Esta pesquisa buscou investigar como se constitui a demanda para a Neurologia a partir dos professores no contexto da Educação Básica. Os referenciais teóricos foram construídos a partir de dois eixos: um olhar crítico para o campo da neuroeducação e seu crescimento a partir dos anos 1990; propõe-se o termo neurocolonização, onde os saberes das neurociências seriam imprescindíveis para a Educação. O outro eixo envolveu o debate sobre os processos de medicalização, formulados a partir de uma leitura panorâmica e de uma revisão de duas genealogias – a de Michel Foucault (2010) e a de Jurandir Freire Costa (1979). A discussão teórica também incluiu um olhar para a interface Psiquiatria-Educação e para a fronteira-território que se constitui entre Psiquiatria e Neurologia. Realizou-se um levantamento dos encaminhamentos feitos à Neurologia na cidade de Novo Hamburgo/RS no segundo semestre de 2015. Junto às cartas de referência analisadas neste levantamento foram encontrados seis documentos assinados por professores. Cinco das seis professoras signatárias destes documentos foram entrevistadas, tematizando a construção de si e os percursos profissionais; os encontros com os trabalhadores de saúde; as hipóteses e expectativas em torno do caso da criança que decidiram solicitar encaminhamento, e como percebem a influência das neurociências sobre o seu trabalho. A análise dos encaminhamentos aponta para uma frequência de situações relacionadas ao campo da Educação superior aos casos de cefaleia e epilepsia/convulsões As entrevistas oferecem indícios da constituição da demanda para a Neurologia apoiada em diferentes elementos: a) o recurso ao saber especialista, demarcado especificamente no dispositivo ‘consulta’; b) o deslizamento dos discursos das neurociências-pesquisa – que se remetem a uma criança qualquer - em direção ao que se constrói na prática clínica e também na prática pedagógica, uma relação entre sujeitos reais; c) a não-aderência a um sistema diagnóstico ou a um campo de problemas, podendo-se falar de crianças e adolescentes descabentes, que povoam as margens das classificações diagnósticas e alimentam um circuito tautológico entre Saúde e Educação; d) hipóteses formuladas pelos professores centradas no modo da família criar sua prole e na expectativa de que o neurologista interfira nestas relações, numa tentativa de normatizar ou padronizar as condutas entre família e escola; e) pouca ênfase à importância dos saberes das neurociências ou dos exames complementares para a tomada de decisão nestes encaminhamentos. Por outro lado, práticas desmedicalizantes também foram reconhecidas a partir da sensibilidade do olhar das ensinantes, ressignificando as diferenças e desarmando os automatismos patologizantes

Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.

Cleft lip and palate (CLP) has been determined to be the second most common birth defect in the United States, affecting 1 in every 940 births (Parker et al., 2010). The team approach is the accepted best practice for children with CLP (Kummer, 2020) and the school-based Speech-Language Pathologist (SLP) has an important role to play in assessment and intervention of children with repaired CLP, however there is little research to describe their collaboration. This research aimed to explore and describe the referral practices of school-based SLP’s to CLP teams. A survey titled “Referral to Cleft Lip and Palate Teams: Practice of School-Based Speech Language Pathologist’s” was developed and distributed to members of the American Speech-Language Hearing Association’s (ASHA’s) Special Interest Groups (SIGs) 15 and 16 following an in depth literature review on the topic. A total of 57 practicing school-based SLPs acted as respondents. The results of the survey suggested VPD was the main reason for making a referral to a CLP team (89.72%), which validates the response that clients mostly referred had suspected VPD (89.47%). Making a team referral was not common practice, as 58.7% had never made a CLP team referral in the schools. ENTs (51.06%) were the preferred choice of referral in comparison to a CLP team (25.53%). Barriers to making CLP team referrals varied and obtaining permission from the school was experienced by some respondents (36.36%). Respondents made valuable comments which centered on positive experiences with working with CLP teams (11/56). The process of making referrals to CLP teams and collaboration between school-based SLPs and CLP teams needs to be addressed in graduate training and CE. According to Vallino et al., (2019) such communication enhances care, bridges the perceived gap between school-based SLPs and CLP teams, and will ensure that children with CLP and VPD receive the best care possible.

Literature Review Undernutrition in the hospital setting has been shown to cause adverse outcomes. Screening for nutritional risk assists in the detection of undernutrition with subsequent early intervention to prevent further decline. While many nutrition screening tools exist, none are proven to detect undernutrition. Furthermore, many barriers exist for utilizing nurses as primarily responsible for screening patients for nutritional risk. Background A hospital reviewed the nutrition screening process and found that the form used and screening factors were insufficient to adequately detect undernutrition and appropriate referrals for dietitians. Objectives 1) Determine if nursing compliance improved when the nutrition screening form was integrated with the Interdisciplinary Care Plan form. 2) Improve the relevance of the nutrition screening risk factors used and the overall screening tool. Methods The Interdisciplinary Plan of Care form was updated to include the nutrition screening tool and used on the Medical /Surgical unit. Data was also collected on the Intensive Care Unit which continued to use the original screening tool. Results Screening completion did not improve with the implementation of the new screening process, however the quality and quantity of referrals from the new screening form did improve. Total compliance for nurses responsibility also improved with the new form. Conclusion Integrating nutrition screening factors into an interdisciplinary plan of care can improve the rate of dietitian referrals. Nutritional screening procedures must be continually reevaluated for effectiveness in detecting undernutrition in the hospitalized patient. Further studies must be conducted to evaluate the validity and specificity of all nutrition screening tools.

