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Implications of technology in music therapy practice and research for music therapy education: a review of literature.

This article reviews the use of technology in music therapy practice and research for the purpose of providing music therapy educators and clinicians with specific and accurate accounts of the types and benefits of technology being used in various settings. Additionally, this knowledge will help universities comply with National Association of Schools of Music requirements and help to standardize the education and training of music therapists in this rapidly changing area. Information was gathered through a literature review of music therapy and related professional journals and a wide variety of books and personal communications. More data were gathered in a survey requesting information on current use of technology in education and practice. This solicitation was sent to all American Music Therapy Association approved universities and clinical training directors. Technology applications in music therapy are organized according to the following categories: (a) adapted musical instruments, (b) recording technology, (c) electric/electronic musical instruments, (d) computer applications, (e) medical technology, (f) assistive technology for the disabled, and (g) technology-based music/sound healing practices. The literature reviewed covers 177 books and articles from a span of almost 40 years. Recommendations are made for incorporating technology into music therapy course work and for review and revision of AMTA competencies. The need for an all-encompassing clinical survey of the use of technology in current music therapy practice is also identified.

Evidence-Based Medicine↗

[Historical sketch of modern pharmaceutical science and technology (Part 4). Post World War II 50 years].

A short history of the pharmaceutical science and technology, postwar 50 years is divided into nine sections for the purpose of discussion. 1. Japan's postwar rehabilitation, Japanese pharmaceutical industries and newly developed pharmaceutical sciences and technologies. In 1945, the Japanese pharmaceutical industry was reconstructed. Production of penicillin was carried out with the strong support of the U.S. Occupation Forces. New sciences in pharmacy (biochemistry, biopharmacy, pharmacology, microbiology, physical chemistry, etc.) were introduced in this period. 2. Introduction age of foreign new drugs and technology (1951 to 1960s). Japan gained independence in 1951. Japanese pharmaceutical companies imported many new drugs and new pharmaceutical technologies from the U.S.A. and European countries in this period. Then, these companies were reconstruction rapidly. However, consequently Japanese pharmaceutical companies were formed as an imitation industry. 3. Rapid economic growth period for pharmaceutical companies (1956 to 1970s). In this period, many Japanese pharmaceutical companies grew rapidly at an annual rate of 15-20% over a period of 15 years, especially with regard to the production of active vitamin B1 analog drugs and some OTC (public health drugs). Some major companies made large profits, which were used to construct research facilities. 4. Problems for the harmful effects of medicines and its ethical responsibility. In the 1970s, many public toxic and harmful effects of medicines were caused, especially SMON's disease. In this time, many pharmaceutical companies changed to its security got development of ethical drugs. 5. Self development of new drugs and administration of pharmaceutical rules (1970s). During the 1970s, many pharmaceutical laws (GLP, GCP, GMP, GPMSP etc.) were enacted by the Ministry of Health and Welfare. In 1976, the Japanese Pharmaceutical Affairs Law was revised, which set forth standards regarding the efficacy and safety of ethical drugs and re-evaluation of drugs. Many facilities were built for the purpose of ensuring efficacy and safety, as shwon in Table 1. 6. Problems of Intellectual Property and followed the revisionist line of research and development for new ethical drugs. In 1976, Japanese pharmaceutical companies ceased to be an imitation industry, and increased research for the development of new drugs. 7. Pharmaceutical science and technology innovation (After 1985). Many of the pharmaceutical innovations during this period were as follows: 7.1) Technology innovation for evaluation of drug efficacy; 7.2) 1st to 3rd medical diagnostic technology innovations; 7.3) medical analytical methods and spectrometry technologies; 7.4) Computer-aided drug-design technology and drug information technology innovation; and 7.5) Drug delivery system and treatment drugs. 8. Recent research and development of new ethical drugs in Japan (1970 to 1995). Cephalosporine type beta-lactams (cefazolin, cefametazole, furomoxef, cefdinir), new quinolones (norfloxcin, ofloxacin, tosfloxcin), H1-Blockers (famotidine), Ca-antagonists (diltiazem, nicardipine), and other new drugs (pravastatine, taclolimus, leuprine) etc. came onto the market. 9. International Harmonization Age and Review toward 21 century. The rapid development and globalization of the pharmaceutical market has promoted international harmonization and rationalization of pharmaceutical regulatory affairs. In 1990, the Japan Pharmaceutical Manufacturers Association published a report toward 21 century, which described practical plans.

