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PubMed2001

Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program.

OBJECTIVES: This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis screening program in Nairobi, Kenya. METHODS: Health clinic data, quality control data, and costs were analyzed. RESULTS: The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program's performance was adequate. The program's effectiveness was problematic because of false-negative and false-positive RPR results. The cost per averted case was calculated to be US$95 to US$112. CONCLUSIONS: The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered.

Cost-Benefit Analysis↗
PubMed1975

Visual decentration: from stereometric points to planeometric forms.

19 3-yr.-olds chose to put blocks together to produce good continuation across stereometric edges. 4 mo. later they began to produce good continuation across planeometric edges. A group of 15 4-yr.-olds chose to produce symmetrical forms rather than simply to align edges. Symmetrical form was produced across planeometric surfaces but not across stereometric contours. These data suggest that visual decentration is first a shift from looking at single points touched to single points displaced from touch and, at a still later age, a shift to the organization of many points. The failure of the older group to produce a symmetrical form across stereometric contours could have resulted from the cultural press to attend to planeometric information.

Age Factors↗
PubMed2006

Creating windows of opportunity for policy change: Incorporating evidence into decentralized planning in Kenya.

PROBLEM: Because researchers and policy-makers work in different spheres, policy decisions in the health arena are often not based on available scientific evidence. APPROACH: We describe a model that illustrates the policy process and how to work strategically to translate knowledge into policy actions. Several types of activity--agenda-setting, coalition building and policy learning--together can create a window of opportunity for policy change. LOCAL SETTING: Activities were undertaken as part of the Kenyan Ministry of Health's new decentralized planning-process. The objective was to ensure that the results of a national assessment of health services were used in the preparation of district-level health plans. RELEVANT CHANGES: Following the intervention, 70 district-level, evidence-based work plans were developed and approved by the Kenyan Ministry of Health. LESSONS LEARNED: Substantial investment and effort are needed to bring stakeholders together to work towards policy change. More in-depth evaluation of these efforts can aid understanding of how systematic approaches to policy change can be replicated elsewhere.

Biomedical Research↗
PubMed1990

Decentralized laboratory testing: attitudes of physicians and medical students.

Attitudes regarding the use of decentralized laboratory testing were examined in two groups of district physicians (DP; n = 15), a group of physicians undergoing postgraduate training as specialists in general medicine (PP; n = 17), and a group of medical students who had completed five years of basic studies (MS; n = 15). A sorting test was employed involving 56 cards with names of laboratory tests presently or soon available for use within primary health care. The DPs showed a relatively high consensus concerning which analyses were needed most for near-to-patient testing. MSs (who had a basically hospital-oriented education) differed from DPs and PPs in emphasizing the need for a greater number of directly available tests in primary health care. The differences probably reflect differences in clinical experience. The importance of practically oriented education is stressed.

Attitude of Health Personnel↗
PubMed1986

Elements of good practice in decentralized clinical laboratories.

The possibilities of producing decentralized clinical laboratory data 'nearer the patient' has augmented rapidly during the last decennium due to both simple and sophisticated equipment, often intended to be operated by nonlaboratorians. The theory and practice of quality assurance in its wider sense has not kept pace with this development. The components of Good Laboratory Practice are presented under the headings: type of laboratory work, discipline, management, personnel, premises, safety, equipment, reagents, standard operating procedures, internal quality control, external quality assessment, method, dedicated operating procedure, syllabi, and clinical relevance. The projects currently being established by different national, regional, and international bodies to formulate guidelines should be coordinated to avoid duplication and conflict.

Chemistry, Clinical↗
PubMed2006

Decentration and cataract formation 10 years following posterior chamber silicone phakic intraocular lens implantation.

PURPOSE: To report a 10-year follow-up for bilateral implantation of a Chiron Adatomed silicone posterior chamber phakic intraocular lens (PIOL). METHODS: A 32-year-old man presented with bilateral blurred vision and monocular diplopia in the left eye of 2 years' duration. RESULTS: Slit-lamp microscopy showed bilateral anterior subcapsular cataract and temporal PIOL decentration, and no visible space between the PIOL and crystalline lens in the right eye. After explantation of the posterior chamber PIOL, lens aspiration, and IOL implantation, uncorrected visual acuity improved to 20/15 in the right eye. Scanning electron microscopy examination showed denser deposits on the central portion of the back surface when compared with the edges. CONCLUSIONS: Long-term follow up of certain designs of posterior chamber PIOLs may reveal late occurrence of complications. Cataract formation may be related to direct contact between the implanted and crystalline lenses.

