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PubMed1990

Technology and ethics: three scenarios for the 1990s.

The 1990s will be a critical decade for medical technology. An irresistible force (an aging population that requires more medical care) will meet an immovable object (limited resources). Technology will be the centerpiece of debates about the efficiency and efficacy of the health system in the United States, which currently has the best medical technology in the world and the highest medical costs, with much of the cost attributable to technology. Faced with the possibilities of maintaining our current health system, or going to other systems (Medical Break-throughs, Reregulation, or a National Health System), the United States needs a national health policy that cost-effectively raises health levels for all people. Technology can be the strong point of such a system. However, we must plan for and manage technology effectively. If managed care is unsuccessful in holding health inflation to below 10%, more radical solutions to the ethical issues involving the cost and availability of technology become increasingly necessary.

Ethics, Medical↗
PubMed1990

The impact of technology on the quality of health care.

Laser technology, developments in three-dimensional imaging, genetic engineering, and biosynthetic materials, and other technologies can promote quality care if they are used appropriately and correctly, are accessible to physicians and patients, and are shown to lead to successful outcomes. Formal organizational linkages and networks will enable providers to specialize in different technology and equipment yet still assure access for their patients to a full continuum of health care services. Advances in technology should have a significant, positive impact on the quality of care, yet with continued escalations in cost. Technology-based cost increases can be minimized with a renewed focus on early detection of diseases and on preventive strategies, efforts to ensure appropriate and cost-effective use of technology, greater selectivity in the use of "halfway" technologies, and increased incentives for healthy life-styles.

Cost-Benefit Analysis↗
PubMed2002

Basic requirements for the transfer of fermentation technologies to developing countries.

Traditional small-scale fermentation technologies offer considerable potential for stimulating development in the food industry of developing countries in light of their low cost, scalability, minimal energy and infrastructural requirements and the wide consumer acceptance of fermented products in these countries. Efficient transfer and adaptation of these technologies is, however, often limited by inadequate basic scientific knowledge of the processes involved and the lack of appropriate biological inoculants and process controls for these technologies. Basic infrastructures, such as suitably equipped laboratories with consistent working conditions, a constant supply of good quality water and reliable power supplies, are critical elements of a minimal technology base for transfer and adaptation of these technologies. Building the institutional capacity in developing countries to facilitate research and development geared toward a better understanding of the technologies applied in small-scale traditional fermentations is essential, as is the encouragement of governments to formulate supportive national policies, which promote small-scale agro-industrial development. Socioeconomic considerations play a critical role in the successful and sustainable transfer and adoption of technologies and their products in developing countries.

Developing Countries↗
PubMed2003

Consumer concerns and expectations about novel food processing technologies: effects on product liking.

Eighty-eight consumers participated in a blind pre-test in which they rated their baseline preference for chocolate pudding, their liking of three tasted brands of chocolate pudding, and their level of concern for 20 different food processing and preservation technologies. All returned one month later and tasted the same puddings, but this time they were informed that they had been processed by one of several different novel or traditional food processing techniques. Different sub-groups were informed of the name of the process, the name plus a factual description of the process, or the name, the factual description, plus a benefit statement. Ratings of expected liking were obtained before and after viewing the samples, but before tasting them. Finally, subjects tasted and rated the products for actual liking and a sub-group rated their concern levels for the same 20 technologies rated in the pre-test. Pre-test results showed females to have significantly higher concern levels for all technologies. Individuals who had demonstrated a willingness to consume foods processed by one novel technology (irradiation) had lower concern ratings for all technologies. Ratings of concern were negatively correlated with expected liking for products believed to be processed by the technologies. Expected liking ratings were positively influenced by visual exposure to the product and by a safety and benefit statement. Linear regression of the change in product liking as a function of whether products were better or worse than expected supported an assimilation model of the effect of disconfirmed expectations on liking/disliking. Lastly, post-test concern levels for many of the technologies were reduced by participation in the study.

Adolescent↗
PubMedDate not supplied

Transferring behavioral technology across applications.

