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PubMed1998

Anterior capsule contraction and intraocular lens dislocation after implant surgery in eyes with retinitis pigmentosa.

OBJECTIVE: The purpose of the study was to investigate the extent of anterior capsule contraction, intraocular lens (IOL) decentration, and tilt after implant surgery in eyes with retinitis pigmentosa (RP). DESIGN: A case-control study. PARTICIPANTS: Forty-seven eyes from 47 patients with typical RP and 47 control eyes from 47 age-matched healthy patients were studied. INTERVENTION: Phacoemulsification surgery with polymethylmethacrylate IOL implantation with continuous curvilinear capsulorrhexis was performed. MAIN OUTCOME MEASURES: The area of the anterior capsule opening obtained with capsulorrhexis and the amount of the decentration and tilt of the IOL were measured using a Scheimpflug photography system at 1 week and 1, 3, 6, 9, and 12 months after surgery. RESULTS: The mean area in the RP group was found to be significantly smaller than that in the control group at 1 month after surgery and later (P < 0.0001). The percent area reduction in the RP group at 6 months was 45.2 +/- 25.8% and 4.6 +/- 13.5% in the control group. Both the decentration length and tilt angle were also greater in the RP group than in the control group. Fourteen (29.8%) of the 47 RP eyes had undergone a neodymium:YAG (Nd:YAG) laser anterior capsulotomy at 12 months after surgery, whereas none of the control eyes had undergone an Nd:YAG. CONCLUSIONS: Anterior capsule contraction in the RP eyes was more extensive than in the control eyes, leading to a high Nd:YAG laser anterior capsulotomy rate. Both lens decentration and tilt also were greater in the RP eyes than in the control eyes.

Anterior Chamber↗

PubMed1997

Clathrin light chain and synaptotagmin I in rat sympathetic neurons.

Clathrin light chain (clathrin LC) and synaptotagmin I in sympathetic neurons in rat superior cervical ganglia (SCG) were studied using immunofluorescence and confocal microscopy. The distributions of clathrin LC and synaptotagmin I were compared with that of tyrosine hydroxylase (TH) and neuropeptide Y (NPY) in double label experiments. The influence of preganglionic regulation on the expression of clathrin LC and synaptotagmin I in post-ganglionic adrenergic neurons was investigated after cutting the cervical sympathetic trunk. In SCGs and irides of control animals, the calthrin LC- and synaptotagmin-I-positive structures were present in a granular pattern in nerve fibers and varicose terminals. In principal neurons, the two proteins were present in a perinuclear network (the Golgi complex). After decentralization, the synaptotagmin-I- and clathrin LC-positive granules normally present in preganglionic nerve terminals outlining the neuronal somata were no longer observed on day 1, but reappeared, and were increased above control in number and intensity, in axon bundles in the ganglia, on day 3 and up to day 28 post-decentralization. In irides, the fluorescence intensity and density of clathrin LC- and synaptotagmin-I-positive nerve terminals in the dilator plate, were semi-quantified using the confocal microscopy software. It was found that both proteins increased shortly after decentralization. Immunoblot data confirmed the immunohistochemical/confocal microscopy observations. Fast axonal transport of clathrin LC- and synaptotagmin I in preganglionic sympathetic neurons was demonstrated in crush-operated cervical sympathetic trunk. Both proteins rapidly accumulated proximally as well as distally to the crush, demonstrating fast anterograde and retrograde axonal transport (recycling). Thus, clathrin LC and synaptotagmin I are normally present in pre- as well as post-ganglionic sympathetic neurons. The colocalization of clathrin LC with synaptotagmin I in the Golgi complex of the adrenergic neurons may imply that clathrin participates in the synthesis/sorting of the fast transported materials in these neurons. Possible explanations for the increase of the two proteins after decentralization are discussed.

Animals↗

PubMed2000

Ablation centration after active eye-tracker-assisted photorefractive keratectomy and laser in situ keratomileusis.