Adult↗
PubMed1976

A network model for decentralized family practice residency training.

The organization of departments and divisions of family practice in a majority of medical schools in the United States has facilitated a recent trend toward increasing numbers of university affiliations with family practice residency programs in community hospitals. Many difficult issues arise when such affiliations are explored and developed. To date, the literature is meager on this important subject. This paper describes the elements of a network model for decentralized family practice residency training which has been in operation at the University of California Davis for over four years. Common issues are outlined, together with the various advantages of affiliation to the community hospital and the university. An active partnership between the medical school and community through a network of affiliated residency programs can effectively contribute to the quality of medical education and patient care on a regional basis and at the same time directly address the problem of physician maldistribution.

California↗
PubMed1992

Pharmacist interventions in a decentralized unit dose system.

In our hospital, the decentralized pharmacists, on a daily basis, are documenting their cost-saving and therapeutic interventions. The cost savings for the first six months in 1991 totaled $45,862. The therapeutic interventions for these six months totaled 2,087. These interventions have a direct impact on the quality of patient care, while at the same time providing input into economics of patient care. The pharmacist interventions at our hospital can be documented and measured, and they do have an impact on physician prescribing habits.

Centralized Hospital Services↗
PubMed1980

Distribution and cost of drugs in a pharmaceutically decentralized health maintenance organization.

A private, free-standing health maintenance organization, Group Health of Arizona, was established with a decentralized pharmacy distribution system. A closed formulary and monthly peer review by pharmacists and physicians influence the number of prescriptions written as well as drug cost. A study was conducted to determine: the 50 most-prescribed items by number and cost; drug cost according to certain therapeutic categories; the average drug cost per prescription; the number of prescriptions dispensed per enrollee; and the cost of drugs dispensed as a percentage of wholesale cost. The objectives of the study were achieved but additional questions requiring future studies were raised.

Arizona↗
PubMed1984

Cost effective method of implementing decentralized unit dose pharmacy services in a Friesen setting.

A limited decentralized drug distribution system was implemented at the Graduate Hospital, a 310-bed Friesen Concept teaching hospital. This mobile system services 252 medical/surgical beds on three floors of the hospital. Operation was limited to hours of peak demand for pharmacy services and to initial doses. The system was able to reduce turnaround time from 217 minutes to 90 minutes for 80-85% of newly written orders. Further, the systems was found to increase the availability of the pharmacist as a reference source and to clarify unclear or inappropriate orders. This approach required no increase in full-time equivalents and minimal capital expenditure.

Centralized Hospital Services↗
PubMed1989

Labor standard development for a decentralized mobile cart unit dose drug distribution system.

A project to develop labor standards for a decentralized mobile cart unit dose drug distribution system was performed. First, the tasks associated with the drug distribution system were defined. Then a predetermined number of observations were made using a modified self-reporting and work sampling technique to document activities of the floor pharmacists and pharmacists in the unit dose room. Stop-watch time studies were performed to evaluate computer entry tasks. From the data collected, average times for completion of each task defined were calculated. For each calculated average time, an adjusted average was calculated based upon other productive and personal time observed as part of the work study. The calculated labor standards are compared with other labor standards reported in the literature.

Centralized Hospital Services↗
PubMed1989

Decentralized hospital management: rationale, potential, and two case examples.

Sunnybrook Medical Centre (SMC) in Toronto designed a unique organizational model for managing hospital services and programs in three clinical units. The SMC model, like a similar model at The Johns Hopkins Hospital (JHH), emphasizes the active participation of physicians in management, the decentralization of budgetary control, and accountability for resource use to the clinical unit level. Expanding on the JHH model, SMC implemented additional financial incentives to encourage changes in clinical practice which would bring direct financial benefit to the respective clinical unit, and thereby to the medical center. To improve quality of service, SMC has also expanded the JHH model of multidisciplinary and participatory approaches to patient care by standardizing managerial roles and responsibilities of each member of the management team. A brief description of issues related to implementation of these unique models summarizes the program's success.

