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PubMedDate not supplied

[Effect of optic aberrations, caused by ablation pattern decentration after laser vision correction, on visual acuity].

The aim of this work was to study the effects of subclinical ablation pattern decentration on the quality of vision after photorefractive laser surgery. Optical high order spherical and coma-like aberrations of 30 eyes were evaluated before, 1 and 3 months after photorefractive surgery (PRK and LASIK). Relationship between the size and shape of the light spot on the retina during transmission of paraxial beams through the eye and the ablation zone decentrations was estimated. The results are presented for pupil diameters of 1 and 6 mm both at the center of the retina along the optical axis and at a distance of 0.5 mm from the center. Decentration of ablation zone by less than 1 mm makes the principal contribution to induction of higher order aberrations. The relative increase factor is 3.9 and 5.1 for the coma-like and spherical aberrations, respectively. At such decentrations spatial resolution of the eye decreases as the pupil size increases, which is most pronounced even at a slight distance from the visual axis but inside the fovea.

Corneal Injuries↗

PubMed2002

Decentralizing tuberculosis treatment: follow-up of patients during the transitional period.

SETTING: Vientiane municipality, Laos. OBJECTIVE: To describe and evaluate the implementation of standardized registration and reporting procedures within the municipality in a period of decentralization. The purpose of the standardization was to obtain complete and reliable information on case-finding and treatment results. DESIGN: Evaluation by review of quarterly reports on case-finding and treatment results, and comparison of information from the records of individual patients on site with the records of the supervisors. RESULTS: Case-finding increased in 1994-1998. Treatment success improved from 26.8% (95% CI 21.5-44.0) to 74.6% (95% CI 69.9-79.3). Given an option for autoadministered long-course treatment versus directly observed short-course treatment, 97% of the patients registered in 1998 received the latter. Following decentralization, evaluation of results of treatment was incomplete due to a high ratio of 'transfer out' patients (16.4%, 95% CI 11.5-21.3). After intervention this proportion was reduced to 2.3% (95 %CI 0.7-3.9). In 1998, approximately 40% of smear-positive patients diagnosed at the National Tuberculosis Center and residing in the districts evaluated were 'transferred' or 'referred' to the districts. All but three of the 68 patients presented at the district hospitals, mostly without delay. Registration and reporting was reasonably accurate. At the end of the period evaluated, decentralization was only partial and problems in case-holding were still evident. CONCLUSIONS: When decentralizing services it is important to establish procedures for management of information flow in order to allow the activities to be evaluated and problems amenable for correction to

Antitubercular Agents↗

PubMed1976

Pharmacy personnel activities and costs in decentralized and centralized unit dose drug distribution systems.

Pharmacy personnel activities and labor costs directly associated with concurrent decentralized and centralized unit dose drug distribution systems in the same institution were compared. A work-sampling observation technique was used for the activity survey. Analysis of the data showed that: (1) the activities of pharmacy personnel vary significantly between the decentralized and centralized systems, (2) pharmacists in the decentralized area spent a significantly greater portion of their productive time performing therapy-related activities than did those pharmacists in the centralized system, (3) multiple staffing patterns associated with the centralized unit dose system afforded a significantly greater participation in educational activities by all pharmacy personnel staffing that area, (4) dispensing activities accounted for most nonpharmacist personnel time in both systems, and (5) based on cost/unit dose and existing staffing patterns, there was no appreciable difference in personnel labor costs associated with the two systems. However, it was determined that a considerable cost difference could be expected if the decentralized system's hours of service were equivalent to those associated with the centralized system.

Communication↗

PubMed1992

[Decentralization of the health sector in Mexico. Scope and limitations of local health systems].

This paper is a product of the reflection on the decentralization and sectorization experiences in Mexico since 1917 with particular emphasis on the 1980s. The historical analysis included the creation of an analytical model designed to identify the relationship between the distinct sanitary policies implemented in Mexico and the tendencies towards decentralization and integration. This analysis is combined with a critical review of the recent decentralization experiences undertaken in the states of Guerrero, Oaxaca and Nuevo León. While comparing Guerrero and Oaxaca, restitution and deconcentration under similar socio-economic conditions were discussed. The comparison between Guerrero and Nuevo Leon allowed the discussion of the benefits and limits of restitution under different socio-economic conditions. In addition, with this model the author discusses a few generalizations regarding the possible future of decentralization.

Catchment Area, Health↗

PubMed2005

The role of membrane technology in sustainable decentralized wastewater systems.