PURPOSE: To evaluate the ablation centration after active eye-tracker-assisted photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and to investigate the effect of surgery, patient, and surgeon on the centration. SETTING: Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan, Republic of China. METHODS: This retrospective study comprised 177 eyes of 101 patients: 16 eyes had PRK and 161, LASIK. All laser treatments were performed with the aid of an eye tracker. The amount of decentration was analyzed by corneal topography. The factors influencing centration were divided into surgery related (PRK/LASIK), patient related (low/high myopia and effect of learning), and surgeon related (learning curve). RESULTS: The mean decentration was 0.33 mm in PRK eyes and 0.35 mm in LASIK eyes. For the surgery-related factor, there was no significant difference between the PRK and LASIK eyes. For the patient-related factors, centration was better in the second eye (effect of learning) and decentration was more severe in eyes with high myopia (low/high myopia). For the surgeon-related factor, there was no significant difference between eyes that had the first 50 LASIK procedures and those that had the last 50 procedures. CONCLUSIONS: An eye tracker, which makes the laser beam follow the eye's movements, helps to avoid severe decentration. This study showed, however, that an active eye-tracking system alone cannot ensure good centration. Patient cooperation and fixation are important.

Cornea↗

PubMed2003

Illustrative estimates of costs and effects of the use of Doppler ultrasonography in high-risk pregnancies.

OBJECTIVES: To examine the cost-effectiveness of Doppler ultrasonography in high-risk pregnancies. METHODS: An analysis was made of the cost-effectiveness of Doppler ultrasonography in high-risk pregnancies in relation to different organizational models. National costs of Doppler ultrasonography for singleton pregnancies with intrauterine growth retardation were estimated for three models. The cost-effectiveness analysis was based on results from a meta-analysis on clinical effects, patient costs, immediate health care costs, and costs per "saved" perinatal death. RESULTS: In the decentralized model (the current situation in Denmark), incremental health care costs were estimated to be 13.5 million DKK, with patient costs set at zero. In the regional and centralized models, the estimated costs were 9.3 million/0.9 million DKK and 3.4 million/2.6 million DKK, respectively. The incremental costs were more than outweighed by the savings made from significant reductions in obstetric interventions. The centralized model dominated the other two models in the cost-effective analysis. In the decentralized model, the costs of avoiding one perinatal death were estimated to be 1 million DKK. The sensitivity analysis suggested that the cost-effectiveness ratio differed considerably, depending on the assumptions used, although the rank order of the three models did not change. CONCLUSIONS: The cost-effectiveness analysis showed that a centralized model with five obstetric centers offering Doppler ultrasonography dominates the regional and decentralized models. However, even with the decentralized model (which reflects the current situation in Denmark), the costs of avoiding one perinatal death would seem to be reasonable. In view of the paucity of available cost and effects data and the sensitivity of the results to changes in the assumptions made, more reliable information is needed before a decision can be made regarding the organization of Doppler ultrasonography for high-risk pregnancies.

Cost-Benefit Analysis↗

PubMed1998

Local reinvention of the CDC HIV prevention community planning initiative.

The Centers for Disease Control and Prevention (CDC), in coordination with 65 states, cities, and territories, implemented HIV prevention community planning beginning in 1994. This large scale innovation in public health planning has involved tens of thousands of professionals and community residents. Though a single case study, Michigan provides a strong test of the implementation of this national prevention planning model because of the state's decentralized approach to HIV prevention community planning involving several hundred residents. A decentralized approach to community planning promises to maximize participation and the sharing of leadership as well as obstacles to community planning. Here, the CDC Guidance for community planning is contrasted with empirical observation of implementation in Michigan. We conclude that the high expectations for a decentralized approach to HIV prevention community planning can be best achieved when a distinction is drawn between information-seeking tasks and decision-making tasks. We recommend that information-seeking tasks be centrally coordinated, and that decision-making tasks be decentralized, to most fully achieve the potential of HIV prevention community planning.

Centers for Disease Control and Prevention, U.S.↗

PubMedDate not supplied

[Visual acuity and astigmatism after eccentric penetrating keratoplasty - a retrospective study on 117 patients].

