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PubMed2006

Assistive technology use among adolescents and young adults with spina bifida.

OBJECTIVES: We sought to determine the use of assistive technology among a population of individuals with spina bifida. METHODS: We performed a descriptive analysis of individuals aged 13 to 27 years diagnosed with myelomeningocele (n=348) using data obtained from an existing database at Children's Hospital and Regional Medical Center, Seattle, Washington. We summarized disease characteristics, utilization of assistive technology, community and self-care independence, and other variables. RESULTS: Eighty-four percent of the respondents lived with at least 1 of their natural parents. Fifty-seven percent used wheelchairs, 35% used braces, and 23% used walking aids. Independent self-care was a common skill, but 72% reported limited participation in structured activities. Half were aged 18 years or older; of those, only 50% had completed high school and 71% were unemployed. Those aged younger than 18 years were all still in school (100%). CONCLUSIONS: Adolescents and young adults with spina bifida rely on assistive technology and specialized care routines to maintain their health. Assistive technology use for mobility is common; little is known about secondary complications associated with use of these technologies or the use of assistive technology to address learning disabilities and other societal barriers. Underutilization of assistive technology could delay successful transitions to independent living and community participation.

Activities of Daily Living↗
PubMed2005

A review of technologies for rapid detection of bacteria in recreational waters.

Monitoring of recreational beaches for fecal indicator bacteria is currently performed using culture-based technology that can require more than a day for laboratory analysis, during which time swimmers are at risk. Here we review new methods that have the potential to reduce the measurement period to less than an hour. These methods generally involve two steps. The first is target capture, in which the microbial group of interest (or some molecular/chemical/or biochemical signature of the group) is removed, tagged or amplified to differentiate it from the remaining material in the sample. We discuss three classes of capture methods: 1) Surface and whole-cell recognition methods, including immunoassay techniques and molecule-specific probes; 2) Nucleic acid methods, including polymerase chain reaction (PCR), quantitative PCR (Q-PCR), nucleic acid sequence based amplification (NASBA) and microarrays; and 3) Enzyme/substrate methods utilizing chromogenic or fluorogenic substrates. The second step is detection, in which optical, electrochemical or piezoelectric technologies are used to quantify the captured, tagged or amplified material. The biggest technological hurdle for all of these methods is sensitivity, as EPA's recommended bathing water standard is less than one cell per ml and most detection technologies measure sample volumes less than 1 ml. This challenge is being overcome through addition of preconcentration or enrichment steps, which have the potential to boost sensitivity without the need to develop new detector technology. The second hurdle is demonstrating a relationship to health risk, since most new methods are based on measuring cell structure without assessing viability and may not relate to current water quality standards that were developed in epidemiology studies using culture-based methods. Enzyme/substrate methods may be the first rapid methods adopted because they are based on the same capture technology as currently-approved EPA methods and their relationship to health risk can be established by demonstrating equivalency to existing procedures. Demonstration of equivalency may also be possible for some surface and whole-cell recognition methods that capture bacteria in a potentially viable state. Nucleic acid technologies are the most versatile, but measure nonviable structure and will require inclusion in epidemiological studies to link their measurement with health risk.

Bacteria↗
PubMedDate not supplied

SARS and population health technology.

The recent global outbreak of SARS (severe acute respiratory syndrome) provides an opportunity to study the use and impact of public health informatics and population health technology to detect and fight a global epidemic. Population health technology is the umbrella term for technology applications that have a population focus and the potential to improve public health. This includes the Internet, but also other technologies such as wireless devices, mobile phones, smart appliances, or smart homes. In the context of an outbreak or bioterrorism attack, such technologies may help to gather intelligence and detect diseases early, and communicate and exchange information electronically worldwide. Some of the technologies brought forward during the SARS epidemic may have been primarily motivated by marketing efforts, or were more directed towards reassuring people that "something is being done," ie, fighting an "epidemic of fear." To understand "fear epidemiology" is important because early warning systems monitoring data from a large number of people may not be able to discriminate between a biological epidemic and an epidemic of fear. The need for critical evaluation of all of these technologies is stressed.

Communicable Diseases↗
PubMed1994

Eugene W. Caldwell Lecture. Technology: the key to controlling health care costs in the future.

