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At least 1,333 records · Page 74Linked to original sources
PubMed1997

Laser in situ keratomileusis for hyperopia.

PURPOSE: To study the efficacy of laser in situ keratomileusis (LASIK) for hyperopia. METHODS: We performed LASIK on 21 eyes using the Nidek EC-5000 excimer laser with software version 2.18 AH. The Chiron Automated Corneal Shaper was used to create the flap. Retreatments were needed in seven eyes due to decentration or undercorrection. RESULTS: Although a high rate of satisfaction was noted among patients, complications were encountered such as decentration (three eyes), undercorrection (four eyes); one patient progressed to low myopia with a loss of spectacle-corrected visual acuity and one patient had regression 3 months after the initial LASIK. CONCLUSION: Although this technique has several advantages over other techniques (holmium, ALK, PRK, hexagonal RK), it has a high rate of retreatment and some complications. Software refinement is needed, and patients should be adequately informed about what to expect from this technique.

Adolescent↗
PubMedDate not supplied

New fixation device for photorefractive surgery and its effect on corneal epithelial wound healing.

PURPOSE: A new eyeball fixation device during photorefractive surgery was designed and tested. The device fixates the eyeball by means of a suction ring, and is then fixated to the headrest of the patient's chair via clipper and metal frames. METHODS: Photorefractive keratectomy (PRK) was performed on PMMA contact lenses placed over the patient's cornea (n=6) to evaluate smoothness of the ablated surface and on rabbit (n=24) and patient (n=30) corneas for evaluation of wound healing time. Decentration with fixation was examined using videokeratography after PRK. RESULTS: After fixation, only small amounts of corneal movement from the patient's pulsating heart were noted. The mean smoothness (root mean square) of the PMMA contact lens ablated surface was 0.43 +/- 0.16 microm in non-fixated eyes and 0.26 +/-0.05 microm in fixated eyes. Mean epithelial healing rate was 47.93 +/- 21.80 microm/hr in non-fixated rabbit eyes and 66.49 +/- 20 microm/hr in fixated rabbit eyes. Mean epithelial healing time was 3.47 +/- 1.11 days in non-fixated human eyes and 2.53 +/- 0.51 days in fixated human eyes. Mean decentration after PRK was 0.30 +/- 0.28 mm in fixated human eyes. CONCLUSION: Fixating the eyeball allows less movement of the eye and achieves a smoother ablation surface for more rapid epithelial healing after PRK.

Adult↗
PubMedDate not supplied

Monocular diplopia related to asymmetric corneal topography after laser in situ keratomileusis.

PURPOSE: To show a specific relationship between monocular diplopia and corneal refractive asymmetry after laser in situ keratomileusis (LASIK). METHODS: One hundred thirty-eight eyes of 98 patients who underwent LASIK for myopia between -2.12 and -17.75 D were examined under room-lighted conditions. We examined 51 eyes at 2 weeks, 46 eyes at 3 months, 32 eyes at 6 months, and 9 eyes at 1 year after LASIK. We attempted to correlate the presence of monocular diplopia with their corneal topographical features. RESULTS: Eight eyes of five patients (five eyes at 2 weeks, three eyes at 3 months after LASIK) produced symptoms of monocular diplopia. These symptomatic patients had a common corneal topographical feature caused by decentralized or inhomogeneous ablation. Every pupillary area in the patients' topographies contained steeper and flatter areas. The range of refractive power variation in these asymmetric areas was at least 1.50 D. The location of the secondary image correlated with the direction of the steeper area in all eight eyes. Pinhole viewing eliminated or reduced the prominence of secondary images in every case. CONCLUSION: Monocular diplopia following LASIK appears to correlate with postoperative corneal refractive power variation inside the pupillary area, caused by decentralized or inhomogeneous ablation.

Adult↗
PubMedDate not supplied

Zonular dehiscence two years after phakic refractive lens (PRL) implantation.

