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The welfare and medical activities in the town of Turin which have been decentralized in the quarters or in grouped quarters in order to answer better to the demands of the users, are analysed and explained here. Also a sample of building structure realized in Turin too, as a standard sample of social and medical centre and of basis services on its territory, is presented.
Central panalgesia is a syndrome which includes systemic pains of a central nature, usually classified as hysteria, fibrositis and masked depression. Exploration of the peripheral neuromuscular junctions (in the iris by pupillometry, and in veins by computerized venotest) indicates an increased monoamine receptor sensitivity. 5-HT vein sensitivity is particularly impressive (up to 1,000 times). In the vein there appears to be a decentralization supersensitivity, as it is extended to different monoamines (5-HT, dopamine, noradrenaline, tyramine). This type of supersensitivity is compatible with the theory of a deficiency of neurotransmitters at the level of the anti-nociceptive and integrated systems, with subsequent central and peripheral supersensitivity. A similar condition limited to the rostral section of the anti-nociceptive system is valid for the mechanism of idiopathic headache including migraine: central and peripheral supersensitivity to monoamines and opiates is also episodically observed in headache sufferers.
Cell numbers have been investigated for several months in disinfectant solutions which were measured out with tap water by decentral automatically dosing apparatuses. They differed not only quantitatively but also qualitatively with respect to the products used: With one product on the bases of aldehydes + organic tin compound 3 h after samples have been collected up to 100 bacteria/100 ml could be cultivated. Thus, cell numbers in disinfectant solutions were in the same range of cell numbers of tap water. Sometimes the cell numbers in both substrates seem to go parallel (Fig. 1). The bacterial compositions in both were similar (Table 3); gramnegative, yellow bacteria of the genera Pseudomonas and Flavobacterium dominated. After the disinfectant in one apparatus has been substituted by one which is composed of aldehydes + a quaternary ammonium compound cell numbers rapidly and permanently decreased to the limit of detectability. Only coryneform bacteria survived for a longer time which were characterized (Tab. 4) but not determined taxonomically. Their facultatively methylotrophic growth was conspicuously.
Case management has been implemented in a variety of health care settings. The implementation of case management at one hospital, including rationale for selection and outcomes, is described here. A decentralized model emphasizing staff nurse control is recommended for hospitals with TQM and shared governance programs already in place.
In a group of 51 patients the authors measured the position of the intraocular lens (the method was based on mathematical analysis of the Purkinje images position) and calculated the postoperative refractive error. The dependence of the postoperative refractive error on IOL position was analyzed and the results of the analysis were compared with the presumptions based on theoretical calculations. The results obtained from the measurement are very close to that assessed by the theoretical calculations. The IOL decentration in the eye causes the the shift of the postoperative refractive error towards myopia and it is probably the cause of the part of the postoperative refractive error.
A small multiprocessor system for integrated processing of medical data in a University Hospital is described. It consists of a central computer system to which, at present, two satellite computers are connected, one in the clinical chemistry area and the other in nuclear medicine. The satellite computers collect and present data while the central computer takes over the storage of data and the executive computer-bound programs. A few examples of its use are given and the characteristics of the decentralized system discussed.
Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).
Since the Government was implementing the policy of decentralization of psychiatric services, a large number of chronic schizophrenic patients failed community management because of the breakdown of family support. The rejected patients were admitted to the Old Persons' Home for protection because no other suitable places were available for them. In a follow-up study in one of the Homes, the one-year prevalence rate of treated psychiatric illness and schizophrenia was found to be 27.5% and 15.3% respectively. Lack of rehabilitation and community care facilities and inadequate staff in all categories were the root of the problem. The author foresees that the Government will face a serious problem in future to cater for the increasing number of chronic schizophrenic patients in the community if it does not take immediate action to improve mental health services in the country.
Decentralizing overtime costs moves this area of authority and accountability from central management to the unit level. Efficiency, quality and cost containment are addressed in the transition process. Together, nurse managers, staff and fiscal services discuss and plan alternatives to assure cost-effective resource allocation.
Traditional quality-control methods are effective for detecting systematic error caused by deterioration of reagents or instruments, but ineffective for detecting sporadic error, which is more likely to occur in low-volume testing environments. Decentralized testing performed by individuals without formal laboratory training has a high potential for sporadic errors. New methods for validating test results, used each time a test result is produced, should replace current quality-control procedures. Under the rules of CLIA '88, manufacturers and the US Food and Drug Administration have an opportunity to develop new approaches to test validation.
Previous work has established the precision and accuracy of a portable blood coagulation analysis system using paramagnetic particles contained in a dry reagent on a disposable test card. We examined the deployment of this technology in decentralized hospital settings and compared test results obtained in the surgical intensive care unit, coronary care unit, and outpatient cardiology clinic with those obtained in the central laboratory. Nursing personnel were instructed in the use of the system, and quality control testing was performed daily by the laboratory staff. In the intensive care units, patient subjects included those on whom tests of prothrombin time and activated partial thromboplastin time had been ordered. Immediate determinations were performed by the intensive care unit nursing staff on the same citrated, whole-blood samples that were subsequently sent to the central laboratory. In the outpatient cardiology clinic, fingerstick blood samples were obtained for prothrombin time determinations with the dry chemistry system. Paired prothrombin time samples obtained by venipuncture were run in the hospital laboratory. The study involved multiple users, multiple locations, two lots of activated partial thromboplastin time cards, and several different instruments, over an extended period. Correlation coefficients between the dry chemistry system and the hospital laboratory under these conditions were in an acceptable range in all sites studied. We concluded that, with appropriate training and quality assurance, the dry chemistry system provides an acceptable alternative to the hospital laboratory for prothrombin time and activated partial thromboplastin time determinations.
