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PubMed2002

Connecting AAC devices to the world of information technology.

Modern day information technology (IT) is converging around wireless networks. It is now possible to check E-mail and view information from the World Wide Web from commercially available mobile phones. For individuals with disabilities, the ability to access multiple and different types of information not only promises convenience, but also can help to promote independence and facilitate access to public and private information systems. There are many barriers to access for people with disabilities, including technological hurdles, security, privacy, and access to these emerging wireless technologies. However, legislation, advocacy, standards, and research and development can ensure that users of augmentative and alternative communication (AAC) and assistive technology have access to these technologies. This article provides a historical context for the field of AAC and IT development, a review of the current state of these technologies, a glimpse of the potential of wireless information access for the lives of AAC users, and a description of some of the barriers and enablers to making access available to users of AAC and assistive technologies.

Communication Devices for People with Disabilities↗
PubMed2003

Sources of information about how to obtain assistive technology: findings from a national survey of persons with disabilities.

A modified discriminant function analysis was performed to determine the interaction between the source of information for assistive technology used by persons with disabilities. In the sample of 1,412 such persons, 901 were found to use some form of assistive technology in their daily lives. Ten distinct sources of information were specified. Respondents were able to mention up to three sources of information for each example of assistive technology used. A total of 930 sources were mentioned. Overall, the most mentioned information source was a physician or other health care professional, accounting for 53% of all sources mentioned. The only other frequently mentioned sources were family and friends (15%) and vocational rehabilitation counselors (13%). We found that physicians and health care professionals provide information to all groups without significant variance--this source of information is clearly nondiscriminant. Respondents who use family and friends as a source of information tend to be older, poorer, unemployed, more severely impaired, non-White, and, most significantly, render a more negative opinion of the amount and utility of information they have received about assistive technology, as well as the helpfulness of assistive technology in general. Persons obtaining information from vocational rehabilitation counselors tend to be better educated, non-White, unemployed, and have a more positive opinion about assistive technology. The limited size of the national population-based sample (n = 1,412) and very low number of responses indicating a state-based agency as the source of information about assistive technology did not allow state-by-state comparisons; alternative approaches, however, suggest a slight decline in the usage of the primary source (physician or other health care professional) with decreasing population, and a larger increase in the usage of family and friends as a source of information.

Data Collection↗
PubMed1999

Fax technology for collecting outcomes data in a computer database.

In this era of cost containment, outcomes research is becoming more prevalent. Therefore, various technologies allowing for flexibility in study design and the capture of specific clinical information need to be examined and used. These technologies include fax data systems, pocket scanners, automated telephone equipment, and hand-held computer devices. Fax data systems convert a fax machine into an automated data-entry system. Data-filled forms are faxed to a computer, the fax is converted, and the data are entered into preset fields in a database. Applications for fax systems include acute care-based and ambulatory care-based drug-use evaluations, drug recall systems, and patient-completed surveys of health status. Pocket scanners are hand-held instruments for rapid data entry and transport. Applications for pocket scanning include patient interview responses, procedure and disease analysis, and procedure coding. Options for automated telephone equipment include surveys with interactive voice-mail responses or keypad data entry, pharmacist-monitored drug information and survey services, fax-back and mail-out services, and patient-generated disease intervention programs. Hand-held computer technology is a source of information on multiple protocols and care pathways. All these technologies improve data collection with respect to accuracy and speed, facilitate data analysis, and promote cost-efficient information sharing. The purpose of this study was to evaluate the use of fax technology in data collection for a prospective, multicenter study of the outcomes and cost-effectiveness of two drugs used in the treatment of cancer. Details for the pharmacoeconomic study can be found elsewhere. Fax technology was selected because of the ease with which those responsible for managing the data collection could be trained to use it, the affordability and efficiency of the technology, the ease with which data could be analyzed, and the accuracy of data collection.

Cost-Benefit Analysis↗
PubMed2004

The risk of birth defects in children born after assisted reproductive technologies.

