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PubMed2001

Promoting patient safety: is technology the solution?

BACKGROUND: On April 30, 2001, the Cleveland Clinic Foundation and Cleveland Clinic Health System Quality Institute sponsored a 1-day conference focused on technology in patient safety. PATIENT SAFETY-A CALL TO ACTION: Kenneth W. Kizer focused on ten high-priority patient safety strategies identified by the National Quality Forum-including implementing recognized "safe practices", recognizing and dealing with professional misconduct, and supporting efforts to create a nonpunitive environment for health care error reporting. CULTURAL IMPLICATIONS OF INTRODUCING NEW TECHNOLOGY: Randolph A. Miller described a computerized clinician order-entry system used to provide decision support, reduce excess test ordering, introduce cost savings, and meet regulations for inpatient radiology and cardiology tests. USING BAR CODES TO ELIMINATE MEDICATION ERRORS: Jeff Ramirez reported on the Veterans Health Administration's use of bar coding technology for point-of-care validation of medication administration, which has resulted in improvements in response time; the efficiency of the dispensing, delivery, and administration process; and patient care. HOW TO MAKE COMPUTERS TEAM PLAYERS: The knowledge base exists to design computers as team players that expand human expertise and help health care practitioners better create safety. Yet David D. Woods challenged the audience to anticipate the changing shape of iatrogenic risk as a result of increasing dependence on automation in health care. TECHNOLOGY AND MEDICATION SYSTEMS: Mark Neuenschwander spoke about automating various steps within the medication use system, through computerized prescriber order entry and bedside scanning. FUTURE TECHNOLOGICAL POSSIBILITIES: Charles Denham suggested how technology may aid health care professionals in their care of patients, such as in using predictive modeling to identify the risks of therapeutic intervention.

Equipment Safety↗

PubMed1995

Estimating increases in outpatient dialysis costs resulting from scientific and technological advancement.

The Medicare program's base payment rate for outpatient dialysis services has never been adjusted for the effects of inflation, productivity changes, or scientific and technological advancement on the costs of treating patients with end-stage renal disease. In recognition of this, Congress asked the Prospective Payment Assessment Commission to annually recommend an adjustment to Medicare's base payment rate to dialysis facilities. One component of this adjustment addresses the cost-increasing effects of technological change--the scientific and technological advances (S&TA) component. The S&TA component is intended to encourage dialysis facilities to adopt technologies that, when applied appropriately, enhance the quality of patient care, even though they may also increase costs. We found the appropriate increase to the composite payment rate for Medicare outpatient dialysis services in fiscal year 1995 to vary from 0.18% to 2.18%. These estimates depend on whether one accounts for the lack of previous adjustments to the composite rate. Mathematically, the S&TA adjustment also depends on whether one considers the likelihood of missing some dialysis sessions because of illness or hospitalization. The S&TA estimates also allow for differences in the incremental costs of technological change that are based on the varying advice of experts in the dialysis industry. The major contributors to the cost of technological change in dialysis services are the use of twin-bag disconnect peritoneal dialysis systems, automated peritoneal dialysis cyclers, and the new generation of hemodialysis machines currently on the market. Factors beyond the control of dialysis facility personnel that influence the cost of patient care should be considered when payment rates are set, and those rates should be updated as market conditions change. The S&TA adjustment is one example of how the composite rate payment system for outpatient dialysis services can be modified to provide appropriate incentives for producing high-quality care efficiently.

Health Care Costs↗

PubMedDate not supplied

Considering technology: living and working in a technocratic society.

In this article, a framework is provided for consideration of technologies that are frequently viewed as either a source of power or frustration. The two widely accepted paradigms of technological and social determinism are analyzed in relationship to women's health care. Those ascribing to the model of technological determinism believe that a technology, once created, takes on a life of its own. Those believing in social determinism view a technology as a neutral tool that can be used in any way that the user desires. Finally, a third model that addresses both of these propensities in conjunction with the technology and social factors underlying its use is presented and recommended for critical analysis of devices used when caring for women.

Female↗

PubMed2006

Comparative assessment of technologies for extraction of artemisinin.