PURPOSE: To report two cases of zonular dehiscence two years after phakic refractive lens (PRL) implantation. METHODS: In case 1, a 31-year-old myopic patient with refraction of -12.75 diopters (D) in the right eye and -20.50 D in the left eye, a 12-mm white-to-white measurement, and anterior chamber depth (ACD) of 3.7 mm underwent implantation of a -11.0 D and a -15.5 D PRL-101. Two years after surgery, a temporal-superior PRL decentration was observed in the left eye. In case 2, a 48-year-old pseudophakic patient with refraction of +8 -2.5 x 20 degrees underwent implantation of a piggyback PRL-200. Two years after surgery, an inferior PRL decentration was observed. RESULTS: The PRL was explanted in both cases. A zonular dehiscence was found--temporal-superior in case 1 and inferior in case 2. CONCLUSIONS: We have stopped implanting PRLs for the present time as the cause of this complication has yet to be determined.

Adult↗
PubMed1998

[Breast carcinoma in routine surgery. Challenges and reality].

This is a brief comment on results in the common surgical treatment of breast cancer. Based on guiding-lines given by the surgical congress 1985 the decentralized treatment routine as it is common today has been analysed and its results have been applied to our regional structures. Under the premises of standardized diagnosis as well as surgical and postoperative treatment the decentralized treatment of breast cancer is still supported and considered useful. Main critical point in the whole therapy concept is the postoperative treatment, especially the adjuvant therapy. Looking for future solutions it seems to be more effective to reduce the amount of surgical facilities for the benefit of profiling the remaining ones. This could be applicable for the treatment of other diseases as well. The improvements that would result from this conceptional concentration would be profitable as well for the patients as for the surgeons.

Breast Neoplasms↗
PubMed1990

Building departmental influence in health care organizations.

This article has outlined several steps to follow in assessing and building department influence at the top management levels of health care organizations. Identifying and contributing to resolving the organization's key areas of uncertainty are strategies that have improved the influence of many departments in recent years. Individual strategies, such as developing one's expertise and sharing that expertise with other departments and top management (an example of the "involvement" technique), also are being used daily by effective department managers. Decentralized management, which entails the assignment of greater responsibilities to middle managers, is increasingly popular in health care organizations. This trend will no doubt facilitate the building of departmental influence in organizational decision making. However, the steps outlined in this article can be implemented whether or not top management endorses a decentralized management style. In a critical sense, departmental influence is too important to be left to top management. It is up to department managers to exert their influence for the good of their employees, the organization as a whole, and their own careers.

Data Collection↗
PubMedDate not supplied

Beyond the categories: human service managers view the new federal aid.

Social agency chief executives in six program areas--welfare, health, mental health, community action, model cities, and community mental health centers--were surveyed to determine their reaction to the recent revenue sharing/block grant efforts to decentralize the federal aid system. Despite their strong belief that social initiatives and values were advanced principally by federal action, and that excessive reliance on state and local officials could severely jeopardize social programs with weak constituencies, agency executives also recognized major weaknesses in traditional categorical grant policy and, to varying degrees, supported revenue sharing and block grant alternatives. Those agencies largely dependent on federal support for their survival--model cities, community action programs, and community mental health centers--tended to support the new aid efforts only reluctantly. Those agencies more fully integrated into the regular policy-making arrangements of local government--health, welfare, and mental health agencies--were considerably more positive in their endorsement of greater decentralization.

Administrative Personnel↗
PubMed1979

Unionism in the health care industry: an overview.

Block profiles the two unions that are the most active in organizing non-nurse health care employees: the National Hospital Union (NHU) and the Service Employees International Union (SEIU). The two international unions present a contrast in structure and ideology. The SEIU is a truly international, decentralized union, whereas NHU is a far more centralized affiliate. As an international union, SEIU characterizes, taxes, and disciplines locals. Its decentralized strategy has been to permit locals to do the bulk of the organizing and collective bargaining, while the national union merely coordinates and offers financial and technical support. Conversely, NHU is an affiliate of the retail, wholesale, and department store union, deriving authority from, paying tax to, and subject to discipline by the parent organization. Its centralized approach has been for national officers to determine when a district will be created and what its jurisdiction will be. The structural differences of the two unions can be traced to their respective histories. As an old-line AFL union, SEIU had an existing structure of independent local unions that operated in health care as they did in other industries. NHU, however, originated as a union of drug store employees and its structure evolved over time. Membership growth and geographic expansion elevated it beyond the status of a local into a division with its own districts. The unions also diverge in their ideology; SEIU takes a more traditional business union approach to collective bargaining and unionism, while NHU is oriented to social welfare, involving itself in more than the work aspect of members' lives. These differences again can be attributed to contrasting histories of the old-line SEIU and the more radical NHU. The authors emphasize that unions are not homogeneous entities but organizations that respond to a similar environment as a result of their respective structures and histories.

