the state of São Paulo, totaling 86 interviewees. The variables studied were: performance of prenatal educational activity, existence of a referral protocol, organization of oral and general health care for the pregnant woman, agreement of references and functionality of the referral and counter-referral system. Content analysis was performed for the discursive questions and triangulation between the responses obtained in the municipalities, AME and DRS. Result: It was observed that 78.57% of the municipalities carry out educational activities with pregnant women; 42.86% did not have an implanted care protocol and in 57.14% there were no established referral criteria. Of the total of municipal managers, 53.57% affirmed to carry out rapid tests for the detection of HIV, Syphilis and Hepatitis B and C; 46.43% rapid pregnancy test and 39.28% reported evaluating the vaccine situation. Regarding primary dental care, there was no protocol esta... (Complete abstract click electronic access below)
Mestre
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Kalezic, Ivana. "Experimental studies of spinal mechanisms associated with muscle fatigue." Doctoral thesis, Umeå : Idrottsmedicinska enheten, Kirurgisk och perioperativ vetenskap, Umeå universitet, Belastningsskadecentrum, Högskolan i Gävle, Umeå, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-332.
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Anthony, Stephanie Nichole. "Teacher attributions, expectations, and referrals for students involved in the child welfare and juvenile justice systems." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1426.
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The primary purpose of this study was to examine differences in the attributions teachers make toward students in the child welfare and juvenile justice systems. The study utilized vignettes and asked teachers to attribute the responsibility for declines in behavior and academic performance to one of five sources (the student, the parents, the teacher, the court system, or the student's friends). The study further asked teachers to identify the extent to which the changes were due to the student's internal traits and external factors, the likelihood of changes in behavior and academic performance with and without intervention, the teachers' beliefs about their ability to impact change, the amount of time the teachers reported being willing to spend with the students outside of class, and the likelihood of the student pursuing post-secondary education. Teachers were also asked to identify to whom they would first refer the student in the vignette for outside assistance due to declines in behavior and academic performance and then provide all referrals they would make.
A total of 224 certified 6th -12th grade teachers in the state of Iowa completed the vignette survey between January 2014 and April 2014. Results indicated that teachers made different attributions toward students on the basis of their involvement in either the child welfare or juvenile justice system. Specifically, teachers attributed the reason for behavioral and academic declines to different sources for students in the child welfare system, the juvenile justice system, and the control condition. Teachers were more likely to attribute academic and behavioral declines to internal factors for students in the juvenile justice system and external factors for students in the child welfare system. Teachers reported students in the juvenile justice system as least likely to change without intervention. The majority of teachers across the three conditions indicated their first referral would be to mental health services within the school. Teachers did not differ in the total number of referrals made, the amount of time until making the referral, the amount of time they would be willing to spend with the student outside of class time in order to impact change, their feelings of efficacy to impact change, and the likelihood of the student obtaining post-secondary education. Finally, limitations of the study are presented, suggestions for future research are discussed, and the implications of this study for teachers and school psychologists are discussed.
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Sasikumar, Manoj. "Essays on the economics of healthcare referrals." Thesis, Aix-Marseille, 2020. http://theses.univ-amu.fr.lama.univ-amu.fr/200527_SASIKUMAR_121xqgcxx784mkbbyl647x274ichz_TH.pdf.
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Cette thèse examine le rôle des avis de médecins spécialisés, car elles ont des implications pour les résultats des patients et l’organisation et la durabilité des systèmes de santé. Le premier projet examine les avis des spécialistes des maladies infectieuses dans un hôpital tertiaire français (hospitalisé). La deuxième question porte sur la complémentarité ou la substitution concernant des relations entre les médecins généralistes et les spécialistes. Le troisième projet examine la manière dont les patients ont réagi à la réforme du parcours de soins en France en termes de conformité, et un examen préalable des facteurs qui affectent cette conformité. La 2e et 3e articles examine les aspects liés à la variation géographique aussi. Dans mon quatrième article, je présente un protocole d'étude rédigé comme un suivi du premier articleThis thesis examines the role of specialist referrals, as they have implications for patient outcomes and the organization and sustainability of health systems. The first project specifically examines the opinions of specialists in infectious diseases in a French tertiary hospital (hospitalized) from the point of view of the payer. The second project examines whether the relationship between General Practitioners (GPs) and specialities is complementary or substitutable. The third project examines the way in which patients reacted to the reform of the care pathway in France in terms of compliance, and a preliminary examination of the factors that affect this compliance. The 2nd and 3rd articles examine aspects related to geographic variation as well. In my fourth article, I present a study protocol written as a follow-up to the first article
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Fidelis, Solange Silva dos Santos. "O processo de implementação e implantação dos CRAS em municípios da região oeste do estado do Paraná." Pontifícia Universidade Católica de São Paulo, 2009. https://tede2.pucsp.br/handle/handle/18008.
