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PubMed1983

Synaptic transmission in the chronically decentralized middle cervical and stellate ganglia of the dog.

Afferent stimulation of one thoracic cardiopulmonary nerve generated compound action potentials in the efferent axons of other ipsilateral cardiopulmonary nerves in dogs, 14 days after their thoracic autonomic ganglia had been decentralized. The compound action potentials were influenced by the frequency of activation and (in 5 of 12 dogs) by pharmacological autonomic blocking agents (hexamethonium, atropine, phentolamine, and propranolol). Moreover, they were abolished transiently when chymotrypsin was injected locally into the ganglia, and extendedly when manganese was injected. Thus, synapses that can be activated by stimulation of afferent nerves exist in chronically decentralized thoracic autonomic nerves and ganglia. It is proposed that regulation of the heart and lungs occurs in part via thoracic autonomic neural elements independent of the central nervous system.

Action Potentials↗
PubMed1986

Neuronal activity recorded extracellularly in chronically decentralized in situ canine middle cervical ganglia.

In chronically decentralized in situ middle cervical ganglia of 10 dogs, 279 spontaneously active neurons were identified. One hundred and ten (39%) of these were spontaneously active during specific phases of the cardiac cycle, primarily during systole, and the activity of nearly half of these cardiovascular-related neurons was modified by gentle mechanical distortion of the vena cavae, heart, or thoracic aorta. Another 60 (22%) of the identified neurons had respiratory--related activity, but the activity of only 2 of them was modified by gentle mechanical distortion of pulmonary tissue. Twenty-nine of the other 109 identified neurons were activated by gentle mechanical distortion of localized regions of the neck, ventral thoracic wall, or ventral abdominal wall. Because of the presence of activity in the chronically decentralized middle cervical ganglion, these data infer that some afferent neurons are located in the thoracic autonomic nervous system. Some middle cervical ganglion neurons were activated by single 1-4 ms stimuli delivered to a nerve connected to the ganglion. During repetitive stimuli delivered at 0.5 Hz none were activated after a fixed latency following the stimuli. Many more neurons were activated by 10- to 200-ms trains of 1-4 ms stimuli delivered with interstimulus intervals of 1-10 ms. The majority of these neurons could still be activated electrically after the administration of cholinergic and adrenergic pharmacological blocking agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1991

Activity of in vivo atrial and ventricular neurons in chronically decentralized canine hearts.

The spontaneous activity of 175 neurons located in the ventral right atrial and ventral interventricular ganglionated plexi was recorded in eight anesthetized dogs, the hearts of which were chronically decentralized at least 2 wk before recordings were made. Ganglia were subsequently identified anatomically in the immediate vicinity of the recording sites. Spontaneous activity was correlated with the cardiac cycle in 57% of the atrial and 62% of the ventricular neurons and with the respiratory cycle in 29% of the atrial and 28% of the ventricular neurons. Spontaneous cardiovascular-related activity was recorded when systemic arterial pressure was between 80 and 175 mmHg. The activity of 23 atrial and 15 ventricular neurons was altered when discrete regions of the heart were mechanically distorted by gentle touch. These data imply that cardiac ganglionated plexi contain afferent neurons that receive inputs from limited regions of the heart. The spontaneous activity generated by intracardiac neurons was not altered when extracardiac tissues were distorted. These results demonstrate that neurons in ganglia on chronically decentralized hearts can generate spontaneous activity, a large fraction of which is correlated with cardiovascular or respiratory events.

Adipose Tissue↗
PubMed1988

Decentralized services for public hospital patients: a cost analysis.

Dr. Sharfstein's introduction: In this era of cost containment and fiscal constraint, it is critical to consider alternative methods of delivering public psychiatric care that emphasize decentralized approaches, shortened lengths of stay, and innovative clinical interventions. This month's report dramatically illustrates the cost savings that can be achieved in a decentralized treatment program, particularly costs associated with the judicial process and involuntary commitment. The need for high-quality services at the local level is greater than ever.

Commitment of Persons with Psychiatric Disorders↗
PubMed1992

The implementation of a restrictive worksite smoking policy in a large decentralized organization.

This study investigates the implementation of a restrictive smoking policy in decentralized worksites. A model which includes four elements--concept, context, process, and outcomes--is used as a framework for identifying characteristics that influence implementation. The organization studied was a state human services agency with approximately 400 worksites spread across 12 geographic regions. Quantitative data collection included three cross-sectional surveys of employees and supervisors administered before and after the date the policy became effective. Qualitative data were collected from three sources, including written comments on surveys, focus groups, and structured interviews with supervisors and top administrators. Tabular analyses and one-way analyses of variance were used to analyze quantitative data. Qualitative data were examined for key themes and have been used to elucidate findings. Those characteristics related to concept, context, and process which appeared to have the strongest influence on expected and unexpected outcomes of the restrictive smoking policy were degree of policy restrictiveness, job characteristics, perceived level of participation in formulation and implementation, and support of supervisors responsible for day to day enforcement. In particular, in this decentralized organization, lack of participation was found to underlie many of the problems experienced in implementation. The practical implications for developing and implementing a worksite restrictive smoking policy are discussed.