The American health care financing system is in a state of crisis. The rising cost of health care and the progressive difficulty Americans are experiencing in accessing the system have produced a great national debate concerning the future of medicine in America. Current health care cost trends, which are not sustainable, are projected to consume 37% of the gross national product by the year 2030. The financing system that supports the health care system is failing. The number of uninsured residents is growing more than twice as fast as the number with health insurance. The legitimate concern about the spiraling cost for medicine has focused attention on seeking root causes. Critics have focused on technology as the single most important factor in driving the cost trends in medicine upward. They have concluded that "long-term control of the rate of increase in expenditures requires that we curb the development and diffusion of clinically useful technology." These critics have not made their case, because they base their conclusions on hospital-derived data. These data are inaccurate because of the phenomenon of "cost-shifting." The critics do not examine the important issue of productivity and do not have reliable data on the costs and benefits of new technologies. Finally, the critics do not take into account the issue of use and abuse of technology. This is particularly important in the ambulatory environment. To break the health care cost spiral, radiologists, as the keepers of new technology, must commit themselves to at least four fundamental initiatives. The current American hospital-based health system must be replaced with an ambulatory system; productivity must be the primary business goal for radiologists; pricing of new services should reflect actual resources consumed, not the in-patient services displaced; and radiologists must reassert their role as doctors' doctors. The health care cost spiral is a real national crisis. The mission for radiology is to introduce the minimally invasive, ambulatory system of the future. The costs for delivering care within the new system will be a fraction of former costs. My assignment is to present a perspective on the role radiology must play in introducing new imaging technology to medicine. One of the distinguishing features of American society is its fascination with technology. It is only natural that the American health care system reflects this orientation.

Cost Control↗
PubMed1997

What's hot and what's not anticipating trends in technology.

Technology tends to progress over time in a step fashion. Changes in productivity associated with technology, when followed over time, often plot out as an S curve. Long quiescent periods are interrupted by rapid rises in technology advance and productivity. Anticipating this is important since it often enables us to plan for new technology. The lag in response to change often leads to bad planning or bad decisions. For example, I recently brought a new 166 Mhz laptop just a month before the new 233s came out, with a corresponding drop in the price of the 166 models ... so it clear I am not omniscient on the subject. In this column we will discuss important trends and identify what is hot and what is not in order to help you anticipate change in technology. I'll explore eight areas in depth. I will also touch on what you need to do to take advantage of the new technology if you have invested in older legacy technology.

Computer Communication Networks↗
PubMed1999

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery.

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

Equipment Design↗
PubMed1999

Technologies to minimize blood transfusion in cardiac and orthopedic surgery. Results of a practice variation survey in nine countries. International Study of Peri-operative Transfusion (ISPOT) Investigators.

OBJECTIVES: Due to the discovery in the 1980s that blood transfusion can transmit HIV, there has been increased interest in technologies that reduce the amount of allogeneic blood used during and after surgery. These technologies include drugs (aprotinin, tranexamic acid, epsilon-aminocaproic acid, erythropoietin), devices (cell salvage), and techniques (acute hemodilution, predeposited autologous donation). The purpose of this study was to ascertain the degree of practice variation, if any, that exists for eight technologies in nine countries in orthopedic and cardiac surgery. METHODS: In each country, either all hospitals or a random sample of hospitals with medical/surgical beds were surveyed between 1995 and 1997. Two instruments were used. The first instrument was a postcard that asked recipients whether the technologies were currently being used in their hospital for orthopedic and/or cardiac surgery to reduce perioperative allogeneic transfusion. The second questionnaire elicited information regarding the degree of use both in qualitative and quantitative terms. Data were collected, entered, and analyzed in each country, with summary results submitted to the Canadian coordinating center on a standardized data collection form. RESULTS: Pharmaceuticals were generally used in a much smaller proportion of hospitals in orthopedic than in cardiac surgery. Aprotinin and tranexamic acid were the drugs most frequently used in cardiac surgery. Nonpharmacological technologies were used to a greater degree than drugs in orthopedic surgery, although there was wide variation among technologies and countries. Acute hemodilution and cell salvage were used in a greater proportion of hospitals for cardiac surgery than orthopedic surgery. CONCLUSIONS: The results of this survey indicate that there is considerable practice variation in the use of technologies to minimize exposure to perioperative allogeneic transfusion within and between countries.

Antifibrinolytic Agents↗
PubMedDate not supplied

Publishing a nursing textbook: collaborating through "seamless technology".