Application flows naturally from good science, and behavioral toxicology is no exception. Phenomena discovered and procedures developed in behavioral laboratories are being applied on a wide scale in commercial, industrial, and governmental settings. In behavioral toxicology, this transfer of technology has occurred in an ad hoc manner, albeit with a degree of sophistication. The development of technology transfer in other disciplines is instructive. A symposium at the May 2001 meeting of the Behavioral Toxicology Society examined this issue, and some participants provide their contributions here. Henry Pennypacker examines the issue of whether behavioral procedures can meet the demanding standards required to transfer technology to commercial endeavors and concludes that, under some conditions, they can. He notes that the shortage of well-developed and transferred behavioral technologies results from a lack of understanding of the process of technology transfer on the part of behavior analysts. In the field of engineering, the results of basic research are transformed to candidate technologies that meet standardized criteria with respect to three properties: quantification, repetition, and verification. Kent Anger describes the challenging steps in the trail from the laboratory to wide-scale application-steps that are essential for the scaling up of any behavioral technique. Finally, Paul Mele describes the legal background to patenting and copyrighting ideas, a process that behaviorists have rarely used. Together, these topics identify the requirements and warn of the challenges and intricacies that await those who seek to transfer behavioral technology beyond the laboratory.

Animals↗
PubMed1999

The behavioral side of information technology.

Exposure to technologies is becoming more prevalent in healthcare technologies. Few strategies have been developed that work reliably to successfully implement information technologies. Information technology enables, but does not guarantee organizational change. A theoretical model has been developed identifying several areas that have been found important in information technology implementation. The information technology adoption model is described, and provides a framework for implementors of information technologies. It provides a structure to categorize areas that may benefit from the development of implementation strategies and the development of evaluation techniques. Implementation and evaluation strategies are discussed as they pertain to end-user fit, user perceptions of innovation usefulness and ease of use, and adoption and utilization.

Attitude to Computers↗
PubMed1999

Methodological approaches of health technology assessment.

In this era of evolving health care systems throughout the world, technology remains the substance of health care. Medical informatics comprises a growing contribution to the technologies used in the delivery and management of health care. Diverse, evolving technologies include artificial neural networks, computer-assisted surgery, computer-based patient records, hospital information systems, and more. Decision-makers increasingly demand well-founded information to determine whether or how to develop these technologies, allow them on the market, acquire them, use them, pay for their use, and more. The development and wider use of health technology assessment (HTA) reflects this demand. While HTA offers systematic, well-founded approaches for determining the value of medical informatics technologies, HTA must continue to adapt and refine its methods in response to these evolving technologies. This paper provides a basic overview of HTA principles and methods.

Humans↗
PubMed1987

The assessment of a new technology for evaluating respiratory abnormalities in sleep.

This study assessed the diagnostic utility of two technologies for evaluating respiratory abnormalities in sleep. We compared conventional polysomnography with a new, ambulatory microprocessor technology. Two key features of the comparison involved: (a) the use of multiple, skilled interpreters of each system; and (b) inter-rater agreement within the systems as a crucial test for the diagnostic utility of each. Results indicated that general categories of respiratory abnormalities could be judged more reliably than more specific categories, regardless of technology. For certain categories of respiratory abnormalities, however, inter-rater agreement with the newer technology was extremely low (e.g., reliability coefficients of .12, .09, and -0.6). Factors contributing to these low diagnostic reliabilities are discussed. Our data indicate that any assessment of new technology cannot be made apart from the clinical judgments to be rendered with that new technology. This approach may be generalizable to the assessment of other diagnostic technologies.

Diagnosis, Computer-Assisted↗
PubMed1991

Technology assessment in the Framingham Heart Study.

To assess the role of observational data bases in technology assessment, we examined 26 articles from the Framingham Heart Study that evaluated a technology, therapy, or predictive instrument. These assessments were grouped into four categories: (a) the study of a technology voluntarily in use by the cohort, (b) the application of an external technology to members of the cohort, (c) the use of the Framingham results to evaluate an unrelated assessment, and (d) the use of the results to validate predictive instruments from other studies. Factors that contribute to the ability of the study to assess voluntary and external technologies include long-term follow-up, a stable cohort, and storage of such nonnumeric data as cardiograms and blood samples. Framingham results have been used to determine outcome measures in later studies. Although the Framingham Study was not designed to assess a technology, we found that large-scale, observational data bases can and do contribute to technology assessment.

Cohort Studies↗
PubMed2004

Cross-national comparison of technology assessment processes.