Cross-Sectional Studies↗
PubMed2006

Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia.

BACKGROUND: A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1) to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2) to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention. METHODS: A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH) offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff. RESULTS: The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response. CONCLUSION: To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and response. Linking the intervention to broader health sector reforms in management processes and organizational culture will be critical to ensure that efforts designed to promote evidence-based decision-making are successful, especially as they are scaled up to the national level.

Focus Groups↗
PubMed2005

An examination of blood center structure and hospital customer satisfaction: what can centralized and decentralized blood centers learn from each other?

The cost of blood and blood products has increased rapidly over the last several years while the supply of available blood donors has simultaneously decreased. Higher blood costs and donor shortages have put a strain on the relationship between blood suppliers and their hospital customers. This study examines the association between blood center centralization or decentralization and several aspects of hospital satisfaction. Centralized and decentralized blood centers have significant differences in various aspects of hospital customer satisfaction. Advantages and disadvantages of the two structures are discussed, as well as areas for future research.

Blood Banks↗
PubMed1994

Decentralization, aging policy, and the age of Clinton.

This article examines the recent trends in decentralization and their implications for aging policy in the Clinton presidency. It first discusses a decade-long trend toward decentralizing policy and then examines some recent federal enactments that promote more discretion by state and local policymakers, suggesting that these may set the framework for aging policy during most of Clinton's first term. A basic premise of the discussion is, however, that the degree of flexibility varies with the policy area being analyzed-housing, transportation, health and social services--and whether these are "old" (pre-1980s) or "new" (post-1980s) policies. It concludes with the suggestion that a dual-centered, shared federal-state solution may provide the best approach to the premier issue in aging policy today-long-term care.

Aged↗
PubMedDate not supplied

Cardiac markers: centralized or decentralized testing?

Testing for the diagnosis of acute myocardial infarction and other diseases included in the spectrum of the "acute coronary syndrome" is rapidly changing from the traditional enzymatic assays to mass measurement of more specific and sensitive markers (cardiac troponins, CK-MB and myoglobin). Several questions have arisen since the introduction of these new markers into the clinical setting: the choice of strategies for optimizing the utilization of biochemical assays combining different (early and specific) markers, a rationale for sampling specimens and the identification of clinically useful turnaround times. In particular, for achieving the last goal, attention has been directed toward near-patient testing for cardiac markers in addition to, or as a replacement for, traditional diagnostic methodologies. While qualitative methods for measuring cardiac markers at the bedside have some limitations which compromise their clinical usefulness, new quantitative devices offer a real alternative to decentralized testing. Regulatory and quality management issues related to near-patient testing, as well as the performance of recently introduced devices for a decentralized measurement of cardiac markers are reviewed.

Biomarkers↗
PubMed2002

[Health sector decentralization and divergences with the medical society in Mexico].

OBJECTIVE: To evaluate the medical society's perception and actions in the context of health sector decentralization in the states of Guanajuato and Sonora, Mexico. METHODS: Qualitative research techniques were applied. Thirty-five semi-structured interviews were conducted with medical college members of both public and private institutions, and collegiate and union representatives of both states studied. RESULTS: Members of medical society in both states acknowledged that decentralization implied in insecurity due to the lack of clarity of health sector regulations. As a result of actions of the medical college in both states there was a growing politicization of medical college members, elaboration of proposals to increase their control over the medical labor market and their participation in the regional political power structure. CONCLUSIONS: This research supports the existing re-articulation of the medical society at a regional level preserving its status as a respected group. In contrast to studies conducted in the United States and Mexico medical authorities have pressed on the regulations in order to preserve their privileged status within the existing contention.

Health Care Reform↗
PubMed1976

Decentralization in the New York City Department of Health: reorganization of a public health agency.

Since the World War I era there has existed within the New York City Department of Health a basic internal struggle between staff directing the bureaus at the central office and the district health officers operating field health centers throughout the city. Recently, in a five-year period, there was a dramatic reorganization of the Department which markedly affected its orientation and programs. In 1972 a new Commissioner initiated a reorganization of the Department which succeeded in decentralizing field operations in contrast to earlier efforts which had failed to reach this objective. The roles of bureaus and districts were redefined, with the latter receiving budgetary authority, authority to supervise personnel, assignment of health managers, and the implementation of a district cost accounting system. While operational decentralization has occurred, policy setting and resource allocation in response to local needs remain central functions.