Health Workforce↗
PubMedDate not supplied

Human service reorganization and its effects: a preliminary assessment of Florida's services integration 'experiment.'.

The present discussion reports on some of the first statewide data gathering and analysis to assess the consequences of the 1975 reorganization of the Florida Department of Health and Rehabilitative Services. Two major concepts guiding the reorganization were: (1) integration of services in order to cover more adequately the needs of clients, including "multi-problem" clients, and (2) decentralization of administrative authority of all programs under a single, district-wide management structure. Despite widespread interest in the Florida system, and two previous studies, no systematic, detailed study of the impact of reorganization at the service delivery level has been conducted until now. The results of this study indicate that departmental employees perceive substantial decentralization of authority and progress toward integration of services since the 1975 reorganization. Perceived improvement in client services is also indicated. Major factors cited as influential in the change are the move toward collocation of services, the establishment of administratively interlinked service networks, and to a lesser extent, the development of generalist managers.

Florida↗
PubMed1987

Nurse accountability program improves satisfaction, turnover.

St. Mary's Hospital and Health Center, Tucson, AZ, responding to changes in health care reimbursement and the need to maintain quality, developed a comprehensive program to improve nurses' professional accountability. The project was based on the assumption that increased job satisfaction and decreased job stress for nurses in an acute care facility would improve retention and recruitment and facilitate decentralization of care delivery. The plan included the following components: Identify and enhance qualifications of nurses through a credentialing mechanism. Restructure nurses' employment terms to professional salaried status. Implement a spiritual, holistic framework for nursing. Identify programs to extend nursing's sphere of influence to activities that promote a continuum of care. Use the patient classification staffing tool as an acuity billing system. Decentralize the nursing organization and move it into the community. Promote an environment conducive to two levels of nursing practice--professional nurse case managers and associate registered nurses. The program's effectiveness was evaluated by measuring nurses' job stress and job satisfaction in 1983 (before the program's implementation), 1985, and January 1987. In 1985, compared with 1983, job stress was significantly lower in several areas measured, while job satisfaction was higher in four of six areas measured. Turnover rate of nurses decreased from 15.2 percent in 1983 to 5.4 percent in 1986. Financial savings from the program also hve been substantial: more than $500,000 for the last two fiscal years.

Arizona↗
PubMedDate not supplied

Governance in multihospital systems: an assessment of decision-making responsibility.

This study examines decision-making responsibility in multihospital system governance. The investigation focuses on the division of decision-making authority between local (hospital) and corporate boards. Fifteen decision areas were considered, including strategic planning, allocation of financial resources, appointment and evaluation of hospital CEOs, and controlling medical staff privileges. Results suggest moderately high levels of corporate (centralized) decision making in multihospital systems. Findings also indicate that type of decision determines whether control is centralized or decentralized. Most centralized decisions were related to resource allocation, formation of new companies, and changes in by-laws of a system hospital. Most decentralized decisions were related to medical staff privileges, service changes, and hospital strategic planning.

Analysis of Variance↗
PubMedDate not supplied

Polarity management: the key challenge for integrated health systems.

