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PubMed2000

[A decentralized breast cancer screening program in the French department of Bas-Rhin].

Since 1989, in the French department of Bas-Rhin, a breast cancer screening program in going on and its results are presented here. This program, concerning women of 50 to 65 years-old, is decentralized, based on private or public radiologists and the motivation of women because there is no invitation. The interval between screening test is 2 years. After 8 years, the results are rather satisfactory: participation rate of the initial cohort is 77% in December 31st 1997, participation at incident screenings is above than 85%, early indicators (recall rate, detection rate, PPV of screening, PPV of biopsy) are improving with time to attain numbers like international studies. The ADEMAS program shows that a decentralized screening program, based on existing medical structures is possible in France. Anyway, it must be organized, evaluated at any time, with a quality assurance system to guarantee the women the best taking charge.

Age Factors↗
PubMedDate not supplied

[Decentralized self-regulation of the integrity of colonial organisms].

The self-regulation of the integrity of colonial organism is accomplished without any central system organs. Abundance of similar structures, parallelism and synchrony of the processes form the basis for self-regulation, thus creating the independent mechanism of the internal coordination of the processes. Decentralized regulation of the integrity is much more economical then the centralized regulation, because it does not demand large volume of information, consequent increase in complexity of its processing and unavoidable problems with coordination. The principles of decentralized self-regulation, addressed in this paper, can be use not only in biology, but also in sociology, psychology, modeling, neuroformatics, etc.

Adaptation, Physiological↗
PubMed2003

[Significant changes in the health system decentralization process in Brazil].

This article discusses the trends and limits of the Brazilian health system decentralization process, identifying the three elements that constitute the strategic induction performed by the national system administrator in accordance with the guidelines contained in the Operational Norms of the Unified National Health System: systemic rationality, intergovernmental and service provider financing, and health care model. The effects of the Federal regulations are analyzed based on the results of the evaluation study focused on the implementation of the full management scheme at the Municipal level. The decentralization strategy induced by Basic Operational Norm 96 has succeeded in improving institutional conditions, management autonomy, and supply, as measured by the Federal resources transferred, installed capacity, production, and coverage of outpatient and hospital services, with the Municipalities authorized to conduct fully autonomous management, without altering the existing patterns of inequity in the distribution of funds to poorer Municipalities.

Brazil↗
PubMed2003

[Comparative study of centralized and decentralized outpatient surgical services].

The results of work of decentralized and centralized out-patient surgical service in two regions of the city of Novokuznetsk are compared. The authors make a conclusion that the centralized out-patient surgical service has a number of advantages as compared with the decentralized service since it allows to concentrate the material resources, to improve the staff of specialists, to widen the volume and spectrum of the medical care and makes prerequisites for profitable work of the institution under conditions of the market relations and competition.

Ambulatory Care↗
PubMed1991

Multidimensional work sampling to study the activities of decentralized clinical pharmacists.

Self-reported multidimensional work sampling (MDWS) was used to study the activities of decentralized clinical pharmacists at six hospitals in Portland, Oregon, and Seattle-Tacoma, Washington, in March through June 1989. A community hospital, a university hospital, and a hospital associated with a health maintenance association were selected in each city, and pharmacists at each site who provided clinical services were recruited. Each pharmacist wore a random reminder device and recorded the activity during which the device sounded by writing on a card numbers assigned to describe work activity, contact, location, and function. Of 6609 classifiable observations, 34.5% (2280) were of clinical activities and 35.8% distributive activities. Pharmacists spent 28.6% of their clinical time reviewing and assessing patients' charts, 17.1% on clinical rounds, 15.9% on activities related to therapeutic drug monitoring, 10.2% providing drug information, 11.6% attending or giving formal education, 6.1% doing research, and 2.6% attending meetings. The average pharmacist spent less than 10 minutes each day with patients but spent a substantial portion of time providing clinical services to other health professionals. Self-reported, multidimensional work sampling appears to be a valuable method for describing and monitoring decentralized pharmacists' work activities at multiple sites and work settings.

Hospitals, Community↗
PubMed1991

[Decentration of posterior chamber intraocular lenses].

In a group of 300 patients with a posterior chamber lens in 19% its decentration was found, in 2.3% the iris capture syndrome. The author discusses possible causes of decentration of the implanted lens, possibilities of its therapy.

Anterior Chamber↗
PubMed1990

[Decentralized psychiatry. Evaluation of the first 5 years of psychiatric service based on a general hospital].