This paper describes results of a multiobjective comparative assessment of several established and emerging technologies for extraction of a natural antimalarial substance, artemisinin. Extractions by hexane, supercritical carbon dioxide, hydrofluorocarbon HFC-134a, ionic liquids, and ethanol were considered. Hexane extraction is an established technology and appears to be the most cost-effective. However, it is characterized by lower rates and efficiency of extraction than all other considered techniques and is also worse in terms of safety and environmental impact. Similarly, EtOH extraction was found to be worse than hexane in all assessment parameters. The new technologies (scCO2, HFC, and ILs) are based on nonflammable solvents and are characterized by faster extraction cycles and more complete extraction of the useful substances and enable continuous extraction processes with reduced solvent inventory. Ionic liquid and HFC-134a technologies show considerable promise and should be able to compete with hexane extraction in terms of cost-effectiveness following due process optimization. New technologies are also considerably safer (no risk of explosions, low toxicity) and greener (having a lower environmental impact in use, potential for biodegradability after use). The methodology of comparative assessment of established and emerging technologies is discussed.

Antimalarials↗

PubMed2001

Foetal images: the power of visual technology in antenatal care and the implications for women's reproductive freedom.

Continuing medico-technical progress has led to an increasing medicalisation of pregnancy and childbirth. One of the most common technologies in this context is ultrasound. Based on some identified 'pro-technology feminist theories', notably the postmodernist feminist discourse, the technology of ultrasound is analysed focusing mainly on social and political rather than clinical issues. As empirical research suggests, ultrasound is welcomed by the majority of women. The analysis, however, shows that attitudes and decisions of women are influenced by broader social aspects. Furthermore, it demonstrates how the visual technology of ultrasound, in addition to other reproductive technology in maternity care, is linked to the 'personification' of the foetus and has therefore contributed to a new image of the foetus. The exploration of these issues challenges some arguments of feminist discourse. It draws attention to possible adverse implications of the technology for women's reproductive freedom and indicates the importance of the topic for political discussions.

Abortion, Induced↗

PubMed2000

From troglodytes to information managers: information management and technology needs to achieve the primary care NHS modernization agenda--the views of three GPs.

In response to the information management and technology changes proposed by the Government's NHS modernization initiative this article examines the issues that GPs feel to be of major significance to their work. Although information and communications technology is widely used in general practice there is no one agreed standard system. The level of technology and the manner in which it is used is also diverse throughout the profession, as are the attitudes that exist amongst GPs regarding the value of information management and technology, and the benefits efficient information management offers to them and to their patients. The views of three local GPs from practices with varying levels of information technology were obtained through semi-structured interviews and the findings developed in the light of current discussions in the published literature. The GPs chosen reflect the disparity within general practice and, perhaps, other units of the NHS in the use and understanding of information management. The main conclusions were that there is ambivalence and scepticism about what NHSnet currently has to offer; that local electronic records benefit patient care, but when networked more widely problems of confidentiality and security result. Practitioners were also mindful of the financial costs of changes and concerned, given the impact of PCGs and clinical governance, as to who will be responsible for ensuring a common level of electronic records, IT provision, and financial and technological support.

Attitude of Health Personnel↗

PubMed1997

A critical review of the belief that technology is a neutral object and nurses are its master.

This paper discusses technology in relation to nursing practice. The purpose of the paper is to introduce to nursing literature a critique of an important and common assumption concerning the relationship between nurses and technology. The discussion centres on the belief that technology is a neutral influence upon the practice of nursing. Technology is argued to be more pervasive an influence upon the politics of practice, the values of individuals, nursing practice and decision making, than many nurses identify. Therefore adequate understanding of the relationship between technology and nursing practice must address the need to be more critical of the belief that technology is a neutral object, and originates from being cognisant of arguments which both support and oppose the assertion.

Attitude of Health Personnel↗

PubMedDate not supplied

Factors influencing the uptake of technologies to minimize perioperative allogeneic blood transfusion: an interview study of national and institutional stakeholders.