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Previous issue date: 2009-10-09Conselho Nacional de Desenvolvimento Científico e Tecnológico
This research aimed to understand how it has developed the process of implementation and deployment of CRAS in western Parana, considering the political administrative division of the State, the SETP by the Regional Office of Cascavel. First constructed a table with the profile of the municipalities that make up the coverage area of the ER in Cascavel, and from the data listed was established methodological procedures with clipping by intentional sampling by setting 7 of a total of 34 municipalities. It involved 10 professionals working in CRAS, 4 professionals in the management of municipal social care policy and 1 professional as the representative of the State Authorities in the region. In the data collection technique was used semi-structured interview in order to enable the construction of the profile of CRAS: conditions of physical infrastructure and human; the actions taken and the conditions that have been carried; conception of persons involved directly with the public social care as the SUAS and the CRAS; the relationship of CRAS and social care network in this context, considering also the conditions for the development of social care policy. It was then possible to view the progress made after initiating the deployment of SUAS, the limitations in that process and the challenges to the achievement of the advocates that the National Policy for Social Care/SUAS. It was possible from direct contact with the subjects, systematize and is currently regarded as the SUAS towns in the region, considering the different realities set in PNAS/SUAS at the rate of population municipalities, large and small porte I, and level of full and basic management. Considering the variety of realities and different degrees of development of social care policy, the research presented common issues, among which stands out: the lack of full team of human resources, physical structure and equipment inadequate; the vulnerable identity of CRAS, an issue exacerbated as installed in the same structure as previously established services, absence of social diagnosis to support interventions; wide emergency demand assuming seconded volume of actions taken hindering the advancement of social-educational work, and allocations of CRAS finally settled, especially as regards the relationship with the social care network in the territory. Finally, this work contributes to trigger the debate about the actual conditions for the deployment of CRAS as an innovative and essential proposal to the success of SUAS, which represents a breakthrough for social care policy
Essa pesquisa teve como objetivo conhecer de que forma tem se desenvolvido o processo de implementação e implantação dos CRAS na região oeste do Paraná, considerando a delimitação político administrativa do Estado, pela SETP através do Escritório Regional de Cascavel. Inicialmente construiu-se um quadro com o perfil dos municípios que compõem a área de abrangência do ER de Cascavel, e a partir dos dados elencados estabeleceu-se os procedimentos metodológicos com recorte por amostragem intencional, definindo 7 de um total de 34 municípios. Foram entrevistados 10 profissionais que atuam nos CRAS, 4 profissionais da área de gestão da política de assistência municipal e 1 profissional da SETP enquanto representante do órgão gestor do Estado na região. Na coleta de dados foi utilizada a técnica de entrevista semi-estruturada, de forma a possibilitar a construção do perfil dos CRAS; as condições de estrutura física e humana; as ações desenvolvidas e as condições em que têm sido realizadas; a concepção dos sujeitos envolvidos diretamente com a assistência social pública quanto ao SUAS e ao CRAS; a relação entre CRAS e a rede socioassistencial; nesse contexto, considerando também as condições de desenvolvimento da política de assistência social. A partir daí foi possível visualizar os avanços alcançados depois de iniciada a implantação do SUAS, as limitações encontradas nesse processo e os desafios a fim de que se alcance o que preconiza a Política Nacional de Assistência Social/SUAS. Foi possível a partir do contato direto com os sujeitos da pesquisa, sistematizar como está se constituindo o SUAS nos municípios da região, considerando as distintas realidades estabelecidas na PNAS/SUAS, pelo índice populacional dos municípios, em grande porte e pequeno porte I, e os níveis de gestão plena e básica. Diante da variedade de realidades locais e de graus distintos de desenvolvimento da política de assistência social, a pesquisa permitiu identificar alguns problemas comuns, entre os quais, destacam-se: a falta de equipe completa de recursos humanos; a inadequada estrutura física e de equipamentos inadequadas; a fragilizada ou por se constituir - identidade do CRAS, questão agravada quando instalado na mesma estrutura que serviços anteriormente estabelecidos; ausência de diagnóstico social para dar suporte às intervenções; ampla demanda emergencial assumindo destacado volume das ações realizadas e dificultando o avanço do trabalho socioeducativo; as atribuições do CRAS por se estabelecerem, principalmente no que se refere à relação com a rede socioassistencial no território. Por fim, essa dissertação vem contribuir para desencadear o debate acerca das condições concretas de implantação dos CRAS, enquanto proposta inovadora e essencial para o sucesso do SUAS, que representa um grande avanço para a política de assistência social
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Raines, Tara C. "Universal Screening as the Great Equalizer: Eliminating Disproportionality in Special Education Referrals." Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/cps_diss/83.
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The overrepresentation of minority students identified for special education services continues to plague schools and serves as a challenge for researchers and practitioners (Ferri&Conner,2005). Teacher nomination, office discipline referrals (ODR), and functional behavior assessments (FBA) continue to guide referral processes (Bradshaw, Mitchell, O’Brennen, & Leaf, 2010; Eklund, et al., 2009; Mustian, 2010). These methods have been found to be riddled with inconsistencies. Practices used to identify students for behavioral and emotional interventions over-identify students from culturally and linguistically diverse backgrounds. The use of a behavioral and emotional screener to make data-based decisions regarding placement and services could provide an objective assessment of student risk.
The first chapter of this dissertation reviews methods used in the identification of students for behavioral and emotional support services. Additionally, the use of universal screening in conjunction with student self-report are proposed as tools for alleviating the overrepresentation of minority students in special education programs for behavioral and emotional disorders.
The second chapter of this dissertation explores the measurement equivalence of Behavior Assessment System for Children, Second Edition (BASC-2) Behavioral and Emotional Screening System Student form (BESS Student) across the Black, Hispanic, and White participants in the norming sample. The BESS Student as a universal screening tool is poised to alleviate the disproportionate number of children of color identified by schools as having behavior and emotional disorders. This instrument also provides an avenue to identify students with internalizing disorders who are often overlooked in present referral practices (Bradshaw, Buckley, & Ialongo, 2008; Kataoka, Zhang, & Wells, 2002).
