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PubMed1992

[A method for determining peroperative centering and monitoring the development of postoperative decentration of intraocular lenses].

After implantation of intraocular lenses (IOL) Purkinje images 3 and 4 (Pi3 and Pi4) are clearer on the anterior and posterior surface of its optical part (subsequently only lens). Along with the corneal Pil this phenomenon was already used in clinical work for more accurate calculations of the degree of decentration and tilt of the lens in the eye. The authors describe a simplified method for assessment of the position of the lens by means of Pil, 3 and 4, using apparatuses with an approximately coaxial light. The method uses overlapping of Pi1, 3 and 4 in perfect centering of the lens in the axis of the eye (it is assessed by drawing a perpendicular line on the centre of the cornea) and marked dislocation of Pi3 in the direction of decentration of the planoconvex lens with the convexity facing the cornea. The inclination of the lens must be eliminated according to positions Pi1 and Pi4. The method is suitable for peroperative centering and for assessment of the direction and extent of decentration of these lenses. The authors discuss the possible use of this method also in biconvex and planoconvex lenses with the convexity facing the retina. In a group of 10 implanted planoconvex lenses the authors demonstrate the possibility of perfect peroperative centring of the lens and other applications of the method. Incorrect position of the IOL at the end of the operation, which can be one of the factors of later complications, did not change during the early postoperative period.

Humans↗
PubMed2004

Impact of decentralization on health services in Uganda: a look at facility utilization, prescribing and availability of essential drugs.

INTRODUCTION: Uganda began implementation of a structural adjustment programme (SAP) in July 1994 in order to improve social services. The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increase in the level of utilization of health facilities. OBJECTIVE: This study evaluated the impact of the decentralization policy on health facility utilization; availability of essential drugs, and prescribing patterns for acute respiratory infections (ARI), diarrhoea, and malaria in two district hospitals in Uganda. DESIGN: Mixed method evaluation design, involving both quantitative and qualitative methods. Time series analyses of data from utilization, pharmacy stock, and prescription records before and after the policy change. Key informant interviews and focus group discussions to obtain information on perceptions and attitude of stakeholders on the process of the policy implementation. STUDY SETTING AND POPULATION: The study was conducted in two district hospitals in northern Uganda. A total of seven years of utilization and pharmacy stock data including 5040 patient records from the hospitals were analysed retrospectively. In-depth interviews were conducted among 11 politicians from each district; 100 open-ended questionnaires were administered to patients in each hospital; 86 health care workers were interviewed using semi-structured questionnaires; and focus group discussions were conducted with 23 health care providers. MAIN OUTCOME MEASURES: Facility utilization was evaluated by average monthly attendance in the outpatient department and paediatric ward admissions. Availability was assessed as average number of drugs per month. Prescribing indicator outcomes included: for malaria, percent chloroquine tablets and percent chloroquine injection; for ARI, percent receiving antibiotics or injections; for diarrhoea, use of oral rehydration salts (ORS), antidiarrhoeal mixtures, and antibiotics. The average number of drugs prescribed assessed polypharmacy. RESULTS: There was a general increase in patient attendance in both hospitals, although the initial increase later declined in Apac. Drug availability was erratic and not always adequate. The situation was better in Lira where funding for drug procurement was more accessible. Prescribing patterns varied, with improvement in some indicators, while others showed no change or even worsened. CONCLUSIONS: The decentralization policy led to increased utilization of health facilities. The perception was that the policy was good because it "empowered the community in terms of creating a sense of responsibility in the stakeholders, and a sense of ownership that facilitated sustainability" of public institutions. In spite of the views expressed by the stakeholders, the policy failed to improve drug shortages, inefficient utilization of resources, and low morale among hospital staff. Staff should be re-trained and better remunerated in order to cope with the implementation of the policy. Local politicians should clearly understand their roles and responsibility under the new policy. Efficient utilization of funds at all levels of the district administrative structures should be ensured.

Delivery of Health Care↗
PubMed2004

Managing mental health service provision in the decentralized, multi-layered health and social care system of Germany.

