Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Decentralization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,405 records · Page 78Linked to original sources
PubMed1994

[Reasons for the explantation of posterior chamber lenses].

In this study we analysed the overall incidence and the types of complications seen after cataract surgery and implantation of posterior chamber intraocular lenses (PC-IOLs) based on a review of 1460 explanted PC-IOLs. Of these explanted PC-IOLs, 1072 (73.4%) were three-piece PMMA IOLs with Prolene haptics, 261 (17.9%) were one-piece all-PMMA IOLs, 81 (5.6%) were silicone IOLs and 46 (3.1%) were of various other designs (multifocal IOLs, disc IOLs etc.). The mean implant duration for all IOLs was 25.57 +/- 29.24 months. The two most important reasons for explantation were IOL decentration (622/1460, 42.6%) and inflammation (347/1460, 23.77%). There was no difference in reasons for explantation between one-piece and three-piece IOLs. Operative techniques such as "can opener" capsulotomy and sulcus fixation have more influence on IOL decentration than the IOL design alone. Modern operative techniques such as continuous curvilinear capsulorhexis, phacoemulsification and symmetrical in-the-bag fixation of "capsular IOLs" should decrease the explantation and complication rate in the future.

Follow-Up Studies↗
PubMed1994

Granulomatous inflammation of the oropharyngeal cavity as a possible cause for unexpected high mortality in a Fischer 344 rat carcinogenicity study.

An unexpected, high, test-substance-unrelated mortality has been found predominantly in female Fischer 344 rats of a 2-year gavage carcinogenicity study, which is still in the active phase. Most of the dead animals (53%) had an impacted food or bedding bolus in the oropharyngeal cavity. Histologic evaluation of this area revealed a calcified, granulomatous inflammation of the sero-mucinous glands (60%), frequently accompanied by papillary projections (50%) into the lumen. Additionally, decentral islet formation of the tracheal cartilage was evident in all animals examined. We assume that the partial blockage of the oropharyngeal lumina was the cause of death, because other possible factors were ruled out. To detect a possible strain-related predisposition, Fischer 344 and Sprague Dawley rats that had been used for technician gavage training were studied. Granulomas and papillary projections, as well as the decentral islet formation in the tracheal cartilage, however, were found in gavaged Fischer 344 but not Sprague Dawley rats. We consider the high mortality to be related to three factors: a predisposition of the Fischer 344 rat strain, an unphysiological pH of the solvent (pH 10), and chronic irritation due to an inflexible, metallic gavage tube.

Animals↗
PubMed1993

Methods used by pharmacy departments to identify drug interactions.

The results of a survey evaluating the methods that pharmacy departments use to manage drug interactions, and their satisfaction with those methods, are reported. A random sample of 300 hospitals with more than 200 beds was selected, and a questionnaire was mailed in January 1991 to the directors of the pharmacy departments of these hospitals. Of the 300 questionnaires mailed, 167 were completed and returned. Thirty-seven percent of the hospitals offered pharmacy services through a central location only, whereas 63% offered such services through a combination of central and decentral locations. The majority of hospitals (83%) detected drug interactions through the knowledge of the pharmacist processing orders. Nearly all central pharmacies had AHFS Drug Information and Facts and Comparisons available for drug interaction information, but these resources were available in only slightly more than half of all decentral pharmacies surveyed. Fifty-four percent of the responding institutions had a computerized drug distribution system with a drug interaction component; 56% of these classified their system as "indispensable" or "helpful," while 44% classified their system as "somewhat helpful but sometimes a hindrance." Sixty-eight percent of all respondents believed that the availability of a drug interaction computer program increased the number of drug interactions identified. Sixty-eight percent of respondents perceived that pharmacists provided proper follow-up. Overall, 66% of respondents were not satisfied with their method for detection and follow-up of interactions. Of those who were satisfied, 79% had a computerized drug interaction program. Respondents who reported departmental audits or quality assessment procedures were also more likely to be satisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Information Services↗
PubMed1993

Patient-focused care.

