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PubMedDate not supplied

Comparison of ablation centration after bilateral sequential versus simultaneous LASIK.

PURPOSE: To compare ablation centration after bilateral sequential and simultaneous myopic LASIK. METHODS: A retrospective randomized case series was performed of 670 eyes of 335 consecutive patients who had undergone either bilateral sequential (group 1) or simultaneous (group 2) myopic LASIK between July 2000 and July 2001 at the China Medical University Hospital, Taichung, Taiwan. The ablation centrations of the first and second eyes in the two groups were compared 3 months postoperatively. RESULTS: Of 670 eyes, 274 eyes (137 patients) comprised the sequential group and 396 eyes (198 patients) comprised the simultaneous group. Three months post-operatively, 220 eyes of 110 patients (80%) in the sequential group and 236 eyes of 118 patients (60%) in the simultaneous group provided topographic data for centration analysis. For the first eyes, mean decentration was 0.39 +/- 0.26 mm in the sequential group and 0.41 +/- 0.19 mm in the simultaneous group (P = .30). For the second eyes, mean decentration was 0.28 +/- 0.23 mm in the sequential group and 0.30 +/- 0.21 mm in the simultaneous group (P = .36). Decentration in the second eyes significantly improved in both groups (group 1, P = .02; group 2, P < .01). The mean distance between the first and second eyes was 0.31 +/- 0.25 mm in the sequential group and 0.32 +/- 0.18 mm in the simultaneous group (P = .33). The difference of ablation center angles between the first and second eyes was 43.2 < or = 48.3 degrees in the sequential group and 45.1 +/- 50.8 degrees in the simultaneous group (P = .42). CONCLUSIONS: Simultaneous bilateral LASIK is comparable to sequential surgery in ablation centration.

Adult↗
PubMedDate not supplied

Fourier analysis of irregular astigmatism after trabeculectomy.

OBJECTIVE: To examine irregular astigmatism following trabeculectomy using Fourier analysis of videokeratography data. PATIENTS AND METHODS: Forty eyes of 40 glaucoma patients, undergoing primary trabeculectomy, underwent videokeratographic examinations preoperatively, and at 2 weeks and 1, 3, 6, and 12 months postoperatively. The dioptric data of the central cornea were decomposed into spherical, regular astigmatic, and irregular astigmatic (decentration and higher-order irregularity) components using Fourier analysis. RESULTS: The mean spherical equivalent did not change throughout the observation period. The regular astigmatic component from 2 weeks to 6 months post-operatively was greater than the preoperative diopter, but the increase was not significant. In contrast, the decentration component increased significantly after surgery, but returned to the preoperative level by 12 months. The higher-order irregularity component also presented a transient increase postoperatively. CONCLUSIONS: Irregular astigmatism, particularly decentration component, increases significantly after trabeculectomy, but returns to the preoperative level 12 months after surgery.

Adult↗
PubMed1975

Altered resting membrane potential in the supersensitive vas deferens of the guinea pig.

Microelectrodes have been used to obtain evidence for cellular changes associated with postjunctional supersensitivity in the vas deferens. Chronic decentralization or denervation caused a partial depolarization. A study of the time course of this depolarization in decentralized vasa deferentia indicated that the phenomenon appeared and reached a plateau between the 2nd and 4th postoperative day, i. e., at the same time as postjunctional supersensitivity develops in this tissue. Junction potentials induced by transmural stimulation and measured in impaled cells were not significantly different in control and decentralized cells. The results are discussed in relation to existing theories of supersensitivity and information in the literature regarding other cellular changes, especially of calcium. It is hypothesized that postjunctional supersensitivity is due, at least in part, to a reduction in resting membrane potential associated with a decrease in calcium bound to the cell membrane.

Animals↗
PubMedDate not supplied

Enhancement of methacholine-stimulated guanosine 3':5'-cyclic monophosphate formation in supersensitive guinea pig vasa deferentia.