BACKGROUND: The effective coordination of mental health service provision is a requirement for successfully reforming mental health care from a hospital-focused system towards a more decentralized, community-oriented one. Implementing such coordination is particularly challenging in a decentralized, multi-layered health and social care system such as exists in Germany. AIM OF THE STUDY: (i) To investigate the coordination and planning of mental health service provision performed at and between the local, Länder and federal political levels in Germany; (ii) to outline the disparities in coordination and planning of mental health service provision that exist between the different political levels and locate key-authorities; (iii) to determine whether a decentralized, multi-layered health and social system such as Germany's allows for adequate coordination. METHOD: (i) Analysis of mental health legislation and policy documents; (ii) guided interviews with officers and consultants of the government units responsible for mental health affairs of the 16 Länder and the federal Ministry of Health and Social Security; (iii) submission of results to the interviewed experts for verification. RESULTS: Multi-professional boards and posts for coordinating and planning mental health services are widely implemented on local state and federal level in Germany. Most of them operate without being required by legislation. The sickness and pension funds are represented in less than half of the boards on state level. Boards on local and on state level are mainly concerned with coordinating social mental health care and have little influence on medical mental health care. Mental health policy documents exist federally and in most Länder. All but one of the mental health legislations of the Länder (present in 12 out of the 16 Länder) also considers regulations concerning coordinating and planning mental heath services. The key-authorities for mental-health policy, legislation and service implementation is with the 16 Länder. The federal government however plays an important frame setting role. Actual service provision is a local responsibility. DISCUSSION: Since the beginning of mental health reforms 25 years ago and in particular in recent years, structures for the coordination and planning of mental health service provision have been established countrywide at local, Länder and federal levels. However, there are hardly any structures that connect the Länder and local levels and act as a source of independent quality assurance. The coordination boards at the Länder level include almost all the parties involved in mental health care, with the exception of sickness and pension funds that are, for the most part, absent. Thus the coordination boards are mainly restricted to governing social services in mental health care. Despite this, the countrywide establishment of diverse boards for the structured coordination of mental health service provision can be regarded in itself as a success, although little is known of the processes and impact of this framework. There are, however, indications that coordination is still restricted to the traditional interfaces and dividing lines of the mental health care system, which they seem unable to overcome. IMPLICATION FOR HEALTH POLICIES: The reform of mental health service provision towards a more community-orientated approach requires sophisticated coordination. The countrywide establishment of structures for the coordination and planning of mental health service provision has been largely possible in Germany. It does, however, require further analysis, since coordination beyond the traditional boundaries seems unlikely. Therefore, incentives are needed in order to encourage "adequate coordination" as well as integration with other parts of the mental health care system.

Community Mental Health Services↗
PubMed1992

[Decentralization of the tuberculosis campaign and its follow-up in the Dosso Department (Niger)].

The national program for tuberculosis control has been decentralized in the dispensaries of Dosso Department since 1985. The physician appointed as departmental coordinator at the Departmental Center for Tuberculosis has organized training and ensured a close follow-up of the activities through supervision and valuation. In spite of an important decentralization and an increase of the sputum examinations, the case detection has not been improved (mean detection rate equals to 0.28/1000. In opposite, the cure rate has been increased appreciably (from 24% to 52%) and the noncompliers rate has decreased (from 42% to 19%). The follow-up of the program has got important side benefits on the other activities. The efficiency of the decentralization and of the follow-up is discussed, the costs of the start and use have been estimated. It has been recommended to integrate the program to the other health activities and to delegate the follow-up to the physicians in change in the Medical Center.

Antitubercular Agents↗
PubMed2006

Decentralized DOTS shortens delay to TB treatment significantly in Cambodia.

SETTING: Rural districts in Cambodia with and without decentralized health center based DOTS program. OBJECTIVE: To compare delays to treatment and behavior of patients up to diagnosis, between the pilot districts where DOTS is decentralized through the health centers, and the control districts where DOTS is provided through hospitals. DESIGN: A cross sectional study with structured questionnaire interviews to all new smear-positive TB patients aged 15 years or older who were registered in the study sites from May 1st to July 31st in 2002. RESULTS: The total delay in the pilot districts was significantly shorter than that in the control districts (median 58 days vs. 232 days, p < 0.01). The median doctors' delay within TB service in the pilot districts was 10 days and that in the control was 6 days. The period between first consultation to any health care provider and first visit to a TB service center, subsequent contact delay, was longer than any other type of delay and significantly different (24 days in pilot vs. 185 days in control, p < 0.01). The distance and travel costs to a TB service center were the factors associated with delay in seeking diagnosis of tuberculosis. No other variables had any significant association with the delay. CONCLUSION: Decentralizing DOTS to primary care health centers is highly effective in reducing the delay to TB treatment in Cambodia.