Integrated care is rapidly becoming the new paradigm of healthcare and with the transition into integrated practice, many providers from various disciplines must determine how best to work as a team to improve patient outcomes. One particular setting where the logistics of integrated practice must be scrutinized is pediatric primary care, specifically in rural areas, as many psychological problems are presented in pediatric primary care, and rural children are at greater risk for engaging in unhealthy behaviors, such as sedentary lifestyle, poorer nutrition, and greater substance use. All of these concerns can be ameliorated with successful referral to behavioral health consultants (BHC) who can assist in treating these various psychosocial issues. In order for the BHC to assist with patients with psychosocial concerns, other medical providers must be able to recognize and refer these patients to the BHC. The purpose of this study was to determine the prevalence of psychosocial concerns in pediatric primary care and how often the attending medical provider noticed these concerns and referred the patient for behavioral health services. The study also examined what types of psychosocial concerns were raised, and if the referral was not addressed during the same visit, the latency between the initial referral and the behavioral health service. Retrospective electronic health record data (N=300) was collected from the well visits of all 4 and 5 year old patients in 2014 from a rural Appalachian pediatric primary care clinic. Results indicated that when a psychosocial issue was raised, the majority of medical providers appropriately referred the patient to the BHC. Psychosocial concerns were raised in 21.3% (n=64) of visits. When psychosocial concerns were raised, 62.5% (n=40) were referred for behavioral health services with 87.5% (n=35) to the in house BHC. When patients were referred to the in-house BHC, 83.3% (n =30) received services immediately, while patients who were not seen immediately, 16.7% (n=5), waited for an average 21 days to be seen by the BHC. The most common psychosocial concerns raised were related to toilet training, temper tantrums, sleep hygiene, and hyperactivity. These findings highlight the high prevalence of psychosocial issues presented in rural pediatric primary care and the continued education of providers about recognizing these concerns so the appropriate referral can be made. These findings also highlight the need for more integrated practice as primary care is the often the primary source of healthcare in rural areas and by addressing all concerns about patient well-being in this setting via integrated care, patient physical and mental health outcomes can be greatly improved.

The purpose of this research was to examine the impact of professional development on teachers' delivery of written praise notes and the number of office disciplinary referrals (ODRs). The professional development consisted of training teachers on the effective use of behavior specific written praise, as well as on how to analyze and respond to praise-note and office disciplinary referral data. It was hypothesized that this process could help support and increase teachers' delivery of behavior-specific written praise notes and would subsequently decrease in the rate of office discipline referrals (ODRs). As baseline data, this study used the participating school's existing data (November through February for academic years 2009-2010 and 2010-2011). Data included number of praise notes and office disciplinary referrals. Across the most recent school year (November thru February 2011-2012), on a monthly basis, data were collected on number and content of notes and the number of ODRs. Current data were compared with baseline data from two previous school years. Although the data did not indicate significant changes between baseline data and post intervention data, overall data suggest a gradual increase in respect to the number of written praise notes. However, contrary to anticipated outcome, a slight upward trend was indicated in the number of office discipline referrals. These results are considered inconclusive in regard to whether professional development significantly impacts the number and specificity of praise notes and decreases the number of students with ODRs. However, the majority of teachers supported delivering written praise notes as an effective intervention to increase desired classroom academic achievement and appropriate social behavior.

No description available.

This study was conducted to investigate the disproportional distribution of subjective and objective discipline referrals to the different student groups’ gender, socioeconomic status, and ethnicity for the 6th through 12th grade students in a central Florida public school district for the school year 2009-2010. The relationship of the disproportional distribution of subjective and objective discipline referrals between gender and socioeconomic status was analyzed. In addition, the relationship of the disproportional distribution of subjective and objective discipline referrals between ethnicity and socioeconomic status was analyzed. Analysis of the discipline referral data from the central Florida public school district for the school year 2009-2010 led to the following findings: (a) males, blacks, and students with low socioeconomic status, were over represented with student discipline referrals of all types; (b) males, blacks, and students with low socioeconomic status, were over represented with subjective discipline referrals; (c) low socioeconomic status males were the major contributors to disproportional distribution for males within the gender group variable, and low socioeconomic blacks were the major contributors to disproportional distribution within the black ethnicity group variable.

