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PubMedDate not supplied

High-tech home care for nurses: questioning technologies.

To build a common ground for questioning, this paper describes and defines technology, inappropriate technology, technology assessment, and technological regimes that community health nurses confront. Then, control of technology and effects on individual, family, and community are explored. In conclusion, two decision-making guides are proposed to help the home health nurse assess the human effects of technology and to support family decisions about whether technology is appropriate.

Adaptation, Psychological↗
PubMedDate not supplied

[The development of a technology for the production of live dried vaccines against avian pasteurellosis and swine erysipelas].

The technology of the production of dried live vaccine against Pasteurella infection of fowl from Pasteur's 2nd avirulent strain, strains AB and K, has been developed. This technology includes the process of batch cultivation of Pasteurella cells, controlled in such parameters as eH, pO2 and glucose concentration, in fermenters in optimized culture medium, based on Hottinger hydrolysate and fermentative casein-yeast hydrolysate, and preservation in improved saccharose-gelatin medium prepared in potassium sulfate buffer solution. The new technology makes it possible to increase the yield of preparations with stable biological activity 5- to 13-fold in comparison with the traditional technology. Furthermore, the technology of the production of live dried vaccine against swine erysipelas from Erysipelothrix insidiosa strain BP-2 has been developed. This technology is based on maintaining the optimum conditions of the batch cultivation of E. insidiosa in meat medium based on Hottinger hydrolysate and media obtained from hydrolysate of pancreatic fermentation products of microbial biomass; the preparation thus obtained is stabilized in peptone-saccharose-gelatin medium prepared in potassium phosphate buffer solution. This increases the yield of the vaccine 8-fold in comparison with the traditional technology, while ensuring the stability of bacteria after drying and during prolonged storage.

Animals↗
PubMedDate not supplied

Imaging: an innovative technology.

Imaging systems combine several technologies to bring the visual dimension to the information age. Computer literature identifies imaging technology as one of the top five fastest growing technologies for the 1990s, with a projected growth rate of 54% and revenues of $6.8 billion by the end of 1993 (Runyan, 1989). Acceptance and use of digital imaging systems have grown because of the maturation of some key technologies which underlie image processing and the increased demand for image and graphic applications in the commercial and scientific sectors. This article presents the historical development of imaging technology, along with a brief description of how the technology works. Current limitations and future possibilities of the digital imaging process are presented. Applications and implications of this technology also are discussed.

Diagnostic Imaging↗
PubMed1993

Technology dependency and iatrogenic injuries.

Research on iatrogenic injuries and technology dependency is sparse in light of the expansive use of technology in health care today. Many of the publications are single case reports of an iatrogenic injury related to a specific type of device. Little has been done to analyze these reports in a collective fashion. Nursing research is especially limited, and most studies were located in the medical literature. The majority of research has been done in pediatric populations with major emphasis on respiratory and nutritional technology. In contrast, little research has been done with adults who are ventilator dependent. Perhaps the paucity of research in this area is related to the Food and Drug Administration (FDA) requirements for technology safety before placement of a device on the health care market with the subsequent assumption by health care personnel that the technology is safe and effective. The challenge for the future is to build programs of nursing research that (1) describe the incidence and nature of iatrogenic injuries associated with technologies that are of high volume and for which many patients are dependent and (2) to tests ways to prevent iatrogenic injuries associated with technologies often used in nursing practice.

Adult↗
PubMedDate not supplied

Implementing instructional technology. Strategies for success.

This article describes strategies for the integration of computer technology in a university-based school of nursing. Faculty concerns related to use of computer technology were assessed in a previous study. A series of computer technology and literacy workshops were developed based on this assessment. Computer use increased and faculty concerns about technology decreased after workshop participation. Other strategies to integrate computer technology include developing an informatics committee and planning and initiating a technology infrastructure consisting of hardware and software resources, and a local area network. Strategic planning was initiated placing increasing emphasis on curriculum integration of computer technology and nursing informatics.

Attitude to Computers↗
PubMed1998

Utilization of intensive care unit technology.

