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PubMed1995

Machine technologies and caring in nursing.

Machine technologies and caring in nursing can be harmonious aspects of clinical nursing practice. The perception of technology and caring as dichotomous is so pervasive that one who is technologically proficient may often be assumed to be incapable of expressing caring. Within a framework of nursing as caring, true technologic competence in clinical nursing practice can be understood as an expression of caring. As such, technological competence assumes an indispensable place in contemporary clinical nursing practice. Nowhere is the link between machine technologies and caring demonstrated more clearly than in the practice of nursing in critical care. A model is presented to illustrate this concurrence.

Clinical Competence↗
PubMedDate not supplied

Using technology to promote perinatal patient safety.

Leaders in health care and national health policy recommend information technology information technology as a strategy to promote patient safety. Technology enables error prevention, surveillance, and analysis. Although there is little research about technology and safety in perinatal care, nurses in the specialty can use current evidence about the electronic health record, decision support systems, and medication safety devices to guide practice. This article includes key issues and general recommendations for the use of information technology to promote patient safety, the most common applications relevant to perinatal care, and strategies for perinatal nurses who implement information technology to promote patient safety.

Adult↗
PubMed2005

Insights from the sharp end of intravenous medication errors: implications for infusion pump technology.

BACKGROUND: Intravenous (IV) medication errors are a common type of error identified in hospitals and can lead to considerable harm. Over the past 20 years there have been several hundred FDA reported incidents involving IV pumps, many of which have led to patient deaths. OBJECTIVE: To determine the actual types, frequency, and severity of medication errors associated with IV pumps. To evaluate the likelihood that smart pump technology without an interface to other systems could have prevented errors. METHODS: Using a point prevalence approach, investigators prospectively compared the medication, dose, and infusion rate on the IV pump with the prescribed medication, doses, and rate in the medical record. Preventability with smart pump technology was retrospectively determined based on a rigorous definition of currently available technology. RESULTS: A total of 426 medications were observed infusing through an IV pump. Of these, 285 (66.9%) had one or more errors associated with their administration. There were 389 documented errors overall; 37 were "rate deviation" errors and three of these were judged to be due to a programming mistake. Most of the documented events would not have caused patient harm (NCC MERP category C). Only one error would have been prevented by smart pump technology without additional interface and software capabilities. CONCLUSION: Medication errors associated with IV pumps occur frequently, have the potential to cause harm, and are epidemiologically diverse. Smart pumps are a necessary component of a comprehensive safe medication system. However, currently available smart pumps will fail to generate meaningful improvements in patient safety until they can be interfaced with other systems such as the electronic medical record, computerized prescriber order entry, bar coded medication administration systems, and pharmacy information systems. Future research should focus on the effectiveness of new technology in preventing latent and active errors, and on new types of error that any technology can introduce.

Academic Medical Centers↗
PubMed2002

Advances in proteomic technologies.

Proteomics is a rapidly emerging set of key technologies that are being used to identify proteins and map their interactions in a cellular context. With the sequencing of the human genome, the scope of proteomics has shifted from protein identification and characterization to include protein structure, function and protein-protein interactions. Technologies used in proteomic research include two-dimensional gel electrophoresis, mass spectrometry, yeast two-hybrids screens, and computational prediction programs. While some of these technologies have been in use for a long time, they are currently being applied to study physiology and cellular processes in high-throughput formats. It is the high-throughput approach that defines and characterizes modern proteomics. In this review, we discuss the current status of these experimental and computational technologies relevant to the three major aspects of proteomics-characterization of proteomes, identification of proteins, and determination of protein function. We also briefly discuss the development of new proteomic technologies that are based on recent advances in analytical and biochemical techniques, engineering, microfabrication, and computational prowess. The integration of these advances with established technologies is invaluable for the drive toward a comprehensive understanding of protein structure and function in the cellular milieu.

Electrophoresis, Gel, Two-Dimensional↗
PubMed2005

Measuring the outcomes of word cueing technology.