Biotechnology↗

[Flat-panel detector technology -State-of-the-art and future prospects-].

A flat-panel detector (FPD) is a long-awaited technology to implement the digital X-ray imaging technology into the radiological department. This paper describes the state-of-the-art technology and future prospects on the FPD technology. State-of-the-art technology was reviewed taking the CXDI series as an example. Several FPD-based systems have been introduced into the Japanese market since CXDI-11 opened it in November 1998. Accompanying CXDI-C2 for control, CXDI-22 for table position and CXDI-31 for portable, the CXDI series fulfills the requirement of the radiography room being a fully digitalized room. The FPD on the CXDI series is comprised of a scintillator (Gd(2)O(2)S:Tb(3+)) as a primary sensor in which the X-ray is captured and an amorphous silicon detector (LANMIT) as a secondary sensor in which the fluorescent light is detected. Since the scintillator is identical to that of the screen-film systems, it can be said as proven, durable and chemically stable and it is expected to produce the same image quality as the screen-film systems. CXDI-31, a portable FPD-based system, was developed targeting thinner dimensions, lightweight, durability and high spatial resolution. Thoroughly re-designing the mechanical structure and reducing the power consumption at the readout IC realized thinner dimensions. Introducing the portable note PC technologies successfully combined lightweight with durability. Improving the sensor process and re-designing the layout made the sensor high resolution without compromising the signal-to-noise ratio. Future prospects were overviewed in the aspect of technology and applications. Sensitivity, spatial resolution, frame rate and portability were described as the upcoming technology. Increasing gain and reducing noise will realize higher sensitivity, especially by adopting the PbI(2), HgI(2) or such photoconductor materials as the primary sensor. Pixelized amplifier will also achieve higher sensitivity. Layered sensor designed such that TFT layer and sensitive layer are constructed separately will decrease the pixel pitch lower than 100 microm. The FPD has been applied in radiography, mammography and angiography. It will expand the applications into low-dose fluoroscopy to replace the X-ray image intensifiers and into cone-beam computer tomography. What the FPD brought was mainly the efficient workflow of the X-ray technologist. However, diagnosis efficiency and patient benefit must be improved further more by combining FPD technology into computer-aided diagnosis, tele-radiography or other IT-based technologies. Such prospect may come true in the near future.

Fluoroscopy↗

Situated, strategic, and AI-Enhanced technology introduction to healthcare.

We work hard on creating AI-wings for physicians to let them fly higher and faster in diagnosing patients--a task that physicians do not want to automate. What we do not work hard on is determining the ENVIRONMENT in which physicians' AI wings are supposed to function. It seems to be a job for social/business analysts that have their own separate kingdom. For the sake of all of us (potential patients!) social/business consultants and their methodologies should not be treated as a separate kingdom. The most urgent task is to achieve synergy between (1) AI/Fuzzy/Neural research, (2) Applied medical AI, (3) Social/Business research on medical institutions. We need this synergy in order to assure humanistic medical technology; technology flexible and sensitive enough to facilitate healthcare work while leaving space for human pride and creativity. In order to achieve humanistic technology, designers should consider the impact of technological breakthroughs on the organizations in which this technology will function and the nature of work of humans destined to use this technology. Situated (different for each organization), Strategic (based on an in-depth knowledge of Healthcare business), and AI-Enhanced (ended with a dynamic model) method for introducing technology to Healthcare allows identifying areas where technology can make medical work easier. Using this method before automating human work will get us closer to the ideal where there is no discontinuity between design and use of programs; where the technology matches users' needs perfectly--the world with humanistic technology and healthcare workers with AI-wings.

Artificial Intelligence↗

Big ticket health technology: is rational utilization possible?