The findings of the measurement equivalence study suggests that the BESS Student is, as designed, identifying behavioral and emotional risk across each of the three groups explored. These findings support the use of a universal screening measure as the first step in a multi-step identification and intervention process. Following up with additional assessment to evaluate the specific areas of risk warranting intervention is pivotal to providing appropriate support services and promoting the behavioral and emotional health of students. Implications for research and practice are discussed.
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Louati, Amine. "Une approche multi-agents pour la composition de services Web fondée sur la confiance et les réseaux sociaux." Thesis, Paris 9, 2015. http://www.theses.fr/2015PA090035/document.
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Dans cette thèse, nous nous intéressons aux problèmes de découverte, de sélection et de composition de services. L'objectif est de satisfaire une requête complexe d'un demandeur de services. Pour ce faire, nous proposons une approche multi-agents fondée sur la confiance et les réseaux sociaux. Nous définissions un modèle de confiance en tant que concept compositionnel formé de quatre composantes: une composante sociale, une composante d'expertise, une composante de recommandation et une composante de coopération. La composante sociale juge s'il est intéressant de suivre un fournisseur avant d'utiliser ses services. La composante d'expertise estime si un service se comporte bien et comme prévu. La composante de recommandation vérifie si un agent est pertinent ou pas et si l'on peut compter sur ses recommandations. La composante de coopération permet aux agents de décider avec qui interagir dans une composition de services. Nous proposons un algorithme distribué pour la découverte de services utilisant la confiance entre les agents ainsi que les systèmes de références dans les réseaux sociaux. Nous développons également une nouvelle méthode s'appuyant sur un modèle probabiliste pour inférer la confiance entre les agents non adjacents tout en tenant compte des rôles des agents intermédiaires. Finalement, nous présentons un processus original de formation de coalitions qui est incrémental, dynamique et recouvrant pour une composition de services dans les réseaux sociaux. Les résultats expérimentaux montrent que nos approches multi-agents sont efficaces, plus performants que les approches similaires existantes et peuvent offrir des résultats plus dignes de confiance à faible coût de communicationsThis thesis deals with service discovery, selection and composition problems. The aim is to fulfill a complex requester query. To do that, we propose a multi-agent approach based on trust and social networks. We define a trust model as a compositional concept that includes social, expert, recommender and cooperation-based component. The social-based component judges whether or not the provider is worthwhile pursuing before using his services. The expert-based component estimates whether or not the service behaves well and as expected. The recommender-based component checks whether or not an agent is reliable and if we can rely on its recommendations. The cooperation-based component allows agents to decide with whom to interact in a service composition. We propose a distributed algorithm for service discovery using trust between agents and referral systems in social networks. We also develop a new method based on a probabilistic model to infer trust between non adjacent agents while taking into account roles of intermediate agents. Finally, we present an original coalition formation process which is incremental, dynamic and overlapping for service composition in social networks. %In particular, our coalition formation process engaging self-interested agents is incremental, dynamic and overlapping. Experimental results show that our multi-agents approaches are efficient, outperforms existing similar ones and can deliver more trustworthy results at low cost of communications
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Newton, Kathryn. "African American Women's Perceptions of and Experiences with Mandated Substance Abuse Treatment: Implications for Counselors." unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-04242008-014909/.
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Thesis (Ph. D.)--Georgia State University, 2008.Title from file title page. Brian J. Dew, committee chair; Kris Varjas, Barbara Gormley, Catherine Cadenhead, Leslie Jackson, committee members. Electronic text (169 p.) : digital, PDF file. Description based on contents viewed July 7, 2008. Includes bibliographical references.
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Carter, David Andrew. "Time for change : a study of enrolment decision dynamics for admission into English secondary education." Thesis, University of Plymouth, 2018. http://hdl.handle.net/10026.1/12305.
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Cross-sectional studies suggest a prevalence of mental health problems from the age that children change to English secondary schools but there are few longitudinal appraisals of these issues and how enrolment policies influence psychological wellbeing. This research focuses on key factors linking competition for secondary schools and family responses to such challenges to determine enrolment policies that can sustain wellbeing longer-term. Integrated, model-based multimethodology was used in this urban, case-based study. Views were induced from multi-agency, expert practitioners to agree a system dynamics concept model. Parental decision-making behaviours were deduced by survey to understand key factors for model calibration. Dynamic system sensitivities were abduced from the simulation model before comparing long-term psychosocial impacts on children from expert, policy-support suggestions. Modelling demonstrates that two principal feedback loops influence family psychosocial systems when deciding secondary schools (parent-child wellbeing reinforcement plus knowledge of schools balancing parent concerns). Exogenous competition stressors on psychosocial systems can erode parent knowledge while testing student resolve. Competition guidance to remove risk-laden school options (league table comparison) before sequencing any remaining choices by profit (school visits), are not always used deciding urban secondary schools. Instead, families lacking experience can adopt decisive styles based on parent needs alone. Given autocratic leadership, child wellbeing rapidly deteriorates when student needs cannot be met by schools. Rather than ending student-selective entrance tests or raising knowledge of schools at visits, effective multi-agency support policy helps by increasing school choice debate frequency within families to address psychosocial system imbalances. The research makes a clear, three-way contribution to knowledge. Firstly, intrinsic case study theory is enhanced by data triangulation between induced, deduced and abduced research approaches. Secondly, the system dynamics discipline is strengthened by studying compulsory school enrolment. Finally, developing practice-based policy through multi-agency groups endorses cooperative rather than unilateral solutions, for helping change lives.