PURPOSE OF REVIEW: This review addresses the question of whether there is evidence of an increased risk of birth defects in children born following assisted reproductive technologies compared with spontaneously conceived children. RECENT FINDINGS: Three recent studies added relatively little new information given their modest size (56-472 assisted reproductive technology children). We therefore considered all published papers that compared birth defects in children born following assisted reproductive technologies with those in children born following spontaneous conception. Overall, only six of the 26 relevant papers concluded there was an increased risk of birth defects following assisted reproductive technologies. The interpretation of many studies was based on statistical significance testing alone. When results showed a greater proportion of defects in the assisted reproductive technology group compared with the spontaneous group, but the results were not statistically significant, this was often interpreted as showing no increase in risk, rather than an increase in risk that may have been due to chance. The vast majority of individual studies were too small to have sufficient power to detect, as statistically significant, clinically relevant results. We found that although only eight (30%) of the studies had statistically significant results, 24 (89%) had an odds ratio estimate comparing assisted reproductive technology with spontaneously conceived children of over 1.0; 19 (70%) had an estimate of 1.20 or greater; and 14 (52%) had an estimate of 1.5 or greater. SUMMARY: Current evidence suggests there is an elevated risk of birth defects in children born following assisted reproductive technologies. Whilst others may disagree with our interpretation, one certainly cannot exclude this possibility on the basis of the current evidence.

Congenital Abnormalities↗
PubMed1998

Who really makes the bed? Uncovering technologic dissonance in nursing.

Technologic dissonance in the practice arena is demonstrated in the use of nonnursing technologies that are present in but technically incongruent with a nursing environment. Technology in nursing is not necessarily nursing technology. The article traces the influences of technologic dissonance beyond the reductionist purview of the medical model to their source in design and engineering philosophies. The vision of technologic consonance in nursing may be realized in the influence and expression of the caring nurse in the design, engineering, ownership, and use of nursing technology.

Empathy↗
PubMedDate not supplied

Nursing students' attitudes toward technology: a national study.

Nursing students' predispositions toward technology may be a factor affecting their use of technology in educational and clinical settings. A national survey was conducted to collect attitudinal measures toward technology and data on technology instruction to assist educators with developing information technology curricula. Outcomes indicate an overall positive attitude toward technology; however, participants reports of formal education in the use of technology applications are low. This shortcoming should be addressed through enhancement of nursing core curriculum.

Adult↗
PubMed1985

Technology and medicine.

Technology, which is older than science, has been of vital importance in the development of modern medicine. Even so, there are voices of dissent to be heard. The disenchantment with technology expressed by Aldous Huxley in Brave new world has been echoed by contemporary writers on the technology of modern medicine. Medicine is seen by some to have been dehumanized by technology, and techniques that are expensive are thought to be consuming a greater proportion of health resources than they deserve. The practice of medicine has, nevertheless, been transformed by modern technology and diagnostic techniques and therapeutic measures undreamed of a few short decades ago are now commonplace. There is no reason why these developments should be any more dehumanizing than the use of similar techniques in modern transportation or communication, nor is their expense out of proportion when compared with other demands on the nation's purse. British workers have been at the forefront of many recent advances. Yet, even though the National Health Service provides a ready market for the products of British medical technology, the nation depends to an inordinate degree on imported products. In the development of appropriate medical technology there is an urgent need for better communication between inventors, scientists, industrialists and the National Health Service. At the same time there is an equal need for improved evaluation of untried techniques. The pressure for a central integrating body to coordinate resources could well be supported by the establishment of evaluation units in the different health authorities in this country.

Diagnosis↗
PubMed2006

The duality in using information and communication technology in elder care.

AIM: The aim of this paper is to report a study illuminating values and perceptions held by professional carers of older people about the use of information and communication technology applications. BACKGROUND: Various information and communication technology applications have successfully been developed to help solve a variety of problems in elder care. Beside different technical barriers and the assumed negative attitudes among older people, staff values and attitudes have been found to be an important cause of resistance to change and slowness in introduction of information and communication technology in health care of older people. METHODS: An interview study was conducted in 2004 with 10 healthcare personnel with 3-26 years experience of working in home care and nursing homes in Northern Sweden. Qualitative content analysis was used to identify recurring themes in the data. RESULTS: The interpretation of values and perceptions among carers revealed a duality where the carers perceived information and communication technology as a promoter of both inhumane and humane care, a duality that seemed to make them defensive and resistant to change. Within the overall duality, other dualities were embedded that described both perceptions about the care of older people and about being a carer. There was evidence of resistance among professional carers towards an introduction of information and communication technology applications in elder care. Carers considered that the same attributes of information and communication technology that could promote humane care could also lead to dehumanized care. CONCLUSION: There should be an ethical discussion when introducing information and communication technology applications in elder care. The best caring alternative for all those concerned should be considered. It should promote aspects of wellbeing and dignity for frail older people and fears of inhumane care among carers must be recognized and discussed.