Decentralization of the guinea pig vas deferens resulted in supersensitivity of the contractile response to methacholine. Methacholine also elevated cyclic GMP to a greater extent in the decentralized vas deferens than in sham-operated controls. Decentralization did not alter basal cyclic AMP or cyclic GMP content. These observations are analogous to the enhanced responsiveness of cyclic AMP formation in supersensitive beta adrenergic systems.

Animals↗
PubMed2003

[Corneal surface analysis].

Fourier analysis is a powerful method of evaluating the surface of the cornea. In 50 patients after photorefractive keratectomy included in our study we measured spherical equivalent, regular astigmatism, irregular astigmatism and decentration retrospectively acquired by Fourier series analysis of corneal topography data 1, 3, 6 and 12 months after operation. Postoperative decentration increased significantly from a mean preoperative value. The preoperative and postoperative values are not significantly different. The Fourier spherical equivalent and the values of keratometric spherical (equivalent) are highly correlated. Correlation among decentration, irregular astigmatism and best corrected visual acuity is important for clinical practice. Due to Fourier analysis we obtain information, which could explain worse results of some surgeries.

Astigmatism↗
PubMed2003

[Effect of central axotomy of sensory neurones on the mechanoreception recovery in initial regeneration of the injured sciatic nerve in rats].

No apparent effect of lumbar dorsal rhizotomy performed simultaneously with the peripheral nerve injury, has been revealed on the triggering of regeneration of sensitive nerve fibers. Re-innervation of the foot skin by either decentralized regeneration of nerve fibers or those sustaining their connections with the central nervous system (CNS), has been shown to start 30 days after surgery. Using the recording of impulse activity of a single nerve fibre, the mechanical thresholds of decentralized regenerating receptors were found to be significantly higher as compared to the thresholds of the regenerating receptors sustaining their connections with the CNS. The findings suggest that afferent nerve fibers and mechanical receptors formed on the periphery, continue functioning after decentralization and sustain their regenerative capacity after injury. However, in marked contrast, the decrease in sensitivity of regenerating receptors is more pronounced.

Animals↗
PubMed2003

Overview of devolution of health services in the Philippines.

INTRODUCTION: In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. In 1992, the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. AIM: The aim of this review is to (i) Provide a background to the introduction of devolution to the health system in the Philippines and to (ii) describe the impact of devolution on the structure and functioning of the health system in defined locations. METHOD: International literature was reviewed on the subjects of decentralization. Rapid appraisals of health management systems were conducted in both provinces. Additional data were accessed from the rural health information system and previous consultant reports. RESULTS: Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. It was found that in 1992-1997, system effects included a breakdown in management systems between levels of government, declining utilization particularly in the hospital sector, poor staff morale, a decline in maintenance of infrastructure and under financing of operational costs of services. CONCLUSION: The aim of decentralization is to widen decision-making space of middle level managers, enhance resource allocations from central to peripheral areas and to improve the efficiency and effectiveness of health services management. The findings of the historical review of devolution in the Philippines reveals some consistencies with the international literature, which describe some negative effects of decentralization, and provide a rationale for the Philippines in undertaking a second wave of reform in order to 'make devolution work'.

Journal Article↗
PubMedDate not supplied

Neodymium:YAG laser anterior capsulotomy for capsular contraction syndrome.

BACKGROUND AND OBJECTIVE: This study presents the outcome of neodymium:YAG laser anterior capsulotomy for capsular contraction syndrome, the safety profile and effectiveness of which are unclear. PATIENTS AND METHODS: Records of 32 patients with a minimum of 3 months of follow-up were reviewed retrospectively. The procedure was considered successful if all of the following criteria were met: centered intraocular lens (IOL) or no obvious change in IOL centration post-capsulotomy, no evidence of re-phimosis in the follow-up period; and no further requirement for surgical intervention due to capsular contraction syndrome in the follow-up period or complications were recorded. RESULTS: The procedure was successful in 25 case; (78%). Failed cases (n = 7, 22.0%) included 5 cases of re-phimosis and 2 cases with progressive IOL decentration. The failure rate was higher in cases with preoperative IOL decentration (P< .01). CONCLUSION: Neodymium:YAG laser anterior capsulotomy was successful in the majority of cases. The failure rate was higher with preoperative IOL decentration.

