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PubMed2000

Decentration, tilt, and near vision of the array multifocal intraocular lens.

PURPOSE: To study the periodic changes in decentration, tilt, and near vision in eyes with the Array(R) multifocal intraocular lens (IOL). SETTING: Department of Ophthalmology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. METHOD: This study comprised 20 eyes of 10 patients older than 60 years who had binocular cataract and bilateral implantation of the Array multifocal IOL. Mean patient age was 66.0 years (range 60 to 75 years). After a clear corneal incision and continuous curvilinear capsulorhexis were made, each eye had phacoemulsification and in-the-bag IOL implantation. The amount of IOL decentration and degree of tilt were evaluated using the EAS-1000 anterior eye segment analysis system 1 day and 1 and 2 months postoperatively. Near and far visual acuities were measured at the same examinations. RESULTS: No statistically significant differences were observed in decentration (P =.13) or tilt (P =.32) throughout the follow-up. Mean uncorrected distance visual acuity was 0.68 +/- 0.27 (SD), and mean uncorrected near acuity was 0.49 +/- 0.15 2 months postoperatively. Uncorrected distance acuity better than 0.5 was achieved in 14 eyes (77.8%), in which the mean uncorrected distance acuity was 0.80 +/- 0.18 and the mean uncorrected near acuity was 0. 53 +/- 0.14 2 months postoperatively. CONCLUSIONS: Tilt and decentration of the Array multifocal IOL showed no significant progression up to 2 months after implantation. For near acuity, the Array IOL may be an effective aid.

Aged↗
PubMed1995

Developing an information system to support the pursuit of decentralization. The perspective of Cearà State in Brazil.

Discusses the national health information system in Brazil which, until very recently, consisted of two main structures of health services with a dichotomy between curative and preventive health care acting in a vertical manner. The autonomy of health authorities and specialized structures created numerous independent health information systems with different methods of data collection. Although the issues of decentralization and a unified health system had been agreed on in 1963, they had not been implemented until the new health policy reform was lunched in 1988. The reform was based on the strengthening of primary health care at national level and accelerating decentralization of health systems. However, in spite of strong political will the new health managers at local level are lacking essential information, data and instruments that only a decentralized health management information system can provide. Based on a study conducted in the Cearà State of the north east of Brazil, explores how the present health information system can support the process of decentralization.

Brazil↗
PubMed1981

Agonist interaction and decentralization supersensitivity in the nictitating membrane of the cat.

1. The responses to individual drugs and to combinations of two drugs were studied in normal and chronically decentralized nictitating membranes (NM) of cats. Noradrenaline (NA), acetylcholine (ACh), serotonin (5HT) and potassium chloride (KCl) and the combinations NA + ACh, NA + 5HT, NA + KCl and ACh + 5HT were injected intra-arterially towards the smooth muscle. 2. Chronic decentralization resulted in supersensitivity to each of these agonists when injected alone. 3. The contraction of the normal NM caused by each drug combination showed potentiation in comparison to the sum of contractions caused by the same drugs given separately. The same drug combinations showed no potentiation in decentralized muscle. 4. Decentralization supersensitivity and potentiation due to agonist interactions in normal preparations may share a common mechanism. The involvement of calcium in this phenomenon is discussed.

Acetylcholine↗
PubMed1984

Analysis of clinical approximation in applying Prentice's rule to decentration of spherocylinder lenses.

A common approximation for obtaining the prism induced by decentration of spherocylinder lenses in non-principal meridia has been compared to the actual prism for numerous cylinder axis orientations. The base direction predicted by the approximation shows significant variations from the actual direction when the cylinder axis is more than 20 degrees from the horizontal or vertical direction. When there is only vertical decentration, the power error is directly proportional to the decentration and the cylinder power. Both the meridional error and the power error depend on the ratio of the sphere power to the cylinder power and on the decentration.

Eyeglasses↗
PubMed1970

Nonspecific supersensitivity of the guinea-pig vas deferens produced by decentralization and reserpine treatment.