Decentralized wastewater treatment has the potential to provide sanitation that meets criteria for sustainable urban water management in a manner that is less resource intensive and more cost effective than centralized approaches. It can facilitate water reuse and nutrient recovery and can potentially reduce the ecological risks of wastewater system failure and the community health risk in a wastewater reuse scheme. This paper examines the potential role of membrane technology in sustainable decentralized sanitation. It is argued that the combination of membrane technology within decentralized systems can satisfy many of the criteria for sustainable urban water management. In particular, the role of membranes as a dependable barrier in the wastewater treatment process can increase system reliability as well as lowering the latent risks due to wastewater reuse. The modular nature of membranes will allow plant size to range from single dwellings, through clusters to suburb size. It is concluded that realization of the potential for membrane-based technologies in decentralized wastewater treatment will require some progress both technically and institutionally. The areas where advances are necessary are outlined.

Conservation of Natural Resources↗

PubMedDate not supplied

[Interpersonal decentration in studies of schizophrenia].

The aim of the work was to establish the difference in the ability to interpersonal decentration between subjects suffering from schizophrenia and mentally healthy controls. The studies performed were also the basis for creation the hypothetical pattern of the deficit in interpersonal decentration which characterizes the behaviour of schizophrenics. Mentally ill patients presented lower level of decentric abilities in comparison with healthy controls. Presented empiric results showed that the specificity of interpersonal decentration (which was understood as an ability to, and actually realized behaviour) was based on extremely subjective outlook of reality which causes the elongation of psychological distance between patient and his/her social environment.

Communication↗

PubMed1988

Brief review of the literature on decentralized drug distribution in hospitals.

Literature pertaining to decentralization of drug distribution in hospitals since 1972 is reviewed. A chronological list of the articles cited, as well as information on the type of decentralization and outcomes in each article, was compiled. Advantages of decentralization reported in the literature include allowance for expansion of clinical services, more-efficient medication handling, improved communication between pharmacists and medical and nursing staff, decreased floor stock, and decreased medication-related nursing time. Some studies reported that the system minimally increased costs. Although the literature reviewed confirms that decentralization improves the quality of pharmaceutical services, more evidence of cost-effectiveness is needed.

Medication Systems, Hospital↗

PubMed1988

Nurses' attitudes toward pharmaceutical services before and after decentralization.

Nurses' attitudes toward the quality of pharmaceutical services were assessed before and after the implementation of decentralized pharmaceutical services at a tertiary-care teaching hospital complex. The same multiple-choice questionnaire was distributed to nurses at the University of Michigan Hospitals 18 months before decentralized services were implemented (November 1982) and again after two satellite pharmacies had been established and a clinical pharmacist had begun providing first-dose dispensing services using a movable medication cart (March 1985). The questionnaire measured nurses' satisfaction with aspects of pharmaceutical services most likely to be affected by decentralization of services (e.g., number of missing medications, accessibility of pharmacists). Nurses' overall satisfaction with pharmaceutical services increased only slightly after services were decentralized. Significant positive changes in nurses' satisfaction occurred in areas served by the satellite pharmacies and the clinical pharmacist; no significant change s in satisfaction occurred in the other areas. Nurses' perceptions of increased helpfulness of pharmacy personnel were a better predictor of increased satisfaction than were changes in the number of missing medications, waiting time for medication delivery, or number of incorrectly dispensed medications. Respondents remained anonymous; therefore, changes in personnel, rather than changed opinions of nurses, may account for the differences in responses between 1982 and 1985. Nurses' attitudes toward pharmaceutical services improved in areas of the hospital served by satellite pharmacies or by a clinical pharmacist using a movable medication cart.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1987

Implementation of mobile decentralized pharmaceutical services in a community teaching hospital.

Administrative strategies that were used to justify mobile decentralized pharmaceutical services in a community teaching hospital are discussed. The report describes the problems prompting the pharmacy's review of its centralized unit dose drug distribution and i.v. admixture services, the evaluation of alternative solutions, the proposal submitted to hospital administrators, the implementation process, and an analysis of fiscal impact. A decentralized system using mobile medication carts was considered the best alternative because it integrated distributive and clinical functions and offered efficiencies in drug distribution; anticipated capital expenditure costs and personnel costs were also lower than the costs of alternatives. The conversion to the new system increased the pharmacy personnel budget by $174,455 annually, representing the addition of 13.8 full-time equivalent (FTE) pharmacists and elimination of 10.4 FTE technicians and interns. The increased personnel budget was offset in fiscal year (FY) 1982-83 by documented savings of $47,000 from pharmacists' clinical activities and by calculated savings of $132,400 in nursing time. Excluding capital expenditures of $19,800 for the medication carts, implementing mobile decentralized services saved the hospital $4945 in FY 1982-83. Mobile decentralized services is a cost-effective approach for providing integrated drug distribution and clinical pharmacy services.