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Teerlink, Elise Ann. "Impact of Peer Praise Notes Issued During Recess: Effects on Office Disciplinary Referrals." BYU ScholarsArchive, 2014. https://scholarsarchive.byu.edu/etd/5588.
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School recess can be a problematic setting due to inadequate safety, supervision, and structure. Peer praise notes (PPNs) is a school-wide positive behavior support strategy that was implemented during recess to address these concerns at a Title I elementary school. An ABAB reversal design across all students was employed to evaluate the effectiveness of PPNs. Overall changes in office disciplinary referrals (ODRs) in each phase of the design, an effect size that reflects a highly effective treatment, and a moderately strong and statistically significant negative correlation suggest that PPNs decreased ODRs. Results from social validity surveys completed by eight recess aides and 88 students indicated that participants had positive perceptions of PPNs improving student behavior and peer relations, communicating playground rules, extending supervision responsibilities, and offering structured activity to peer praisers. Students' perceptions were overall more positive than the recess aides' perceptions. Limitations, future research, and implications are addressed.
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Shrifter, Courtney Nicole. "Child Welfare and Delinquency: Examining Differences in First-Time Referrals of Crossover Youth within the Juvenile Justice System." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/649.
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The link between child welfare and juvenile justice is well established, with over forty years of research that focuses on the increased risk of delinquency associated with child maltreatment. However, with over 700,000 children in the United States being victims of abuse and/or neglect in 2010 (DHHS, 2011), it is important to continue investigating this connection. Few studies are able to identify the same youth in both systems, therefore this study provides the unique opportunity using child welfare and juvenile justice administrative data from Oregon, to compare juvenile offenders that have been in the child welfare system, otherwise known as "Crossover" youth, to Non-Crossover juvenile offenders. The study attempted to examine if Crossover youth differ in terms of demographics, as well as if they committed offenses with higher severity scores than Non-Crossover youth. It also investigated whether an individual's status as a child welfare youth impact processing decisions in the juvenile justice system. Results indicate that Crossover youth have a higher percentage of females, African Americans, and are significantly younger. Crossover youth also have higher severity scores than non-crossover youth, and have a higher percentage of more intense adjudicated delinquent sanctions. Limitations of these findings and suggestions for further research are discussed.
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Bour, Jennifer L. "Comparing Parent Ratings of Referred Preschoolers on the Child Behavior Checklist and Behavior Assessment System for Children - Second Edition." TopSCHOLAR®, 2008. http://digitalcommons.wku.edu/theses/9/.
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Stephens, Alan D. "The relationship between the cognitive assessment system and the teacher's report form for referred children /." The Ohio State University, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=osu1488202678775265.
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Mabitsela, Lethabo. "Exploratory study of psychological distress as understood by Pentecostal pastors." Thesis, University of Pretoria, 2003. http://hdl.handle.net/2263/30114.
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The study is an exploratory investigation of Pentecostal pastors' perceptions on psychological distress, using grounded theory. Semi-structured interviews were conducted with five senior pastors, of Pentecostal churches in Soshanguve township located near Pretoria in South Africa. Data was analysed using open, axial and selective qualitative research methods. Verification of the results by the participants enhanced the validity and reliability of the research. Results indicate that there seems to be certain similarities between the established frameworks in psychology and the worldview of pastors with regard to psychological distress. It seems as if the pastors share common views about psychological distress with the medical, interpersonal and cognitive schools of thought. Therefore, psychological distress would be regarded as impairment in the social and occupational life spheres. The pastors' referral patterns and strategies to deal with religious clients' psychological distress are discussed, as well as their limitations as mental health care workers for their communities. It is suggested that, to bring psychological services to the black community, psychologists form collaborative relationships with Pentecostal pastors.Thesis (MA(Clinical Psychology))--University of Pretoria, 2003.
Psychology
unrestricted
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Regatão, Milene Camargo. "Estudo topográfico da dor de origem dentária." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/42/42137/tde-20052010-135831/.
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A maioria dos pacientes que têm dor de origem dentária pulpar ou periapical tem dor referida, e algumas características da dor parecem influenciar este fenômeno. Por meio do preenchimento de fichas clínicas, com informações sobre as características da dor, investigamos, em 60 voluntários, a distribuição topográfica de áreas de dor referida de origem dentária. Por meio de métodos psicofísicos, comparamos a resolução espacial da dor com a resolução espacial de outras modalidades somestésicas (mecânica e térmica). Nossos resultados indicam que a intensidade da dor favorece o fenômeno da dor referida e interfere na sua dispersão topográfica. Dentes algógenos com polpa viva influenciam um maior espalhamento da dor. A organização hodológica do núcleo espinal do trigêmeo e mecanismos fisiológicos de integração neural podem explicar de maneira satisfatória várias características da dor referida. Além disso, observamos que a resolução espacial na localização da dor é maior que a resolução espacial da localização de outros estímulos somestésicos nos elementos dentários.The majority of patients who suffer from toothache report referred pain to other sites in the head and neck. Thus, the aim of this study was to investigate the clinical and psychophysical characteristics of referred pain in the orofacial region and how factors such as intensity, duration and nature of odontogenic pain might modulate them. We employed psychophysical and clinical methods to correlate pain perception with the anatomy and physiology of the trigeminal system. Sixty patients reporting primary toothache were investigated as to the clinical and psychophysical aspects of their pains symptoms and signals (intensity, duration, location and state of the pulp inflammatory process). Pain intensity and state of irreversible pulp inflammation were found to significantly affect facilitate the incidence of referred pain and its spread across vertical laminations. Considering these results, we proposed a physiological model based on both neuronal integration (spatial and temporal summation) and the topographic organization of the trigeminal system, which is able to explain the observed characteristics of referred dental pain.