Electronic communication can enhance long-distance networking and scholarly activity and make long-distance collaboration through technology a reality. Technology presents a new world of opportunity for improving writing skills, nurturing collegiality, and maximizing efficiency in the successful completion of collaborative projects. The concept of "seamless technology" introduced by the authors provides a guide to assist partners involved in collaborative projects to manage technology for a successful, rewarding experience. Basic questions regarding technology that need to be answered on the front end of a long-distance project are suggested in this article. In addition, the steps taken by the authors to co-author and co-edit a nursing textbook and accompanying instructor's manual by using electronic communication and other sources of technology are outlined. The authors address ways that long-distance collaboration required them to maximize their communication and planning skills, thereby increasing productivity and reducing costs. The challenges and rewards of working together exclusively through technology are discussed, and finally, implications for professional nursing are addressed.

Authorship↗
PubMed2000

Technology architecture guidelines for a health care system.

Although the demand for use of information technology within the healthcare industry is intensifying, relatively little has been written about guidelines to optimize IT investments. A technology architecture is a set of guidelines for technology integration within an enterprise. The architecture is a critical tool in the effort to control information technology (IT) operating costs by constraining the number of technologies supported. A well-designed architecture is also an important aid to integrating disparate applications, data stores and networks. The authors led the development of a thorough, carefully designed technology architecture for a large and rapidly growing health care system. The purpose and design criteria are described, as well as the process for gaining consensus and disseminating the architecture. In addition, the processes for using, maintaining, and handling exceptions are described. The technology architecture is extremely valuable to health care organizations both in controlling costs and promoting integration.

Computer Systems↗
PubMed2000

Management matters: technology succeeds when management innovates.

It is widely believed that better technology means better business: now that consumers and patients have direct access to computers and information services, the cost of care should decrease and services improve. Yet even with the advent of computer technology and the phenomenal growth of the Internet, costs have increased and quality problems have persisted. Far more important than the technology, then, is how business is conducted and systems are organized. Despite overwhelming evidence that computer services can significantly reduce the costs of care, healthcare organizations have not adopted the changes, or have tried and failed. This article explores what it will take to succeed. We propose a list of necessary nontechnical changes. Patient expectations will change the nature of care; clinicians' roles and training, the gatekeeper profession, healthcare financing and bundling of services, and capital costs will all change. In the end, management innovations make the difference between the success and failure of new technology. Technology is important, but it is not enough. Without new practices, we can buy the technology but will fail to effectively use it. Unless management modifies the very nature of its business, technology's promise to the healthcare industry will go unfulfilled.

Capital Expenditures↗
PubMedDate not supplied

IMRT (intensity modulated radiation therapy): progress in technology and reimbursement.

For a new treatment technology to become widely accepted in today's healthcare environment, the technology must not only be effective but also financially viable. Intensity modulated radiation therapy (IMRT), a technology that enables radiation oncologists to precisely target and attack cancerous tumors with higher doses of radiation using strategically positioned beams while minimizing collateral damage to healthy cells, now meets both criteria. With IMRT, radiation oncologists for the first time have obtained the ability to divide the treatment field covered by each beam angle into hundreds of segments as small as 2.5 mm by 5 mm. Using the adjustable leaves of an MLC to shape the beam and by controlling exposure times, physicians can deliver a different dose to each segment and therefore modulate dose intensity across the entire treatment field. Development of optimal IMRT plans using conventional manual treatment planning methods would take days. To be clinically practical, IMRT required the development of "inverse treatment planning" software. With this software, a radiation oncologist can prescribe the ideal radiation dose for a specific tumor as well as maximum dose limits for surrounding healthy tissue. These numbers are entered into the treatment planning program which then calculates the optimal delivery approach that will best fit the oncologist's requirements. The radiation oncologist then reviews and approves the proposed treatment plan before it is initiated. The most recent advance in IMRT technology offers a "dynamic" mode or "sliding window" technique. In this more rapid delivery method, the beam remains on while the leaves of the collimator continually re-shape and move the beam aperture over the planned treatment area. This creates a moving beam that saturates the tumor volume with the desired radiation dose while leaving the surrounding healthy tissue in a protective shadow created by the leaves of the collimator. In the dynamic mode, an IMRT treatment session generally can be initiated and completed within the traditional 15-minute appointment window for radiation oncology clinics. In addition to being comforting for the patient, this rapid treatment delivery mode satisfies a key financial issue for hospitals and clinics by giving them the ability to handle high patient loads and achieve a more rapid return on their investment in an IMRT system. New IMRT reimbursement codes have been issued under the pass-through provisions of Medicare's Outpatient Prospective Payment System (OPPS), which authorize special or increased reimbursement levels for promising new developments in healthcare technology that previous reimbursement procedures did not address. These pass-through payments are generally applicable for defined periods during a promising new technology's early stage of adoption. In the case of codes G0174 and G0178, the effective period has been left open-ended. While the CMS adoption of these new IMRT reimbursement codes certainly paves the economic road for the diffusion of this technology by flattening out some of the economic obstacles, there are still bumps to overcome. The most obvious one is the investment in hardware and software that may be required. However, the added demands on staff and the cost of training cannot be ignored. IMRT is a treatment process involving FDA-approved medical devices, offering the hope of improved treatment outcomes with fewer complications for patients and higher reimbursement rates for hospital providers. By the end of the year 2001, there will probably be more than 75 hospitals with IMRT capabilities in place.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