PURPOSE: The purpose of this study was to asses the functional results of eccentric homologous penetrating keratoplasty in respect of diagnosis as well as position and size of the corneal graft. PATIENTS AND METHODS: In this retrospective study, visual acuity and astigmatism of 117 cases of a round eccentric homologous penetrating keratoplasty in 91 eyes of 91 patients were analysed. The PK became necessary because of a corneal ulcer (104), 6 eyes with corneal scars and 7 eyes with ectatic corneal diseases. Using 84 postoperative slides the following parameters were quantified: graft diameter and transparency, distance of the geometric centre of the cornea from the central trephination margin (distance) as well as from the geometric centre of the graft (decentration). Seventeen grafts were classified as eccentric peripheral keratoplasty (mean diameter 5.0 +/- 1.7 mm) with the optical axis through the host cornea and 67 as eccentric central keratoplasty (7.0 +/- 1.3 mm) with the optical axis through the graft. RESULTS: The average follow-up period was 25 months. The astigmatism after 3/12/24 months was 6.7/6.3/5.5 D, but was irregular and not measurable in 74 %/52 %/49 %. The astigmatism increased with increasing decentration (24 months, p = 0.04). After 3/12/24 months, the VA in ulcers was 0.1/0.16/0.16, in scars 0.2/0.6/0.5 and in ectatic diseases 0.3/0.5/0.6. The position of graft and the visual acuity did not correlate significantly. After 24 months, larger the graft size was associated with better visual acuity. With increasing decentration the visual acuity decreased (p = 0.02) and was significantly lower (0.15) in the case of - 2.0 < distance < 2.0 mm than in the case of distance > 2.0 mm (0.4; p = 0.01). CONCLUSION: The diagnosis resulting in eccentric penetrating keratoplasty seems to have a major impact on the long-term functional prognosis of visual acuity. In addition, visual acuity is limited by high and often irregular astigmatism. Our results indicate that an increasing decentration of the graft is not invariably associated with decreasing visual acuity, provided the graft-host junction is not located in direct proximity of the optical axis.

Adolescent↗

PubMed1981

Centration and coverage of hydrogel contact lenses.

Decentration of the AOsoft lenses and Bausch & Lomb Soflens occurs during wear. The extent of the decentration of 14 lenses on 36 eyes of 18 subjects was studied by means of a biomicroscope with a reticle mounted in the ocular. Unexpectedly, for the AOsoft vault IV lens greater decentration occurred than for flatter lenses. Corneal toricity showed no correlation with lens decentration.

Adult↗

PubMed1969

Sweat gland function of the donkey (Equus asinus).

1. Donkeys sweat on exposure to heat and in response to intravenous adrenaline infusion.2. Thermal sweating was abolished by the adrenergic-neurone blocking agent bethanidine but not by atropine.3. Sympathetic decentralization (by preganglionic sympathectomy) abolished thermal sweating but adreno-medullary denervation had no effect.4. Exercise resulted in sweating from both sympathetically innervated and decentralized skin and from the innervated skin of animals which had previously undergone adreno-medullary denervation.5. Insulin-induced hypoglycaemia resulted in sweating from sympathetically decentralized skin and from innervated skin in two out of four animals. Adreno-medullary denervation abolished the sweat gland response to insulin administration.6. Cold exposure inhibited the response of innervated sweat glands but not that of decentralized glands to adrenaline infusion.7. It was concluded that heat-induced and exercise-induced sweating of the donkey is controlled by adrenergic nerves; adreno-medullary secretion may contribute to sweating during exercise, and that cutaneous blood flow is important in the response of the glands to humoral stimulation.

Adrenal Medulla↗

PubMed1999

Evaluation of corneal thickness and topography in normal eyes using the Orbscan corneal topography system.