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Trevisiol, Michele. "Exploiting implicit user activity for media recommendation." Doctoral thesis, Universitat Pompeu Fabra, 2014. http://hdl.handle.net/10803/283657.
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This thesis explores in depth how to use the user browsing behavior, and in particular the referrer URL, in order to understand the interest of the users. The aim is, first, to understand the preferences of the users from their navigation patterns, i.e., from the implicit actions of the users. Then, to exploit this information to personalize the content offered by the service provider. The key findings from our studies allowed us to propose different solutions in terms of recommender systems and ranking approaches for media items. We show how the browsing behavior of the users captured by the browsing logs is extremely meaningful to understand new users and to estimate their preferences.Esta tesis analiza de modo exhaustivo el comportamiento del usuario en la web y, en particular, su interacción con las URLs recomendadas, para así conocer sus intereses. El objetivo fundamental es, en primer lugar, entender las preferencias de usuario a partir de sus patrones de navegación por la web, estudiando sus acciones implícitas. En segundo lugar, se trata de aprovechar esta información para personalizar el contenido ofrecido por el proveedor de servicios. El resultado de estos estudios nos ha permitido proponer diferentes soluciones en términos de sistemas recomendadores y ranking de productos multimedia. De este modo, hemos podido demostrar cómo el comportamiento del usuario en la web, obtenido a partir de registros de navegación, es extremadamente útil para comprender a nuevos usuarios y poder así estimar sus preferencias.
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Yu, Liang-Zhi, and 禹良治. "A HL/7-based Outpatient Referral System." Thesis, 2000. http://ndltd.ncl.edu.tw/handle/78182928124390999135.
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碩士國立成功大學
工程科學系
88
With the rapid growth of the Internet, hospitals gradually exchange data through the Internet to improve the efficiency of data processing. In essence, the environment of a referral is distributed, and there are huge volumes of data having to be exchanged between referring and referred-to providers. If we could take advantage of information technologies to exchange referral information, the integration of the clinical or demographic data in different hospitals may be more easily, and then, the unnecessary examinations and the waste of medical resources could be reduced. In the process of medical data exchange, if there are not any standards to follow, hospitals have to customize their exchange interfaces so that the complexity of exchange may increase. Therefore, the development of medical data exchange standards is urgent and necessary. In order to avoid the situation described above, the HL/7 (Health Level / Seven) standard has been developed. Its primary goal is to provide standards for medical data exchange, to simplify custom interfaces in programming, and to share the medical information. In this study, we design and implement an electronic referral system based on the messages and trigger events of the HL/7 standard. Moreover, we not only propose the architecture of implementing the HL/7 standard but also model the referral system by Unified Modeling Language (UML). Finally, this study will be recommended as a reference of implementing the HL/7 standard for the National Cheng-Kung University Hospital (NCKUH) or other cooperative hospitals.
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Chien, Yi, and 錢逸. "The analysis of establishment of high security referral system." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/93136948036581573943.
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碩士中原大學
醫學工程研究所
90
Due to the prosperous development in information technology (IT), the idea to facilitate the internet/intranet in hospitals for the exchange of medical information and reducing of administrative is well established. However, the concern about data is accompanied with IT infrastructure construction. These concerns include whether hackers may steal or alter the content of medical information; Any illegal access may happen intentionally. Thus, network security is becoming a crucial factor in the growth and development medical information system of the Internet. This research mainly focuses on enhancing network security of referral system between National Taiwan University hospital and Logkog’s hospital. There are four aspects in designing such system: 1. Confidential information--coding the electronic medical information for transmission of safety. 2. Data integrity--preventing unauthorized alternation of the electronic medical information transmission. 3. Identification--identifying password administration on both sides network system. 4.Access control--precaution have no enough the right body can access data in the database. To reach the above security requirement, this study integrates the SSL (Secure Sockets Layer) and the Virtual Private Network (VPN) mechanism for data transmission safety. It also exploits a Filter and a source code modification method and to establish an authorization mechanism. This study is also thoroughly analyzed the safe capability and evaluated the communication load with the safety mechanism implemented. In addition, this research also analyze the affect of Ddos hacker attack to the established referral system.
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Lin, Pei-Chun, and 林佩君. "A study on patients’return factors of bidirectional referral system." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/pjpkbc.