Technology utilization in acute and critical care holds great promise for improving the management and outcome of patients. However, before this promise can be realized, technology has to be properly evaluated for appropriateness of use. This evaluation must include both the clinical impact on patient outcomes as well as the economic impact. Following this initial evaluation, for technologies deemed appropriate for use, careful preparation of clinicians in the use of the technology is necessary. Education must prioritize how the technology is to be used as well as provide incentives for the clinicians to change their current practice. If these three key steps are followed, technology can achieve the promise of improving patient management and outcome. Unfortunately, evidence exists which suggests that these three steps are not followed in many, if not most, hospitals in the United States. In this article, a method of implementing these three steps is presented. However, it is essential that national organizations and societies become active in this process, lest widespread variation in technology utilization continue.

Attitude of Health Personnel↗
PubMed2001

Barriers that impede the adoption of pediatric information technology.

BACKGROUND: Information technology (IT) is a critical but underused component of health care. Many factors contribute to the inconsistent adoption of IT. OBJECTIVE: To review the literature to better elucidate barriers that are likely to affect the adoption of IT by pediatric professionals. DATA SOURCES: Manuscripts were found using a MEDLINE search combining the terms medicine, information systems, and technology transfer. I also obtained references cited by relevant articles. Finally, I explored the Internet using http://www.google.com and http://www.northernlight.com. STUDY SELECTION: Articles discussing barriers or factors affecting the adoption of IT were considered for inclusion. Articles unrelated to clinical IT were excluded. DATA SYNTHESIS: A variety of barriers exist that affect the adoption of useful technologies. Situational barriers include challenges imposed by the current national health environment, financial and legal risks associated with technology purchasing and use, and access to technology. The most significant barrier is that pediatric health care practitioners may lack the knowledge or training to use IT effectively. CONCLUSIONS: Although some barriers exist that may be challenging to overcome, other barriers, such as the lack of knowledge about the uses of IT, are imminently solvable. Efforts to overcome these barriers should begin in earnest and should include educating stakeholders in the care of children and adolescents, as well as improving the knowledge about various technologies available to support pediatric and adolescent health care.

Biomedical Technology↗
PubMed2006

Tackling the chemogenomic space by novel screening technologies.

Drug discovery in the chemogenomic space has seen some tremendous changes over the last decade. Compared to previous times, not only the number of available chemical compounds for screening, but also the number of molecular targets used for screening has increased significantly. This has triggered the need for very fast, efficient, and effective novel readout technologies for compound testing. Novartis has developed two novel high-throughput screening (HTS) technologies for that purpose--NanoScreen and SpeedScreen. NanoScreen is a highly miniaturized and fully automated HTS/uHTS test system with confocal single-molecule as well as non-confocal detection capabilities and is used for functional screening in the range of 1-5 microl per sample. The integration of the single-molecule readout technologies into the system enables highly sophisticated biochemical test systems with multi-parameter readout for very high data quality. SpeedScreen is a highly miniaturized and automated screening system for high-throughput affinity-selection of compounds. In practice, pools of compounds are incubated with the target protein and the unbound chemical compounds are removed from the target-compound complex via very fast, multiparallel size-exclusion-chromatography. The holoenzyme is disintegrated and analyzed via microbore reversed-phase high performance liquid chromatography (microbore RP-HPLC). Both systems have been developed and implemented with great success at the Novartis Lead Discovery Center (LDC) in Basel. These technologies have enabled us to access targets that would otherwise not have been possible, e.g., very expensive targets, "orphan" drug targets, or targets that are "non-tractable" by conventional screening technologies. Taken together, these novel screening technologies enable novel approaches for chemogenomic research that would have not been possible in the past.

Animals↗
PubMed1989

Technology and the work of the doctor outside the hospital.

This article examines the ends to which technology are employed in the office practice of medicine. It argues that the types of decisions technology supports are of greater impact on how medicine is practiced over the long view than the actual technologies themselves. The more relevant the technologies are to the effectiveness of diagnosis and treatment, the more they drive the practice of medicine toward a standard endeavor. Similarly, technologies that make existing tests and procedures more efficient often reduce the skill level that is needed to provide care. The results of these forces coupled with the increasing administrative, economic, and regulating pressures lead to a diminished role for physicians unless a conscious effort is made to introduce technologies that enhance their unique and discretionary work with patients.

Decision Making↗
PubMed1998

Basis for decisions on emerging health technology. A Danish feasibility study.