Adaptation, Psychological↗
PubMed2005

Promoting practical clinical management learning: the current situation about Information and Communications Technology capability development in student nurses.

AIM: This paper is about work-based learning in information management for student nurses. It seeks, through a literature review, to make a case for and promote Information and Communications Technology capability development in student nurses within their clinical environment. BACKGROUND: The profession of nursing, like many other jobs, is facing the increasing usage of information technology in day-to-day operations. Admission and discharges of patients have been held on computer databases since at least the 1980s. With the new Labour Government in 1997, increasing focus was placed on the effectiveness of the National Health Service and using computers as one way to assist in achieving greater effectiveness. Nurse education therefore needed to reflect this need and support trainee nurses to acquire skills in Information and Communications Technology. This paper is part of an ongoing professional doctorate inquiry into Information and Communications Technology capability development in student nurses. EVALUATION: A literature search was conducted on teaching information and technology skills via Cumulative Index to Nursing and Allied Health Literature. Most of the available studies were neither based on the UK nor were they about student nurses. As there is a dearth of published work in this specific area, relevant, related and tangential literature was reviewed. KEY ISSUES: It is argued that current practice and published work on Information and Communications Technology capability development by student nurses hardly exists. The literature confirmed that success in this area requires sound change management, an understanding of National Health Service culture, and effective people leadership skills. Nurse educators and managers need to pay more attention to understand how organizations work, particularly organizations where student nurses carry out their work. CONCLUSIONS: As the search revealed a significant gap in the literature in this area, a practical conceptual framework to fully analyse, develop and implement sustained Information and Communications Technology capability in student nurses is proposed.

Clinical Nursing Research↗
PubMed2002

Continuous renal replacement therapy. Keeping pace with changes in technology and technique.

The rapidly changing nature of new technologies and techniques in acute health care means it can be difficult keeping pace. Most facilities, large or small, are usually in continuous evaluation of a new technology. Published reviews and professional group guidelines can assist the process of change for continuous renal replacement therapy (CRRT) technologies and techniques. The current techniques and technologies are a mixed application of old and new technologies providing a combination of convective and diffusive solute clearance methods. There are a variety of anticoagulation approaches. New, purpose-built CRRT machines offer many advantages over old technology but their costs can be prohibitive and users do not always meet them with rapid behavioral change. Reading journal publications and texts, scientific meetings, education and training, Internet web site review/participation, quality improvement activities and an accurate local data base are the keys to keeping pace with changes and identifying whether a benefit can be anticipated and demonstrated. Possible changes for the future of techniques and technologies may be in the areas of modified approaches to continuous therapy with tailored approaches for specific patient care settings. Improved membrane characteristics for wider indications and the bio-artificial kidney are emerging along with blood pump and circuit design improvements, with new machine/operator interfaces.

Equipment and Supplies↗
PubMed2004

Assistive technology and handwriting problems: what do occupational therapists recommend?

BACKGROUND: Handwriting difficulties for students are a common reason for referral to occupational therapy. Little research evidence is available concerning the factors guiding technology recommendations for these children. PURPOSE: The objective of this survey research was to describe the technology-related recommendations and factors involved in the decisions made by Canadian occupational therapists for these students. RESULTS: More therapists recommended the use of keyboard-based strategies (93%) than dictation-based strategies (72%). Experienced therapists were more likely to prescribe technology tools. Dictation to a scribe (93%) and desktop computers (89%) were the strategies most frequently recommended. Equipment cost and availability of funding, and the availability of support in the school for the student were the most influential factors, respectively, on the keyboard and dictation strategy type prescribed. PRACTICE IMPLICATIONS: The results confirmed that occupational therapists prescribe a range of technology solutions. Factors influencing these recommendations differ depending on the nature of the technology, the person, environment or occupation. Knowing the factors guiding occupational therapist technology recommendations will help provide valuable information about the practical implications of the available technologies.