The trend away from a departmental focus and toward "patient-focused" care in hospitals is described; advantages of and barriers to such a change and its effects on pharmacy are discussed. Patient-focused care is characterized by decentralization of services, cross-training of personnel from different departments to provide basic care, interdisciplinary collaboration, various degrees of organizational restructuring, use of "clinical pathways"--recommended components of care for patients with a particular diagnosis, simplification and redesign of work to eliminate steps and save time (e.g., providing care according to predetermined protocols and charting only exceptions to the protocol), and increased involvement of patients in their own care. Its objectives are to use nonclinical and clinical staff more effectively and to improve patients' perceptions of the quality of care and staff members' job satisfaction. It is unrealistic to expect quick reductions in hospital costs through patient-focused care, and workers will worry about job security if an institution overemphasizes this aspect. A 1993 survey of 311 hospitals found that almost half had or planned to have patient-focused care projects. Adoption of patient-focused care projects may be slowed by workers' fear of new responsibilities and new reporting relationships. However, not all patient-focused care models involve radical organizational changes, and reorganizations can be such that pharmacy staff members are still connected to the pharmacy department even if they are supervised by a nonpharmacist. In some institutions patient-focused care projects have given pharmacy its first opportunity for decentralization.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital-Patient Relations↗
PubMed1993

Optical zone centration in keratorefractive surgery. Entrance pupil center, visual axis, coaxially sighted corneal reflex, or geometric corneal center?

PURPOSE: To study the differences in optical zone marking using the geometric corneal center, entrance pupil center, visual axis, and the coaxially sighted corneal reflex as centration points. METHODS: A modified autokeratometer was used to photograph the cornea in 50 volunteers under standardized levels of illumination, with the subject fixing on the keratometer target. These photographs enabled us to mark the above-mentioned centration points and measure the direction and degree of decentration. RESULTS: From the corneal intercept of the visual axis, the entrance pupil center was found up to 0.75 mm (mean, 0.34 mm) temporally, the corneal reflex was found up to 0.62 mm (mean, 0.02 mm) nasally, and the geometric corneal center was found up to 1.06 mm (mean, 0.55 mm) temporally. CONCLUSION: The ideal physiologic centration point is the corneal intercept of the visual axis. The decentration from the visual axis was least if the coaxially sighted corneal reflex was used for centration.

Cornea↗
PubMedDate not supplied

Making policy and procedure systems work effectively.

Policy and procedure manuals can be cumbersome to keep current and updated. One approach to meet this challenge is by implementing a decentralized system to develop, review, revise and approve policies and procedures. Mechanisms to operationalize such a system involve sharing of responsibility and accountability of specified policies and procedures by various existing committees and development of coordinating systems and support mechanisms. Other key attributes of a decentralized system included collaboration and extensive communication strategies.

Humans↗
PubMed1996

Corneal asphericity following excimer laser photorefractive keratectomy. Summit PRK Topography Study Group.

BACKGROUND AND OBJECTIVE: To analyze corneal asphericity following excimer laser photorefractive keratectomy (PRK) and its influence on clinical outcomes. PATIENTS AND METHODS: A computer program (Holladay Diagnostic Summary, EyeSys Laboratories, Houston, TX) was used to qualitatively and quantitatively analyze the corneal asphericity of 132 patients 1 year following PRK for correction of myopia. Color maps depicting actual corneal asphericity as compared to the normal expected asphericity were reviewed, and quantitative values of asphericity were evaluated for associations with clinical outcomes of uncorrected visual acuity and spectacle corrected visual acuity, achieved refractive correction, a subjective glare/halo index, and subjective patient satisfaction, as well as standard corneal topography patterns and optical zone decentration following PRK. RESULTS: Following PRK, all corneas exhibited a positive central asphericity, changing from a prolate (negative asphericity) to an oblate optical contour. There was a trend toward higher positive asphericity measurements with improving spectacle corrected visual acuity which was not statistically significant; such a relationship was not found with uncorrected visual acuity. A significant association was found between greater achieved refractive correction and increased postoperative positive asphericity. No association was found between postoperative asphericity and the glare/halo index, subjective patient satisfaction, topography pattern, or optical zone decentration. CONCLUSION: Asphericity may be a useful quantitative descriptor of corneal optical contour following PRK. Greater positive central corneal asphericity is found with greater degrees of refractive correction. Further understanding of both the pre- and post-operative corneal contour and the consequent optical effects should aid in a better understanding of the optical outcomes of PRK.

Color↗
PubMedDate not supplied

[Malaria situation in Madagascar].