BACKGROUND: Measurement of assistive technology outcomes is complex because many factors (e.g., environment and model of service delivery) influence the successful use of the technology. PURPOSE: Using the example of measuring the outcomes of word cueing technology, this paper presents an approach for measuring assistive technology outcomes. METHOD: The Canadian Occupational Performance Measure (COPM) was administered to 29 children with physical and learning disabilities, between the ages of 3.9 and 19 years. Participants were provided with WordQ, a software program designed to assist the development of writing skills. Follow-up data were collected through telephone interviews. RESULTS: The COPM findings supported the effectiveness of WordQ Version 1 to enhance written productivity, with a mean performance change score of 3.5 (SD = 1.5). The COPM was an effective tool for measuring clients' perceived outcome of word cueing technology. Telephone interview was considered a successful method for collecting outcome data. PRACTICE IMPLICATIONS: A mix of tools and methodologies should be used to gain a comprehensive understanding of the impact of assistive technology.

Adolescent↗
PubMed2005

Clinical report: use of the Canadian Occupational Performance Measure in vision technology.

BACKGROUND: The Canadian Occupational Performance Measure (COPM) has gained wide acceptance in general occupational therapy research and practice, however, the use of the COPM in assistive technology assessments and outcomes is not as well documented. PURPOSE: This clinical report discusses the utility of the COPM in assistive technology, as illustrated by the assessment and follow-up of clients requiring high technology vision aids. RESULTS: The COPM makes important contributions to the outcomes of providing vision aids. The COPM ensures a needs review that incorporates all areas of occupational performance, which in turn directs the clinician to match the technology to client needs. From a clinical perspective, the quantitative follow-up data are helpful to determine clients' improvement in occupational performance as well as their satisfaction with the assistive technology. For administrative purposes, the COPM results provides accountability to the funding agency. PRACTICE IMPLICATIONS: The COPM can be readily integrated into the assessment and follow-up of assistive technology service delivery and adds value to both components of the process.

Activities of Daily Living↗
PubMed1996

Assistive technology for postsecondary students with learning disabilities.

An increasing number of students with learning disabilities are attending postsecondary institutions. To meet the educational demands of these students, support service providers will likely rely on assistive technology. This article lists types of assistive technology appropriate for use with persons with learning disabilities at the postsecondary level and discusses ways in which assistive technology enhances learning. Additionally, an overview of legislation that has had an impact on assistive technology at the postsecondary level is presented. Issues involving assistive technology programs at the postsecondary level are discussed. Postsecondary assistive technology program components, device selection, and training guidelines also are outlined.

Adolescent↗
PubMed2006

Technology dependence in home care: impact on patients and their family caregivers.

BACKGROUND: The purpose of this review is to explore how home technology care affects patients, family caregivers, and quality of life (QOL). METHODS: A literature search was conducted to identify studies of home parenteral nutrition (HPN) and other technology prescribed home care. RESULTS: Technology dependence influences health-related QOL. Patients and their family caregivers must balance the positive aspects of being in the home environment with the challenges of administering complex therapies at home. Patients and caregivers need additional support to reduce the physical, emotional, social, and financial burdens they experience. CONCLUSIONS: More research is needed to address effective interventions to reduce patient and caregiver burdens and to improve outcomes for technology-dependent individuals. A greater level of preparedness for managing home technology and technology-related problems may improve quality of life.

Caregivers↗
PubMedDate not supplied

The implications of microarray technology for animal use in scientific research.