Adolescent↗
PubMedDate not supplied

[Strategies for municipal decentralization in health].

The decentralization of health services has been planned as a process that must reach the municipal level. The present work analyses the global framework of the decentralization strategy, the components for structural health changes, the characteristics of the transferences to the states, and ends with the basic elements of strengthening and decentralization of health services to the municipalities.

Health Planning↗
PubMed1990

Decentralization of superior cervical ganglia attenuates heat stroke formation in rabbits.

The effects of preganglionic decentralization of (sympathetic trunk resection) or post-ganglionic excision (ganglionectomy) of the superior cervical ganglia on cerebral blood flow and the formation of heat stroke were assessed in rabbits. An intravenous isotope method for external measurement of cerebral circulation time was applied to rabbits for determining cerebral blood flow. Heat stroke was induced by exposing animals to a high ambient temperature of 40 degrees C. The occurrence of loss of sensation, decreased muscle tone and unconsciousness was taken as the onset of heat stroke. The results showed that decentralization of the superior cervical ganglia enhanced the cerebral blood flow, whereas ganglionectomy reduced the cerebral blood flow. In addition, the latency for the onset of heat stroke and the survival time after the heat stroke were greatly prolonged by the former surgical procedure, but shortened by the later one. The data suggest that decentralization of the superior cervical ganglia attenuates formation or development of heat stroke by promoting an increase in cerebral blood flow in rabbits.

Animals↗
PubMed1975

Induction of tyrosine hydroxylase elicited by beta adrenergic receptor agonists in normal and decentralized sympathetic ganglia: role of cyclic 3',5' - adenosine monophosphate.

A subcutaneous injection of an oil suspension of l-epinephrine (270 mumol/kg), dopamine (270 mumol/kg) or l-norepinephrine (270 mumol/kg), when administered with phenoxybenzamine (32 mumol/kg i.p.) to blocl alpha adrenergic effects, increases the cyclic 3', 5'-adenosine monophosphate (cAMP) content in superior cervical ganglia (SCG) of rats. The increase is highest after l-epinephrine and dopamine and is barely detectable after l-norepinephrine; it lasts longer than 2 hours after l-epinephrine, about 30 minutes after dopamine and is fleeting after l-norepinephrine. The duration of the increase in cAMP elicited by l-epinephrine in SCG of rats is dose-related. Furthermore, when the cAMP increase lasts longer than 90 minutes, 48 hours later the tyrosine hydroxylase (TH) activity in SCG is increased. l0Epinephrine (150 mol/kg s.c.) induces TH in decentralized ganglia. One injection of l-isoproterenol (77 mol/kg i.p.) increases cAMP concentrations in intact and decentralized SCG. This increase lasts only 30 minutes and fails to induce TH 48 hours later. However, if the increase of cAMP concentration is prolonged by four successive injections of l-isoproterenol (15 30-minute intervals) the TH activity of intact and decentralized SCG is increased 48 hours later.l-Isoproterenol (four injections of 77 mumol/kg, each) and l-epinephrine (270 mumol/kg) fail to induce TH in the adrenal medulla. dl-Propranolol (125 mumol/kg i.p.) injected 30 minutes before l-isoproterenol blocks the increase of cAMP content and the delayed induction of TH activity in SCG. The elevation of TH activity elicited in SCG by beta adrenergic receptor agonists is always preceded by an increase of cAMP concentration lasting 90 minutes or longer. However, the induction of TH elicited by cold exposure or by reserpine administration can occur without an apparent increase in ganglionic cAMP concentration.

Adrenal Medulla↗
PubMedDate not supplied

Posttetanic potentiation in decentralized and nondecentralized superior cervical ganglia of the cat.

The present investigation was aimed to answer the following elementary, though important question concerning the sympathetic ganglion: Do the decentralized preganglionic terminals retain their full capacity to develop posttetanic potentiation (PTP) before substantial Wallerian degeneration takes place? Experiments were performed on the cat superior cervical ganglion in situ, and they followed a factorial design. The factors were: tetanization (supramaximal pulses, 0.2 ms, 24 Hz, 30 s), acute decentralization, and moderate hexamethonium blockade (5 mg/kg). Two levels were dealt with, namely, the indicated maneuvers were either performed or not performed. PTP was was measured in the S2 wave and the following variables were studied: decay constant, area under the curve and delay to summit occurrence. The analysis of variance showed that decentralization did not affect the development of PTP. Therefore, the nondegenerated terminals are fully capable of sustaining PTP, without the aid of the preganglionic cell bodies.