1. The sensitivity of the guinea-pig vas deferens to noradrenaline, histamine, methylfurmethide and potassium was examined in vitro following decentralization and reserpine treatment.2. One day after decentralization or administration of reserpine (1.0 mg/kg daily) the sensitivity of the vas deferens was not increased. After 5 days' treatment the muscle was supersensitive to all four stimulants.3. The magnitude of the sensitivity increase to an individual drug was the same following both chronic reserpine treatment and decentralization. However, the degree of supersensitivity differed for the four stimulants. The order of potentiation was noradrenaline>histamine>methylfurmethide>potassium.4. The magnitude of the supersensitivity was inversely correlated with the slope of the dose-response curves to the four agonists. The dose-response curve to potassium had the steepest slope, followed in order by methylfurmethide, histamine and noradrenaline.5. A hypothesis is presented to account for the inverse relationship between the slope of the dose-response curve and the degree of supersensitivity which follows reserpine treatment or decentralization.

Animals↗
PubMed2006

Tilt and decentration of the intraocular lens following combined vitrectomy and pars plana lensectomy.

PURPOSE: To investigate intraocular lens (IOL) tilt and decentration following combined vitrectomy and pars plana lensectomy (PPL) with IOL implantation in patients with proliferative diabetic retinopathy. METHODS: We followed 25 patients with proliferative diabetic retinopathy who underwent PPL and IOL (MA60BM) implantation at the time of pars plana vitrectomy (PPL group), and 25 patients who underwent phacoemulsification and IOL (MA60BM) implantation without vitrectomy (PE group). Intraocular lens tilt and decentration were evaluated quantitatively, using the anterior eye segment analysis system, approximately 12 months after surgery. RESULTS: There was no significant difference in IOL tilt (p = 0.47) or decentration (p = 0.26) between the PPL and PE groups. CONCLUSIONS: The present study suggests that tilt and decentration of the IOL are acceptable in combined vitrectomy and pars plana lensectomy.

Aged↗
PubMed2006

Influence of tilt and decentration of scleral-sutured intraocular lens on ocular higher-order wavefront aberration.

AIM: To investigate the influence of tilt and decentration of scleral-sutured intraocular lenses (IOLs) on ocular higher-order wavefront aberrations. METHODS: In 45 eyes of 36 patients who had undergone scleral suture fixation of posterior chamber IOL, tilt and decentration of IOLs were determined by Scheimpflug videophotography, and higher-order aberration for a 4-mm pupil was measured using the Hartmann-Shack aberrometer. In another 100 eyes of 100 patients after standard cataract surgery with posterior chamber IOL implantation, ocular higher-order aberration was measured. RESULTS: In eyes with scleral-sutured IOL, the mean (SD) tilt angle and decentration were 4.43 degrees (3.02 degrees ) and 0.279 (0.162) mm, respectively. Ocular coma-like aberration in the sutured IOL group was 0.324 (0.170) microm, which was significantly greater than that of the standard cataract surgery group (0.169 (0.061) microm, p<0.001, Student's t test). No significant difference was found in ocular spherical-like aberration between the sutured IOL group (0.142 (0.065) microm) and standard surgery group (0.126 (0.033) microm; p = 0.254). In the sutured IOL group, IOL tilt significantly correlated with ocular coma-like aberration (Pearson's correlation coefficient r = 0.628, p<0.001), but no significant correlation was found between IOL tilt and ocular spherical-like aberration (r = 0.222, p = 0.175). The IOL tilt did not correlate with corneal coma-like (r = 0.289, p = 0.171) and spherical-like (r = 0.150, p = 0.356) aberrations. The IOL decentration did not correlate with any higher-order aberrations. CONCLUSION: In eyes with scleral-sutured posterior chamber IOL, tilting of the lens induces considerable amount of ocular coma-like aberrations.

Aged↗
PubMed1996

Reorganization of the innervation of the vas deferens after sympathetic decentralization.