Costs and Cost Analysis↗

PubMed1986

Decentralization of pharmaceutical services in a large hospital complex.

The decentralization of pharmaceutical services to two patient-care areas remote from the central pharmacy in a large hospital complex is described. The addition of a fifth building to a large hospital complex led to problems with drug distribution and interprofessional communication, since the pharmacy that provided services to the 120 beds in the new building was located in a building some distance away. Decentralization of pharmaceutical services to a 24-bed surgical intensive-care unit and a 48-bed surgical patient-care unit in the new building was accomplished through a satellite pharmacy located on the intensive-care unit with support from a mobile medication cart located on the surgical unit. The satellite is staffed from 0700 to 2200 each day by one pharmacist and one technician per eight-hour shift. Evaluations of medication turnaround time, number of interactions with nurses and physicians, efficiency of the drug distribution system, quantity of floor stock maintained on the units, and productivity performed before and after the implementation of decentralized services indicated improvements in all areas. A survey of the nursing staff indicated that nurses were very satisfied with the improvements in pharmaceutical services. The implementation of decentralized pharmaceutical services in two patient-care areas remote from the central pharmacy was successful in improving services to these areas.

Centralized Hospital Services↗

PubMed1981

Delivery time in a decentralized pharmacy system without satellites.

The time required for pharmacy to deliver medications to the nursing unit under centralized and decentralized unit dose drug distribution (without satellites) systems was compared. Routing slips were attached to physicians' drug orders generated at a surgical nursing unit. Under the centralized system, the ward clerk sent the order to the pharmacy via pneumatic tube; the pharmacist received the order, transcribed it, and prepared the medication; and supportive personnel delivered the drug to the nursing station. The time required to perform each step was recorded on the routing slip for a five-week period. Under the decentralized system, the ward clerk placed the physicians' orders in the pharmacy box on the nursing unit. The pharmacist picked up the orders, filled them from a decentralized master medication cart, and placed the drug in the nurses' medication cart. Time required to complete the medication process was significantly less under the decentralized system than under the centralized system (54.15 +/- 42.82 versus 83.80 +/- 48.16; p less than 0.05).

Humans↗

PubMed1994

Fiscal decentralization of public mental health care and the Robert Wood Johnson Foundation program on chronic mental illness.

Organizational change for local mental health systems has been advanced as an important aspect of improving the performance of public mental health systems. Fiscal decentralization is a central element of many proposals for organizational change. We employ data from the states of Ohio and Texas to examine some of the consequences of fiscal decentralization of public mental health care. The data analysis shows that local mental health systems respond to financial incentives, even when they are modest; that fiscal decentralization leads to increased fiscal effort by localities; and that decentralization also results in greater inequality in service between poorer and wealthier localities.

Chronic Disease↗

PubMed2005

The Danish health care system: evolution--not revolution--in a decentralized system.

The Danish health care system has undergone gradual changes, but not radical reforms, from 1970 until 2004. Theoretically, the development can be viewed from the perspective of fiscal federalism, decentralization, and incentives embodied in reimbursement systems. Furthermore, path dependence and incrementalism have characterized the system. The Danish health care system is decentralized politically, financially, and operationally. The counties are responsible for health care, and finance it out of county income and property taxes along with block grants from the state. Hospitals are publicly owned while general practitioners are private entrepreneurs working on contract with the counties. Hospital services and GP and specialist services are free, while there are co-payments for drugs, adult dental care, physiotherapy and the like. Co-payments make up close to 19% of total health expenditures. The system has been characterized by expenditure control, reasonable positive development in productivity, and a high degree of patient and citizen satisfaction despite waiting lists. Free choice of hospital was introduced more than 10 years ago. It has recently been expanded so that after waiting 2 months for treatments like elective surgery at public hospitals, citizens can choose either private hospitals or go abroad with full payment from public funds. The thinking behind decentralization gradually has been eroded for a number of reasons. This has led to a reform that will be effective as of January 2007. The number of counties will be reduced, but the new regions retain responsibility for health care. A national earmarked health tax will be introduced so that the regions will receive revenues from state block grants and municipal co-payment, for instance an amount per hospitalization.