Integrated health systems are confronted with numerous dilemmas that must be managed. Many of these dilemmas are an inherent part of the system's structure, given that multiple competing hospitals, medical groups, and (sometimes) health plans are often under one organizational roof. This article presents an analysis of these dilemmas--referred to in the management literature as polarities--as they are found in six integrated health systems in Illinois. The nine polarities that must be managed include (1) hospital systems that want to be organizations of physicians; (2) system expansion by growing the physician component; (3) system centralization and physician decentralization; (4) centripetal and centrifugal forces involving physicians; (5) system objectives and physician interests; (6) system centralization and hospital decentralization; (7) primary care physicians and specialists; (8) physician autonomy via collectivization; and (9) vertical and virtual integration. The article identifies some of the solutions to the polarities that have been enacted by systems. In general, executives and physicians in integrated health systems must attend to the processes of integration as much as or more than the structures of integration.

Cooperative Behavior↗
PubMed1999

Tuberculosis prevention and control activities in the United States: an overview of the organization of tuberculosis services.

After a 20% increase in tuberculosis (TB) cases between 1986 and 1992, TB cases in the United States have declined from 1993 through 1997, an average of 5 to 7 per cent per year. In this paper, we review trends and the current epidemiology of TB in the US, present a brief history of TB control efforts in the country, and present the key strategies for TB control in the US. We describe the current organizational structure of TB services in the US, the role of the private sector in TB control, and how TB control is funded. Finally we discuss the mechanisms by which TB policy is developed. The US model represents a categorical disease program that combines a centralized role of the national government in development of policy, funding, and in the maintenance of national surveillance, and a decentralized role of state and local jurisdictions, which adapt and implement national guidelines and which are responsible for day-to-day program activities. Given the relative success of this combined approach, other countries facing the challenge of maintaining an effective TB control program in the face of increased decentralization of health services may find this description useful.

Adolescent↗
PubMedDate not supplied

Centralizing physician office functions. A paradigm shift.

Recent trends show that organizations that once thought business office centralization was beneficial are re-thinking their strategies and decentralizing business office functions. This article focuses on the paradigm shift from business office centralization to decentralization and the political factors effecting this shift. It provides actual case summaries to demonstrate what has transpired, and presents an alternative strategy to establishing successful business office functions, a hybrid business office.

Financial Management↗
PubMed2000

Sympathetic nervous system plays a role in postnatal eyeball enlargement in the rabbit.

PURPOSE: To examine the role of ocular sympathetic activity in the enlargement of the rabbit eyeball during postnatal growth. METHODS: Fourteen New Zealand albino rabbits aged 5 weeks underwent unilateral surgical transection of the cervical sympathetic trunk caudal to the superior cervical ganglion. Postoperative enlargement of both eyeballs was monitored by measuring the axial length and corneal diameters every 2 weeks for 22 weeks (7-27 weeks of age). Rabbits were housed under a 12-hour light/12-hour dark cycle, and the measurements were made in the middle of the light period. At a final age of 30 to 31 weeks, the refractive state of the whole eye was determined on both sides by measurement through the central cornea with a refractometer. Rabbits were then killed, eyeballs enucleated, and their ocular volumes determined. RESULTS: From 9 weeks of age the axial length and corneal diameters were significantly shorter (P < 0.05) in the decentralized eye (surgical side) compared with the intact eye. This reduction remained statistically significant throughout the study period. However, the final refractive states of the two eyes were found not to be different. The mean ocular volume determined after postmortem enucleation was 4.5% less in the decentralized eye than in the intact eye (P < 0.05). CONCLUSIONS: Sympathetic nervous system activity is involved in the normal enlargement of the rabbit eyeball during postnatal growth. However, removal of the ocular sympathetic tone at the age of 5 weeks does not significantly alter the refractive state of the eye when measured in young adulthood.

Aging↗
PubMed2000

Depressed immunity and impaired proliferation of hematopoietic progenitor cells in patients with complete spinal cord injury.