Malaria remains one of the major public health problems in Madagascar. For malaria, most of the eco-epidemiological facies of the African continent are found on this large island because of its geo-climatic diversity. These include the subequatorial facies on the east coast, the tropical facies on the west coast, the high-altitude tropical facies in the center and the subdesert facies in the south. In the first two facies, the stable type of malaria is encountered, where the major vectors are A. gambia and A. funestus. In the other two facies, the transmission of the disease is highly unstable yet causes deadly epidemics, principally from A. arabiensis. Malaria is even imported to a few inhabited zones situated above 1,500 m in altitude and to the centers of the large cities. The strategies of the fight against malaria consist of the following; early and correct health care of the cases throughout the country, supported by the community; drug prophylaxis for the target group of pregnant women; and eradication of adult insects in the central highlands, supported by an efficient surveillance. The utilization of mosquito bed nets impregnated with insecticide has not yet gone beyond the trial period. However, despite the efforts undertaken and the expenses run through by the national program, the fight against malaria is still far from covering the entire population. The high costs of spraying within the homes, the expanse of the country and the poor accessibility of many regions during the season of transmission, and insufficient sanitary coverage of the rural population in terms of quality and quantity, constitute the principal constraints of the fight. The current reorganization of the health service in Madagascar constitutes a favorable opportunity to establish a new approach for the fight against malaria. This is geared towards the participation of the decentralized health structures and the contribution of the community in the conception and the achievement of their respective strategies for the fight, supported by the central Service of the Fight Against Malaria. This new decentralized approach seems more appropriate to respond to the demands of the specific and selective strategies of the fight, better adapted to the different facies described above, and to render the National Program of the Fight Against Malaria more efficacious.

Climate↗
PubMed1996

Sympathetic stimulation of corneal epithelial proliferation in wounded and nonwounded rat eyes.

PURPOSE: To determine the effect of ocular sympathetic nerves on corneal epithelial proliferation in the rat. METHODS: Osmotic pumps filled with bromodeoxyuridine (BrdU) were implanted subcutaneously in adult rats to label corneal epithelial cells entering the S-phase of the cell cycle during a 24-hour period. Corneas in some animals were wounded with n-heptanol. Several days or weeks before pump implantation, animals were subjected to either unilateral superior cervical ganglionectomy (SCGectomy), unilateral transection of the cervical sympathetic trunk (sympathetic decentralization), bilateral SCGectomy plus unilateral topical norepinephrine administration, or unilateral SCGectomy plus systemic capsaicin administration. Differences in BrdU-labeling indices between experimental and control eyes in each group were determined from cell counts on paraffin sections. RESULTS: Superior cervical ganglionectomy and sympathetic decentralization significantly decreased epithelial proliferation in nonwounded and wounded corneas. Topical applications of norepinephrine to eyes that had been deprived of their sympathetic innervation completely reversed the antiproliferative effect of ocular sympathectomy. Systemic administration of the neurotoxin capsaicin, in conjunction with unilateral SCGectomy, did not alter the proliferative rate; comparison was made to animals that received unilateral SCGectomy only. CONCLUSIONS: Ocular sympathetic nerves stimulate rat corneal epithelial proliferation under normal physiological conditions and during corneal wound healing. The promotion of DNA synthesis by these nerves occurs independently of functional interactions with capsaicin-sensitive, ocular sensory nerves and appears to be related, at least in part, to the release of norepinephrine.

Alcohols↗
PubMed1997

Rigid lens dynamics: lid effects.

PURPOSE: Lid architecture, lid tension, blink action, and blink rate may all influence rigid lens centration and stability. The aims of this study were to assess the nature of the relationship between lid geometry and lens position and to examine the influence of lens-lid interactions on the association between lens position and lens center of gravity and mass. METHODS: Eight subjects (four with high riding lenses and four with low riding lenses) participated in the study. Each subject was fit with 12 lenses-six designs in each of two materials. Lens center of gravity was calculated and lens mass was measured in every case. For each lens, the following four lens dynamics variables were assessed over a five blink cycle for both the vertical and horizontal meridians: 1) initial lens position; 2) settled lens position; 3) amount of lens movement; and 4) rate of lens movement. Lower lid position and palpebral aperture height were measured for each subject. RESULTS: Graphical analysis showed that a low upper lid position and small palpebral aperture promoted superior lens decentration, while a high upper lid position and wide palpebral aperature predisposed an individual to inferior lens decentration. Significant lid-lens overlap was a common finding with high riding lenses in both the initial and settled lens positions. The results also suggested that while a rigid lens tended to become more stable as the lens center of gravity shifted further behind the corneal apex, this gravitational effect was reduced for lenses that interacted with the upper lid. CONCLUSIONS: Lid geometry can influence rigid lens centration and stability by modifying the effects of lens design and lens mass. We recommend that consideration be given to the nature of potential lens-lid interactions prior to lens fitting.

Blinking↗
PubMedDate not supplied

Implementing a unit based quality improvement program: one hospital's experience.