In 1977 the state parliament of Berne took the decision to reform the existing psychiatric health care. decentralized, community oriented institutions were to be established with the aim of preventing secondary disabilities due to psychiatric illness, and of enhancing or instigating rehabilitative measures. 4 different psychiatric services based in general hospitals were installed. The present report presents an analysis of statistical data collected during the first 5 years on one of these services. We found a linear increase of admission which appears to be due to several factors: demand, image, manpower, cooperation with other institutions, breadth of the offered service. Furthermore, the distance between the institution and the place of living proved to be an important factor influencing the incidence of psychiatric treatment and the degree of cooperation with other care services--this aspect being consistent with the arguments for a decentralization of care. The degree of consistency in the distribution of diagnoses and the changes of treatment was surprising: an average of 50% of our patients were referred on an out-patient basis, approx. 40% by general hospital wards, 16% remain under the care of the general hospital. Our statistical analysis shows that in an average of 61% of the cases in which a referral to a psychiatric hospital was discussed, this measure could be avoided (although there is a certain degree of subjectivity in this judgement). The psychiatric service does not appear to compete with private practice care: 44% of the patients are referred to general practitioners and practing psychiatrists for after care, while only half as many are referred from private practices.

Adolescent↗
PubMedDate not supplied

Decentralized unit orientation: a model for professional practice.

Facilitating use of professional practice models is a goal of nursing administrators and educators. A plan for decentralized unit orientation designed to foster use of nursing process and nursing standards was developed within the division of surgical nursing. Conceptual frameworks, topic selection, behavioral objectives, content outline, teaching strategies, operationalization of the plan, and methods to evaluate learning are described in this article. Staff development educators can use the information to assist unit managers in developing a decentralized unit orientation plan that emphasizes professional practice.

Curriculum↗
PubMed1987

Recording schedule II drug use in a decentralized drug distribution system.

A decentralized system for Schedule II controlled substance distribution and accounting that does not rely on proof-of-use sheets is described. Controlled substances are kept in a vault in the central pharmacy; technicians assigned to work in the controlled substances vault are responsible for monitoring, ordering, and storing these medications. The narcotic vault technicians also prepare narcotic boxes that are used by technicians in patient-care areas to transport and issue Schedule Ii substances to nursing units. Twice during each morning and evening shift, technicians in patient-care areas visit each nursing station, replenish the unit's stock of Schedule II medications, and document on a narcotic use form all doses that have been administered since the last technician visit. Nurses leave small cards preprinted with patients' names and room information in the narcotic drawers to alert technicians to administered doses of Schedule II substances; the technicians are responsible for reconciling medications missing from the drawers with doses recorded in patients' medication administration records as being administered. Periodic audits are performed to ensure that actual inventories and the recorded information are correct. The decentralized system for distribution and accounting of Schedule II substances has been successful in increasing the flexibility of inventories on individual nursing units and ensuring maximal pharmacy department control over the dispensation of these medications.

Humans↗
PubMedDate not supplied

A decentralized clerkship: strategies for standardizing content and instruction.

Course decentralization in a required family medicine clerkship occurred because additional teaching and clinical resources were needed to meet the educational goals and objectives of an entire class of medical students. The decentralized teaching effort, which consisted of a variety of practice models, had the potential for an inconsistent exposure to the required educational content of the clerkship. Course monitoring and evaluation also was difficult because of the logistics of the various teaching sites. In order to minimize inconsistent content exposure, efforts to standardize course requirements occurred through criterion-based faculty and teaching site selection, initial faculty development, and provision of appropriate library resources. Continuous standardization consisted of required periodic faculty development, frequent evaluation of faculty and teaching sites, and comparative studies of student performance. Standardization of some of the students' patient care experience resulted from the use of predetermined list of required clinical encounters. A computer assisted evaluation of students' patient experience log defined the actual student patient care population at various teaching sites and compared this to course requirements. Deficits in patient care experiences were addressed by providing either the appropriate patient encounters or alternative experiences through print, audiovisual, or teaching sessions.

Clinical Clerkship↗
PubMed1987

Adrenergic decentralization modifies the circadian rhythm of intraocular pressure.

The effect of unilateral decentralization on the circadian rhythm of IOP was examined in rabbits to determine whether postganglionic sympathetic nerves to the eye can play a role in regulating the circadian rhythm of IOP in the absence of input from the central nervous system. Decentralization produced a marked reduction of the dark phase increase of IOP, but had little effect on IOP during the light phase. Therefore, circadian signals from the central nervous system, which contribute to the dark phase increase of IOP, arrive at the cervical ganglia by way of preganglionic fibers of the sympathetic chain and travel to the eye through postganglionic adrenergic nerves.

Animals↗
PubMed1987

Decentralization: are nurses satisfied?

Job satisfaction is often cited as one reason for decentralization. However, is it really an effective way to promote employee satisfaction? The author explores the impact of decentralization on the job satisfaction of staff nurses and first-line managers.

Decision Making↗
PubMed1986

Activity analysis of decentralized pharmacists in a unit dose dispensing and drug-administration program.

The relative amount of time spent by pharmacists on specific activities related to a pharmacy-coordinated drug administration and dispensing program in a 1000-bed tertiary-care teaching hospital was determined. Discrete activities of decentralized pharmacists involved in the program were defined using information from published reports and a short pilot study. Using a work-sampling technique, two pharmacy residents who had been trained to work as decentralized pharmacists performed instantaneous observations of the activities of pharmacists on five patient-care floors over a one-month period. Neither weekend nor night-shift activities were observed. Approximately 26% of a pharmacist's time was spent coordinating drug administration activities, and another 25% was spent providing clinical consultation or drug information services or performing research. The remainder of pharmacists' time was spent in activities related to drug distribution, interprofessional communication, or miscellaneous tasks. A work-sampling method proved useful in quantifying the amount of time associated with pharmacists' activities in a pharmacy-coordinated drug administration program.