Baltimore↗
PubMedDate not supplied

Health care system builds management centers through decentralization.

While University Hospitals of Cleveland has moved dramatically toward a decentralized management structure that emphasizes "product groupings," the alignment still has strong process orientations. The hospital cautions against blind acceptance of industrial models in the health care field.

Academic Medical Centers↗
PubMed1988

Cost-benefit of a clinical services integrated with a decentralized unit dose system.

Clinical pharmacy services are believed to be beneficial to patient care and to have the potential to reduce drug costs. This study was designed to apply cost-benefit analysis techniques to selected clinical pharmacy services provided by staff pharmacists assigned to a mobile decentralized unit-dose drug distribution system. Pharmacists' interventions were identified and recorded by the pharmacists and the investigator over an eight-week period. Interventions, to which a monetary value could be assigned, included non-formulary drug use, drug regimen adjustments, and the duration of drug therapy. A total of 543 interventions were recorded or observed. Of these, 174 (32 percent) fit the criteria for inclusion in the study. Those interventions accepted by physicians (87 percent) were assigned a dollar value and tabulated. Costs to provide the service were the pharmacists' salaries. Benefit to cost ratios of 1.08 and 1.59 demonstrated that the benefits accrued from selected clinical pharmacy services exceeded the costs to the hospital.

Canada↗
PubMedDate not supplied

How to develop an effective decentralized laboratory testing program.

In this article, we offer practical guidelines for developing an effective decentralized laboratory testing (DLT) program. Based on more than 10 years of experience with a DLT program for bedside blood glucose monitoring, we have identified eight essential steps in this process, including: developing an effective multidisciplinary DLT committee that oversees the various DLT programs; performing a needs analysis and a cost analysis as part of the application for approval of a program from the DLT committee; instrument selection and method evaluation; and, finally, implementing a DLT program including initiating a quality assurance program. A collaborative effort by everyone from the beginning is an important key to success.

Canada↗
PubMed1999

[Practical aspects of mechanical autotransfusion in tumor surgery in a decentralized clinic].

The surveys of Hansen et al. demonstrated the safe inactivation of tumor cells in salvaged blood by g-irradiation. This method opens up the possibility of extending the intraoperative autotransfusion to tumour surgery. A prospective survey at the University Hospital of Leipzig demonstrated the practicability of intraoperative autotransfusion with gamma-irradiation of salvaged blood at a hospital with a decentralized structure. A clinically-relevant reduction of quality of the blood product by gamma-irradiation with 50 Gray or by transport was not observed. Adherence to fixed working regulations ensures that gamma-irradiation is conducted correctly and the salvaged erythrocyte concentrate is available in an acceptable period of time.

Blood↗
PubMed2003

[Decentralization of health care and medical teaching: the Chilean experience].

In Chile there has been a close interaction between medical teaching and health care. In 1943, the University of Chile School of Medicine (founded in 1833) created Chairs in several public hospitals. The University of Chile School of Public Health (founded in 1943) played a key role in the creation in 1952 of a centralized National Health Service (NHS). The NHS had outpatient clinics and hospitals all over the country and was responsible for health care and for the promotion of health and disease prevention programs. In 1954, the NHS and the School of Medicine set up Residencies and General Practitioners programs aimed at improving the distribution of specialists and general practitioners throughout the country. In 1979, the NHS was replaced with 27 autonomous Health Services headed by the Ministry of Health, while the administration of primary care outpatient clinics was transferred to the municipal government. However, sanitary programs were still managed at the central level. Higher education also expanded and was decentralized. There are currently 60 universities and 17 medical schools, compared to eight and six, respectively, in 1981. The number of students in higher education has increased by 370% in 20 years. At the present time, the Chilean health case system is a predominantly public system with a strong and sizeable private system. Sixty two percent of the population is covered by public health insurance, while 27% is covered by private insurance. New and well equipped private clinics have multiplied. Private non profit institutions manage the prevention and treatment of work related injuries and diseases. Chile's outstanding health indicators (fertility rate: 17.2 x 1,000; mortality: 5.4 x 1,000; maternal mortality: 2.3 x 10,000; neonatal mortality: 4.5 x 1,000; life expectancy: 76 years) are a direct consequence of the improved social, cultural and economic condition of the general populations as well as of the sanitary programs sustained over the past half century.

Certification↗