BACKGROUND: Alternatives to allogeneic blood transfusion exist and are being used to varying extents in Australian hospitals. Evidence on effectiveness and cost-effectiveness is generally inconclusive and provides a suboptimal basis for policy development. AIM: To describe the influences on uptake of transfusion technologies as perceived by national and institutional stakeholders. METHODS: Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opportunity to comment on their transcript and the manuscript. RESULTS: A total of 71 interviews were conducted with representatives of the media, specialist medical societies, consumer special interest groups, the Australian Red Cross Blood Service (ARCBS), government, private health insurers, technology manufacturers, prominent clinicians in the area and a sample of clinicians drawn from hospitals with variable use of blood-saving technologies. Technical advances and acceptance of lower transfusion triggers were identified as the main influences on the decrease in use of allogeneic blood transfusion in the past decade. Participants indicated that patients were most aware and supportive of autologous predonation. Participants noted that 'enthusiasts' were involved in educating about the need for alternatives, negotiating resourcing and maintaining the use of a technology. Funding mechanisms were seen as main barriers to use of alternatives. A discrepancy was noted in the rigour of evaluation and regulation of pharmaceuticals and devices/procedures. CONCLUSIONS: Uptake of blood transfusion technologies by institutions was dependent mostly on funding arrangements and the presence of an 'enthusiast'. Critical review of the evidence for effectiveness or cost-effectiveness of these technologies was rarely mentioned. Opportunities exist for evidence-based medicine principles to play a greater role in policy decisions in this area.

Blood Donors↗

PubMed2006

Advanced imaging and technology in gastrointestinal neoplasia: summary of the AGA-NCI Symposium October 4-5, 2004.

Imaging and other advanced technologies for detection of gastrointestinal cancers are undergoing a major revolution on several fronts. This is facilitated by convergence of key technologies including advanced endoscopic-detection systems, more specific contrast agents, rapid and high-resolution cross-sectional imaging, and miniaturization of construction systems for making all imaging equipment smaller and less invasive. This convergence is occurring along traditional translational research pathways (clinical medicine-molecular biology) as well as nontraditional lines (clinical medicine-optical physics/engineering and molecular biology-optical physics/engineering). These new efforts are producing a wide array of technologies aimed at improving detection, classification, and monitoring of gastrointestinal neoplasia, especially for colorectal and esophageal cancer because of easier accessibility. A critical goal is to detect lesions at their premalignant stages, thereby permitting meaningful intervention. Inspired by these advances, the American Gastroenterological Association and the National Cancer Institute sponsored a symposium held in Bethesda, MD, from October 4-5, 2004, bringing together leading investigators with diverse backgrounds in imaging technology. The aims of this symposium were to summarize the state of the art and priorities for research in the coming decade in the field of imaging and advanced technology for gastrointestinal neoplasia. In this overview, we summarize the salient results of that symposium. The initial sections discuss the major technologies in each area of endoluminal imaging and molecular imaging followed by applications to specific diseases such as Barrett's esophagus and colon neoplasia. Each section focuses on the current state of the art then lists major priorities for research in the field.

Barrett Esophagus↗

PubMedDate not supplied

Survey of distance technology use in AACN member schools.

The American Association of Colleges of Nursing surveyed its members by using a 104-item instrument to determine the state of the art in distance technology use. Survey results indicated a recent acceleration of course offerings through distance technology at all levels of nursing education. The most cited reason for this was to improve access to nursing education. Resources for distance technology tended to reside in public, rather than private, institutions. Trends were for greater use of video and computer-based technologies. Although technology use is increasing, computers and other technologies are not used in the didactic or clinical educational experience in many schools. Areas for further evaluation are identified.

Education, Distance↗

PubMedDate not supplied

The role of control technologies in preventing occupational disease.

There has been little past emphasis on determining the impact of control technologies on health. Compliance with legally mandated standards has received the greatest emphasis, certainly since passage of the OSHA of 1970. Risk assessment focuses on needed data to estimate risk and can be used for estimates of workplace impacts before and after adoption of control technologies. Two possible approaches to workplace improvements are suggested for estimating impacts on worker health. Persons removed from risk can be used where workers' exposures to hazardous agents are reduced from above to below a TLV. Second, for carcinogens the percent reduction in exposure can be used as a surrogate for reduction in future cancer incidence. Both measures suffer from a host of assumptions required by the user. There may be better measures for estimating today the reductions in chronic disease which control technologies will bring about. These measures are desperately needed to establish priorities and to guide installation of control technologies. Finally, research in control technologies is needed to improve effectiveness and to lower costs. However, it is widely accepted by engineers in this field that while improved methods are always welcome, current available technologies are under-utilized in practice.