Child↗
PubMed2000

Recovering ethics after 'technics': developing critical text on technology.

Much modern science and ethics debate is on high-profile problems such as animal organ transplantation, genetic engineering and fetal tissue research, in discourse that assumes technical tones. Other work, such as narrative ethics, expresses the failed promise of technology in the vivid detail of human experience. However, the essential nature of contemporary technology remains largely opaque to our present ethical lens on health care and on society. The limited controversies of modern science and ethics perpetuate 'technics', a technical, problem-solving mindset that fails to grapple successfully with the complexity of technology. A critical dialectic between practice and scholarship widens the ethical conversation in nursing to consider technology as an ongoing set of daily and fundamental moral choices on how we live. Critical text on technology recovers ethics from the limits of technics, and assists nurses to develop an inherent knowledge of technology that is needed to provide ethical care in a technological world. There are overlooked ethical challenges in the mundane, everyday routine activities of professional practice, and these have gone largely unexamined. Ethical behavior is not the display of one's moral rectitude in times of crisis. It is the day-to-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions.

Choice Behavior↗
PubMed2004

Patients' perspectives on high-tech home care: a qualitative inquiry into the user-friendliness of four technologies.

BACKGROUND: The delivery of technology-enhanced home care is growing in most industrialized countries. The objective of our study was to document, from the patient's perspective, how the level of user-friendliness of medical technology influences its integration into the private and social lives of patients. Understanding what makes a technology user-friendly should help improve the design of home care services. METHODS: Four home care interventions that are frequently used and vary in their technical and clinical features were selected: Antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. Our qualitative study relied on the triangulation of three sources of data: 1) interviews with patients (n = 16); 2) interviews with carers (n = 6); and 3) direct observation of nursing visits of a different set of patients (n = 16). Participants of varying socioeconomic status were recruited through primary care organizations and hospitals that deliver home care within 100 km of Montreal, the largest urban area in the province of Quebec, Canada. RESULTS: The four interventions have both a negative and positive effect on patients' lives. These technologies were rarely perceived as user-friendly, and user-acceptance was closely linked to user-competence. Compared with acute I.V. patients, who tended to be passive, chronic patients seemed keener to master technical aspects. While some of the technical and human barriers were managed well in the home setting, engaging in the social world was more problematic. Most patients found it difficult to maintain a regular job because of the high frequency of treatment, while some carers found their autonomy and social lives restricted. Patients also tended to withdraw from social activities because of social stigmatization and technical barriers. CONCLUSIONS: While technology contributes to improving the patients' health, it also imposes significant constraints on their lives. Policies aimed at developing home care must clearly integrate principles and resources supporting the appropriate use of technology. Close monitoring of patients should be part of all technology-enhanced home care programs.

Adult↗
PubMed2006

Multimedia Bootcamp: a health sciences library provides basic training to promote faculty technology integration.

BACKGROUND: Recent research has shown a backlash against the enthusiastic promotion of technological solutions as replacements for traditional educational content delivery. Many institutions, including the University of Virginia, have committed staff and resources to supporting state-of-the-art, showpiece educational technology projects. However, the Claude Moore Health Sciences Library has taken the approach of helping Health Sciences faculty be more comfortable using technology in incremental ways for instruction and research presentations. In July 2004, to raise awareness of self-service multimedia resources for instructional and professional development needs, the Library conducted a "Multimedia Bootcamp" for nine Health Sciences faculty and fellows. METHODS: Case study. RESULTS: Program stewardship by a single Library faculty member contributed to the delivery of an integrated learning experience. The amount of time required to attend the sessions and complete homework was the maximum fellows had to devote to such pursuits. The benefit of introducing technology unfamiliar to most fellows allowed program instructors to start everyone at the same baseline while not appearing to pass judgment on the technology literacy skills of faculty. The combination of wrapping the program in the trappings of a fellowship and selecting fellows who could commit to a majority of scheduled sessions yielded strong commitment from participants as evidenced by high attendance and a 100% rate of assignment completion. Response rates to follow-up evaluation requests, as well as continued use of Media Studio resources and Library expertise for projects begun or conceived during Bootcamp, bode well for the long-term success of this program. CONCLUSION: An incremental approach to integrating technology with current practices in instruction and presentation provided a supportive yet energizing environment for Health Sciences faculty. Keys to this program were its faculty focus, traditional hands-on instruction, unrestricted access to technology tools and support, and inclusion of criteria for evaluating when multimedia can augment pedagogical aims.

