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PubMedDate not supplied

[The impact of technology in Pathological Anatomy and the contribution of this speciality to technological development].

It is obvious that technology has contributed throughout history to the development of the different sciences. In this article, we define the concept of Pathology as a medical speciality, and we explain its influence in a hospital, considering very different fields such as education, research, quality control, hospital information, and patient care. This speciality has undergone a considerable evolution, to which technological innovation has undoubtedly contributed. As a basic discipline, it is of great importance in pre and post-graduate training, in the medical education at the hospital or outside it, and in the fields previously mentioned. Its relation with other disciplines such us Chemistry, (fixation and dyeing), Physics (mechanical devices), Mathematics (algorithms, morphometry, statistics...) and Telecommunications (telepathology, image analysis...) is examined and their contribution to Pathology is evaluated. We are also aware of contributions made by Pathology to technological innovation in the evaluation of different diagnostic methods or in the recent therapeutic technologies based on Radiotherapy, Hyperthermia, laser, prothesis, etc.; where histological examination provides accurate information about the therapeutic capacity or side-effects, or the rejection reactions caused, aiding the research to obtain adequate results.

English Abstract↗
PubMedDate not supplied

From computer technology to information technology. Findings from a national study of nursing education.

A research survey was conducted on a stratified random sample of National League for Nursing accredited diploma, associate, baccalaureate, and master programs to determine the status of computer and information technology in nursing education. Fifty-five percent (n = 190) of the 347 selected schools responded. Compared with national statistics, all programs (diploma, associate, and higher degree) were proportionately represented. Findings indicated that schools have almost universal access to computers and educational software. However, further data analysis indicated that a majority of schools lacked a coordinated plan for technology implementation and were underfinanced for technology and related personnel. In addition, less than one third of the schools addressed nursing informatics (the information of nursing) in the curriculum and only 19 schools indicated that nursing informatics was offered as a separate course. Successful strategies for the implementation of computer and information technology are presented based on the findings.

Computer User Training↗
PubMed2006

Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems).

OBJECTIVES: Australia, Canada, and many European countries now use various forms of health technology assessment (HTA) in decision making regarding the reimbursement of drugs and other health technologies. To achieve a better understanding of the potential for use of HTA in this context, an analytical framework was developed to describe and classify existing fourth hurdle systems. METHODS: Based on a review of published literature, and official documentation, the key aspects of a fourth hurdle system were identified at two levels: policy implementation and individual technology decision. Characteristics of the systems were grouped under four main headings: constitution and governance, objectives, use of evidence and decision processes, and accountability. The comprehensiveness and relevance of this framework was assessed by an independent group of experts in HTA. A pilot study was undertaken, using only published sources, to test the feasibility of obtaining the information needed to complete the framework. RESULTS: The framework was found to be sufficiently broad to encompass all the issues of interest regarding the systems, but the proportion of information available from published sources was variable between sections of the framework and between countries, with average availability of 45 percent. CONCLUSIONS: The analytical framework will help researchers and policy makers in individual countries to understand their own systems and will allow some preliminary sharing of experience between countries. More experience of its application is needed to judge whether it will provide the basis for more formal comparison of systems and whether it will determine their appropriateness for particular decision contexts.

Australia↗
PubMed1990

[Technology development as social process: prospects and frontiers of social scientific elucidation of technological advancement].

This article provides an overview of the new developments in social scientific technology research which have changed considerably as a result of public debate and reactions to the importance of advancements in technology. The shift in emphasis, away from the effects of technology to its shaping, is described and certain hypotheses and concepts of advancement in the study of the social conditions underlying technical development processes are presented.

Culture↗
PubMed1994

Current status of economic appraisal of health technology in the European Community: report of the network. The EC Network on the Methodology of Economic Appraisal of Health Technology.

The use of economic evaluation to assess the costs and consequences of health care technologies has steadily increased in recent years. However, little is known about the influence economic studies have on health care decision makers or policy at local and national level. This paper reports the results of a survey of economic evaluations in EC countries to identify the impact of the results on decision and policy making in health care. Health service researchers in 10 EC countries were identified and asked to participate in the survey. The researchers were asked to locate economic evaluations in their country and complete a standardised questionnaire for each study. The criteria for inclusion in the survey were first, the studies should have been started or reported since 1987, second, the evaluations should include a comparison of the cost and consequences of the technologies assessed and finally, the appraisals should include a comparison of alternative health care technologies or programmes. A total of 66 studies which met the survey criteria were reported. Of these, 27% were thought to have influenced health care decision makers or policy. The results suggested that method of dissemination, source of funding and purpose of the study may be important determinants of whether an economic evaluation will be used in health care policy or decision making. The results of the survey suggest that economic evaluation currently has a relatively low impact on health care policy or decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed2006

Development and evaluation of a novel dry-coated tablet technology for pellets as a substitute for the conventional encapsulation technology.