AIMS: To map the thickness, elevation (anterior and posterior corneal surface), and axial curvature of the cornea in normal eyes with the Orbscan corneal topography system. METHODS: 94 eyes of 51 normal subjects were investigated using the Orbscan corneal topography system. The anterior and posterior corneal elevation maps were classified into regular ridge, irregular ridge, incomplete ridge, island, and unclassified patterns, and the axial power maps were grouped into round, oval, symmetric bow tie, asymmetric bow tie, and irregular patterns. The pachymetry patterns were designated as round, oval, decentred round, and decentred oval. RESULTS: The thinnest point on the cornea was located at an average of 0.90 (SD 0. 51) mm from visual axis and had an average thickness of 0.55 (0.03) mm. In 69.57% of eyes, this point was located in the inferotemporal quadrant, followed by the superotemporal quadrant in 23.91%, the inferonasal quadrant in 4.35%, and the superonasal quadrant in 2.17%. Among the nine regions of the cornea evaluated (central, superotemporal, temporal, inferotemporal, inferior, inferonasal, nasal, superonasal, and superior) the central cornea had the lowest average thickness (0.56 (0.03) mm) and the superior cornea had the greatest average thickness (0.64 (0.03) mm). The mean simulated keratometry (SimK) was 44.24 (1.61)/43.31 (1.66) dioptres (D) and the mean astigmatism was 0.90 (0.41) D. Island (71.74%) was the most common elevation pattern observed in the anterior corneal surface, followed by incomplete ridge (19.57%), regular ridge (4.34%), irregular ridge (2.17%), and unclassified (2.17%). Island (32.61%) was the most common topographic pattern in the posterior corneal surface, following by regular ridge (30.43%), incomplete ridge (23. 91%), and irregular ridge (13.04%) patterns. Symmetric bow tie was the most common axial power pattern in the anterior cornea (39.13%), followed by oval (26.07%), asymmetric bow tie (23.91%), round (6. 52%), and irregular (4.53%) patterns. In the pachymetry maps, 47.83% of eyes had an oval pattern, and round, decentred oval, and decentred round were observed in 41.30%, 8.70%, and 2.18% of eyes, respectively. CONCLUSION: The information on regional corneal thickness, corneal elevation and axial corneal curvature obtained with the Orbscan corneal topography system from normal eyes provides a reference for comparison with diseased corneas. The Orbscan corneal topography system is a useful tool to evaluate both corneal topography and corneal thickness.

Adult↗

PubMed1985

Activity of in situ middle cervical ganglion neurons in dogs, using extracellular recording techniques.

Neuronal activity in the in situ middle cervical ganglion of dogs was investigated using extracellular recording techniques. The recorded action potentials were frequently active during specific phases of the cardiac cycle, particularly during systole, and this activity persisted following acute decentralization of the ganglion. The activity of these action potentials was modified when systemic arterial pressure was altered by isoproterenol, noradrenaline, adrenaline, or partial occlusion of the aorta, whether in the intact or acutely decentralized preparation. These neurons were active between systolic pressures of 70 and 180 mmHg (1 mmHg = 133.322 Pa). Action potentials were frequently modified by mechanical distortion of the superior vena cava, ventricular epicardium, or adventitia of the aorta, whether the preparation was acutely decentralized or not. Seventy percent of these action potentials were unaffected by stimulation (1 ms, 4 V, 0.5 Hz) of a cardiopulmonary nerve and 27% were suppressed by such stimulation. Five of the neurons were activated by such stimulation. It is presumed that the latter neurons had axons in a cardiopulmonary nerve and most likely were efferent sympathetic postganglionic neurons. Sixty-three percent of these spontaneously active phase-locked units were modified by stimulation of a ramus or an ansa. It is postulated that some of the neurons in the middle cervical ganglia can be modified by afferent axons arising from receptors in thoracic organs, in particular from the great vessels and heart, whether in an intact or acutely decentralized preparation. The majority of these neurons are presumed not to be afferent neurons or efferent postganglionic neurons, as they are not activated directly by electrical stimulation of axons in cardiopulmonary nerves. Rather they are presumed to be interneurons. These results lend support to the thesis that considerable integration of neuronal activity related to thoracic cardiovascular dynamics occurs within the middle cervical ganglia of dogs.

Action Potentials↗

PubMed2004

Sympathetic nervous system activity in rat thyroid: potential role in goitrogenesis.