Environmental Health↗

PubMedDate not supplied

Laser technologies in toxicopathology.

One of the main concepts in toxicology and risk assessment is the identification of compounds with the least toxicity, gaining increased understanding of the underlying mechanisms of efficacy and toxicity so as to accelerate the early selection of compounds for development. For this purpose, "cutting-edge" technologies, such as flow cytometry (FC), laser scanning cytometry (LSC) and confocal laser scanning microscopy (CLSM), have proved to be valuable tools. FC, LSC and CLSM have been successfully applied in a wide range of areas within toxicology and research including genetics, reproduction, dermatology, pathology and target organ toxicity. The scope of this paper is to give a short overview of the usefulness of the different laser applications. Specific examples of the impact of these technologies will be presented or can be found in the references. Flow cytometry methods have been successfully applied in immunophenotyping, micronuclei scoring, polyploidy determination, apoptosis and cell cycle evaluation, cell proliferation and quantification. A three-parameter FC method for the analysis of testicular toxicity has also been established as an alternative to traditional histopathological methods. This method allows a large number of cells to be analysed in a short time and provides quantitative values to evaluate testicular damage in the rat. Laser scanning cytometry has been used in our unit for rat blood cell immunophenotyping, tumor proliferation, apoptosis and cell cycle analysis on minipig and rat skin and cardiac cells identification. The wide range of applications that can be applied with the LSC shows the enormous potential of this technology in research and development. Confocal laser scanning microscope was used in our laboratory, in collaboration with the research department, to investigate the mechanisms underlying hepatic lesions found in dogs, to detect fibrinogen influx into rat lung, to explore the mechanism of eye toxicity and to quantify dopaminergic fibers in brain sections. Integrating these technologies within discovery pathology allowed us to understand disease processes with respect to their development and subsequent consequences. It contributes to descriptive pathologic diagnostic and allows a productive interaction with research and development. These technologies offer a range of novel applications and have been shown to be useful tools in terms of specificity, sensitivity, reliability, rapidity and quantification. Expertise in cutting-edge technologies, pathology and cell and molecular biology is essential to a successful and flexible interaction across all therapeutic areas in drug discovery.

Animals↗

PubMedDate not supplied

Engineering technology in rehabilitation of older adults.

As most people age they adapt to and compensate for age-related changes and continue to function independently. However, a growing percentage of the older population requires assistance in completing functional activities in the home or community. How older people adapt and compensate and the types of assistance they need are the subjects of technology-based research. Engineering technology has been evaluated in research on falls, wandering, and spatial orientation. Both high- and low-technology strategies and interventions have been shown to be useful in clinical rehabilitation and residential settings. How technological interventions can be used by older adults to facilitate the performance of functional activities is discussed. Examples are presented to demonstrate how technology can be used to reduce wandering behaviors in both institutionalized and noninstitutionalized populations; reduce falls in older populations; and improve muscle strength, an important factor in maintaining good balance and avoiding falls. It is argued that interventions based on technology may, in the long rung, be more humane and cost-effective than institutional care. Areas for future research are suggested.

Aged↗

PubMedDate not supplied

The shaping of individual meanings assigned to assistive technology: a review of personal factors.

PURPOSE: This review article examines the development of individualized meanings assigned to assistive technology and how these personal meanings influence the integration of assistive technology into daily activities. METHODS: A review of the published literature regarding assistive technology use and abandonment was conducted by performing two independent searches using 26 search terms and three databases. Publications were reviewed for whether they addressed device use, device abandonment, coping, adjustment, adaptation, values, outcomes and/or cultural issues; 81 publications met these criteria. RESULTS: The evidence suggests that psychosocial and cultural issues influence the shaping of individualized meanings assigned to assistive technology. Theoretical arguments suggest that the process of adapting to disability is another influential factor. CONCLUSIONS: The synthesis of evidence and theories suggests that successful integration of assistive technology into daily lives requires potential device users to explore: (1) the meanings they assign to devices; (2) their expectations of assistive technology; (3) the anticipated social costs; and (4) ways to understand that disability is one, but not the defining, feature of one's identity.