Pellet formulations as represented by multiparticulate systems are often contained in hard capsules. We examined the use of a different approach to the making of compressed tablets containing pellets, OSDRC-technology. OSDRC-technology employs a double-structure punch (center punch and outer punch) allowing for dry-coated tablets to be assembled in a single run. We examined the effects of the thickness of the outer punch, formability of pellets, and diameter of tablets on pellet filling. The results revealed that thinner outer punches are not always better for filling small tablets with large amounts of pellets. We considered that this was because the core pellets spread in a cone shape within the formulating tablets at filling, requiring a thickness of the outer punch and a particle density of the diluents at which pellets would not exude from the formulating tablets. It was suggested that the formability of core pellets affects the maximum number of layers of pellets, and higher formability would yield better results. However, we found that pellets with poor formability (tensile strength of < or =2 kPa) could be used in tablets. For the tablets, the larger the diameter, the greater the maximum number of layers. We considered this to be due to the friction between the pellets and punch wall. We concluded that OSDRC-technology could be applied to capsule-like forms containing pellets > or =50 wt% through an unconventional approach.

Cellulose↗
PubMed1998

International collaboration in health technology assessment: a study of technologies used in management of osteoporosis.

A collaborative study was undertaken by members of the International Network of Agencies for Health Technology Assessment (INAHTA). The evidence of the effectiveness of bone density measurement and selected treatments in preventing fractures in later life was reviewed. There was fair evidence that bone density measurement can predict risk of fractures and that hormone replacement therapy and intranasal salmon calcitonin preserve bone mass and decrease the risk of fractures. However, it was estimated that only 1-7% of hip fractures would be prevented if these technologies were used in a screening program for menopausal women. Results of the assessment were endorsed by 13 INAHTA members, disseminated widely and provided input to policy and further work in this area. The project demonstrated the feasibility of international collaborative health technology assessment.

Bone Density↗
PubMed2004

Managing team interpersonal processes through technology: a task-technology fit perspective.

This article addresses the broad question, How can virtual teams that manage a majority of their interactions through information and communication technologies (ICTs) be made more effective? Focusing specifically on interpersonal interactions, the task-technology fit paradigm is used as the foundation for a theoretical model that seeks to identify how such teams can match available communication technologies to the different types of interpersonal interactions in which they engage. The authors draw on media synchronicity theory to identify the functionalities of the wide range of ICTs available today, and map these functionalities onto the salient communication needs of 3 key interpersonal processes: (a) conflict management, (b) motivation and confidence building, and (c) affect management. The model also incorporates a temporal dimension examining how the communication needs, and hence, the need for ICT functionality, varies depending on the virtual team's developmental stage. Opportunities for future research arising from the theoretical model are discussed.

Conflict, Psychological↗
PubMed2006

Comparison of conference abstracts and presentations with full-text articles in the health technology assessments of rapidly evolving technologies.