The continuous enhancement of the quality of patient care is the prime directive of a Nursing Quality Improvement Program. A decentralized approach, using a Unit Based Quality Improvement model, was used in one hospital. In this paper, the author examines the process from conceptualization to implementation and evaluation of the decentralized approach.

Hospital Units↗
PubMedDate not supplied

Basic principles of information technology organization in health care institutions.

This paper focuses on the basic principles of information technology (IT) organization within health sciences centers. The paper considers the placement of the leader of the IT effort within the health sciences administrative structure and the organization of the IT unit. A case study of the University of Missouri-Columbia Health Sciences Center demonstrates how a role-based organizational model for IT support can be effective for determining the boundary between centralized and decentralized organizations. The conclusions are that the IT leader needs to be positioned with other institutional leaders who are making strategic decisions, and that the internal IT structure needs to be a role-based hybrid of centralized and decentralized units. The IT leader needs to understand the mission of the organization and actively use change-management techniques.

Health Facility Administration↗
PubMed1997

Misunderstanding and psychic truths.

The author begins by pointing out that the psychoanalytical method and the concept of the unconscious are necessary conditions if the concept of psychic reality is to maintain its psychoanalytical relevance. She emphasises the importance of the concept of Nachträglichkeit, or retroactive assignment of new meaning, as a link between the concepts of psychic reality and historical truths on the one hand and decentred listening and misunderstanding on the other. Recalling the Freudian development of the concept of psychic reality, she stresses that 'the other' is present from the outset in the constitution of the psyche; she discusses the relations between intrasubjectivity and intersubjectivity in the transference and concludes that, through the function of 'listening to listening', misunderstanding becomes the royal path to the discovery of the patient's psychic reality. Some clinical examples are discussed in detail to illustrate the function of decentred listening. The author's viewpoint is not based on criteria concerning a correspondence, or lack of correspondence, between psychic reality and material reality. Her aim is to link psychic reality and historical truths as a way of overcoming solipsism.

Animals↗
PubMed1997

[French screening program of breast cancer. Results from 5 districts (1989-1994)].

Randomized clinical trials have demonstrated that screening by mammography can reduce the breast cancer mortality rate by 30 to 50% in women aged 50 to 69 years. In France, pilot screening programmes were begun in 1989, and a national programme is being implemented since 1994. After 8 years of experience, the present study aims to assess the effectiveness of the French decentralized model of screening. This study presents data obtained by the National Steering Committee from the reports of five district programmes. Efficacy indicators from 1989 to 1994 are presented and compared with European targets. Data are presented by screening round. The prevalent round concerns 260,226 women screened, the subsequent incident rounds concern 119,761 women. Attendance rates at 5 years range from 24.2% to 50.9%. The mean recall rate was 7.8% in the first and 4.5% in the second round 5.4 and 2.7 cancers were detected per 1,000 women screened during the first and second round, respectively. and 30% of invasive cancers were of 10 mm or less and 70% had no nodal involvement. The interval cancer rate was 0.55% one year after screening and 1.05% two years after screening. Results from our decentralized screening system are variable yet satisfactory overall, namely thanks to the progressive implementation of quality assurance. However, attendance rates remain low, whereas actual mammographic coverage is 60% in France. A generalized screening programme can only be foreseen in France if its implementation is very gradual and if the quality of screening is high. The improvement of radiological quality remains the primary objective of the National Steering Committee however this implies training of all personnel. In the long run, organized screening should prevail over spontaneous screening. It is unlikely that we will achieve the target reduction in mortality rate in our country.

Aged↗
PubMed1998

Physiological factors in the circadian rhythm of protein concentration in aqueous humor.