Reorganization of autonomic efferent pathways to the rat vas deferens was noted after chronic (30 days) sympathetic decentralization produced by hypogastric nerve (HGN) transection. In normal rats, electrical stimulation of the HGN elicited an increase in vasal pressure (VP) bilaterally, whereas pelvic nerve (PN) stimulation did not alter VP. However, after unilateral HGN transection, stimulation of the PN on the transected side but not on the normal side increased VP. The decentralized vas exhibited larger VP responses to stimulation of the contralateral HGN in comparison with the normal vas. After bilateral HGN transection, PN-induced VP responses were elicited at lower stimulus intensities than in rats with unilateral transections. PN-induced VP responses were blocked by hexamethonium and prazosin but were not altered by atropine. Distension of the vas lumen occurred after decentralization. PN-induced VP responses were not detectable in extremely distended vas. These data indicate that, after degeneration of sympathetic preganglionic axons, decentralized adrenergic ganglion cells are reinnervated by parasympathetic or sympathetic preganglionic pathways and that the reinnervation influences vasal function.

Animals↗
PubMedDate not supplied

Comparison of tilt and decentration between phacoemulsification and phacotrabeculectomy.

PURPOSE: To determine the extent of intraocular lens (IOL) tilt and decentration values after combined surgery in patients with cataract and glaucoma. MATERIALS AND METHODS: A total of 106 cataractous eyes undergoing IOL implantation were divided into 2 groups. Group 1 comprised 42 eyes undergoing phacotrabeculectomy surgery for cataract and primary open-angle glaucoma (POAG), and group 2 comprised 64 eyes undergoing phacoemulsification surgery for senile cataract. The length of IOL decentration and the angle of IOL tilt were quantitated by using Purkinje reflections and photographic documentation. RESULTS: The differences regarding both the IOL tilt (2.84 +/- 0.37; 2.97 +/- 0.37, respectively) and decentration (0.39 +/- 0.27; 0.49 +/- 0.35, respectively) was insignificant (p > 0.05) between groups. CONCLUSION: There is no increased effect of phacotrabeculectomy on tilt and decentration of IOLs in eyes with POAG when compared with eyes which underwent phacoemulsification surgery.

Aged↗
PubMedDate not supplied

Intraocular lens decentration and posterior capsule opacification: anatomo-pathologic findings after implantation of AMOSI40 IOLS.

PURPOSE: To evaluate the incidence of intraocular lens (IOL) decentration and posterior capsule opacification (PCO) after implantation of a three-piece posterior chamber silicone IOL in a series of eyes examined postmortem. METHODS: Twenty-three pseudophakic enucleated human cadaver eyes, implanted with AMO SI40NB IOLs after phacoemulsification, were analyzed. Eyes obtained postmortem were sectioned at the equatorial plane and the anterior segment photographed from a posterior view. Location of IOL optic and haptics, type of fixation, and centration of IOL was evaluated. PCO was graded and the presence of Nd:YAG laser posterior capsulotomy was noted. RESULTS: Mean age at the time of surgery was 77.83 years, mean time since implantation was 18.26 months. In all the eyes examined, IOL haptics were positioned in the capsular bag. Mean decentration was 0.20+/-0.16 mm. No correlation was found between IOL decentration and time since implantation. The degree of peripheral PCO ranged from none (13.0%) to mild (39.1%) to moderate (26.1%) to severe (21.7%). The degree of central PCO ranged from none (52.2%) to mild (30.4%) to moderate (4.3%). Three patients (13.0%) underwent Nd:YAG laser posterior capsulotomy. CONCLUSIONS: A very good centration can be obtained when silicone AMOSI40NB IOLs are correctly implanted with the haptics inside the capsular bag. About half of the implants showed no central PCO while Nd:YAG laser posterior capsulotomy rates documented a relatively low PCO 18 months after surgery. A careful in the bag haptics placement is needed in order to reduce the IOL decentration and to prevent central PCO.

Aged↗
PubMed2006

Organizational decentralization in radiology.