Hospital Bed Capacity, 500 and over↗
PubMed1987

Effects of pergolide on the cardiovascular responses to sinoaortic deafferentation in dogs with intact or surgically decentralized adrenal glands.

In pentobarbital-anesthetized dogs with decentralized adrenal glands, sinoaortic baroreceptor deafferentation produced an increase in mean aortic blood pressure which reached a maximum (42 +/- 5 mm Hg, n = 6) within 5 min and then waned entirely within the subsequent 25 min. In contrast, in sham-operated dogs, the maximal pressor response due to deafferentation was of greater magnitude (63 +/- 6 mm Hg, n = 8) and of much longer duration (44 +/- 4 mm Hg, 60 min after deafferentation). Heart rate was only augmented slightly in both preparations. A marked elevation of epinephrine plasma concentration occurred 5 min after deafferentation and the magnitude of this effect was 8 times greater in dogs with innervated than denervated adrenal glands. Norepinephrine plasma concentration increased moderately and similarly in the two preparations. Administration of pergolide (30.0 micrograms/kg i.v.) 15 min before undertaking the deafferentation procedure induced a small, short-lasting increase in blood pressure and a small fall in heart rate in dogs in which the innervation to the adrenal glands was left either intact (sham-operated) or removed surgically. In dogs with adrenal gland denervated, pergolide blocked entirely the pressor response and the small elevation in plasma concentration of catecholamines evoked by sinoaortic deafferentation in the matched, saline-pretreated group. However, in sham-operated dogs (intact adrenal innervation), pergolide reduced partially (by 41%) the increase in blood pressure and plasma epinephrine concentration caused by deafferentation. The decrease in heart rate, produced by pergolide, was abolished by deafferentation in sham-operated and adrenal decentralized dogs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Glands↗
PubMed1979

Decentralization of pharmaceutical services without satellite pharmacies.

The decentralization of pharmaceutical services without the addition of pharmacy satellites is described. Mobile, master medication carts are used by pharmacy personnel in the patient-care areas to fill the unit dose carts used by nurses. A combination medication administration record and patient profile eliminates duplication of effort by pharmacy and nursing. Responsibilities of pharmacists and technicians, the process of hospital-wide implementation of the system, current levels of service, and a clerkship designed to improve staff pharmacists' clinical abilities are described. The ratio of the number of drug doses administered to the number of drug doses handled per patient-day increased after the implementation of the new system. This indicated that individual doses were handled fewer times by pharmacy personnel. This method of decentralization permitted integration of distributive and clinical pharmaceutical services with a minimal personnel cost increase, no additional space requirements nor expenditures for renovation, and only a small cost for master medication carts. Because the pharmacists work in the patient-care areas, they are in more frequent contact with nurses, physicians and patients.

Costs and Cost Analysis↗
PubMed1966

Centralization vs. decentralization in medical school libraries.

Does the medical school library in the United States operate more commonly under the university library or the medical school administration? University-connected medical school libraries were asked to indicate (a) the source of their budgets, whether from the central library or the medical school, and (b) the responsibility for their acquisitions and cataloging. Returns received from sixtyeight of the seventy eligible institutions showed decentralization to be much the most common: 71 percent of the libraries are funded by their medical schools; 79 percent are responsible for their own acquisitions and processing. The factor most often associated with centralization of both budget and operation is public ownership. Decentralization is associated with service to one or two rather than three or more professional schools. Location of the medical school in a different city from the university is highly favorable to autonomy. Other factors associated with these trends are discussed.

Libraries, Medical↗
PubMed1978

Decentralized pharmacist concept solves unit dose problems.

In order to solve problems associated with the unit dose drug distribution system at LDS Hospital, the decentralized pharmacist concept was tried. The pharmacist uses a master medication cart to fill new drug orders at the nursing station and a computer video terminal at the nursing station to check patient profiles. The reactions of nurses and members of the medical staff to the decentralized pharmacist are described.

Hospital Bed Capacity, 500 and over↗
PubMed1983

Decentralized preparation of short-term prescriptions for discharged patients.

The rationale for and implementation of a decentralized system for filling short-term discharge prescriptions are described. To prevent interruption of drug therapy, orders for three-day supplies of medications were filled in the outpatient pharmacy and returned to patients before discharge. Under the old system, more than 20% of medications ordered were not received by patients. Reasons for this problem were identified, and a new system was designed in which these discharge prescriptions were filled in satellite pharmacies. A follow-up study under the new system showed that only 1.5-3% of discharge medications were not received by patients and that patients' use of the discharge medication program was increased. Implementation of a decentralized discharge prescription program using the existing satellite pharmacies allowed increased efficiency in delivery of medications to patients at the time of their discharge from the hospital.

Boston↗