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碩士中臺科技大學
醫護管理研究所
96
Objectives: The transferred system has been known to cut the medical cost, therefore, our current study is to explore the return rate of transferred patients to general practice clinics and its related factors as the reference for formulating the policy of bidirectional referral system. Methods: We applied the data of transferred patients in mid-Taiwan community medical groups as our research resources. The sampling is nonprobability mainly based on the intention and cooperation of each individual clinic to select basic clinical physicians and referred patients by judgement from 3 community medical groups of Central Region Branch Bureau of National Health Insurance as our research subjects. We evaluate the frequency of returned checkup of those patients after being transferred by mailing or phone questionnaires by using logistic regression analysis to determine those factors affecting the returned rate. Our study has collected 499 effective questionnaires and the correspondence rate was 31.1%. Results: The return rate of transferred patients in the past two years is 27.5%. Using the logistic regression analysis under all controlling related factors, our results demonstrate the intention of patients to return to the original clinics was determined by the convenience of the clinic locations and the request from their original physicians. Upon cross evaluation of these two factors, we found that co-existence of the convenience of the clinic locations and the request from their original physicians play the determined roles for the return rate as compared to each individual factor alone. Conclusion: Increasing the return rate to make the referral satisfaction, we have to fortify the concept for patients to find a fixed clinic for their initial visit and notify the referred physicians about the importance of patients’ return to their original doctors. Through close communication and cooperation between the clinic and hospital physicians in vertical and horizontal manners, the patients can then be taken in a much more integrative way with higher quality of health care system.
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Tsao, Tsung-sheng, and 曹宗聖. "Exploration on the Medical Referral System in Ma-Tuz Area." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/02972517500401742538.
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碩士高雄醫學大學
公共衛生學研究所碩士在職專班
92
In order to improve and upgrade the means of transferring patients for higher quality medication treatment to save patients is the main purpose. During the transfer the local health department and Labor Insurance Department of Ma-Tzu are making improvement and correction in carrying out the program. The date samples were gathered from January 2001 to December 2003. These date cases is within 3 years. Among 505 were military armies, 1909 local residents making a total of 2414 cases. The observation style including descriptive analysis, X2-test, one way ANOVA and logistic regression analysis. To visualize the difference medical demand and treatment condition, and medical services influence the transportation process. The result of the observation: 一. Medical demand and Medical condition The number of makes are double against the number of females. Ages 20 to 30 years old typically the youngtees. While the ages which range from 40 to 50 years old are greater in number. Disease of the musculoskeletal system are the most numerous (18%). Secondly is the disease of the genitourinary system (12.9%). Thirdly is the disease of the digestive system (10.7%). The local residents are more on the diseases of the genitourinary system (14.5%), neoplasms is 13%, musculoskeletal system is 12.4%. The process of transfer patients are cases of surgery are the most common which is 39.1%, internal medication of 25.7%. Surgical department includes orthopedics and general surgery is much demand, internal department includes cardiac, thoracic, and digestive department is much in demand. There are the most common case for transfer to medical centers the highest is 69.3%,regional hospitals 22.7%, specialist hospitals and clinics at least 8%. The transfer of patients to these various hospitals are saturating due to the physicians qualification, the degree of illness, and these these transfer of department depends greatly on it. The emergency helicopters of transferring patients are more of common cases of orthopedics and surgical department. 二. The usage of airport transfer facilities The sea freight is decreasing yearly while air freight in increasing every year. The period time of transfer to Taiwan is evidently lessened, thus increasing the accessibility of patients. A part of the usage of helicopter, it has altered to airplanes to decrease the percentage of helicopter usage. 三. Influence of Medical Services with the help of airport usage The frequency of transferring from one department to the other will gradually increase. Thus the percentage of having specialist’s treatment also follows. It can also reduce the predicament of the insufficiency of critical care personal. There some difference in the number of transfer patients relative to the season they transferred. In this study, we recommend the Bureau of National Health Insurance should carry out the integrated care service in remote districts, and support specialist transference service. In order to elaborate its benefits, it should be done by providing physicians, longer service period, and not to be transfer red too frequently based on local demand. The improvement of the transport system by the authorities is beneficial is beneficial to transference and the availability of medical care. Key words: Ma-Tzu Area, medical transfer, emergency helicopter, accessibility, traffic tools.
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Chatterjee, Subhayu Saroj. "Instant messaging interface and transport for the multiagent referral system." 2003. http://www.lib.ncsu.edu/theses/available/etd-12102002-204742/unrestricted/etd.pdf.
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Hung, Li-Wen, and 洪麗雯. "Establishment and Evaluation of acute myocardial infarction referral information system." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/76efqh.
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碩士國立高雄應用科技大學
資訊管理系碩士在職專班
101
Acute myocardial infarction, abbreviated as AMI, which is identified one of the critical care by Department of Health, is the second prize of the ten causes of death. There are ninety minutes in the golden first aid. Therefore, It’s emergent to rescue the patient. At the onset of the rescue, time is not allowed to waste. But not every hospital can treat the patients of AMI well, the moment when the incidence of patients happened, the general public or ambulance will sent them to the nearest emergency room for treatment. Once they sent to the hospital which can’t treat them well, it will miss the golden rescue time and make the patient may cause irreparable physical harm. If we can’t make the treatment of AMI well, we will cause more waste of medical resource and social costs. The purpose of this research, hope to set up an transferred information system of AMI which makes all levels of medical institutions link to AMI acute severe referral network. While the ambulance is sending the patients of AMI to the nearest regional hospital, they can immediately transfer the patient quickly and efficiently through referral information system with their correct medical information automatically to the severe emergency responsibility hospital. In the way of transferring the patients to another severe emergency responsibility hospital which has obtained patient medical information, they have time to schedule the operating room and the cardiac intensive care unit immediately, starting intensive group to wait for the patients’ arrival, immediately implanted in the operating room to save more prime time. Therefore, it won’t be missed the golden rescue time to send the wrong hospital. Take two regional hospitals in Kaohsiung and one hospital medical center as experimental subjects, this research makes three hospitals link to AMI referral network. Through the experimental subjects, creates acute myocardial infarction referral information systems, computerize manual operation and integrates of all referral information automatically through the system to improve data accuracy and reduce the rate of misdiagnosis. In clinical practice, supporting mobile medical device iPad mini for the clinicians, it may let doctors can use the device without geographical restrictions. In addition, referral mechanism can be activated at any time through the mobile devices, or view the patient referral information and trends and deal with the results. The benefits of this referral information system built by this research can save the time of patients of AMI to be transferred, reduce the rate of misdiagnosis and increase patient safety. Hope this research can be extended to all of the medical centers to create AMI referral network. There will be no regret of patients of AMI to be sent to the wrong place in the future.