[Robotic and systems technology for advanced endoscopic procedures].

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in other fields of endoscopic surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. This consists of a system of devices for endoscopic surgery (HF, light source, etc...) with which the surgeon interacts directly, positioning systems for optic and instruments that the surgeon drives as the likes without assistance, and a chair to increase the comfort of the surgeon during surgery. The system of endoscopic devices named OREST (Dornier, München) designed already in 1992 opened the way to a number of systems available today that allow to the surgeon a direct control of the instrumentation. A considerable step ahead in endoscopic technology is the introduction of robotic technology to design assisting systems for solo-surgery and microsurgical instrument manipulators. Results of a number of experimental trials on combinations of different positioning devices are presented and commented. A further step in the employment of robotic technology is the design of "master-slave manipulators" to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system, named ARTEMIS, designed in cooperation with the Research Center in Karlsruhe, could be used in experimental applications. Clinical use of the system, however, will require further development of the arm mechanics and the control system. The combination with the implementation of telecommunication technology will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

Endoscopes↗
PubMed2002

[Use of modern technologies and designing means for development of automated information systems for military medicine].

At present time, the intensive activity implementation of automated information systems (AIS) to the military medical establishment are observed. From design quality the successful functioning of the AIS depend on. The effective functioning and the interaction of the automated information technologies by specialists, which computers and telecommunications use for performance of the their purpose, are a goal of the design. Today, there are two classes" technologies for designing of the automated information systems of military medical application: conventional technology and integrated instrumental means technologies. In this article, the conventional technology and integrated instrumental means technologies are considered more detail. CASE-technologies (the functional-oriented and object-oriented approaches) and RAD (Rapid Application Development) are viewed.

Automation↗
PubMed2004

Experience of King Abdul-Aziz City for science and technology in funding medical research in Saudi Arabia.

Funding scientific research is important for accelerating the progress of science and technology, to fulfill the development objectives of the country. King Abdul-Aziz City for Science and Technology (KACST) was established in 1977 to support and promote applied scientific research and coordinate the activities of the scientific research institutions and centers in line with requirements of development plans of the Kingdom. King Abdul-Aziz City for Science and Technology also cooperates with other concerned institutions in formulating strategies and national policies for the development of science and technology. King Abdul-Aziz City for Science and Technology has started several research grants programs, which include; Annual General Grants Program, National Grants Program, Limited Grants Program, Humanities Grants Program, Graduate Students Grants Program and Production Sectors Grants Program for the promotion of science and technology in the Kingdom. The process of funding follows a systematic scientific mechanism based on predetermined research priorities. Selection of the research proposals is accomplished on the basis of strict scientific criteria. The funding of medical research projects is considered most important among all scientific fields, as these are related to human health. The medical field is classified into specific sub fields constituting the major branches of medicine. Since 1979, KACST has funded 430 medical research projects at an estimated cost of 185.9 million Saudi Riyals representing approximately 31.2% of the grants total funding. King Abdul-Aziz City for Science and Technology puts much emphasis on publishing results obtained from the research projects through different channels. Seven hundred and thirty-eight scientific papers have been published in all fields whereas 243 research papers out of them are in the medical field. This paper highlights the establishment, aims and tasks associated with KACST. Also, the paper reviews research funding by KACST grants programs with a focus on funded medical research projects and publications of research papers originating from different funded projects.

Biomedical Research↗
PubMed2002

Moore's Law, disruptive technologies, and the clinician.