Microarray technology has the potential to affect the number of laboratory animals used, the severity of animal experiments, and the development of non-animal alternatives in several areas scientific research. Microarrays can contain hundreds or thousands of microscopic spots of DNA, immobilised on a solid support, and their use enables global patterns of gene expression to be determined in a single experiment. This technology is being used to improve our understanding of the operation of biological systems during health and disease, and their responses to chemical insults. Although it is impossible to predict with certainty any future trends regarding animal use, microarray technology might not initially reduce animal use, as is often claimed to be the case. The accelerated pace of research as a result of the use of microarrays could increase overall animal use in basic and applied biological research, by increasing the numbers of interesting genes identified for further analysis, and the number of potential targets for drug development. Each new lead will require further evaluation i n studies that could involve animals. In toxicity testing, microarray studies could lead to increases in animal studies, if further confirmatory and other studies are performed. However, before such technology can be used more extensively, several technical problems need to be overcome, and the relevance of the data to biological processes needs to be assessed. Were microarray technology to be used in the manner envisaged by its protagonists, there need to be efforts to increase the likelihood that its application will create new opportunities for reducing, refining and replacing animal use. This comment is a critical assessment of the possible implications of the application of microarray technology on animal experimentation in various research areas, and makes some recommendations for maximising the application of the Three Rs.

Animal Testing Alternatives↗
PubMed2004

Converging technologies for enhancing human performance: science and business perspectives.

Our goal is to provide a rough sketch of some of the possible implications of converging technologies for enhancing human performance ((Roco and Bainbridge, 2002)) from both a science and a business perspective. Converging technologies refers to a type of coevolutionary progress that is characterized by rapid advances across multiple areas of technology (nano-bio-info-cogno or NBIC), accelerated by interdisciplinary cross-fertilization as the advances in one area spill over and speed progress in other areas. The rapid, multi-front progress characteristic of converging technologies results in better technological capabilities which are faster and cheaper, and can be broadly applied for many different purposes. In this paper, we specifically explore applications of converging technologies for enhancing human performance, that is, enhancing our human ability to achieve goals both individually and collectively. These applications hold the promise to make people healthier, wealthier, and wiser as well as to make businesses more responsive, resilient, and adaptive.

Biological Evolution↗
PubMed2004

An assessment of the readiness of hospice organizations to accept technological innovation.

We surveyed seven of the 62 certified hospice programmes in the state of Missouri. The survey consisted of 19 questions that covered demographic information, how employees received new information, the current use of various forms of technology, employees' comfort with technology and their perceptions of the use of video-phones. A total of 124 surveys were returned. Respondents were categorized within the following disciplines: nurses (48%), administrators and nurse supervisors (6%), social workers (9%), physicians (3%), home health aids (18%), chaplains (5%) and other staff (e.g. clerical and bereavement staff) (12%). Staff reported using several types of technological device at work but not a video-phone or a Web camera. There were significant differences between hospices in the degree of use of computers at work, the number of devices used at work and the perceived benefits of video-phone technology. There were significant differences between disciplines in the degree of use of computers at work and at home, the number of devices used at work, and their comfort both with the use of new technology and with the idea of introducing new technology to patients and their families. Because there were variations in the perceived usefulness of video-phones for hospice care, the introduction of such equipment would require substantial involvement of the users.

Attitude of Health Personnel↗
PubMed1999

Employment, child care, and mental health of mothers caring for children assisted by technology.

OBJECTIVE: This study examines 1) the way that children with chronic conditions are cared for at home and assisted by technology affects maternal employment and child care; 2) the social and clinical factors associated with the decision of a mother to quit employment to care for a child at home; and 3) the way in which care at home and the decision of a mother to quit a job affects maternal mental health. DESIGN: The 6-month postdischarge status of 70 mothers of children assisted by technology (study group) was compared with the 6-month postdischarge status of 58 mothers of children (matched for age and gender) hospitalized for acute illnesses (comparison group). Between January and December 1993, we gathered information on sociodemographic status, employment status and changes in employment, severity of the child's condition, child care and nursing services at home, family support, and maternal mental health. RESULTS: One third of mothers in the study group reported that they quit employment to take care of a child at home with only 37.1% remaining employed outside the home, compared with 69.0% of comparison group mothers. Single caretakers were 15 times more likely to quit employment compared with mothers in two-parent families. Availability of child care had an independent effect on a mother's decision to quit a job, whereas the severity of the child's condition did not. Child care hours were significantly lower in study group families and were provided mostly by relatives compared with day-care facilities and regular babysitters in comparison families. Family support was highest among employed mothers in both the study and the comparison groups and lowest in study group mothers who were neither employed currently nor before the child's illness or who had quit employment to care for the child. Family income was significantly lower in families with a child assisted by technology. Families in the study group had 20-fold higher uncompensated health care costs than did the comparison group. Mothers caring for a child assisted by technology reported less good mental health than did comparison group mothers, and employment seems to mediate this relationship. CONCLUSIONS: Caring for a child assisted by technology seems to create barriers to maternal employment diminishing family resources at a time when financial needs actually may increase. Lack of family support and child care services increase the likelihood that mothers of children assisted by technology will stay out of the labor force. Remaining employed buffers the negative effects of care at home on maternal mental health. Health policies for children with chronic health problems should address issues of financial burdens and the labor force participation of their caretakers.