Adult↗
PubMedDate not supplied

[Administrative deconcentration and social benefits].

This paper defines the concepts of deconcentration and decentralization in terms of the different approaches and doctrines that relate to the two processes. In addition, it describes the two types of deconcentration, functional and territorial, stressing the importance of implementing both types and placing special emphasis on the role of space both in the structure of health service administration and in the distribution of authority between the State and the decentralized agencies. Finally, the relationship between deconcentration, democracy, community participation, and social benefits is analyzed, and possible ways to shift responsibility to decentralized agencies are suggested.

Government↗
PubMed1989

Optic disc photogrammetry: magnification factors for eye position, centration, and ametropias, refractive and axial; and their application in the diagnosis of optic nerve hypoplasia.

To determine if image magnification from ametropia or other factors required correction in the photogrammetric diagnosis of optic nerve hypoplasia, the following variables were studied using two standard 30 degrees field fundus cameras (Zeiss FF-3 and Kowa RC-2): (1) distance between the camera and the subject--variations in this distance do not change the image size; (2) decentration of the camera (i.e., decentration of the optic disc image within the field)--no effect was found using the Kowa camera, but in the Zeiss, a 2% (0.07 mm) increase in disc image size was found for each mm of optic disc decentration in the field; (3) ametropia, refractive experimental (induced in one subject with soft contact lenses, from +8.00 diopters (D) to -8.00D)--no significant change in image size was found (In addition, in 50 healthy adult eyes with various refractive errors, including ten with uncorrected aphakia, there was no significant difference found for the size of the optic nerve in different refractive ametropias. No correction factor was necessary for aphakia or for other refractive ametropias); and (4) ametropia, axial--axial myopia showed minor but significant magnification: a linear increase in the horizontal diameter of the optic disc image of 2% (0.07 mm) was found for each diopter of axial ametropia exceeding 3D. There was insufficient data for axial hyperopia. These magnification factors should be applied when measuring the optic disc on 35-mm transparencies to make a diagnosis of optic nerve hypoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aphakia↗
PubMed1989

[Long-term follow-up following posterior chamber lens implantation with defective or absent posterior chamber].

41 patients were follow up in whom a posterior chamber lens was implanted despite of ruptured posterior capsule. Follow-up period was 9 months to 5 years: 30 lenses were well centered, 7 were slightly decentrated, 2 were strongly decentrated. In 2 cases the lens was luxated into the vitreous. CME was observed in two cases and retinal detachment in 5 cases. In 6 selected patients without posterior capsule, a 2-loop PCL (Simcoe-type) was implanted by controlled suture-fixation into the ciliary sulcus. The inferior haptic was sutured directly in the 6 o'clock position while the superior haptic (12 o'clock) was fixed indirectly by an "iris flap" (made from the "iridectomy") which was turned posteriorly. Follow-up period of 1-2 years: no decentration, vitreous in the anterior chamber in 2 cases.

Follow-Up Studies↗
PubMed1987

Job characteristics and satisfaction of pharmacy technicians.

Perceptions of job characteristics and job satisfaction of central-area technicians and drug-administration technicians at The Ohio State University Hospitals were analyzed. A questionnaire was administered to 79 pharmacy drug-administration technicians; 44 central-area technicians; 10 pharmacy residents, who served as objective raters (5 in the central area and 5 in the decentral area); 13 central-area pharmacists; and 17 decentral-area pharmacists. Perceived job characteristics were measured with the Job Characteristics Inventory; job satisfaction was measured by the Minnesota Job Satisfaction Questionnaire. The two groups of technicians differed significantly in their perceptions of task identity, task significance, and dealing with others. Significantly greater autonomy in technicians' jobs was perceived to exist by pharmacists and raters in both areas than by technicians. Significantly greater task identity was perceived by the central-area technicians than by their raters, and significantly greater task importance was perceived by both groups of technicians than by their pharmacists and raters. Friendship opportunities were perceived to exist to a significantly greater degree by decentral pharmacists and raters than by the drug-administration technicians. In the institution studied, both central-area and drug-administration technicians tended to be dissatisfied with their jobs. Central-area technicians' satisfaction was influenced most by the technicians' relationships with their supervisors and the feelings of accomplishment they gained. Drug-administration technicians were most satisfied if they believed they had opportunities to use their abilities. Efforts to increase job satisfaction among pharmacy technicians should focus on increasing feedback and task identity.