OBJECTIVES: To compare methods and results among four health technology assessment organizations in different countries. METHODS: All assessment reports published between 1999 and 2001 by VATAP (United States), NICE (United Kingdom), CCOHTA (Canada), and AETS (Spain), were reviewed. Detailed information about the organization, the technology assessed, the methods used, and the recommendations made were collected. A descriptive analysis of the variables, as well as comparisons of means and proportions, was performed. RESULTS: Sixty-one reports assessing seventy-six technologies were published: nine (11.8 percent) by VATAP, thirty-nine (51.3 percent) by NICE, twenty (26.3 percent) by CCOHTA, and eight (10.5 percent) by AETS. A total of 64.5 percent of the technologies assessed were related to a high prevalence disease in the corresponding country. Most of the assessments addressed treatments (73.7 percent) and were mostly drugs (56.6 percent) and devices (23.7 percent). Most organizations used reviews of effectiveness and economic evaluations (64.5 percent), systematic reviews (21.1 percent), and original economic evaluations (36.7 percent). In 38.1 percent, the technology was recommended; the rest of the cases had no formal recommendations. CONCLUSIONS: Critical issues for future technology assessment efforts are making assessment processes more consistent, transparent, and evidence-based; formalizing the inclusion of economic and ethical considerations; and making more explicit the prioritization process for selecting technologies for assessment and reassessment.

Canada↗
PubMed2003

Effect of government actions on technological innovation for SO2 control.

The relationship between government actions and innovation in environmental control technology is important for the design of cost-effective policies to achieve environmental goals. This paper examines such relationships for the case of sulfur dioxide control technology for U.S. coal-fired power plants. The study employs several complementary research methods, including analyses of key government actions, technology patenting activity, technology performance and cost trends, knowledge transfer activities, and expert elicitations. Our results indicate that government regulation appears to be a greater stimulus to inventive activity than government-sponsored research support alone, and that the anticipation of regulation also spurs inventive activity. Regulatory stringency focuses this activity along particular technical pathways and is a key factor in creating markets for environmental technologies. We also find that with greater technology adoption, both new and existing systems experience notable efficiency improvements and capital cost reductions. The important role of government in fostering knowledge transfer via technical conferences and other measures is also seen as an important factor in promoting environmental technology innovation.

Air Pollutants↗
PubMed1996

Are the returns to technological change in health care declining?

Whether the U.S. health care system supports too much technological change-so that new technologies of low value are adopted, or worthwhile technologies become overused-is a controversial question. This paper analyzes the marginal value of technological change for elderly heart attack patients in 1984-1990. It estimates the additional benefits and costs of treatment by hospitals that are likely to adopt new technologies first or use them most intensively. If the overall value of the additional treatments is declining, then the benefits of treatment by such intensive hospitals relative to other hospitals should decline, and the additional costs of treatment by such hospitals should rise. To account for unmeasured changes in patient mix across hospitals that might bias the results, instrumental-variables methods are used to estimate the incremental mortality benefits and costs. The results do not support the view that the returns to technological change are declining. However, the incremental value of treatment by intensive hospitals is low throughout the study period, supporting the view that new technologies are overused.

Aged↗
PubMed1996

Measuring the outcomes of assistive technology: challenge and innovation.

Documenting outcomes is becoming an essential function in assistive technology. Successfully documenting outcomes, however, depends on having appropriate measurement instruments and methodologies available. This is a challenge, as few measures are available which target the measurement of assistive technology outcomes. New instrumentation and approaches may need to be created or older measures radically adapted for assistive technology applications. This paper reviews measurement issues specifically relevant to assistive technology outcomes assessment. Many of the issues relate to measurement theory, as it is important to understand how instruments based on traditional psychometric concepts may not be the most appropriate for applications of assistive technology outcomes assessment. Fortunately, the assistive technology field also has innovative ideas being developed and tested. These may hold some promise as we all pursue better ways to document the outcomes of our assistive technology devices and services.

Data Collection↗
PubMed1998

Toward a holistic view of genetic technology as a way of knowing.

Technology changes the face of science and, ultimately, nature. How do we as nurses come to know technology? Nurses' ways of knowing, as described by Carper, help nurses better understand technology as a way of knowing; that is, using empirical, ethical, personal, and esthetic ways of knowing provides a means to incorporate technology into holistic nursing practice. Knowledge of technology also requires considering clients' and families' multiple facets of knowing. The article summarizes the nature of technology, nurses' ways of knowing in the context of genetic technology, and the rationale for understanding clients' and families' ways of knowing.

Diffusion of Innovation↗
PubMedDate not supplied

Technology assessment, transfer, and management: the implications to the professional development of clinical engineering.