The role of sympathetic innervation in regulation of thyroid function is incompletely understood. We, therefore, carried out studies in rats utilizing techniques of norepinephrine turnover to assess thyroid sympathetic activity in vivo. Thyroidal sympathetic activity was increased 95% by exposure to cold (4 degrees C), 42% by chronic ingestion of an iodine-deficient diet, and 32% in rats fed a goitrogenic diet (low-iodine diet supplemented with propylthiouracil). In addition, fasting for 2 days reduced sympathetic nervous system activity in thyroid by 38%. Thyroid growth and 125I uptake were also compared in intact and decentralized hemithyroids obtained from animals subjected to unilateral superior cervical ganglion decentralization. Unilateral superior cervical ganglion decentralization led to a reduction in thyroid weight, in 125I uptake by thyroid tissue, and in TSH-induced stimulation of 125I uptake in decentralized hemithyroids. These results suggest that sympathetic activity in thyroid contributes to gland enlargement and may modulate tissue responsiveness to TSH.

Animals↗

PubMed2002

Long-term neuromodulatory regulation of a motor pattern-generating network: maintenance of synaptic efficacy and oscillatory properties.

Rhythm generation by the pyloric motor network in the stomatogastric ganglion (STG) of the spiny lobster requires permissive neuromodulatory inputs from other central ganglia. When these inputs to the STG are suppressed by cutting the single, mainly afferent stomatogastric nerve (stn), pyloric neurons cease to burst and the network falls silent. However, as shown previously, if such a decentralized quiescent ganglion is maintained in organ culture, pyloric network rhythmicity returns after 3-4 days and, although slower, is similar to the motor pattern expressed when the stn is intact. Here we use current- and voltage-clamp, primarily of identified pyloric dilator (PD) neurons, to investigate changes in synaptic and cellular properties that underlie this transition in network behavior. Although the efficacy of chemical synapses between pyloric neurons decreases significantly (by <or=50%) after STG decentralization, the fundamental change leading to rhythm recovery occurs in the voltage-dependent properties of the neurons themselves. Whereas pyloric neurons, including the PD, lateral pyloric, and pyloric cell types, are unable to generate burst-producing membrane potential oscillations in the short-term absence of extrinsic modulatory inputs, in long-term decentralized ganglia, the same cells are able to oscillate spontaneously, even after experimental isolation in situ from all other elements in the pyloric network. In PD neurons this reacquisition of rhythmicity is associated with a net reduction in outward tetraethylammonium-sensitive ionic currents that include a delayed-rectifier type potassium current (I(Kd)) and a calcium-dependent K(+) current, I(KCa). By contrast, long-term STG decentralization caused enhancement of a hyperpolarization-activated inward current that resembles I(h). These results are consistent with the hypothesis that modulatory inputs sustain the modulation-dependent rhythmogenic character of the pyloric network by continuously regulating the balance of membrane conductances that underlie neuronal oscillation.

Animals↗

PubMed1994

Altered impulse activity modifies synaptic physiology and mitochondria in crayfish phasic motor neurons.