At present, most hospitals have a department of radiology where images are captured and interpreted. Decentralization is the opposite of centralization and means 'away from the centre'. With a Picture Archiving and Communication System (PACS) and broadband communications, transmitting radiology images between sites will be far easier than before. Qualitative interviews of 26 resource persons were performed in Norway. There was a response rate of 90%. Decentralization of radiology interpretations seems less relevant than centralization, but several forms of decentralization have a role to play. The respondents mentioned several advantages, including exploitation of capacity and competence. They also mentioned several disadvantages, including splitting professional communities and reduced contact between radiologists and clinicians. With the new technology decentralization and centralization of image interpretation are important possibilities in organizational change. This will be important for the future of teleradiology.

Hospital Shared Services↗
PubMed2006

Phakometry and lens tilt and decentration using a custom-developed Purkinje imaging apparatus: validation and measurements.

We present a Purkinje imaging system for phakometry and measurement of tilt and decentration of crystalline and intraocular lenses (IOLs). Crystalline lens radii of curvature were estimated by using both a merit function and the equivalent mirror approaches. Tilts and decentrations were estimated by using Phillips's linear analysis. We present a complete validation of the technique through exhaustive computer simulations and control experiments, and measurements in 17 normal eyes (mean age 26.67 +/- 2.31) and nine postcataract surgery eyes (mean age 74 +/- 2.3). Crystalline lens radii ranged from 12.7 to 8.81 mm and from -5.64 to -7.09 mm for anterior and posterior surfaces, respectively. Crystalline lens tilt ranged from 2.8 to -2.87 deg horizontally and from 2.58 to -1 deg vertically. Crystalline lens decentration ranged from 0.09 to 0.45 mm horizontally and from 0.09 to -0.22 mm vertically. IOL tilt ranged from 3.6 to -1.51 deg horizontally and from 5.97 to -1.85 deg vertically. IOL decentration ranged from 0.53 to -0.31 mm horizontally and from 0.13 to -0.96 mm vertically.

Corneal Topography↗
PubMedDate not supplied

[Mechanisms for allocating financial resources after decentralization in the state of Jalisco].

OBJECTIVE: To analyze, from the decision maker's perspective, the financial resource allocation process of the health services of the state of Jalisco (SSJ, per its abbreviation in spanish), within the context of decentralization. MATERIAL AND METHODS: Through a qualitative approximation using semi-structured individual interviews of key personnel in managerial positions as the method for compiling information, the experience of the SSJ in financial resource allocation was documented. From September to November 2003, the perception of managers and administrators regarding their level of autonomy in decision-making was explored as well as the process they follow for the allocation of financial resources, in order to identify the criteria they use and their justifications. RESULTS: From the point of view of decision-makers, autonomy of the SSJ has increased considerably since decentralization was implemented, although the degree of decision-making freedom remains limited due mainly to high adminstrative costs associated with salaries. In this sense, the implications attributable to labor situations that are still centralized are evident. Some innovative systems for financial resource allocation have been established in the SSJ for the sanitary regions and hospitals based upon administrative-managerial and productivity incentives. Adjustments were also made for degree of marginalization and population lag, under the equity criterion. CONCLUSIONS: General work conditions and decision-making autonomy of the sanitary regions constitute outstanding aspects pending decentralization. Although decentralization has granted more autonomy to the SSJ, the level of decision-making freedom for allocating financial resources has been held within the highest hierarchical levels.

Delivery of Health Care↗
PubMedDate not supplied

Decentralization of health systems in Latin America.

Decentralization is often a major part of health reform policies. However, there have been few attempts to comparatively study the degree of decentralization and the effects of decentralization on equity of allocations to health, so we do not know how best to implement this reform. This article uses an innovative comparative analysis of the "decision space" that was allowed to local municipalities in the health reforms of Bolivia and Chile, two countries that have had several years of experience in implementing decentralization. The studies found that relatively little decision space was allowed to local authorities over key functions of health care systems. The studies also found that central authorities often reduce the decision space in order to direct more resources to health or to restrict local choice over human resources issues. The studies found that more equitable allocations of health funding were achieved through a common equalization fund for the municipalities in Chile and by forcing the assignment to health of a specific percentage of the central government transfers to municipalities in Bolivia.