The advancement of technical power described by Moore's Law offers great potential for enabling more cost-effective medical devices and systems. However, progress has been slow. Many factors for this failure have been cited, including the anti-rational economic structure of healthcare and the complexity and long time scale of medical development. Christensen et al. suggest that "disruptive technologies" may circumvent some of these difficulties. "Disruptive Technologies" are defined as those that are established in one market, but then penetrate and overwhelm another market. These incursions are accelerated by economic factors, and capitalize on functionality, reliability, and advancements supported by the original market. Christensen has cited many examples from industrial and service businesses, but few examples can be found yet in healthcare. We argue that positive technology impacts in medicine occur most readily when innovators augment the skills of and collaborate with caregivers, rather than seeking to displace them. In the short term, a new approach may improve efficiency or quality. In the longer term, such approaches may obviate human tasks at lower-skill levels, and even permit task automation. One successful example has been the introduction of flexible monitoring for physiologic information. Systems for computer-aided diagnosis, which have failed to impact complex decision making, have succeeded in simpler specialty areas such as the interpretation of EKG's and mammograms, and may do the same with analysis of some pathology images. The next frontier may the operating room, and the adoption of such systemic technologies by caregivers in emergency medicine and general care may then have an even wider "disruptive" effect. Responding to time and cost pressures, and the desire to move care to the patient, other workers, such as radiologists, will drive the trend away from isolated, complex, large-scale devices, and toward integrated, modular, and simpler networked technologies. In summary, technological "push" will continue in the demanding cutting-edge application areas as always, but the "disruption" will occur through wider application of lower-cost technologies, pulled by the users. The capabilities described by Moore's Law will allow the advancements necessary to facilitate this dissemination of capability and its ultimate benefit, so long sought.

Cost-Benefit Analysis↗
PubMed2004

The challenge of leadership in technology and education.

The leadership qualities necessary today in technology, education, and other modern organizations include the ability to recognize rapid changes in organizational environments and ensure continuous transformation and adaptability to that change. The important skills of such leaders include understanding their own business, articulating vision, creating a positive culture, communicating effectively, and measuring results. Rapidly emerging technology is prone to misunderstanding by those who mistake the surface features of how technology works with the functional opportunities it provides. Organizations that transform processes in parallel by adopting new technologies can expect much larger productivity gains than can those who merely insert technology. The problems of memory, speed, and cost have been addressed; the new challenge of technology is making it universal. Education in America is in danger. The infrastructure is outdated and it is not oriented toward change. Jobs will follow competence. Although the challenges of leadership today, especially in technology and education, are great, so is the opportunity for impact and the excitement of bringing diverse skills to bear.

Administrative Personnel↗
PubMed2005

Cyber-anthropology: a new study on human and technological co-evolution.

For the first time cyber-anthropology is defined as a concept and a new field of study aimed at the analysis of person's reciprocal relations with the computer-generated (CG) world evolved as a result of technological progress. In the cyber-era, simulated reality has come to the point of becoming a force that has the potential to transform the human race. Digital beings such as virtual and embodied agents, although not a part of the natural human habitat, have become necessary elements of people's surroundings and life conditions. As a theoretical construct, Cyber-anthropology is concerned with the merger of natural and artificial worlds mediated by the human imagination, as well as compatibility between people and digital life they have created. As an empirical study, Cyber-anthropology deals with the psychophysiology and psychophysics, semantic and semiotics of human engagement with computer-generated reality that is viewed as a Complex Interactive System. Personal competence as a crucial element of any cyber-system underlines the importance of psychological culture in artificial world exploration. A newly developed concept of Psychological Culture is viewed as an essential part of Cyber-anthropology while concentrating on the following core issues: (1) ethical questions, such as whether or not technological tools can be employed to solve human problems; (2) moral consequences of bringing cutting edge technology into our every day life; (3) studies of individual differences regarding psychological competence of technology users through effective vs. ineffective, independent vs. addictive, and active vs. passive dichotomies. Psychological Culture is defined as the study of a person's competence associated with the use of modern technology and individual acceptability of technological innovations. Several crucial dilemmas arise when a human being is engaged in a simulated environment, and artificial agents inhabit a human world. The ultimate goal of Psychological Culture is to provide people with the knowledge necessary for adequate recognition of scientific innovations to overcome obstacles in the process of implementing technology to enhance human well being.

Anthropology↗
PubMedDate not supplied

Technical and technological skills assessment in laparoscopic surgery.

OBJECTIVES: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation. METHODS: Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room. RESULTS: One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=<0.05. Construct validity for both technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=<0.05. CONCLUSIONS: Our study demonstrates that technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations.

Adult↗