Action Potentials↗
PubMed2025

A decentralized future for the open-science databases.

The continuous and reliable open access to curated biological data repositories is indispensable for accelerating rigorous scientific inquiry and fostering reproducible research outcomes. However, the current paradigm, which relies heavily on centralized infrastructure for the storage and distribution of foundational biomedical datasets, inherently introduces significant vulnerabilities. This centralized model is susceptible to single points of failure, including cyberattacks, technical malfunctions, natural disasters, and even political or funding uncertainties. Such disruptions can lead to widespread data unavailability, data loss, integrity compromises, and substantial delays in critical research, ultimately impeding scientific progress. The downstream effect of such interruptions can be the widespread paralysis of diverse research activities, including computational, clinical, molecular, and climate studies. This scenario vividly illustrates the inherent dangers of consolidating essential scientific resources within a single geopolitical or institutional locus. As data generation is accelerating and the global landscape continues to fluctuate, the sustainability of centralized models must be critically re-evaluated. A shift toward federated and decentralized architectures may offer a robust and forward-looking approach to enhancing the resilience of scientific data infrastructures by reducing exposure to governance instability, infrastructural fragility, and funding volatility, while also promoting equity and global accessibility. Inspired by established models such as ELIXIR's federated infrastructure and the policy and funding frameworks developed by CODATA and the Global Biodata Coalition (GBC), emerging Decentralized Science (DeSci) initiatives can contribute to building more resilient, fair, and incentive-aligned data ecosystems. The future of open science depends on integrating these complementary approaches to establish a globally distributed, economically sustainable, and institutionally robust infrastructure that safeguards scientific data as a public good, further ensuring continued accessibility, interoperability, and preservation for generations to come. Here, we examine the structural limitations of centralized repositories, evaluate federated and decentralized models, and propose a hybrid framework for resilient, fair, and sustainable scientific data stewardship.

data accessibility↗
PubMed1984

Effects of pre-ganglionic decentralization or post-ganglionic excision of the superior cervical ganglia on brain edema and heat stroke in rats.

The preventive effect of pre-ganglionic decentralization (Sympathetic trunk resectioN) or postganglionic excision (ganglionectomy) of the superior cervical ganglia on thermal injury induced brain edema or the development of heat stroke was assessed in rats. Brain edema was induced by cold or heat injury to the cortex in 24 rats. The results showed that decentralization, but not excision, of the superior cervical ganglia greatly inhibited the formation of brain edema which was subsequently induced. When heat stroke was induced by exposing 24 rats to an ambient temperature of 41 degree C, the latency for the onset of the heat stroke and the survival time after the heat stroke were greatly prolonged by the former surgical procedure, but shortened by the later one. The present study demonstrates the potential benefit to brain edema and heat stroke of the pretreatment with decentralization of the superior cervical ganglia.

Animals↗
PubMed1978

Medication delivery time requirements in centralized and decentralized unit dose drug distribution systems.

Medication delivery time requirements in centralized and decentralized unit dose drug distribution systems were compared. Four stages in the receipt of medication orders and the delivery of doses were identified, and the time required to perform each stage was recorded by pharmacist observers for seven days in each system. In the centralized system, it required 138--220 minutes to deliver doses after orders were ready to be collected at the nursing station, with the time varying according to order type. The same cycle required 1--40 minutes in the decentralized system. Delays in medication delivery were shorter in the decentralized system.

Georgia↗
PubMed1983

Combination medication cart and computer terminal in decentralized drug distribution.

A decentralized unit dose distribution system using mobile pharmacy carts and computer terminals for filling inpatient and discharge medication orders is described. The system uses computer terminals mounted on mobile medication carts. Medication orders are collected from each nursing station by the pharmacist. Using the mobile combination decentralized medication cart/computer terminal (cart/CRT), the pharmacist examines and updates the patient's drug profile, checking for drug allergies and interactions, and bills the patient for drugs dispensed. Unit dose drugs requiring no additional labeling are dispensed from the decentralized cart to the patient's drawer in the unit dose medication cart. When a label is necessary, the pharmacist commands the computer to print a label in the central pharmacy. Discharge orders are entered at the cart/CRT, filled and recorded in the central pharmacy, and distributed to the patients by the pharmacist on the nursing unit. Turnaround time for routine inpatient orders and discharge orders decreased substantially using this system, and the system was perceived as beneficial by nurses, physicians, and pharmacists.