The objectives of the feasibility study were to evaluate sources of information for an eventual Danish system for early identification and assessment of emerging health technology, to identify potential users of the system, and to clarify their specific need for information concerning emerging health technology. The methods used were questionnaires to informants within and outside the health services and to decision makers on different levels in the health services, and follow-up telephone interviews. Our study reveals a strong, and to some extent unsatisfied, need among policy makers, planners, and managers in the Danish health services for information concerning emerging health technology. The requested information should in particular concern indication for use, number of patients affected, clinical effectiveness and side effects, running cost, and investments. The time horizon most relevant to the decision makers seems to be only zero to 2 years. Furthermore, we found that numerous sources are available that frequently display information on emerging technology important to the health services. The challenges seem to be to select information of sufficient importance and quality, and to combine information, since very few, if any, single primary sources cover all the requested information. In conclusion, we recommend the establishment of a Danish national system for early identification and assessment of emerging health technology, consisting of a small secretariat that collaborates nationally and internationally, the latter in particular on identification of technology and on development of methods for early assessment.

Decision Making↗
PubMed1991

Resource allocation in contemporary paediatrics: the case against high technology.

High technology has introduced a new dimension to medical treatment. There are inevitable social costs as well as benefits, and the allocation of resources to high technology, as opposed to other areas of health care, is a contentious issue. The current balance in health service funding between high technology and low technology is not appropriate. It is driven by the technological imperative and only offers solutions to a limited number of problems. There is a scarcity of health resources left to develop intersectoral responses and provide adequate funding for research into person-intensive interventions suitable for many problems. Arguments against allocating too many resources to high technology in paediatrics are examined in this paper.

Australia↗
PubMed1994

Colliding forces in radiology: technologic imperative, resource limitations, and accountability demands.

Advances in radiology over the past 20 years are the product of a technologic imperative that has produced new approaches to the acquisition of medical images and modifications to conventional approaches. The imperative has placed radiology at the leading edge of the computer-technology era of modern medicine and has also produced several big-ticket technologies that have been identified as major contributors to rising health care costs. Consequently, the demands for quantitative data on the impact and cost-effectiveness of the use of these technologies in the clinical arena are increasing. Meeting the growing demand for accountability in radiology requires that the discipline adopt innovative approaches for assessing its technologies and acquire new types of data, including documentation of cost savings accrued by selective use of radiologic technologies and demonstration of the efficiency and cost-effectiveness of triage schemes that lead to more effective decision making. The requirement of quantitative accountability represents a new way of doing business for radiology and a new approach to management for those responsible for business.

Cost-Benefit Analysis↗
PubMed2003

Frankensteins and cyborgs: visions of the global future in an age of technology.

This paper draws attention to the role of representation in the depiction of scientific and technological innovation as a means of understanding the narratives that circulate concerning the shape of things to come. It considers how metaphors play an important part in the conduct of scientific explanation, and how they do more than describe the world in helping also to shape expectations, normalise particular choices, establish priorities and create needs. In surveying the range of metaphorical responses to the digital and biotechnological age, we will see how technologies are regarded both as 'endangerment' and 'promise.' What we believe 'technology' is doing to 'us' reflects important implicit philosophies of technology and its relationship to human agency and political choice; yet we also need to be alert to the assumptions about 'human nature' itself which inform such reactions. The paper argues that embedded in the various representations implicit in the new technologies are crucial issues of identity, community and justice: what it means to be (post)human, who is (and who is not) entitled to the rewards of technological advancement, what priorities (and whose interests) will inform the shape of global humanity into the next century.

Biomedical Technology↗
PubMed1994

The dynamics of technological change in medicine.

This paper contrasts a dynamic and interactive view of technological change with the linear model of medical innovation that is still so deeply ingrained in many policy discussions. In particular, it focuses on the role of feedback mechanisms between the users and the developers of medical technology and the demand and supply forces (including competition among medical specialties) determining this feedback. It explores three distinct mechanisms by which technological change may contribute to rising health care spending: intensity of use of existing technology, introduction of new technologies, and expanded application of these new technologies.

Diffusion of Innovation↗
PubMed1999

Auto-disable syringes for immunization: issues in technology transfer.

WHO and its partners recommend the use of auto-disable syringes, "bundled" with the supply of vaccines when donor dollars are used, in all mass immunization campaigns, and also strongly advocate their use in routine immunization programmes. Because of the relatively high price of auto-disable syringes, WHO's Technical Network for Logistics in Health recommends that activities be initiated to encourage the transfer of production technology for these syringes as a means of promoting their use and enhancing access to the technology. The present article examines factors influencing technology transfer, including feasibility, corporate interest, cost, quality assurance, intellectual property considerations, and probable time frames for implementation. Technology transfer activities are likely to be complex and difficult, and may not result in lower prices for syringes. Guidelines are offered on technology transfer initiatives for auto-disable syringes to ensure the quality of the product, the reliability of the supply, and the feasibility of the technology transfer activity itself.