Journal Article↗
PubMed2006

Religious belief, perceptions of human suffering, and support for reproductive genetic technology.

Reproductive genetic technologies are becoming more controversial as they become more ubiquitous. The opponents of these technologies are largely religious groups, a fact that leads to the question of why religious groups would be more opposed to these technologies than others. Since all of these technologies are justified by their ability to relieve suffering of some kind, it is hypothesized that the actively religious have a notion of suffering different from that of advocates for these technologies, and this different notion of suffering leads to opposition to the technologies. In this article I report on a qualitative interview study of the religiously active in the United States. I find that the religiously active do have views of suffering that are distinct from the medical consensus, and these views are related to people's conclusions about the advisability of reproductive genetic technologies.

Genetic Testing↗
PubMedDate not supplied

Workload and availability of technology in metropolitan community pharmacies.

OBJECTIVE: To assess workload characteristics and the presence of prescription processing technologies within metropolitan community pharmacies in the United States. DESIGN: Cross-sectional postal survey. SETTING: 18 metropolitan statistical areas (MSAs) in the United States. PARTICIPANTS: 3000 managers located in community pharmacies processing at least 500 third-party claims per month for four major pharmacy benefits managers. INTERVENTIONS: 34-item survey instrument designed to collect data about the pharmacy including demographics, workload issues, handling of drug-drug interactions (DDIs), and pharmacists' attitudes toward computerized DDI alerts. MAIN OUTCOME MEASURES: Workload (hours of operation, prescription volume, staffing hours, prescription processing intensity) and prescription processing technologies (telecommunication systems, automated counting/filling or verification devices, number of computer terminals, and computer software vendors). RESULTS: Overall, 736 usable surveys were returned (response rate, 25.3%). On average, respondents reported a volume of approximately 1340 prescriptions per week processed at a rate of almost 17 prescriptions per hour. Independent pharmacies processed approximately 3 prescriptions per hour more than chain pharmacies even though a statistically equal or slightly lower proportion of those pharmacies had automated technologies. The presence of technology was generally high for all pharmacies, particularly countertop tablet/capsule-counting devices and telefacsimile machines. The most common software vendors differed considerably between chain and independent pharmacies. CONCLUSION: The number of prescriptions processed per hour and number of technologies available increased with the total weekly volume of prescriptions processed in this national survey. A majority of pharmacies had at least one type of automated prescription processing technology and an automated telecommunication system for accepting new or refill prescriptions. Independent pharmacies processed more prescriptions per hour than did chains but did so with fewer categories of technologies.

Automation↗
PubMed1996

Technology and alternative cancer therapies: an analysis of heterodoxy and constructivism.

Theories of the construction of technology are reviewed from the wider interdisciplinary conversation known as science and technology studies (STS) and from the growing field of the anthropology of science and technology. These theories are used to contribute to research situated at the intersection of the anthropology of alternative medicine and of medical technologies. Cases drawn from the research tradition on microbial theories of cancer are considered to show how unorthodox medical theories become embedded in technologies through choices in microscope design and treatment technologies. In turn, the technologies contribute to the heterodox standing of the researchers, their research, and their therapies.

Anthropology, Cultural↗
PubMed2005

Identification of technology options for reducing nitrogen pollution in cropping systems of Pujiang.

This work analyses the potential role of nitrogen pollution technology of crop systems of Pujiang, County in Eastern China's Zhejiang Province, rice and vegetables are important cropping systems. We used a case study approach involving comparison of farmer practices and improved technologies. This approach allows assessing the impact of technology on pollution, is forward looking, and can yield information on the potential of on-the-shelf technology and provide opportunities for technology development. The approach particularly suits newly developed rice technologies with large potential of reducing nitrogen pollution and for future rice and vegetables technologies. The results showed that substantial reductions in nitrogen pollution are feasible for both types of crops.

Agriculture↗