Acute Disease↗
PubMed2006

Comparison of vitros dry slide technology for determination of lithium ions with other methods.

The lithium ions concentration in human serum was determined using Dry-slide technology Vitros 250 Analyser (Ortho Clinical Diagnostic), atomic absorption spectrometry (AAS) method Perkin Elmer 403 and ion-selective electrode (ISE) potentiometry AVL 9181. We compared lithium ions results in sample sera between these methods. Our reference method was AAS. We analyzed lithium ions concentration in 23 sera samples of patients after oral administration of lithium carbonate (3x 300mg) Jadran, Galen Laboratory Rijeka, by dry-slide technology, AAS and ISE methods. The quality control, precision, reproducibility and accuracy for Vitros dry slide technology were assessed. We established that the main difference between AAS method and dry slide technology was not statistically significant at p< 0.05 according to Student t-test. Therefore, the dry slide technology may be a useful alternative or it may even replace other methods, such as AAS. The main difference between dry slide technology and ISE methods was statistically significant at p<0.05 using Student t-test. By ISE method, we obtained considerably higher results, which may be explained by the presence of electrolytes or medicaments interfering with lithium ions.

Adult↗
PubMed2003

Melanoma Vaccine--AVAX Technologies: DNP-VACC, M-Vax.

Adis CommentsAVAX Technologies is developing a therapeutic melanoma vaccine [M-Vax, DNP-VACC] consisting of autologous tumour cells conjugated to a highly immunogenic hapten, dinitrophenyl, which makes the cancer cells more easily recognised by the immune system. AVAX licensed the autologous cell vaccine technology (AC Vaccine) from Thomas Jefferson University in Philadelphia, USA, where it was originally developed. M-Vax was launched in Australia in the first half of 2000, but was withdrawn from this market in September 2002 due to financial constraints faced by the company and its need to focus its resources on initiatives that provide the greatest return. Although AVAX applied for Federal Government price reimbursement in Australia through the Medical Services Advisory Committee during 2001, the vaccine is not reimbursed in Australia. Obtaining Federal Government reimbursement was a step AVAX considered essential for the success of the M-Vax. AVAX has not ruled out re-entering the Australian market again at a later date. AVAX will now concentrate on gaining approval in the US and Europe. M-Vax has received orphan drug designation from the US FDA. M-Vax is in preregistration in Germany, Japan and The Netherlands for treatment of stage III melanoma. In September 1999, the company announced that it expected to market M-Vax for treatment of stage III melanoma in Germany, Japan and the Netherlands. This announcement came after AVAX's continuing dialogue with senior regulatory authorities in several pharmaceutical markets. The commercial availability of M-Vax in Germany, Japan and The Netherlands will be subject to meeting certain requirements specified by the regulatory agency in each country. Phase II data have been submitted for regulatory approval in these countries; phase III data may not be required because the vaccine contains autologous tumour cells. This was the case with the Australian approval of M-Vax, which was on the basis of data from phase II trials. Clinical development: M-Vax was in a pivotal phase III trial for treatment of stage III melanoma in the US, and a multicentre phase II trial in the US for treatment of patients with stage IV melanoma with lung metastases. However, in late March 2001, AVAX announced that the FDA had suspended these trials until the agency had further reviewed them. Subsequently, AVAX received written communication from the FDA indicating that the suspension is related to manufacturing issues. These events triggered the resignations of AVAX's executive Vice-President and Vice-President of operations, at the request of the company's board of directors. AVAX met with the FDA in October 2001 to discuss the clinical holds on M-Vax and O-Vax. AVAX's proposed improvements involving a frozen vaccine were also discussed at the meeting. Following the meeting AVAX was told by the FDA that selected characterisation work would have to be carried out on the new products, and new INDs submitted. In