1. Crayfish phasic motor synapses produce large initial excitatory postsynaptic potentials (EPSPs) that fatigue rapidly during high-frequency stimulation. Periodic in vivo stimulation of an identified phasic abdominal extensor motor neuron (axon 3) induced long-term adaptation (LTA) of neuromuscular transmission: initial EPSP amplitude became smaller and synaptic depression was significantly reduced. We tested the hypothesis that activity-induced synaptic fatigue-resistance seen during LTA was dependent upon, or correlated with, mitochondrial oxidative competence. 2. Periodic unilateral conditioning stimulation of axon 3 entering each of two adjacent homologous abdominal segments (segments 2 and 3) increased the synaptic stamina in both "conditioned" axons; mean final EPSP amplitudes, recorded after 20 min of 5-Hz test stimulation, were significantly larger than those measured with the same protocol from contralateral unstimulated axons. 3. During 5-Hz test stimulation of the conditioned axon 3 of segment 3, acute superfusion with 0.8 mM dinitrophenol or 20 mM sodium azide [inhibitors of oxidative adenosinetriphosphate (ATP) synthesis] produced increased synaptic depression. Drug-free saline superfusion of the conditioned axon 3 of segment 2 in these same animals did not affect the increased synaptic fatigue resistance seen in this segment. Thus both successful induction (in axon 3 of saline-perfused segment 2) and attenuation (in axon 3 of drug-perfused segment 3) of the increased synaptic stamina can be demonstrated with this twin-segment conditioning protocol. 4. Confocal microscopic imaging of mitochondrial rhodamine-123 (Rh123) fluorescence was used to assess relative oxidative competence of conditioned and unconditioned phasic axons. Conditioned phasic axons showed significantly higher mean mitochondrial Rh123 fluorescence than contralateral unstimulated axons. In the same preparations that showed increased postconditioning Rh123 fluorescence, the synaptic fatigue resistance measured from conditioned axon 3 was also significantly greater than that recorded from contralateral unstimulated axon 3. 5. Axotomy of the phasic extensor nerve root (containing axon 3), before in vivo conditioning stimulation of its decentralized segment, prevented induction of both the increased synaptic stamina in axon 3 and the enhanced mitochondrial fluorescence in decentralized motor axons of the nerve root. Hence, induction of both changes requires axonal transport of materials between the soma and the motor synapses of axon 3. 5. Axotomy of the phasic extensor nerve root (containing axon 3), before in vivo conditioning stimulation of its decentralized segment, Prevented induction of both the increased synaptic stamina in axon 3 and the enhanced mitochondrial fluorescence in decentralized motor axons of the nerve root Hence, induction of both changes requires axonal transport of materials between the soma and the motor synapses of axon 3 6. Because mitochondrial Rh123 fluorescence is primarily dependent upon the oxidative activity of these organelles, our findings suggest that conditioning stimulation of phasic extensor axon 3 increases its mitochondrial oxidative competence and that the enhanced synaptic stamina seen during LTA in axon 3 is correlated with, and dependent upon, oxidative activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗

PubMed2005

Lithuanian health care in transitional state: ethical problems.

BACKGROUND: Throughout the economic and political reforms in post-communist countries, significant changes have also occurred in public morality. One of the tasks of the Lithuanian health policy is to create mechanisms for strengthening the significance of ethical considerations in the decision-making processes concerning health care of individuals and groups of individuals, as well as considering the positions of physicians and the health care system itself in a general way. Thus, health care ethics could be analyzed at two levels: the micro level (the ethics of doctor-patient relationships) and the macro level (the ethics of health policy-making, which can be realized by applying the principles of equal access, reasonable quality, affordable care and shared responsibilities). To date, the first level remains dominant, but the need arises for our attention to refocus now from the micro level to the patterns of managing and delivering care, managing the health care resources, and conducting business practices. DISCUSSION: In attempting to increase the efficiency of health services in Lithuania, a common strategy has been in place for the last fifteen years. Decentralization and privatization have been implemented as part of its policy to achieve greater efficiency. Although decentralization in theory is supposed to improve efficiency, in practice the reform of decentralization has still to be completely implemented in Lithuania. Debates on health policy in Lithuania also include the issue of private versus public health care. Although the approach of private health care is changing in a positive way, it is obvious that reduced access to health services is the most vulnerable aspect. In the Lithuanian Health Program adopted in July 1998, the target of equity was stressed, stating that by 2010, differences in health and health care between various socio-economic groups should be reduced by 25%. SUMMARY: The restructuring of health care system in Lithuania should be based on a balance between decentralization and centralization, and between public and private health care sectors. Successful transition requires a balanced role of the government. Today it is obvious in Lithuania that continuous encouragement to make sacrifices was not enough to induce the system to function well, and in an ethical manner.

Decision Making, Organizational↗

PubMed2001

Medication errors in United States hospitals.