OBJECTIVES: To assess the extent of use of data from conference abstracts and presentations in health technology assessments (HTAs) provided as part of the National Institute for Health and Clinical Excellence (NICE) appraisal process. Also to assess the methodological quality of trials from conference abstracts and presentations, the consistency of reporting major outcomes between these sources and subsequent full-length publications, the effect of inclusion or exclusion of data from these sources on the meta-analysis pooled effect estimates, and the timeliness of availability of data from these sources and full articles in relation to the development of technology assessment reviews (TARs). DATA SOURCES: A survey of seven TAR groups. An audit of published TARs: included all NICE TARs published between January 2000 and October 2004. Case studies of selected TARs. REVIEW METHODS: Analyses of the results of the survey and audit were presented as a descriptive summary and in a tabular format. Sensitivity analyses were carried out to compare the effect of inclusion of data from abstracts and presentations on the meta-analysis pooled effect estimates by including data from both abstracts/presentations and full papers, and data from only full publications, included in the original TAR. These analyses were then compared with meta-analysis of data from trials that have subsequently been published in full. RESULTS: All seven TAR groups completed and returned the survey. Five out of seven groups reported a general policy that included searching for and including studies available as conference abstracts/presentations. Five groups responded that if they included data from these sources they would carry out methodological quality assessment of studies from these sources using the same assessment tools as for full publications, and manage the data from these sources in the same way as fully published reports. All groups reported that if relevant outcome data were reported in both an abstract/presentation and a full publication, they would only consider the data in the full publication. Conversely, if data were only available in conference abstract/presentation, all but two groups reported that they would extract and use the data from the abstract/presentation. In total, 63 HTA reports for NICE were identified. In 20 of 63 TARs (32%) explicit statements were made with regards to inclusion and assessment of data from abstracts/presentations. Thirty-eight (60%) identified at least one randomised controlled trial (RCT) available as a conference abstract or presentation. Of these, 26 (68%) included trials available as abstracts/presentations. About 80% (20/26) of the 26 TARs that included RCTs in abstract/presentation form carried out an assessment of the methodological quality of such trials. In 16 TARs full reports of these trials were used for quality assessment where both abstracts/presentations and subsequent full publications were available. Twenty-three of 63 TARs (37%) carried out a quantitative analysis of results. Of these, ten (43%) included trials that were available as abstracts/presentations in the review; however, only 60% (6/10) of these included data from abstracts/presentations in the data analysis of results. Thirteen TARs evaluated rapidly evolving technologies and only three of these identified and included trial data from conference abstracts/presentations and carried out a quantitative analysis where abstract/presentation data were used. These three TARs were used as case studies. In all three case studies the overall quality of reporting in abstracts/presentations was generally poor. In all case studies abstracts and presentations failed to describe the method of randomisation or allocation concealment. Overall, there was no mention of blinding in 66% (25/38) of the abstracts and in 26% (7/27) of the presentations included in case studies, and one presentation (4%) explicitly stated use of intention-to-treat analysis. Results from one case study demonstrated discrepancies in data made available in abstracts or online conference presentations. Not only were discrepancies evident between these sources, but also comparison of conference abstracts/presentations with subsequently published full-length articles demonstrates data discrepancies in reporting of results. Sensitivity analyses based on one case study indicated a change in significance of effect in two outcome measures when only full papers published to date were included. CONCLUSIONS: There are variations in policy and practice across TAR groups regarding searching for and inclusion of studies available as conference abstracts/presentations. There is also variation in the level of detail reported in TARs regarding the use of abstracts/presentations. Therefore, TAR teams should be encouraged to state explicitly their search strategies for identifying conference abstracts and presentations, their methods for assessing these for inclusion, and where appropriate how the data were used and their effect on the results. Comprehensive searching for trials available as conference abstracts/presentations is time consuming and may be of questionable value. However, there may be a case for searching for and including abstract/presentation data if, for example, other sources of data are limited. If conference abstracts/presentations are to be included, the TAR teams need to allocate additional time for searching and managing data from these sources. Incomplete reporting in conference abstracts and presentations limits the ability of reviewers to assess confidently the methodological quality of trials. Where conference abstracts and presentations are considered for inclusion in the review, the TAR teams should increase their efforts to obtain further study details by contacting trialists. Where abstract/presentation data are included, reviewers should discuss the effect of including data from these sources. Any data discrepancies identified across sources in TARs should be highlighted and their impact discussed in the review. In addition, there is a need to carry out, for example, a sensitivity analysis with and without abstract/presentation data in the analysis. There is a need for research into the development of search strategies specific to identification of studies available as conference abstracts and presentations in TARs. Such strategies may include guidance with regard to identification of relevant electronic databases and appropriate conference sites relevant to certain clinical areas. As there are limited case studies included in this report, analyses should be repeated as more TARs accrue, or include the work of other international HTA groups.

Adult↗
PubMed1986

Medicare payment for new technologies. Can the process be improved despite conflicting goals? An ECRI technology management assessment.

Decisions about Medicare payment for new technologies are made by a multiagency process that became even more complex with the advent of DRG-based payments for inpatient care. Numerous problems with this decision-making process are widely acknowledged to exist but difficult to solve because of inherent conflicting goals. This report proposes consideration of basic improvements to the process, including: increased support for clinical and cost studies, particularly from manufacturers of new technologies; approval of provisional payments to providers who agree to collect effectiveness and cost data; additional research into technology assessment methods; clarification of decision-making criteria; opening of the coverage-decision process to greater public scrutiny; according more weight to recommendations of the Prospective Payment Assessment Commission; submission of additional data to the Food and Drug Administration; and increasing the flow of information among Medicare coverage-decision agencies and other third-party payers. Many of these modifications can be accomplished without congressional action, if the interested parties are willing to work together to improve the coverage-decision process.