Medical technologies that have high initial and operating costs are commonly labeled 'Big Ticket Technologies'. However, technologies with lower initial and operating costs, but which are utilized extensively in patient care, should be considered Big Ticket as well. Some of these technologies are product innovations, because they represent a new product or service. Others are process innovations because they provide an alternative way of delivering health care. Radiology and radiation oncology offer many examples of Big Ticket technologies in medicine, including CT scanners, MRI units and linear accelerators. Other examples include extracorporeal shock wave lithotripsy and resuscitation and intensive care technologies. Differences in the availability of these technologies in various countries reflects financial incentives and disincentives at work in the countries, expectation levels for health care in the countries, and the degree to which the diffusion and use of medical technologies are regulated. Evidence of the cost-effectiveness of medical technologies, and the impact of their use on health outcomes, is rapidly being added as an additional criterion for evaluation of the usefulness of medical technologies in health care.

Cost-Benefit Analysis↗

Use of the Internet in scanning the horizon for new and emerging health technologies: a survey of agencies involved in horizon scanning.

BACKGROUND: A number of countries worldwide have structured horizon scanning systems which provide timely information on the impact of new health technologies to decision makers in health care. In general, the agencies that are responsible for horizon scanning have limited resources in terms of budget and staff. In contrast, the number of new and emerging health technologies, i.e. pharmaceuticals, medical devices, and medical and surgical procedures, is growing rapidly. This requires the Horizon Scanning Systems (HSSs) to devise efficient procedures for identification of new health technologies. The role of the Internet for this purpose has as yet not been documented. OBJECTIVE: To describe and analyse how the Internet is used by horizon scanning systems to systematically identify new health technologies. METHODS: A questionnaire was developed and distributed among 10 agencies known to work within this specific area. The questionnaire specifically focussed on type of sites scanned, frequency of scanning, and importance of a site for the identification of a new health technology. RESULTS: A 100% response rate was obtained. Seven out of 10 agencies used the Internet to systematically identify new health technologies, of which 6 provided complete information. A total of 110 web sites were scanned by these 6 agencies. The number of sites scanned per agency ranged from 11 to 27. Most sites were scanned weekly (41%) or monthly (33%). Thirty-one percent (31%) of the total number of sites was considered as highly important. The agencies spent at least 2 hours a week and at most 8 hours per week scanning the Internet. Although each agency's remit differed somewhat in scope, on average the same types of sites were scanned. These include sites from regulatory agencies, sites with information on new drugs or new devices, and sites with news from newswires. However, within these types there was not much correlation between the individual sites that agencies judged important to scan. CONCLUSION: The use of the Internet for identifying new health technologies is increasing in the majority of horizon scanning systems around the world. At the same time there is considerable variation between individual agencies in their approach to this source of information. This can only be partially explained by differences in scope of scanning activities of the individual agencies. A coordinated effort to develop Internet search strategies for either different categories of health technologies or different clinical specialties may improve efficiency and quality of scanning in terms of the number of potentially relevant technologies identified.

Biomedical Technology↗

Assessing the social impacts of medical technologies.

The introduction of a new medical technology can have indirect, unintended, or unanticipated effects on individuals or on social systems. Although these impacts result from the widespread use of the technology, many of them can be predicted while the technology is being developed. A method for systematically identifying and evaluating these impacts is technology assessment. Such an assessment, made while a technology is being developed, could provide useful information for decision making about research and development and in planning for the technology's eventual introduction. Because only a few medical technologies have been formally assessed and because the process of medical technology development is porrly understood, one must be cautious in recommending widespread use of technology assessment. Nevertheless, enough is now known to permit the formulation of approaches that could be used in preliminary attempts at medical technology assessment.

Costs and Cost Analysis↗

Non-invasive glucose monitoring: assessment of technologies and devices according to quantitative criteria.