December 2001 AVAX announced that the development of a frozen vaccine and changes to various policies and procedures would ensure that the company complied with the FDA regulations. A new IND was submitted to the FDA for M-Vax in September 2002. In August 2002, AVAX had been unsure whether following approval of its new IND it would re-initiate clinical development for both M-Vax and O-Vax in parallel, or advance one of the agents and wait for further funding for the other. However, in September it indicated that clinical trials of both vaccines would be conducted following approval of the IND. A total of 42 patients are to be enrolled in each trial. In October 2002, AVAX announced that the US FDA had no outstanding issues regarding the IND. AVAX can now proceed with clinical trials as planned. AVAX Technologies was enrolling patients with stage III melanoma in the pivotal US phase III trial for registration of M-Vax trade ed, multicentre trial designed to compare the efficacy of the vaccine against high-dose interferon-alpha, the standard post-surgical treatment for stage III melanoma. The two end-points are rate of melanoma tumour recurrence and overall survival. The dosing regimen chosen for this study is that which was found from several clinical studies to be most effective at eliciting a positive delayed-type hypersensitivity skin response to autologous melanoma cells. The study was being conducted at more than 20 US sites. A low dose of M-Vax was also being evaluated in a phase II study at Thomas Jefferson University in the US. On 16 March 2000, AVAX announced promising interim results from this study, which revealed that 65% of 23 evaluated patients developed an immune response of the same magnitude as that observed with higher doses of M-Vax in previous studies. The study was to enroll a total of 46 patients, who were to receive seven doses of M-Vax over 7 weeks. The advantage of using a low dose of M-Vax is that it requires a smaller amount of the patient's tumour tissue to produce the vaccine (approximately half that required in previous studies) and therefore more patients would be eligible for treatment. On the basis of these results, AVAX modified the pivotal phase III trial to use the low dose of M-Vax to treat additional patients with smaller tumours. On 29 March 2000, AVAX announced that it had initiated a multicentre phase II study in the US in patients with stage IV melanoma and lung metastases. Patients were receiving seven doses of M-Vax at weekly intervals and a booster at 6 months. AVAX initiated the study because of promising results in a study of stage IV melanoma patients with lung metastases in which patients treated with M-Vax had tumour regression and prolonged survival. Commercial agreements: In June 1999, AVAX announced its first international commercialisation opportunity for M-Vax, in Australia, where the company subsequently launched the vaccine (now withdrawn) in the first half of 2000. AVAX formed a subsidiary, AVAX Australia, which was co-marketing M-Vax in Australia together with Australian Vaccine Technologies (formerly Neptunus International Holdings). Under the terms of this agreement, Australian Vaccine Technologies purchased dollars A10 million in shares, a 50% interest, in AVAX Australia. The final dollars A3 million installment was made in August 2000. AVAX had an option to purchase up to 5% of shares in Australian Vaccine Technologies. In August 2002, AVAX extended and expanded an existing production agreement with Medigene for approximately 1 year. Under the terms of the agreement, Genopoietic (Medigene) in France will process clinical samples of M-Vax. In October 2002, AVAX signed a distribution agreement with Ferrer International, SA (Grupo Ferrer) for sales and distribution of the AC Vaccines, including M-Vax and O-Vax. The agreement covers Europe, Latin America and certain Asian territories. Under the terms of the agreement AVAX will retain manufacturing rights and will sell the vaccine to Ferrer. In return, Ferrer will make payments to AVAX for the product as well as certain milestone payments for marketing and registration goals. M-Vax was manufactured in Australia by Bioenterprises, a subsidiary of Biotech Australia. However, in 2002, the manufacturer underwent an acquisition with significant changes, which resulted in its decision to discontinue manufacturing M-Vax.