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

[Technology assessment and operating procedures for the technological resources in the new Community Health Service].

INTRODUCTION: The main purpose of this contribution is to set today's situation of technology assessment and point to some organizing and integrative ways with the evolution concern ASL (Local Health Firm). PATIENTS AND METHODS: We outline main critical processes that fix correct management of technological resource thought data available in national and international literature. We single out more common methods to quantify, evaluate, control and manage biomedical technologies. RESULTS: We expound decisional process that lead Viterbo ASL (Local Health Firm) to a progressive controll of tecnological resource and its management after aggregation of the five USL (Local Health Units) that constituted Viterbo ASL and describe procedures assumed. CONCLUSIONS: We underline the importance of full and complete information in business and decisional process. Inside the complexity of italian view, we outline an organizative solution with a low economic impact and with a high technical content.

Decision Making, Organizational↗
PubMedDate not supplied

Medical technology assessment: economic evaluation of new technologies.

Growing expenditures in health care made it necessary to find control mechanisms to evaluate expenditure. Medical technology assessment is becoming a valuable tool to assist policymakers in controlling new medical technologies. This review deals with the increasing importance of economic evaluation as part of medical technology assessment and describes various techniques by which an economic evaluation can be performed.

Cost Control↗
PubMed1993

Court-ordered reimbursement for unproven medical technology. Circumventing technology assessment.

OBJECTIVE--Because we found examples where courts of law ruled against insurance carriers that had been sued for reimbursement for unproven medical procedures, we conducted a case study to determine the reasoning behind these decisions that run counter to accepted medical science. Such actions circumvent health technology assessment and could contribute to escalating health care costs and poorer quality health care. DATA SOURCES--A literature search identified 17 cases between 1980 and 1989 in which an insurance company was sued to reimburse a patient who had received an unproven or questionable health technology; 14 of these suits were decided in favor of the plaintiff, and the insurance company was ordered to pay. Discussed in this article are six of these cases, two involving Laetrile (amygdalin), two involving immunoaugmentative therapy, and two involving thermography, technologies that had previously been assessed as not safe, not effective, or inadequately evaluated. DATA SYNTHESIS AND CONCLUSIONS--The circumstances determining how the courts arrive at these "unscientific" decisions fall into three general categories: (1) for legal reasons, the insurance contract is interpreted in favor of the insured; (2) the reluctance and/or inability, legal or otherwise, of the courts to use published scientific literature; and (3) the use of adversarial "expert" witnesses with potential conflicts of interest. To address this situation, we first urge the legal and insurance industries to cooperate in improving the contract language and process in a way that would be both legally and scientifically appropriate. Second, we encourage the courts to use and foster the use of published peer-reviewed scientific material as evidence whenever possible. Third, we recommend that the courts choose their own unbiased expert witnesses to interpret scientific material.

Amygdalin↗
PubMed1997

Health technology assessment in Australia: the role of AHTAC. Australian Health Technology Advisory Committee.

This paper outlines and discusses the field of medical technology assessment and the role of the Australian Health Technology Advisory Committee (AHTAC) in that process. Developments in medical technologies have altered the way in which health care is practised and delivered. The policy task is a complex one; attempting to balance the need for cost containment whilst at the same time ensuring that the processes of innovation into Australia, and diffusion occur in a manner which maximises the benefit and minimises any harm to the Australian community.

Australia↗
PubMed2006

International diffusion of new health technologies: a ten-country analysis of six health technologies.