PURPOSE: The authors addressed three questions concerning the circadian rhythm of aqueous humor protein concentration in rabbits. First, is there an endogenous oscillator for this circadian rhythm? Second, does a circadian rhythm occur for individual aqueous humor protein components? Third, what is the role of ocular sympathetic nerves, which are more active in the dark phase, in this circadian rhythm? METHODS: Adult New Zealand albino rabbits were entrained to a daily 12-hour light/12-hour dark cycle. Under a constant dark environment for 24 hours, rabbits were killed at 4-hour intervals, beginning at 2 hours before the onset of the subjective light phase. Eight rabbits were used for each of the six time points. Aqueous humor and vitreous humor were collected, and their protein concentrations were determined. Major aqueous humor protein components were resolved by polyacrylamide gel electrophoresis (PAGE), stained with silver reagent, and analyzed using densitometry. Another group of eight light-dark-entrained rabbits underwent unilateral transection of the cervical sympathetic trunk. Three weeks after the operation; the circadian elevation of intraocular pressure (IOP) at 2 hours into the dark phase was determined for both eyes. Rabbits were later killed at this time point, and total protein concentrations in aqueous humor and vitreous humor were determined in both eyes. Major aqueous humor protein components in both eyes were resolved by PAGE and were compared. RESULTS: In light-dark-entrained rabbits, a circadian rhythm of protein concentration appeared in the aqueous humor under a constant dark environment. Total protein concentration in aqueous humor increased sharply in the early subjective light phase, remained relatively high during the remainder of the subjective light phase, and decreased in the subjective dark phase. Analyses of albumin and other abundant proteins in the aqueous humor showed that all of them varied similarly in a circadian pattern. In contrast, total protein concentration in the vitreous humor remained unchanged. In rabbits with unilaterally decentralized ocular sympathetic nerves, total protein concentrations in the aqueous humor and the vitreous humor in the early dark phase showed no difference between the two eyes. In addition, there was no difference in individual aqueous humor protein concentration between the two eyes. However, the nocturnal IOP elevation in the decentralized eye was less than that in the contralateral, intact eye. CONCLUSIONS: The circadian rhythm of aqueous humor protein concentration in rabbits can continue without an external signal of dark-light change, indicating the existence of an endogenous oscillator. A similar circadian rhythm occurs for various major aqueous humor protein components. The nocturnal increase in ocular sympathetic activities plays a limited role in the circadian rhythm of aqueous humor protein concentration.

Animals↗
PubMed1997

[Complications in excimer laser photorefractive keratectomy].

The complications of photorefractive keratectomy with excimer laser for myopia depend on preoperative myopia and inter-individual variability in wound healing. Loss of best corrected visual acuity is induced by Haze, irregular astigmatism and decentration. Haze is more frequent after treatment of high myopia. Decentration is a severe complication because its treatment is not well defined and is difficult. Corneal ulcerations infectious and non-infectious have been reported. Other complications are described: induced astigmatism, over and under corrections, central islands, halos, loss of corneal sensitivity, abnormal epithelial healing, recurrent epithelial breakdown, sterile corneal infiltrates, elevated intraocular pressure, subretinal hemorrhage.

Corneal Ulcer↗
PubMed1998

[Pseudophacos explant: the causes and the functional results].

We've studied a number of 20 cases of pseudophakic explantation performed in the Eye Center Timişoara between 1991-1997 from 2605 pseudophakic implantations. The interval between implantation and the moment of explantation was between 4 days and 7 years. The causes which indicated pseudophakic explantation were: pseudophakic bullous keratopathy, IOL decentration and dislocation, uveitis, persistent secondary glaucoma. The study refers to the established treatment for avoiding the explantation and also to the functional results obtained after pseudophakic explantation. Most of the explanted artificial lens cases were anterior chamber lens--13, all of them ALCON type, also we've explanted 4 pupillary implants Fedorov type. The visual acuities obtained after explantation were between hand movement perception and 10/10. Before surgery, visual acuity was between light perception and 10/10. The best functional results were obtained in pseudophakic decentration and dislocation cases and the worst in pseudophakic bullous keratopathy, uveitis and secondary glaucoma cases.

Humans↗
PubMed1998

Organization of health care in Croatia: needs and priorities.

AIM: Description and analysis of the present situation of health care system in Croatia, and its characteristics in the transitional process of restructuring. METHODS: A descriptive method was used. The data from the regular statistical publications were used for the analysis. RESULTS: Croatia is faced with problems similar to those in other countries of the Central and Eastern Europe (CEE), such as control of health expenditure, balancing the development of different segments of health care services, stabilization of effectiveness and quality of care, transition from one-party system to pluralistic democracy, introduction of a free market economy, war devastations, etc. On the other hand, the Croatian experience in the development of a decentralized and integrated primary health care, decentralized health insurance system, education of general/family practitioners, and a tradition in the implementation and development of public health measures, have facilitated and contributed positively to the whole process of transition. CONCLUSION: In contrast to the economic difficulties, war devastations, and changing the social system, the Croatian health care system proved its stability and sustainability. The highest priority and needs are now related to coping with unhealthy behavior of the population, such as smoking, accidents, physical inactivity, and nutritional problems, which should be solved and controlled by the implementation of preventive programs, organization and management of public health services, and further focusing onto the integrated type of primary health care in the organization of services. Hospital services need more intensive and skilled management, as well as support measures for better quality of work.

Croatia↗