The bone marrow is supplied with both sensory and autonomic neurons, but their roles in regulating hematopoietic and immunocompetent cells are unknown. Leukocyte growth and activity in patients with stable and complete spinal cord injuries were studied. The innervation of the bone marrow below the injury level lacked normal supraspinal activity, that is, a decentralized bone marrow. Lymphocyte functions were markedly decreased in injured patients. Long-term colony formation of all hematopoietic cell lineages, including dendritic cells, by decentralized bone marrow cells was substantially reduced. It was concluded that nonspecific and adaptive lymphocyte-mediated immunity and growth of early hematopoietic progenitor cells are impaired in patients with spinal cord injuries. Possibly, this reflects cellular defects caused by the malfunctioning neuronal regulation of immune and bone marrow function.

Adult↗
PubMedDate not supplied

The economics of central billing offices.

The anticipation of economies of scale in physician billing has led many medical practices to consolidate their billing operations. This article analyzes these economies of scale, comparing performance indicators from centralized and decentralized operations. While consolidation provides compliance, control and information, diseconomies of scale can exist in the centralized receivables management process. The authors conclude that physician practices should consider a hybrid approach to billing, thus reaping the benefits of both centralization and decentralization.

Accounts Payable and Receivable↗
PubMed2000

[Autonomic nervous system and pancreas. (Analysis of the influence of different types of autonomic denervation in glandular regeneration phenomena and the interactions of the exocrine-endocrine-Axis)].

The present tests, in male Wistar rats, center around the trophic and functional changes of the pancreatic gland (R G), both exocrine and endocrine, induced by different types of autonomic nervous interruptions. First Group of Tests: Following one year celiac ganglionectomy (CG), nonpancreatectomized (Non-Pt) rats showed, basally, in blood, a drop of glucose (G), without changes of insulin (I). At autopsy, the CG animals showed an increase of the pancreatic we weight, of the total protein, of the RNA but not DNA. In the Pt. 95% rats, superimposing CG triggered, on the one hand, a drop to control values of the raised G blood levels, and on the other, a rise of I Besides, in feces, a rising of chymotrypsin concentration. At autopsy, in the PG, an increase of total protein and of RNA. Second Group of Tests: CG, after 6 months, induced, in blood, both basally and a 2 h glucose tolerance test, significant opposite enzyme activities changes in respect to C. Indeed, as amylase (A) was increased, that of lipase (L) was depressed. When alcohol feeding (AF) was superimposed to CG rats, a reversal of the L values was observed. The latter reached levels significantly higher those of the C. In in-vitro tests, the isolated islets of CG disclosed to release more I to the bath medium than those of the C animals. Third Group of Tests: Analyzing, in conscious animal, the L excretory changes in the basal bile pancreatic secretion (BB-PS) induced by chronic (2 months interruption of the autonomic nervous innervation of the PG, it was found that CG, truncal vagotomy (V), the association of CG + V, peri-Vaterian duodenotomy (PV-D), but not bilateral splachicectomy (Spl), inhibit, significantly the L output. It was also shown that superimosing AF to the V or CG + V animals reverted to C values the I depressed levels. In acute interruptions (24 h) of the autonomic nervous innervation of the PG: CG, V, P. V-D, the depression in the BBPS is highly significant, more than 40%. From these three sets of experiments it is concluded that: Firstly, CG increases the regenerative and functional capacity of both the exocrine pancreas. This is distinctively evident when the secretory mass is reduced like in the Pt. 95% series of animals. CG probably exerts its effects suppressing the releasing of some negative reins: adrenergic, pepdidergic (galanin). Secondly, CG evokes modifications of the normal Islet-pancreon inter-relationships. The rising of A and the drop of L in blood elicited by this type of autonomic nervous interruption probably reflects an increased release of I by the Langerhans islet. Thirdly, CG, the same as V. CG + V and P.V-D, but not Spl, depress the intrapancreatic cholinergic tone. This might by at the basis of the depression of L excretion in the BB-PS. The reversion to C Through the coupling of chronic alcohol intoxication to the autonomic decentralized PG would be a reflection of an increased sensitivity to ethanol of the intrapancreatic ganglionic neurons. The augmented acetylcholine release at the nerve terminal would lead to a high intrapancreatic cholinergic tone that, in the end, might be at the basis of the reversal changes induced in the autonomic decentralized PG by the chronic ethanol intoxication.

Animals↗