Cancer Vaccines↗
PubMed2006

Microarray technology as a universal tool for high-throughput analysis of biological systems.

Over the last years microarray technology has become one of the principal platform technologies for the high-throughput analysis of biological systems. Starting with the construction of first DNA microarrays in the 1990s, microarray technology has flourished in the last years and many different new formats have been developed. Peptide and protein microarrays are now applied for the elucidation of interaction partners, modification sites and enzyme substrates. Antibody microarrays are envisaged to be of high importance for the high-throughput determination of protein abundances in translational profiling approaches. First cell microarrays have been constructed to transform microarray technology from an in vitro technology to an in vivo functional analysis tool. All of these approaches share a common prerequisite: the solid support on which they are generated. The demands on this solid support are thereby as manifold as the applications themselves. This review is aimed to display the recent developments in surface chemistry and derivatization, and to summarize the latest developments in the different application areas of microarray technology.

Antibodies, Monoclonal↗
PubMed1981

Policies toward medical technology: an international review.

Rapidly rising medical care costs have become an important political issue in industrialized countries during the past decade. Attempts to control the growth in expenditures have focused on the contribution of medical technology to costs. All industrialized countries have begun to experiment with the kinds of mechanisms necessary to effect changes in development, diffusion, and use of medical technologies. This paper describes government policies toward: 1) research and development, 2) evaluation, 3) safety and efficacy regulation, and 4) investment in and use of medical technologies. To clarify how these policies work in practice, policies toward CT scanners, renal dialysis, and coronary bypass surgery are examined. Rapid changes in policies and laws in different countries are attempts to find effective policy mechanisms, but also reflect the difficulties of choosing a realistic policy objective. Until recently, most countries have focused on promoting the development and adoption of new technologies, or increasing the efficiency of their production and use. A few governments have begun to question and test the benefits of medical technologies as an aid to decision making. Finally, with the growing realization that every kind of care that is beneficial cannot be provided, some countries have begun to consider limiting the diffusion of technologies to a level that strikes a balance between the benefits to be gained and the costs of achieving them.

Coronary Artery Bypass↗
PubMed2000

Genetic technologies and achieving health for populations.

The remarkable progress in genetics over the last 50 years has led to the development of genetic technologies to identify or alter genes in living organisms, and these technologies can be applied to people. This article presents background information on the role of genetics in human disease, outlines the technologies, and discusses the sources of the strong push for a genetic approach to ill-health and some implications and harmful consequences of using these genetic technologies. The determinants of most diseases are complex and are embedded in a social context. To focus on only one strand of this web--the genetic strand--because it is one that may be amenable to biological/pharmaceutical treatment, although profitable for industry, does not address other important determinants of health and may lead to a harmful overemphasis on genetic approaches. The author outlines some limitations to the potential contribution of genetic technologies to population health across the globe and the need for policy development if these technologies are to have an appropriate place in health care.

Adult↗
PubMed2003

Son preference, sex selection, and the "new" new reproductive technologies.

Throughout recorded history, humans have tried to influence the sex of their offspring, through pregnancy injunctions, infanticide, and infant/child neglect. Reproductive technologies developed in the late 20th century allow determination of the sex of the offspring during pregnancy, making "sex selection" through abortion possible. Especially in parts of East and South Asia, sex selection against female fetuses has had dramatic consequences for male/female sex ratios. However, "newer" new reproductive technologies, such as prenatal genetic diagnosis and DNA-weighted semen selection, can now be applied for sex selection; eventually, the latter technology may become easily accessible as a noninvasive method. The prospects of these new technologies for sex selection must be considered in the light of cultural values surrounding son preference / daughter discrimination in many parts of the world, most notably Asia, as well as preferences for a "gender-balanced" family in much of the West. The ethical issues surrounding these technologies, such as the right to life and the equal treatment of female children, are potentially profound, but legislating the appropriate use of these "newest" new reproductive technologies will be difficult.

Asia↗