Job Description↗
PubMed1985

Rapid recovery of pineal function after partial denervation: a possible role for heteroneuronal uptake of transmitter in modulating synaptic efficacy.

The pineal gland is innervated by sympathetic neurons whose cell bodies are located in the two superior cervical ganglia and whose axons reach the gland via the two internal carotid nerves (ICNs). Bilateral decentralization of the superior cervical ganglia, produced by lesioning both cervical sympathetic trunks (CSTs), abolishes the circadian rhythm in the activity of the pineal enzyme serotonin N-acetyltransferase (NAT). We have examined the effects on NAT activity of unilaterally cutting the ICN or the CST. During the first night after either operation, nocturnal NAT activity was reduced by 75% compared to controls. However, during the second night after unilaterally cutting the ICN, NAT activity was restored to control values, and normal enzyme activity was seen in these lesioned animals for up to 1 month after this operation. On the other hand, following unilateral decentralization of one superior cervical ganglion, enzyme activity was reduced for at least 5 months. The high enzyme activity in animals with one ICN cut was abolished by cutting the contralateral CST, indicating that the recovery of NAT activity depended on the remaining intact sympathetic neurons. Electrical stimulation of the intact ICN during the daytime in animals in which the contralateral ICN was cut produced an increase in pineal NAT activity which was greater than the increase seen when similar stimulation was performed in sham-operated animals or in animals in which the contralateral superior cervical ganglion had been decentralized. The time course of the recovery of nocturnal NAT activity after unilateral denervation of the pineal gland was similar to the time course of the decrease in norepinephrine uptake sites in the gland.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Decentralization/regionalization in health care: the Quebec experience.

The decentralization policy in Canada was initially aimed at decentralizing the management of services by creating regional bodies within which interested parties would participate in establishing priorities, elaborating programs, allocating resources and assessing program efficiency and effectiveness. A look at the Quebec experience provides insight into the difficulties and implications of decentralization.

Catchment Area, Health↗
PubMed1995

The satellite laboratory and point-of-care testing. Integration of information.

Laboratory testing is returning to the point of care, where it started in the 19th century. This decentralization of testing is occurring because of the many advantages it brings to the practice of critical care medicine, such as faster turn-around time and better patient management in inpatient and outpatient settings. However, decentralization of testing is decentralizing laboratory information. In addition, bedside analytical systems are causing a quality assurance dilemma in which data can be seen and acted on before the appropriate quality checks are completed. Current information technology allows these data to be integrated and thus patient care processes to be enhanced through tracking of clinical outcomes and reducing costs. Because the goal of point-of-care testing is to provide data in a timely manner, the future success of any point-of-care/satellite testing system will depend on the ease with which it can be integrated into the medical information system.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Blood gas/pH analyzers.