Technology, as applied in healthcare, is an encompassing term for products, equipment, procedures and services allied in some way with healthcare. This paper discusses technology as the word applies to healthcare. Areas of activity under the umbrella of technology--technology transfer, technology assessment and technology management--will be defined and discussed from the standpoint of their interaction with clinical engineering. The clinical engineering profession has approached participation in each of these activities in a nonsystematic manner, resulting in limited impact and a limited role. To go beyond its present role, the profession must study the processes of technology assessment, transfer, and management to understand their components, critical paths, strengths and weaknesses. This research should be undertaken by a joint group of clinical engineers representing practitioners and academia. Existing key players or professions should be identified, the role clinical engineers wish to pursue as a professional group and the skills required to assure competency should be declared, and appropriate resources for acquiring knowledge and experience identified.

Biomedical Engineering↗
PubMed1997

Technology coverage decisions by health care plans and considerations by medical directors.

OBJECTIVES: Decisions made by private health care plans as to whether to cover new medical technology have a significant impact on access, diffusion, and costs. This study describes the variation in health plan coverage of different laser technologies and the types of considerations used in making coverage decisions for them. METHODS: In a cross-sectional national survey of medical directors at private plans, medical directors indicated current coverage of 15 different laser therapies, and then ranked the top five considerations both in favor and against recommending coverage for three of the laser therapies (angioplasty, discectomy, and photodynamic therapy). The influence of explicit clinical information and/or plan characteristics on coverage and the importance of considerations was examined through multivariate analyses (multiple logistic or linear regression analysis). RESULTS: Overall, 231 medical directors responded from plans representing 66% and 72% of persons in US health maintenance organization and indemnity plans, respectively. Current coverage for 13 of the 15 laser therapies varied between 20% and 90%. For-profit and indemnity plans covered approximately two more of the different laser technologies than nonprofit plans and health maintenance organizations. Considerations most frequently listed in favor of and against recommending coverage across the three laser technologies were clinical, economic, and regulatory. Legal, competitive, and compassionate concerns were listed less frequently. Considerations were not uniform across laser therapies; they reflected the specifics of the technology under review. Plan characteristics influenced the ranking of considerations as well. For instance, health maintenance organizations were two to three times more likely than indemnity plans to list potential for decreased cost in favor of recommending coverage. CONCLUSIONS: These findings demonstrate that there is substantial variation in coverage of new technologies, indicating that a large proportion of the population covered by private health plans are ineligible for treatments that are routinely available to others. A greater range of medical therapy may be available for persons enrolled in indemnity and for-profit plans should their physicians choose to prescribe it. Clinical and economic considerations, including cost-effectiveness, predominate in coverage decisions for new technologies. The importance of considerations appears sensitive not only to specific clinical information, however, but also to characteristics of health plans.

Cross-Sectional Studies↗
PubMed2006

Curriculum development and technology incorporation in teaching neuroscience to graduate students in a medical school environment.

Today's neuroscience faculty member wears multiple hats and requires diverse skills to succeed in the competitive environment in which they find themselves. A common refrain from graduates is that there is a need for better training in the diverse, multiple skills that they will need to succeed in obtaining a faculty position and excelling in that position once it is obtained. Our university recently developed a new neuroscience graduate program that allowed us to create a curriculum and core courses de novo and that could be tailored to provide training in diverse skills used by everyday neuroscience faculty members. The current article details our rationale, design, and implementation of this new curriculum and its two major core courses. The genesis of the new curriculum also provided an opportune time to introduce and test new teaching technology in the two neuroscience core courses. The technology incorporated included on-line WebCT course sites, computer performance system, and the Tegrity system. Herein, we elaborate on our experiences with the use of this technology in the small class graduate course setting and provide insight on student feedback on the perceived effectiveness of the technology. The mechanisms and considerations that are needed for incorporation of such technology are also discussed. While no single curriculum or technology incorporation scheme will be applicable to all programs, it is hoped that our experiences in curriculum design and technology incorporation will be beneficial to other universities as they consider refining existing programs or beginning new ones.

Curriculum↗
PubMedDate not supplied

Visualizing the future: technology competency development in clinical medicine, and implications for medical education.

OBJECTIVE: In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? METHOD: Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical, technological and cultural shifts that will shape medical education and practice. RESULTS: From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care. Physicians will choose how they will be end-users of technology, technology developers, and/or the interface between users and developers. These choices will guide the types of skills each physician will need to acquire. Finally, the authors explore the implications of these trends for medical educators, including the competencies that will be required of educators as they develop the medical curriculum. CONCLUSIONS: Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine. By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace.

Attitude to Health↗