Computers↗
PubMed1982

Nurse staffing in a decentralized organization: part II.

It must be emphasized that none of the steps described in this planning process emerged overnight. Rather, they were achieved through a process of evolution, sometimes through trial and error, and always with consultation and participation by many members of the hospital nursing staff. Participation by many in the process of planning for a workable staffing system has been essential to its success. Indeed, creative scheduling by the head nurse is possible because of the way in which the system has been organized. The fact that head nurses are responsible for staffing their own units makes it infinitely easier for them to see what they need to make their units operate effectively and efficiently. Creative scheduling includes the possibility of arranging nurses' hours outside the rigid three-shift schedule used by so many hospitals. Many El Camino nurses now report for work at different hours. In addition, the use of flexible work weeks has proven valuable. Some head nurses now allow for a ten-hour, four-day work week; in emergency staffing situations there have, on occasion, been twelve-hour days. Even as this system evolves, it faces change. Just as the requirements for staff cannot be rigid, so must problem solving be flexible and constantly under review. The fact that El Camino believes in constant monitoring of its system is essential to its success. A key philosophical foundation of decentralization is that it must be subject to change. This is no less true in staffing than in other parts of the decentralization structure. By agreeing that change is constant and necessary and that participation is required at all levels of the staffing planning process, we have constructed the outlines of a system that will work in the future as well as it does in the present. Our system centers around the head nurses. It involves their planning; thus it also involves the support of those members of the nursing staff who can provide essential information. But the decisions about how to use the information remain with the head nurse. And that, as much as anything, is at the heart of the decentralized nursing structure.

California↗
PubMed1982

Decentralized budgeting: holding the purse strings, part 1.

A decentralized nursing structure allows the head nurse to become actively involved in the planning and budgeting process. In Nursing Decentralization: The El Camino Experience (published in November 1981 by Nursing Resources) the authors describe the development of a budgeting system that supports autonomy, accountability, and authority at the practitioner level. For JONA readers, we present, in two parts, an abridged version of the chapter "Budgeting: Holding the Purse Strings." Part 1, which follows, outlines important steps for the development of a successful and efficient budgeting program that can be adapted to meet the needs of other decentralized organizations. Part 2, which details a typical budget session, will appear in the next issue of JONA.

Budgets↗
PubMed1995

Regulatory requirements (CLIA '88, JCAHO, CAP) for decentralized testing.

All decentralized testing is regulated according to the Clinical Laboratory Improvement Amendments of 1988. Two organizations, the Joint Commission on Accreditation of Health Care Organizations and the College of American Pathologists, have received deemed status for their voluntary standards from the Health Care Financing Administration. Deemed status means that the organizations' voluntary standards meet or exceed the federal requirements. The decentralized testing sites can exercise several options in determining which organization, and hence which set of standards, will be used to regulate their testing processes. In this article, the authors outline the various regulatory requirements, provide insight into the relationship of each, and offer a framework for decentralized testing sites to follow to meet the requirements.

Certification↗
PubMed1995

Pilot Project for Financial Decentralization in Senanga, Zambia.

Decentralization of finances and responsibilities has been one of the most interesting developments in the health systems in developing countries during the last decades. In 1992, Senanga District (Zambia) was involved in a Pilot Project for Financial Decentralization. In order to evaluate the experiences of the health staff, focus group discussions were organized. Although several constraints were faced during the implementation of the project, decentralization was regarded as a valuable and workable concept. Continuation was advocated by all health workers.

Accounting↗
PubMed1994

Decentralized testing in the 1990s. A survey of United States hospitals.

Laboratory testing is increasingly moving out of the central laboratory and into other areas of the hospital. Many factors are driving this trend, but most revolve around the desire for prompt, medical decision making guided by quick, convenient on-site or decentralized testing using emerging new technologies. This article reviews a 1993 independent survey on decentralized testing throughout US hospitals. It discusses and quantifies various aspects of decentralized testing technology as well as identifies general trends.

Clinical Laboratory Techniques↗