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Mojaki, Monnapule Eric. "Evaluation of referral system in Thaba Nchu Health sub-district." Thesis, 2010. http://hdl.handle.net/10539/8827.
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MPH, Faculty of Health Sciences, University of the WitwatersrandIntroduction: South African health system embraces the District Health System model. 1 District health system includes health stations or posts, other health care facilities such as private health practitioners, community based organisations. primary health care clinics and district hospitals. District hospitals provide first level of outpatient or inpatient care for patients who have been referred by their primary care providers. District hospitals usually provide 24 hour care and are integrated into district health system. The above set up is similar in Thaba Nchu Health sub district where Dr.J.S.Moroka Hospital (DJSMH) is a district hospital and therefore, a referral point for 11 clinics within Thaba Nchu sub district and 4 clinics from the neighbouring sub district. In addition, there are 5 general practitioners rooms within Thaba Nchu sub district. The DJSMH is overburdened with increasingly high caseload. Main Aim: To evaluate the referral system in the Thaba Nchu Health Sub-district, Free State Province in terms of the factors that influences its function. Methodology: This was a descriptive study undertaken at Dr.J.S.Moroka Hospital Outpatient and Casualty departments. The study included review of routinely collected hospital information on patients’ records and registers. No intervention was done for this study. Results : The referral system within the sub district is not fully functional. Most patients that are seen in the DJSMH are self referrals. The case load and work load of the two designated areas could be reduced if most of the patients could have started and be seen at the primary health care clinics. Although the registers were helpful in collecting information, the documentation on patients’ records by health workers is not consistent; it is poor and need to be improved. The records have shown that the personnel are doing little in strengthening the referral system within the district. Conclusion: This study was the first of its kind to be done in this DJSMH. Although there are good practices with regard to referral system within the Thaba Nchu subdistrict and Dr. J.S Moroka Hospital, much still has to be done to ensure that the primary health care clinics and hospitals are effectively functioning in rendering services relevant to each level of care. More patients seen in the DJSMH are self referrals that could be managed at the primary health care clinics. The interventions recommended in this study will assist in strengthening the delivery of district health care system and in particular improve the referral system within the sub district.
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Dlakavu, Welekazi Fuziwe. "Self referral of women in labour at Chris Hani Baragwanath Hospital after the introduction of a triage down referral system." Thesis, 2013. http://hdl.handle.net/10539/12297.
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Background and objectives
There has been a steady annual increase in the number of deliveries performed at Chris Hani Baragwanath Hospital in recent years. A 2004 audit found that approximately one third of deliveries conducted at the hospital were of women who had referred themselves and were low risk and as such did not require delivery at a specialist centre. A triage down-referral system back to midwife obstetric units was implemented in 2008 to address the problem of low-risk self-referrals at the hospital. This study was conducted after the establishment of the triage system to find out whether the establishment of the triage system had been accompanied by a decrease in the proportion of self-referred women presenting to Chris Hani Baragwanath Hospital in labour, and to assess delivery outcomes in these patients.
Literature review
The literature review was conducted using Pubmed and MDConsult using the key words self referral, triage, gatekeeper, low-risk pregnancy, maternity / labour and referral systems. Relevant references were accessed via the University of the Witwatersrand eJournal portal. Appropriate articles cited by other authors were also reviewed. Appropriate websites were also used and referenced.
Methods
This was a retrospective descriptive study which included all women presenting in labour to the hospital maternity admissions area. The study population was clinical case-files of all births that were admitted in labour from 1 May to 31 May 2010. A simple random sample of these files was drawn. Results
One hundred and eighty two intra-partum admissions were sampled. Thirty-five (19%) of these women were self-referred. Seven out of the 35 (20%) required caesarean sections. Five more (14%) needed oxytocin augmentation of labour, and one more (3%) had a vacuum delivery. Twenty women (57%) did not develop any complications during labour and could have been delivered at their midwife obstetrics units. During the month of the study, the triage down-referral system attended to 171 women and down-referred 83 (49%).
Conclusion
The establishment of a triage down- referral system has been accompanied by a curtailment in the number of low-risk pregnancies presenting self-referred at the referral hospital labour ward, compared with the audit in 2004.
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Carrick, Curtis. "Developing an optimization algorithm within an e-referral program for clinical specialist selection, based on an extensive e-referral program analysis." 2013. http://hdl.handle.net/1993/21711.