Blood gas/pH analyzers (BGAs) measure or calculate several physiologic parameters, typically from an arterial blood sample, to assist clinicians in diagnosing, assessing, and monitoring the patient's condition (e.g., respiratory status) and regulating therapy (e.g., ventilation). In this study, we focused on the use of BGAs in two different settings: (1) centralized testing locations that service several different hospital departments or areas and (2) decentralized, sometimes referred to as "point-of-care," testing areas. (Also refer to the Guidance Article, "Point-of-Care' Laboratory Testing: Is Decentralized Testing the Best Alternative for Your Hospital?" in this issue). In this Evaluation, we evaluated seven GBAs from seven manufacturers, examining the appropriateness of each device for use by the two types of potential users: (1) specialized personnel (e.g., medical technologists) experienced in using and maintaining laboratory equipment and (2) nonspecialized personnel (e.g., nurses) who do not have such experience but may be expected to operate the devices in facilities using a decentralized testing program. We rated each unit separately for these two user types to help facilities choose the unit that best fits their testing program. Note that we did not test all capabilities of these units; for example, we did not test electrolyte or other metabolite determinations or the accuracy of derived (i.e., calculated) parameters. Our ratings were based largely on whether a BGA could report erroneous derived parameters. We also considered the level of operator maintenance required, as well as cost and human factors issues, when ranking the units within their ratings group. Only one unit was rated Acceptable for use by either specialized or nonspecialized personnel. The remaining units were rated Conditionally Acceptable because they could present erroneous values for one or two derived parameters. Our conditions of acceptability include (1) that the parameter(s) in question be determined by using a multiwavelength oximeter or (2) that the BGA not report results for these parameters. (Although we did not evaluate oximeters in this study, we did test the accuracy of one oximeter parameter on the one evaluated BGA that contains an integral oximeter.)

Blood Gas Analysis↗
PubMedDate not supplied

[Essential research in health systems].

Public health research and education in Mexico require further decentralization to improve its availability, quality and relevance for the development of local health systems. This article presents the experience of the Northern Regional Center for Health Systems Development (Nuredess-Norte), a consortium for the decentralization and regionalization of public health research and education of El Colegio de la Frontera Norte and the National Institute of Public Health. Nuredess-Norte initiated its activities in 1990 establishing a binational network of health systems consultants along the border, following a common methodology to improve health system quality through research. Later a Health Systems Development Teaching Program was established at the level of specialization with a high degree of decentralization and linkage with local health systems. Nuredess-Norte undertakes research, design and evaluation of innovations along the US-Mexico border. Emphasis is given to community participation and the development of primary health care.

Delivery of Health Care↗
PubMedDate not supplied

Excimer laser photorefractive keratectomy for hyperopia.

BACKGROUND: Excimer laser photorefractive keratectomy has generated considerable interest as a technique for correcting myopia. In this study, the excimer laser was used to correct hyperopia. METHODS: A prospective clinical study based on the results of photorefractive keratectomy in 23 consecutive hyperopic eyes (one eye per patient) is presented. The excimer laser used in this study was a MEL 60 (Aesculap-Meditec); this laser emits 193-nanometer laser light. A 1-year follow-up study of two groups of eyes was performed. All patients were followed for 12 months. The first group comprised 15 hyperopic eyes with preoperative refraction between +2.0 and +7.5 diopters (mean spherical equivalent +4.7 +/- 1.6 D). The second group comprised eight aphakic eyes with preoperative refraction between +11.0 and +16.0 D (mean spherical equivalent +13.1 +/- 2.0 D). RESULTS: In group 1, 12 eyes (80%) were within +/- 1.0 D of the intended correction (baseline, +2.0 to +7.5 D) after 1 year. In group II, only three of the eight aphakic eyes (37%) were within +/- 1.0 D of the intended final refraction (baseline, +11.0 to +16.0 D). The stability of refraction in group I was better than in group II. At 12 months, best corrected visual acuity was unchanged in 14 eyes of group I. One eye had lost two lines. In group II, best corrected visual acuity was unchanged in six eyes after 12 months. In two eyes, best spectacle-corrected visual acuity was lower than the preoperative value, because of decentration of the ablation zone. After 1 year, 80% of the eyes in group I and 25% of those in group II had a visual acuity of 20/40 or better. CONCLUSION: Photorefractive keratectomy is an efficient and relatively safe procedure for correcting hyperopia up to +7.5 D. The predictability is good. Results of photorefractive keratectomy to correct highly hyperopic (aphakic) eyes are not as encouraging. Three patients in this study lost one to three lines of best spectacle-corrected visual acuity due to decentration of the clear zone. Two of the patients belonged to group II. Therefore, we do not recommend photorefractive keratectomy in highly hyperopic eyes, especially if they are aphakic, because even slight decentration may lead to loss of best corrected visual acuity. As in other refractive surgical procedures, great care must be taken to improve the centration of the clear zone.

Adult↗