Our decentralized hospital information system, written in the ISO/ANSI M languages, has been operated from the time the hospital at the Fukui Medical School was opened 10 years ago. We switched to a new hospital information system in January, 1995. This new system is equipped with multimedia technology, so electronic medical records and the viewing of images is possible.
BACKGROUND: Community-based preceptors are increasingly being used to provide clinical experiences for medical students; therefore, the issue of when and how to monitor the appropriateness of teacher-learner interactions in the clinical setting has become increasingly complex and urgent. This paper describes how an audiotaping program in a department of family medicine was designed to account for preceptor and student needs and what this audiotaping experience revealed about the teaching strengths and weaknesses of full-time and volunteer faculty. METHODS: Audiotaped case discussions between third-year students and preceptors were evaluated using a structured instrument that reflected important responsibilities of clerkship preceptors. Reviews were compared using chi-square to evaluate for significant differences between university and community preceptors in overall quality of interaction with students and in specific deficiency areas. Ninety-five percent confidence intervals were used to evaluate for significant differences in frequency of occurrence among deficiencies. RESULTS: A total of 376 audiotaped case discussions were reviewed between July 1992 and June 1994. University preceptors had significantly more "superior" interactions with students than their community peers (P < .05). However, university and community preceptors had nonsignificant differences when specific deficiency areas were compared. Deficiencies in students who were allowed to present cases and assessments occurred significantly less frequently, while deficiencies in preceptors using open-ended questions occurred significantly more frequently than deficiencies in other areas. CONCLUSIONS: This study shows that volunteer faculty performed comparably to full-time university faculty in both the frequency of deficiencies in teacher-learner interactions identified and in the types of deficiencies identified. Both university and volunteer faculty had the most deficiencies in higher-order teaching skills--those involving synthesizing and assessing student knowledge and selecting appropriate questions based on that information. Audiotaped case discussions have a potentially significant role in monitoring teacher-student interactions, particularly on decentralized clinical rotations.
This study describes procedures and indentifies problems in the reclassification of a small medical school library collection that is decentralized into five locations in three different communities. A total of 9,915 monographic titles (14,911 volumes) were reclassified in a nine-month period. The reclassification staff consisted of one professional, two nonprofessionals, and one partime student assistant.
In this Equipment Management Guide, we provide guidance to help hospitals determine whether implementing an automated decentralized pharmacy dispensing system (ADPDS) will be an effective way to improve their drug distribution process. We describe the ADPDSs themselves and then discuss factors that hospitals should consider before deciding on such a system. Specifically, we identify several areas that many pharmacies target for improvement and discuss whether and how an ADPDS can help the facility make the desired improvements. We also provide guidance for determining the cost-effectiveness of such a system, as well as for selecting a system that will most appropriately meet the hospital's needs. In the Evaluation that follows this Guide, we present our criteria for evaluating ADPDSs and the results of our testing of three such systems.
We investigated the effects of a neuropeptide, pituitary adenylate cyclase-activating polypeptide- (PACAP) 27, on the sinoatrial nodal pacemaker activity and the mechanisms for the cardiac effects of PACAP-27 in the autonomically decentralized heart of the anesthetized dog. PACAP-27 (0.01-0.3 nmol) injected into the sinus node artery increased followed by decreased sinus rate. PACAP-27 (0.1 and 0.3 nmol) caused atrial fibrillation spontaneously. After atropine, PACAP-27 never decreased but only increased sinus rate as did vasoactive intestinal peptide. However, propranolol did not affect the negative and positive chronotropic effects. Tetrodotoxin but not hexamethonium abolished the negative chronotropic response to PACAP-27 in atropine nontreated dogs, and tetrodotoxin also inhibited the positive chronotropic response by 34% in atropine-treated dogs. In atropine- and propranolol-treated dogs, positive chronotropic responses to PACAP-27 were inhibited by PACAP-(6-27), a PACAP receptor antagonist but not by vasoactive intestinal peptide (10-28), a vasoactive intestinal peptide receptor antagonist. These results indicate that PACAP-27 causes the negative chronotropic effect through the postganglionic parasympathetic nerve activation and it produces the positive chronotropic effect mediated by PACAP receptors with an activation of non-adrenergic, nonvasoactive intestinal peptide-ergic nerves at least in part in the dog heart. Atropine and tetrodotoxin abolished atrial fibrillation induced by PACAP-27 but other blockers did not. These results suggest that neurally released acetylcholine induced by PACAP-27 participates in the induction of atrial fibrillation.
A nursing council modeled after the traditional five nursing roles--manager, educator, practitioner, evaluator and researcher--improves patient outcomes and enhances nurse work satisfaction. The council provides a participative forum to address nursing and patient-care issues within a decentralized matrix organization.
In chronically decentralized nictitating membranes of cats the responses to norepinephrine and to acetylcholine were markedly prolonged. The increased duration was not directly related to the increased amplitude of the contractions. It is likely to be due to a change of the muscle itself.