Aim of this review was to describe the main technologies for non-invasive glucose monitoring and the corresponding most relevant devices. The review tries to overcome the limitations of previous reviews on this topic, such as the lack of objective criteria for inclusion or exclusion of technologies or devices, and the poor organization of the information, which often does not allow easy comparison between technologies and devices. In this review, the information is concise and organized into specific categories, and hence it becomes easy to compare advantages and disadvantages of the different technologies and devices. For technologies, the categories of information considered are the technology name, the underlying physical principle, the technology limitations and the measurement sites on the human body. For devices, the categories of information are the device name, its approval condition (FDA Approval and/or CE Mark), the technology on which it is based, a device general description, the tests performed on the device, the corresponding results, safety information, aspects affecting usability, current status of the device and the manufacturer, an Internet reference for the device. A total of 14 technologies and 16 devices are included. Conclusions of the review were that, despite some interesting and promising technologies and devices, a satisfactory solution to the non-invasive glucose monitoring problem still requires further efforts.

Adult↗

Identification of glaucoma-related visual field abnormality with the screening protocol of frequency doubling technology.

PURPOSE: To evaluate the predictive power of frequency doubling technology to distinguish glaucoma suspects from persons with glaucoma visual field loss. METHODS: A consecutive series of 76 subjects referred to a glaucoma service underwent perimetry in one eye with frequency doubling technology in a screening mode and Humphrey 24-2 threshold testing in random order, and had optic disk and clinical nerve fiber layer grading. RESULTS: All subjects performed perimetry with both instruments satisfactorily, with an average test time of 1.8 +/- 0.7 minutes per eye for the frequency doubling technology (instrument time). Of 33 eyes classified as abnormal by glaucoma hemifield test, 91% (30/33) were abnormal on frequency doubling technology (two or more abnormal locations of 17), whereas 94% (31/33) of glaucoma suspects with normal Humphrey fields had normal results with frequency doubling technology. Frequency doubling technology results were highly correlated with Humphrey mean deviation by linear regression (r2 = .74, P = .047) and with corrected pattern standard deviation probability value. A frequency doubling technology error score for each quadrant of the field was highly correlated with the number of severely abnormal points per quadrant in Humphrey threshold tests (r2 = .63, P = .034). There was close agreement between clinical examination of the optic disk and nerve fiber layer and frequency doubling technology results. Three-level quantification of abnormality in frequency doubling technology results did not add to diagnostic accuracy. CONCLUSION: Frequency doubling technology testing shows promise as a screening method in glaucoma.

Aged↗

Impact of emerging technologies on medication errors and adverse drug events.

Published evidence on the effects of computerized physician order entry (CPOE), automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs) on medication errors and adverse drug events (ADEs) were reviewed. Emerging technologies have been recommended as potential mechanisms for reducing medication errors. Critical evaluations of the impact of these new technologies on medication errors and other adverse outcomes are lacking. PubMed was searched to identify all peer-reviewed publications linking four technologies (CPOE, ADMs, bar coding, and CMARs) with reductions in medication errors and ADEs and secondary endpoints. All controlled studies that assessed the impact of the technologies were evaluated. The appropriateness of the use of these technologies was also examined. Few studies were identified that evaluated the technologies' impact on these endpoints. Of the evaluated technologies, CPOE was the most studied; however, investigations were limited to selected medical centers. The appropriateness of use of the technologies was evaluated even more infrequently. A literature review revealed a paucity of controlled, generalizable studies confirming the benefits of technologies intended to reduce medication errors and ADEs. Very little evidence on the appropriateness of the use of these technologies was found.

Drug Therapy, Computer-Assisted↗

The physician's role in a world of technology.

Technology has come to dominate the medical world over the past 100 years. Some of this technology has come from science and some has been imported from the world of business. Some technology exists in the form of physical objects; other technology takes the form of systems and organization. Technology to manage information has played a particularly critical role in changing how medicine is practiced. Those who choose to apply the latest technologies to patient care do so in ways that are not merely a reflection of some "objective" set of scientific data. Rather, the use of technology transforms both the clinical encounter and the technology itself, and in so doing reflects the values of those who created and those who use the technology. Despite the many ways that technology has come to be used for medical care over the course of the past century, the role of the physician has remained central.