Denmark↗

PubMedDate not supplied

Decentralization and human resource management in the health sector: a case study (1996-1998) from Nampula province, Mozambique.

Despite political, cultural and geographical diversity, health care reforms implemented in many developing countries share a number of common features regarding management and structural issues. Decentralization of decision-making from the central authority to local and provincial levels is generally regarded in the literature to be an important way of achieving a more equitable distribution of health care and better management practices, aligned with local priorities and needs. However, in the absence of clear guidelines, continuous monitoring and an adequate supply of financial and human resources, decentralization processes are more likely to have a low impact on the process of health care reform and can, to a certain extent, provoke inequalities between regions in the same country. This qualitative study in Nampula province, Mozambique, was conducted to assess the impact of decentralization, through an analysis of the viewpoints of provincial health managers regarding their perceptions of the process, particularly with regard to the management of basic and elementary nurses. Secondary data from Nampula provincial reports and documents from the Mozambican Health Ministry were also reviewed and comparisons made with the experiences of other developing countries.

Health Care Reform↗

PubMedDate not supplied

Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China.

Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended.

China↗

PubMedDate not supplied

Decentralization and health care in the former Yugoslav Republic of Macedonia.

Since its independence in 1991, the Republic of Macedonia became a highly centralized state, with most relevant decisions taken at the central level in Skopje, resembling the highly centralized system, which once characterized Former Yugoslavia. As agreed in the Framework Agreement, which ended six months of internal conflict, the Macedonian Government will decentralize public services delivery, including social protection, health, education, and infrastructure over the course of the next few years. Within health care, it is argued that by placing policy-making authority and operating control closer to the client, decentralization will reduce some of the inequities in service provision and inefficiencies present within the current centrally controlled system. In principle, local voters will have more information on the price and quality of services, thereby increasing competition in the sector and strengthening the private sector. The emphasis on market incentives resulting in greater efficiency and better management of health care institutions is viewed as one of the benefits of privatization. Critics of decentralization and the subsequent privatization of public services fear it may result in an erosion of quality and consistency across regions, leaving some regions, cities, villages and potentially vulnerable groups worse off than others. The paper argues that if the institutional weaknesses in Macedonia have not been addressed, decentralisation could result in further excluding the rural population from health care provision. Similarly, the need for a clear delineation of responsibilities and functions among different levels and institutions is outlined.

Delivery of Health Care↗

PubMedDate not supplied

The impacts of decentralization on health care seeking behaviors in Uganda.

This paper examines the impacts of a public sector decentralization program on health care seeking behaviors in Uganda in the 1990s. Shifting priorities by local governments in Uganda's decentralized health system away from provision of primary health care, in particular the provision of public goods or goods with substantial consumption externalities, and toward provision of private health goods such as curative care are linked to shifts in individual-level care utilization behaviors. This analysis finds that, while the country has been undergoing a multitude of changes in recent years, decentralization appears to have led to increases in the use of curative services with largely private benefits, perhaps at the expense of the use of primary health care services and services with consumption externalities. A longer period of analysis is required to determine the persistence of these effects.

Health Care Reform↗

PubMed1992

Inhibition of neutrophil chemotaxis and activation following decentralization of the superior cervical ganglia.

Recent studies have shown that bilateral decentralization (sympathectomy) of the superior cervical ganglia (SCG) of rats sensitized to the parasite Nippostrongylus brasiliensis attenuated the development of pulmonary inflammation following allergen challenge. Sympathectomy inhibited total leukocyte infiltration into lung lavage fluids, particularly neutrophil infiltration. To define the effects of decentralization of the SCG on neutrophil responses, peripheral blood neutrophils of rats were isolated and tested in in vitro chemotaxis and phagocytosis assays. Neutrophils from rats that were sympathectomized 7 days previously displayed a marked reduction in chemotaxis to N-formyl-methionyl-leucyl-phenylalanine and leukotriene B4 compared to neutrophils from sham-operated or unoperated groups. Although the degree of chemotaxis was greater in blood neutrophils from parasite-infected rats than from uninfected rats, sympathectomy markedly reduced the chemotactic responses of both groups. In addition, neutrophils of sympathectomized rats were unresponsive to lipopolysaccharide-induced metabolic activation as assessed by in vitro phagocytosis and oxidative reduction of nitroblue tetrazolium. Thus, decentralization of the SCG of rats affects the chemotactic responses and functions of neutrophils. Understanding the role of the sympathetic nervous system in modulating the behavior of neutrophils will shed light on the interactions between the nervous and immune systems.

Animals↗