This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness-adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 mortality data from the Health Care Financing Administration. Simple statistical tests and a severity of illness-adjusted multiple regression analysis were employed. The study population consisted of 1116 hospitals that reported information on medication errors and 913 hospitals that reported information on medication errors that adversely affected patient care outcomes. We evaluated factors associated with the 430,586 medication errors and 17,338 medication errors that adversely affected patient care outcomes. Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year. Each hospital experienced a medication error that adversely affected patient care outcomes every 19.23 days (or every 401 admissions). The following factors were associated with increased medication errors/occupied bed/year: lack of pharmacy teaching affiliation (slope = 0.8875, p=0.0416), centralized pharmacists (slope = 1.0942, p=0.0001), number of registered nurses/occupied bed (slope = 1.624, p=0.032), number of registered pharmacists/occupied bed (slope = 25.0573, p=0.0001), hospital mortality rate (slope = 2.8017, p=0.0192), and total cost of care/occupied bed/year (slope = 0.01432, p=0.0091). Factors associated with decreased medication errors were location in the Mid-Atlantic census region (slope = -1.5182, p=0.03), affiliation with a pharmacy teaching program (slope = -1.0252, p=0.0349), decentralized pharmacists (slope = -0.9843, p=0.0037), and number of medical residents/occupied bed (slope = -1.478, p=0.0014). There was a 45% decrease in medication errors (1.81-fold decrease) in hospitals that had decentralized pharmacists, compared with hospitals that had centralized pharmacists. In addition, there was a 94% decrease in medication errors that adversely affected patient care outcomes (16.88-fold decrease) in hospitals that had decentralized pharmacists compared with hospitals that had only centralized pharmacists. Based on previous field studies and our findings in 1116 hospitals, it appears that one of the most effective ways to prevent or reduce medication errors is to decentralize pharmacists to patient care areas. The results of this study should help hospitals reduce the number of medication errors that occur each year.

Education, Pharmacy↗

PubMed1982

Further evidence for postganglionic actions of prostaglandin F2 alpha and histamine in the submandibular gland of the dog.

To test the possibility that prostaglandin F2 alpha and histamine might produce salivary and vasodilator responses by stimulation of preganglionic parasympathetic nerve fibers in the submandibular gland the responses to the two substances of chronically decentralized glands were compared with those of acutely decentralized ones in anesthetized dogs. No significant differences in responses to either prostaglandin F2 alpha or histamine were noted between chronically decentralized glands and acutely decentralized ones. Thus, it was concluded that prostaglandin F2 alpha and histamine only stimulate parasympathetic postganglionic neurons within the gland and neither of the responses is related to non-cholinergic ganglionic transmission.

Acetylcholine↗

PubMed1997

[Corneal topography analysis before and after photorefractive keratectomy].

OBJECTIVE: To study the change of corneal surface morphology before and after photorefractive keratectomy (PRK) and analyze the decentralization of the ablation. METHODS: Corneal topography was examined on 122 eyes of 80 cases with myopia by computer-assisted photokeratography before and after PRK. RESULTS: Before PRK, the corneal topography of most examined eyes (75.4%) was symmetric bow tie pattern or asymmetric bow tie pattern; after PRK, the corneal topography of the ablated regions was mainly round or approximately round (63.9%). There is no relationship between the distance of decentralization of the ablation site and preoperative refractive diopters. But the more is the distance of decentralization, the more is the increase of postoperative corneal astigmatism and also the more is the decrease of the best corrected visual acuity. CONCLUSION: Examination and analysis on the corneal topography before and after PRK can clearly display the changes of the corneal surface morphology, and also can quantitatively evaluate the decentralization.

Adult↗

PubMed2000

Through Mintzberg's glasses: a fresh look at the organization of ministries of health.

In 1987, district health care policies were officially adopted by a majority of developing countries. Many operational problems constraining implementation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. However, the policy of operational and administrative decentralization has often been critically obstructed by inappropriate organizational structures in ministries of health. By applying Mintzberg's analytical framework to several ministries of health, we identify structural deficiencies that make systems unfit to match their policy environment and yield the expected outcomes of functional and decentralized services. We propose a typology likely to elicit strategies for decentralizing health care administration. Our analysis is based on the following steps: a description of Mintzberg's concepts of organizational structure, generic components (strategic apex, technostructure, supporting structure, middle line, operational core) and functions (horizontal and vertical integration, liaison devices, vertical and horizontal decentralization) applied to health systems; a discussion of divisionalized adhocracy as a suitable configuration for health organizations with a need for a high degree of regional autonomy, community participation, medical staff initiative, action research and operational research, and continuous evaluation; a discussion of the organizational features of a number of health ministry systems and a consideration of strategies for transforming configurations towards divisionalized adhocracy.

Community Health Services↗