Forecasting↗

Risk perception and technological development at a societal level.

This article tests the hypothesis that the exposure to the threat to societies posed by the introduction of new technologies is associated with a normalization of risk perception. Data collected in 2000 by the International Social Survey Programme (ISSP) on environmental issues were used to explore this hypothesis. Representative samples from 25 countries were employed to assess the national levels of perceived threat to the environment associated with a series of technologies and activities. These values were correlated with economic indicators (mainly from the World Bank) of the diffusion of each of the technologies or activities in each country. Results indicate a negative association of risk perception with the level of technological prevalence (societal normalization effect) and a positive association with the rate of growth of the technology (societal sensitivity effect). These results indicate that the most acute levels of perceived environmental risk are found in those countries where the level of technological prevalence is low but where there has recently been substantial technological development. Environmental awareness is a mediator of the relationship between risk perception and the indices of technological diffusion. This result means that: (1) societal normalization of risk is not a direct consequence of prevalence of the technology, but is driven by awareness of technological development and that (2) societal sensitivity to risk is associated with lower levels of environmental awareness.

Journal Article↗

Young children with respiratory problems and assistive technology needs: a nursing care perspective.

An examination was conducted of the technology needs of 33 children with respiratory problems ages 0-5 years as part of a larger survey of persons with disabilities. Unmet technology needs were reported for these children in all areas of life functioning. Children's needs for assistive technology exceeded their usage of equipment and devices in two thirds of the identified areas of functioning. Technology needs were critical particularly in the areas of taking care of the home; using a telephone; using a computer; talking with others; and use of specialized cars, vans, and buses. It was reported for most children that evaluations preceded the provision of assistive technology, and that families were satisfied with technology services received. More than three fourths of the families reported not having had the opportunity to purchase technology on a credit plan, with two thirds of the families showing that such an option would have been helpful to them. Also, more than one half of the children could not try their technology before it was purchased. A need for more information about assistive technology and services was reported for more than one half of these children. Lack of transportation services were reported for most children, with families of almost two thirds of the children indicating travel exceeding 50 miles to receive technology and services. Implications for nurses involved in comprehensive service delivery to these children are discussed.

Arkansas↗

Perspectives on speech recognition technology.

Speech recognition technology is used in all sorts of applications. However, for radiology, the issues are more complex than merely being able to dial a contact from an address book. In addition, radiologists have been hesitant to embrace the technology, with some preferring the status quo. Speech recognition technology has dramatically improved over the past several years, and they generally have been broadly commercialized. However, the use of speech recognition for composition of text reports or email has had only limited acceptance. The overriding reasons appear to be that most computer users prefer not to talk to their computers. They have learned to compose text documents via a "type-and-organize" methodology rather than composing the document "in their heads" and dictating. Radiologists are still required to dictate their reports, whether it is digitally, into an analog tape recording device or via a speech recognition system. The benefits extend to the radiologist's patients, and to the radiologist's employers--the hospitals or imaging centers--but it could be said that there is little direct benefit for the radiologist There is a belief that systems should focus more on improving radiologist efficiency rather than emphasizing cost savings and turnaround time. Integration with existing systems is critical. But any technology, in order for it to be well accepted by the primary user, needs to benefit that user. Before selecting any speech recognition technology a radiology administrator should do some research and find answers to several questions that address the basics of speech recognition technology and the companies that provide this technology. In addition, the radiology administrator must ensure that the facility is prepared to implement the technology and address any workflow- or culture-related issues that may arise. There are a number of opportunities for improvement in speech recognition radiology applications. These include the ongoing need for improvement recognition rates, the need to streamline integration with picture archiving and communication system (PACS) and radiology information system (RIS) technologies, and the general need to improve the user interface. In addition to these improvements, one can expect an increased adoption of structured reporting technologies within radiology. These techniques allow easier automated extraction of content and more flexible communication and organization of data (such as communication to electronic medical record systems).

Diffusion of Innovation↗

[Is gene technology immoral?].