OBJECTIVES: The objective of this study was to examine and explain the differential international diffusion of six health innovations. METHODS: A retrospective diffusion study was undertaken of sildenafil, cyclooxygenase-II (COX II) inhibitors, beta interferon, verteporfin, deep brain stimulators, and drug-eluting coronary stents in ten countries-Australia, Canada, Denmark, France, The Netherlands, Norway, Spain, Sweden, Switzerland, and the United Kingdom. We plotted diffusion curves of daily defined doses per quarter, vials or implants per million population, and examined the association between diffusion and five key variables. RESULTS: Canada, Switzerland, and Sweden are generally high users of new technologies; Spain, Denmark, and particularly the United Kingdom are low users. Almost all countries experienced rapid adoption of sildenafil with diffusion to a similar level; there was variable adoption and diffusion of COX II inhibitors, verteporfin, and interferon beta; drug-eluting stents penetrated the market in a similar way in all but one country; and two countries had very different adoption patterns for deep brain stimulators. Above average health spending and the presence of health technology assessment (HTA) or other guidance reports are consistently associated with increased diffusion. Early warning activity and a national coverage decision being taken are more likely to be associated with a reduced diffusion. CONCLUSIONS: The significant differences in diffusion between different countries are not consistent with a neat evidence-based world. The tools available to policy makers to control diffusion (early warning systems, HTA, and a fourth hurdle) play some part in influencing diffusion but need close scrutiny of how successfully they operate.

Australia↗
PubMed2001

SHORT REPORT Technological dreams: The implications of new technologies for occupational therapy education and evidence-based practice.

Computer technologies will change both occupational therapy education and practice. Technological optimists suggest that there will be positive benefits for distance learning and supervision, universal equal access to information and expertise, and positive cross-cultural exchange. However, technologies have inevitable and unexpected costs. In this report I explore the potential for future problems with professional induction, educational reductionism, cultural imperialism and deprofessionalization through a review of the literature. I suggest that early recognition of the costs as well as the benefits of computer-based education will be important to the development of international occupational therapy.

Journal Article↗
PubMed2000

Assisted reproductive technology in the United States: 1997 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1997. DESIGN: Data were collected electronically by using Society for Assisted Reproductive Technology Clinical Outcome Reporting System software and were submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): 335 programs submitted data on procedures performed in 1997. Data were collated after November 1998 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and structural and functional abnormalities. RESULT(S): Programs reported initiating 73,069 cycles of ART treatment. Of these, 51,344 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 27.9%; 1,943 were cycles of GIFT, with a delivery rate per retrieval of 30.0%; and 1,104 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 28.0%. The following additional ART procedures were also initiated: 4,616 donor oocyte cycles, with a delivery rate per transfer of 40.0%; 10,181 frozen embryo transfer procedures, with a delivery rate per transfer of 18.8%; 1,584 frozen embryo transfers using donated oocytes, with a delivery rate per transfer of 22.2%; and 600 cycles using a host uterus, with a delivery rate per transfer of 34.6%. Furthermore, 1,173 cycles were reported as combinations or more than one treatment type, 40 cycles as research, 258 as embryo banking, and 226 as other (unclassified) cycle types. As a result of all procedures, 17,311 deliveries resulting in 25,059 babies were reported. CONCLUSION(S): In 1997, more programs reported ART treatment and the number of reported cycles increased significantly (10.9%) compared with 1996. In comparable cycle types, the overall success rate (deliveries per retrieval) increased by 1.8%, which represents an increase of 6.9% compared with the success rate for 1996.

Abortion, Spontaneous↗
PubMed1996

Assisted reproductive technology in the United States and Canada: 1994 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1994. DESIGN: Data were collected on the Society for Assisted Reproductive Technology (SART) Database program and submitted to KMPG Peat Marwick, who served as the 1994 collection center for the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Two hundred forty-nine programs submitted data on procedures performed in 1994. Data were collected after October 1995 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULT(S): Programs reported initiations of 39,390 cycles of ART treatment, excluding frozen embryo and donor oocyte cycles. Of these, 33,700 cycles initiated were IVF (standard, with micromanipulation, and for host uterus transfer) with 20.7% deliveries per retrieval; 4,214 were cycles of GIFT with 28.4% deliveries per retrieval; 926 were cycles of zygote intrafallopian transfer with 29.1% deliveries per retrieval; and 550 were combination cycles, combining IVF and one of the tubal transfer techniques, resulting in 29.7% deliveries per retrieval. In addition to these cycles initiated in 1994, 7,046 frozen ET procedures were reported, either as separate procedures or in combination with another ART procedure with 15.4% deliveries per procedure, and 3,119 donor oocyte cycles were initiated with an overall success of 46.8% deliveries per retrieval. As a result of all procedures, a total of 9,573 deliveries were reported. CONCLUSION(S): In 1994, there were fewer programs reporting a similar number of treatment cycles of ART as in 1993. Overall average success rates (deliveries per procedures) exhibited only a small increase compared with previously reported summaries.

Adult↗