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When referring physicians decide to refer their patients to specialist care, they rarely, if ever, make a referral decision with the benefit of having access to all of the desirable information. It is therefore highly unlikely that the referring physician will make the optimal choice of specialist for that particular referral. A specialist selection optimization algorithm was developed to guarantee that the “right specialist” for each patient’s referral was chosen. The specialist selection optimization algorithm was developed based on feedback from over 120 users of the e-referral program. The developed algorithm was simulated, tested, and validated in MATLAB. Results from the MATLAB simulation demonstrate that the algorithm functioned as it was designed to. The developed algorithm provides referring physicians with an unprecedented level of support for their decision of which specialist to refer their patient to.
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WANG, MING-JIE, and 王銘杰. "A study of the behavior of physicians toward medical referral system." Thesis, 1989. http://ndltd.ncl.edu.tw/handle/37715245318908583714.
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Rothberg, Judy Nicola. "Neonatal refferral patterns within a referral system in southern Gauteng, South Africa." Thesis, 2010. http://hdl.handle.net/10539/8553.
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MMed (Paediatrics), Faculty of Health Sciences, University of the WitwatersrandThe aim of regionalisation of neonatal services is to offer a basic level of care to the majority of the obstetric/neonatal population who are at low risk, with smaller numbers of more specialised hospitals offering higher levels of care to the fewer, higher-risk patients. On review of relevant literature there has long been a shortage of neonatal intensive care unit (NICU) beds in the South African public sector. This study was an audit within a referral system in the public sector. The aim was to identify the need for NICU beds, establish whether the need was being met, ascertain which patients required referral and which were accepted, and delineate factors that influenced the outcome of acceptance versus refusal. Subjects and Methods Data collection took place between 30 October and 11 December 2006. Seven health facilities in southern Gauteng were included as study sites. These included 2 primary healthcare clinics, 3 district, 1 regional hospital and the tertiary referral facility, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The study included all neonates requiring transfer to a NICU, for any reason, during the study period. Data collection relied upon completion of information sheets by doctors requesting or accepting transfer of ill neonates at each of the hospitals involved. The primary outcome was acceptance or refusal at CMJAH NICU. Secondary outcome was survival or death within the study period. Results Forty-seven external requests for NICU beds were recorded at CMJAH and another 22 requests came for births within CMJAH. Only 13 (28%) of external requests were accepted. All internal requests were accommodated. Most requests came from level 2 (district or regional) hospitals, many outside the designated referral system, mainly for infants with respiratory distress. Infants older than 24 hours of age (OR 0.16; 95% CI 0.04-0.65), those with congenital abnormalities, and those requiring surgery (OR 0.11; CI 0.23-0.57) were significantly more likely to be accepted. Greater numbers of staff on duty at CMJAH also correlated with the probability of acceptance into NICU. Conclusion Relatively few external requests were accepted. CMJAH provides sub-specialist services including paediatric surgery and therefore should accept patients requiring such management. However, there was a high number of patients refused admission for ‘simple’ neonatal respiratory conditions. Level 2 hospitals should be able to manage these. Furthermore, hospitals are not following strict referral protocols. The findings are indicative of the continued shortage of neonatal intensive care beds, poor adherence to referral guidelines, and a general failure of regionalisation within the sector under consideration.
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Chen, Tsung-an, and 陳聰安. "The present study is attempted to investigate the acceptance of doctor to the information network referra and referral system in Penghu." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/70581904346757393240.
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碩士國立中正大學
資訊管理所
94
Due to rapid development and propagation of information technology, network information technology has expanded into area of healthcare management. By utilizing the establishment of network information referra and referral system, it can provide positive benefit on the hospital management such as case history management, the take care for doctor to practice, and clinical diagnosis. Doctor plays a key role in the operation of referra and referral system. The present domestic investigations concerning the doctor acceptance of referra and referral system were mainly examined base on the National Health Insurance (NHI) and finance. However the corresponding investigation based on the acceptance to telemedicine technology is relatively lacking. Penghu consists of 64 islands. Because of the geography limit, Penghu’s medicine resource is poor for a long time. referra and referral system is very important in Penghu’s medicine service system. Thus, the present study is attempted to investigate the acceptance of doctor to the information network referra and referral system in Penghu. Furthermore, the authors hope the results can be an effective reference to the medicine polity and medicine information integration in Penghu region. Then improve the medicine quality of Penghu. The main purpose of the present investigation is as bellows: 1. Confirm the percept of the doctor in Penghu to the network information referra and referral system. 2. Confirm the influence factors of the doctor in Penghu to the network information referra and referral system. The investigation is based on the responses of doctors served in Penghu.Totally 129 questionnaires were delivered to the health examination department of different hospital, and effectively replied by 80, the return rate was 62.02%.The results indicate that independent variable is relative to personal innovativeness, and perceived usefulness. These factors will be the primary positive influence to the establishment of network information referra and referral system in Penguh region. For the doctor’s decisions to accept network information referra and referral system, perceived usefulness is significant, however, perceived ease of use is not significant. The reason is doctor is a highly specialized job and the doctor himself possesses high degree of education. The learning capacity for doctor is more excellent than the other workers. Thus, perceived usefulness is the main choice for doctor to use network information referra and referral system. That is, the practice and usefulness of network information referra and referral system are the main intentions to the acceptance of doctor.