Abstract Word-of-mouth (WOM) personal referrals are more efficient and influential than other forms of advertising; however, there is a lack of information regarding the value of referral programs. The purpose of this qualitative case study was to explore the perceptions of business owners, staff, and customers of alternative health care organizations in a Midwestern U.S. state about efficient referral strategies, measuring the effect of those strategies, and motivations of consumers to make referrals. Maslow's hierarchy of needs theory of motivation and customer decision-making theories provided the conceptual framework. The research questions addressed how industry leaders perceived and ranked referral strategies and addressed customers' perceptions and motivations to make personal referrals. Data collection consisted of semistructured interviews with 4 business owners, 2 staff members, and 10 client participants. Data were analyzed using constant comparative analysis methods, and member checking enhanced the accuracy of the findings. Results indicated that participants viewed WOM personal referrals as the most efficient nontraditional strategy to make or receive referrals, and they perceived referrals from impartial and trustworthy sources as the most valued information. This research has implications for positive social change. Findings may be used to enhance business owners' understanding of the value of personal referrals in their marketing mix, and of the motivation for customers to make referrals. WOM personal referrals may be used as a marketing strategy to increase sales and lower costs of formal advertising, which may contribute to the growth of the business.

L’ostéopathie connaît une popularité croissante au Québec. Cependant, la collaboration interprofessionnelle (CIP) entre les médecins et les ostéopathes est un phénomène relativement nouveau et encore peu étudié. Cette étude mixte séquentielle explicative vise à : 1) décrire la situation actuelle au Québec en termes de collaboration entre les médecins et les ostéopathes impliqués auprès de la clientèle pédiatrique et 2) explorer les facteurs facilitants et les barrières à la CIP. Méthodologie : Le volet quantitatif a été réalisé à l’aide de questionnaires postaux destinés à tous les médecins et ostéopathes œuvrant auprès d’une clientèle pédiatrique. Vingt et un entretiens semi-dirigés ont par la suite été réalisés. Les données recueillies dans les questionnaires ont été analysées à l’aide de statistiques descriptives et de modèles de régression alors qu’une analyse thématique a été effectuée pour le contenu des entretiens. Résultats : Au total, 274 médecins (14 %) et 297 ostéopathes (42 %) ont complété les questionnaires. Dix de ces médecins et 11 ostéopathes ont participé aux entretiens. Les références en ostéopathie sont associées à la présence d’une relation professionnelle (rapport de cote (RC) 4,10 (intervalle de confiance (IC) à 95 % 2,12; 7,95), p < 0,001), aux consultations personnelles (RC 2,58 (IC 95 % : 1,35; 4,93), p = 0,004), à la pratique en milieu non hospitalier (RC 1,89 (IC 95 % :1,03; 3,47), p = 0,040) et à la connaissance du rôle de l'ostéopathe (RC 1,22 (IC 95 % :1,01 ; 1,47), p = 0,042). Les facteurs facilitants additionnels mentionnés sont les expériences positives rapportées par les parents, la formation antérieure en santé et l’expertise en pédiatrie de l’ostéopathe, le respect des limites professionnelles et la complémentarité des soins, la sécurité perçue de l'ostéopathie ainsi que les demandes de communications interprofessionnelles émises par les parents. Le langage, la difficulté de vulgarisation, le contexte organisationnel et légal, l'incertitude quant aux rôles, la rareté des interactions interprofessionnelles et les données probantes limitées dans le domaine ostéopathique constituent les principales barrières à la CIP. Conclusion : Une certaine collaboration existe déjà entre les médecins et ostéopathes, mais l’optimisation de cette collaboration pose encore plusieurs défis. Dans le contexte actuel de processus d’encadrement de la profession d’ostéopathe par l’Office des professions du Québec et de la création d’un premier programme universitaire, ces résultats pourront guider les efforts visant la promotion d’une collaboration productive et des soins sécuritaires axés sur le patient. / Abstract: Osteopathy is growing in popularity in Quebec. Interprofessional collaboration (IPC) between physicians and osteopaths is a new phenomenon and information about it is scarce. This explanatory sequential mixed-methods study aimed to 1) describe current collaborative practices between physicians and osteopaths involved with pediatric patients and 2) explore enablers of and barriers to the development of IPC. Methods: Postal questionnaires about collaborative practices were first sent to all physicians and osteopaths working with pediatric patients in Quebec. Semi-structured individual interviews were then conducted with a subset of 21 participants. The data collected in the questionnaires were analyzed using descriptive statistics and regression models, while a thematic analysis was carried out for the content of the interviews. Results: A total of 274 physicians (14%) and 297 osteopaths (42%) completed the survey while 10 of those physicians and 11 osteopaths were purposely selected for interviews. Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and knowledge about role of osteopathy (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). Additional enablers identified by respondents include: positive experiences reported by parents; the osteopath having had pediatric experience or previous training as an allied health practitioner; mutual respect for professional boundaries and complementarity; perceived safety of osteopathy; and parents’ requests for interprofessional communication. The main barriers to IPC include: language; difficulties communicating findings of osteopathic palpation assessment; organizational and legal contexts; uncertainty regarding one another’s roles, lack of interprofessional interactions; and limited scientific evidence. While some collaboration currently exists between physicians and osteopaths, optimizing these relationships and interactions still poses several challenges. In the current context of the pending regulation and standardization of osteopathic training in Quebec, these results could be used to guide efforts to promote productive collaboration and safe patient-oriented care.