Since it came into being in the USA in the early 1970s, gene technology has always been fundamentally controversial, especially in the German-speaking countries. The optimistic--or critical--supporters of gene technology are convinced that, in view of gene technology's not otherwise attainable advantages for human and animal health, for food production and other important aims, it would be ethically unacceptable to restrict to the minimum or even ban it. On the other hand, the radical critics are convinced that gene technology, in view of its anthropologically false starting-point, the questionable interests behind it, and above all its unforeseeable, serious negative implications for mankind and environment, is unacceptable on ethical grounds. Critical reflexion on these polarized arguments must start from the question why precisely gene technology is so controversial, and what are the criteria for ethical assessment. These reflexions presuppose that the prior judgement of gene technology as a technology in the ideological field is rooted in life attitudes, history and nature in general, and this is true not only of gene technology's opponents but also its supporters. It is thus a question of one ideology vs. another. Chief importance here attaches to the mankind-nature relationship and the need to take seriously the fundamental ambivalence of all (!) human action with unforeseeable consequences. The conclusion is that neither to demonize nor to glorify gene technology, as a matter of principle, does justice to its wide and varied positive or negative potential. The ethical assessment of gene technology must be differentiated according to the aims and possible implications.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗

High cost technology in health care: a benefit or a burden?

The influence of high cost technology goes beyond its consequences for the selected patient groups that benefit from its application. Past and future technological developments have a variety of social, economic and ethical implications which have to be taken into account when balancing its costs and benefits to society. Departing from an economic perspective we describe a number of mechanisms underlying the emergence of high cost technology which help us to understand some of the characteristics of high cost technology, such as its focus on quality enhancement rather than on economy. To assess the actual performance of high cost technology in terms of efficiency and equity is difficult as there may be debate about the perspective guiding such assessment and as there still is scarce information on high cost technology in terms of these economic indicators. The increasing technological opportunities have triggered a wider debate on the desired evolution of our health care systems. In some countries there is a tendency to diminish government involvement in health care and emphasize private (for profit) enterprise as a reaction to not being able to finance all new high cost technology. The risks of such strategies are discussed briefly. We conclude that the main actors in health care should adjust their behaviour in order to accomplish the introduction of more cost-effective technologies and to achieve a more socially efficient distribution of their benefits.

Biomedical Research↗

The impact of the UK NHS purchaser-provider split on the 'rational' introduction of new medical technologies.

This article uses evidence from case studies of the introduction of three new medical technologies to explore the impact of the UK NHS purchaser--provider split on the diffusion of new medical technologies. A desirable policy objective is assumed to be the 'rational' diffusion of medical technologies according to evidence that they are clinically and cost effective. Theoretical mechanisms are identified through which diffusion could be controlled, and the case studies are used to explore the extent to which rational technology diffusion occurs in practice in the NHS. They illustrate the influence of purchasers and providers on the introduction and early use of new technologies and explore the extent to which research about clinical and cost effectiveness is used to inform decisions about technology adoption. The results demonstrate the limited influence of purchasers and the short term clinical and organisational objectives pursued by providers in relation to technology adoption. It is suggested that initiatives to promote rational technology diffusion might be most effective if they are focused on decision making in providers, and if they aim to balance the influence on decisions of administrative and financial information about the technologies with more systematic use of research about clinical and cost effectiveness.

Cost-Benefit Analysis↗

Coalition building and public opinion. New reproductive technologies and Canadian civil society.

The process of technology assessment is evolving. The process of policy development for technology is the least understood in the cycle of technology assessment. The process of policy development, which should involve extensive consultation and a broad-based research and evaluation program, is often fraught with difficulties and can cause further analysis or the assessment process to come grinding to a halt. This article reviews some social, political, and ethical issues and the role of civil society in influencing the technology assessment process for new reproductive technologies in Canada. It is written from the perspective of one of the Deputy Directors of Research and Evaluation for the Royal Commission on New Reproductive Technologies and highlights the strengths and difficulties of technology assessment when civil society and technology assessment come face to face. A brief update by a policy analyst in Health Canada on the current situation of legislation on new reproductive technologies has been provided and is included at the end of this article.

Advisory Committees↗