Bolivia↗
PubMed2004

Decentralization of health services: the Kerala People's Campaign.

The 1996-2001 Kerala People's Campaign for Decentralized Planning has provided much new information about the possibilities and potential of decentralizing public health and health care services. Analysis of investment patterns of the various government levels involved in the campaign, supplemented with case study materials, allows for an evaluation of the decentralization project against its own stated goals. These included (1) creating a functional division among government levels appropriate to the health tasks each level can best perform; (2) generating projects that reflect the felt needs of the people, as voiced through local participatory assemblies; (3) maintaining or increasing levels of equality in health, especially with regard to income, caste, and gender; (4) stimulating communities to mobilize voluntary resources to supplement devolved public funds; (5) stimulating communities to create innovative programs that could become models for others; and (6) making the health services function more effectively overall. The analysis supports the conclusion that the campaign achieved each of the goals to a large degree. Shortcomings arose from the inexperience of many local communities in drafting effective projects as well as problems deriving from the fact that some sections of the health bureaucracy could not be decentralized. Lessons of the campaign are already being applied to new programs in Kerala.

Community Health Services↗
PubMed1991

Documentation of pharmacist interventions in a decentralized unit dose system.

The purpose of this study was to justify the increased costs of providing decentralized pharmacy service by defining therapeutic interventions as they relate to improved patient care and by documenting cost savings generated by decentralized pharmacist interventions. Data were collected on a daily basis from information provided by the decentralized pharmacists using a daily worksheet. The various interventions were then categorized as cost-saving interventions and therapeutic interventions. Decentralized pharmacist interventions do provide important therapeutic interventions as well as cost-effective interventions. The total cost-saving interventions in 1989 was $126,509 and this included the automatic drug conversions. The pharmacists also provided 2506 therapeutic interventions.

Centralized Hospital Services↗
PubMed1980

Analysis of dispensing activities before and after decentralization of pharmaceutical services.

Changes in drug handling activities, revenue, and telephone communications were documented during a conversion from a centralized unit dose system to decentralized pharmacists and unit dose services in a 310-bed university teaching hospital. All decentralized services were mobile; no physical satellites were utilized. Computer programs were used to collect and analyze drug handling and revenue data during a prestudy control period and three equal-length study periods after decentralization of pharmaceutical services for five patient care areas of the hospital. All telephone calls to the central pharmacy were recorded and classified by type during 21 days of the prestudy period and were compared with 21 days of the second postimplementation period. The mean number of doses handled decreased for all patient care areas. After decentralization the number of telephone calls to the central pharmacy requesting clinical drug information, as well as distributive information, decreased sharply. Moving the pharmacist to the patient care unit decreased the time that pharmacists spent handling drugs and improved communication with the medical and nursing staffs.

Centralized Hospital Services↗
PubMed1999

Federalist flirtations: the politics and execution of health services decentralization for the uninsured population in Mexico, 1985-1995.

Around the world health services delivery systems are undergoing decentralization, responding to pressure to increase equity, efficiency, participation, intersectoral collaboration and accountability. This study examines the Mexican health decentralization efforts of the past decade to discern the motivations for the reform, the context for its implementation, the politics of its downfall, and the reform's impact at subnational levels of government. Sparked by economic crisis and pressure from international creditors for fiscal reform; demands for greater democracy, equity, and quality; and technocratic impulses to rationalize health services delivery, the decentralization reform could not overcome the authoritarian centralism of the federal government and its corporatist clients. In the end, even in the most technically capable states, the reform was unable to overcome political obstacles to decentralizing fiscal power, redistributing resources in an equitable fashion, and eliminating the inefficiencies of separate but unequal health systems for social security recipients and the uninsured population.

Delivery of Health Care↗