Administrative Personnel↗
PubMed1993

Providing leadership to a decentralized total quality process.

Integrating total quality management into the culture of an organization and the daily work of employees requires a decentralized leadership structure that encourages all employees to become involved. This article, based upon the experience of the University of Michigan Hospitals Professional Services Divisional Lead Team, outlines a process for decentralizing the total quality management process.

Hospitals, University↗
PubMedDate not supplied

Decentralized testing in the '90s. A survey of U.S. 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. Although many theories exist about the viability of on-site testing, research on the subject has been minimal. This article reviews the results of a 1993 independent survey on decentralized testing among laboratory managers at U.S. hospitals and quantifies various aspects of this new movement within such institutions.

Centralized Hospital Services↗
PubMed1981

Implementation of a modified decentralized drug distribution system with the use of master medication carts.

A decentralized drug distribution system with the use of master medication carts was implemented. This system was designed so that roving pharmacists could dispense new medication orders quickly and develop a more personal means of nurse-pharmacist interaction for the benefit of better patient care. The key to the system using roving pharmacists is a master medication cart, a pharmacy dispensing unit on wheels, which travels to each nursing unit. The pharmacy medication profiles are kept with the cart, and at each nursing unit patient medication profiles are reviewed, new drug orders are filled, missing medications and discrepancies are resolved, and nurse-pharmacist consultations can take place. There are two roving pharmacists who make simultaneous rounds of all nursing units in the hospital with two similarly stocked master medication carts from 9 A.M. to 9 P.M., seven days a week. All unit dose drawers are filled in the central pharmacy and are exchanged once daily at 2 A.M. by the night pharmacy technician. Each master medication cart carries about 300 different medications, which comprise nearly 95% of the drug needs of the 340 patients served by the two medication carts. The pharmacy department has added 1.4 Full-Time Equivalent (FTE) registered pharmacists and eliminated 2.8 FTE pharmacy messengers in implementing the decentralized drug distribution system. Currently, three registered pharmacists per day are assigned to the inpatient unit dose drug distribution system (two roving pharmacists and one unit dose filling pharmacist). Our roving pharmacists play a vital role in improving patient care. The overwhelming support by the nursing and medical staff represents an attempt by the hospital to continue to provide an optimal health care delivery system.

Colorado↗
PubMed1983

Analysis of drug information questions on a decentralized pharmacy service unit.

The pharmaceutical services at Rhode Island Hospital integrate the decentralized distribution role of the pharmacist with the provision of patient-specific drug information. This service is backed up by a Drug Information Center (DIC). A study to analyze the inquiries addressed to pharmacists assigned to a decentralized unit (PSU) was conducted over a 30-day period. The survey tabulated what kind of requests were made, if they could be answered with the information available on the patient care unit, and what action was taken as a result of the information provided. When the requests were categorized according to the type of information, the PSUs and the DICs top three categories were the same. Only 3.8% of the requests for information on the PSU could not be answered using the references available on the unit. Fifty one per cent of the requests received by the PSU were acted upon by the inquirer exactly according to the information provided by the pharmacist.

Drug Information Services↗
PubMed1989

Establishment of a permanent decentralized pharmacy in the coronary and progressive care units.

Critical care units, such as Coronary Care Units (CCU) and Progressive Care Units (PCU), are patient care areas with complex and rapidly changing needs. Services that enable health care providers in these areas to function more quickly and accurately are constantly sought. A 3 week pilot project was organized in a pharmacy department to evaluate the potential impact of a decentralized pharmacy service in the CCU and PCU areas. Distributive and clinical pharmacy services were provided by two pharmacists during the study. Nursing evaluated the study period as being highly favorable, and missing doses decreased by 57%. The departments of nursing and administration responded to this pilot by funding positions from nursing toward the establishment of a permanent decentralized pharmacy in these units.

Baltimore↗
PubMed1999

Decentralized didactic training for physician assistants: academic performances across training sites.

Decentralized training for the didactic portion of allied health programs has been assessed for its ability to increase the likelihood that graduates will practice in underserved areas. The question still remains whether these distant sites provide an education that is comparable to that offered at the main campuses. Exams and final grades for all classes over the course of five years at MEDEX Northwest in Seattle were compared to determine whether there was any major discrepancy between the main training location and the decentralized sites. With the exception of three individual cases, overall academic performances in all training sites were comparable. This suggests that programs employing some of the curricular and administrative controls in place at MEDEX Northwest can achieve a parity in education across their various training sites.

Alaska↗