Disposable Equipment↗
PubMed1994

Technology assessment in dentistry.

Technology, in the context of dental health care, is a term that can encompass systems such as water fluoridation, clinical procedures such as sealants, or clinical protocols such as antibiotic coverage of patients with a history of heart surgery. Similarly, the term technology assessment (TA) describes a multidisciplinary, scientific process established to guide policy on the adoption and distribution of health technologies. While this process is already well established in medicine, it is just beginning in dentistry. As such, TA is still evolving in dental care in terms of methods and process. TA is required to guide the content of curriculum and standards of practice in a rapidly changing dental environment. It should precede the adoption or deletion of both technologies and of writing practice guidelines. TA makes it possible to shed inappropriate technologies or the inappropriate application of existing technologies, which may free resources to pay for improvements in the dental care we offer.

Canada↗
PubMed1994

Technology assessment of endoscopic surgery.

Endoscopic surgery is considered a milestone in the evolution of surgical technique in nearly all fields of surgery. However, the inappropriate use of the new technology in medicine has also been heavily criticised. Systematic technology assessment of endoscopic surgical techniques is mandatory to prove the real benefits and complications, so defining the indications for their appropriate use. This article describes methods of technology assessment suitable for endoscopic techniques with emphasis on relevant endpoints for surgeons and patients. The general stages of a comprehensive technology assessment include: 1. feasibility (safety and technical performance) 2. efficacy (patient benefits in pioneering places) 3. effectiveness (patient benefits in average hospitals in the community as a whole) and 4. economic evaluation (cost-benefit analyses). We used the example of laparoscopic cholecystectomy to describe the methods of technology assessment. A cohort study on 500 patients revealed that laparoscopic cholecystectomy is as safe as the conventional standard open technique. The results on efficacy strongly support the hypothesis of more comfort and less trauma with the endoscopic technique. Major endpoints evaluated were postoperative pain, convalescence, fatigue and quality of life. Data on effectiveness and economics are still in a "premature" state and should be the subject of further analyses. It is concluded, that other disciplines such as neurosurgery should evaluate their endoscopic surgical techniques according to the rules of technology assessment outlined in this paper.

Cholecystectomy, Laparoscopic↗
PubMed1996

The review process used by US health care plans to evaluate new medical technology for coverage.

OBJECTIVE: To examine the process and information used by medical directors (MDs) of private health plans to make medical coverage determinations for new medical technologies, and to assess the influence of plan characteristics on the process. DESIGN: Cross-sectional national survey. PARTICIPANTS: Two hundred thirty-one MDs at private health plans representing 66% and 72% of the US population covered by HMOs and indemnity plans, respectively. MEASUREMENTS: Actual and optimal review process, final decision authority, sources, and evidence used for technology coverage decisions. RESULTS: In 96% of plans, MDs take part in the medical policy review process for new technology. However, MDs have final authority over coverage decisions in only 27% of plans. Indemnity plans are more likely to assert that MDs should be responsible for final decisions, odds ration (OR) = 3.3 (95% confidence interval [95% CI] 1.4, 10). Optimal sources of information of new technology were journals, medical society statements or practice guidelines, and opinions of national experts. Actual sources of information used differed from optimal ones; local experts were used more often than is considered optimal (p < .001). For-profit plans were more likely than nonprofit plans to use national experts, OR 2.5 (95% CI 1.3, 5.0), and practice guidelines, OR 5.0 (95% CI 2.5, 10). Randomized trials (94% of MDs) meta-analyses (61%), and reviews (42%) were considered the best evidence for making coverage decisions. Barriers to making optimal decisions were lack of timely evidence on effectiveness and cost-effectiveness, not legal or regulatory issues; HMO, small, and nonprofit plans were two or three times more likely to list lack of cost-effectiveness data than their counterparts (p < .05). CONCLUSIONS: Although MDs are nearly always involved in the technology evaluation process, a minority of MDs retain final authority over coverage decisions. Evidence from strong scientific research designs is the most frequently cited basis for decisions, but there is need for more timely, rigorous scientific evidence on medical interventions. How a health plan evaluates a new medical technology for coverage varies with identifiable plan characteristics.

Cross-Sectional Studies↗