Adaptation, Psychological↗

PubMed2005

Characteristics of assistive technology service delivery models: stakeholder perspectives and preferences.

PURPOSE: The purpose of this study was to identify the key characteristics of an assistive technology service delivery model preferred by the various stakeholders in Manitoba, Canada. METHODS: A descriptive, exploratory approach consistent with qualitative research design was used to explore this issue. Three focus groups were held using a semi-structured interview guide and a hypothetical case study to guide the discussion. Eighteen adults participated in the study, each representing one of three groups of stakeholders (assistive technology service providers, funders and users). Interviews were audiotaped, transcribed and analysed using an inductive process to develop categories and themes. RESULTS: Three primary themes emerged from the data: the user of assistive technology is a unique individual; a decision-making process exists; and, assistive technology devices and services are complex. Based on the study results, recommendations for the delivery of assistive technology services are outlined. CONCLUSIONS: The results of this study may be useful for developing funding guidelines, supporting the importance of assistive technology in enabling meaningful activities, and examining current delivery of services in different contexts.

Adult↗

PubMedDate not supplied

Application of emerging technologies in toxicology and safety assessment: regulatory perspectives.

Emerging technologies applied in the regulatory field encompass a group of technologies that are used in addition to or in replacement of the standard toxicology studies conducted to support an Investigational New Drug Application (IND) or New Drug Application (NDA). The standard package includes general toxicology studies of various duration, safety pharmacology studies, genetic toxicology studies, and reproductive toxicology studies. New and emerging technologies applied to the regulation of new drugs include the use of novel biomarkers, transfected cells and transgenic animals, and the "omics" technologies (toxicogenomics, proteomics, and metabonomics). These technologies are at various stages of regulatory development and acceptance. For example, the use of transgenic animals have gained acceptance by regulatory authorities to replace a 2-year carcinogenicity assay. Alternatively, the "omics" technologies are not sufficiently advanced to achieve regulatory acceptance as replacements, although these assays have a role early in drug development and they may prove useful as supplements to standard studies. Data from these assays have been used to address specific mechanistic questions in combination with standard toxicology assays.

Consumer Product Safety↗

PubMed2006

Access technology and dementia care: influences on residents' everyday lives in a secure unit.

There is a need to understand how technology can best be used to facilitate well-being in people with dementia. This study sought to describe how access control technology influenced the everyday lives of people with dementia living in a secure unit. The staff members and the unit's residents participated in the study. Data were collected through ethnographic observations and semi-structured interviews over 6 months, and were analyzed using the constant comparative method. The results show how access technology supported the residents' sense of security, territoriality, orientation, and adaptation to the environment. However, certain conditions were necessary for these influences to appear. Overall, the results indicate that access control technology may be used to support the well-being of people with dementia, and to increase their opportunities to feel in place in a secure unit. However, there is an urgent need in the future for further exploration of the conditions for use of technology in the field of dementia care, and the necessity of making careful evaluations of the use of technology in this field cannot be overemphasized.

Dementia↗

PubMedDate not supplied

Analogical reasoning in handling emerging technologies: the case of umbilical cord blood biobanking.

How are we individually and as a society to handle new and emerging technologies? This challenging question underlies much of the bioethical debates of modern times. To address this question we need suitable conceptions of the new technology and ways of identifying its proper management and regulation. To establish conceptions and to find ways to handle emerging technologies we tend to use analogies extensively. The aim of this article is to investigate the role that analogies play or may play in the processes of understanding and managing new technology. More precisely we aim to unveil the role of analogies as analytical devices in exploring the "being" of the new technology as well the normative function of analogies in conceptualizing the characteristics and applications of new technology. Umbilical cord blood biobanking will be used as a case to investigate these roles and functions.

Bioethical Issues↗