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PubMed1992

Laser technology planning.

Lasers continue to be a highly useful and important surgical tool, and, in today's competitive healthcare environment, they are also an effective marketing tool. The public perceives lasers to be "high-tech" instruments, associating them with excellence of care. And the availability of state-of-the-art equipment such as lasers is often critical to medical staff recruitment. However, lasers are not universal surgical tools, as some proponents suggest. They are costly, and other less expensive technologies are acceptable and sometimes more desirable for certain procedures. Also, marketing reasons alone cannot justify laser acquisition. Faced with new, more restrictive federal regulations for Medicare reimbursement of capital expenses, hospitals need effective technology planning more than ever, particularly when planning for such "high-ticket" items as lasers. They can no longer afford to acquire lasers based on the perceptions of the public or the demands of one or even a few physicians; poor planning in the past has caused many new lasers to collect dust from low utilization. (ECRI's 1991 user survey on general-purpose surgical lasers found that, on average, hospitals use lasers in less than 5% of their total surgical procedures.) Hospitals need to approach the acquisition of laser technology cautiously to ensure that the appropriate equipment is obtained, that it will be well utilized for procedures in which it offers a demonstrable improvement over alternative technologies, and that it will also conform to the overall strategic plan of the institution. The purpose of this article is to provide guidance on the technology acquisition process, whether a hospital is acquiring its first laser or has a well-established laser program.(ABSTRACT TRUNCATED AT 250 WORDS)

Capital Expenditures↗

PubMed1997

Health-care technology transfer: expert and information systems for developing countries.

Computer-based technologies such as information systems and expert systems have an undoubted contribution to health-care development in developing countries. This paper addresses the appropriateness of these technologies for developing countries, the criteria to be used in selection of the technology to be transferred, and the need for a systematic approach to evaluation. A conceptual model for assessing transferability so as to achieve an effective transfer, has been introduced. This requires not only an attempt to amplify the role of information and expert systems in health-care improvement and for socio-economic development, but the analysis of prior experience in transferring these technologies to developing countries. Following this approach, and using operational research techniques such as the Analytic Hierarchy Process, a subjective assessment model has been described that can systematically guide decision-making about computer-based health-care technology to be transferred to developing countries.

Developing Countries↗

PubMed2006

Twenty-first century learning in schools: A case study of New Technology High School in Napa, California.

The most pertinent question concerning teaching and learning in the twenty-first century is not what knowledge and skills students need--that laundry list was identified over a decade ago--but rather how to foster twenty-first century learning. What curricula, experiences, assessments, environments, and technology best support twenty-first century learning? New Technology High School (NTHS) in Napa, California, is one example of a successful twenty-first century school. In this chapter, the author describes the components of this exemplary high school, illustrating an environment that will cultivate twenty-first century student learning. New Technology High School began by defining eight learning outcomes, aligned with the standards of the Partnership for 21st Century Skills; to graduate, students demonstrate mastery of these outcomes through an online portfolio. To help students achieve the outcomes, NTHS employs project- and problem-based learning. Whereas in traditional classrooms students work alone on short-term assignments that do not lend themselves to deep understanding, the project-based learning approach has students working in teams on long-term, in-depth, rigorous projects. Students' work is supported by the school's workplace-like environment and effectiv use of technology. Meaningful assessment is essential to project-based learning; students receive continuous feedback, helping them become self-directed learners. In fact, NTHS uses outcome-based grading through which students constantly know how they are performing on the twenty-first century outcomes. Research has shown that NTHS graduates are better prepared for postsecondary education, careers, and citizenship than their peers from other schools. To facilitate twenty-first century learning, all schools need to rethink their approach to teaching and learning. New Technology High School is one way to do so.

Adolescent↗

PubMed2006

Teens and technology: preparing for the future.

In the past two decades, economic, technological, demographic, and political forces have stimulated major change in the learning and working landscape for young people. These circumstances compel us to prioritize the integration of technology skill building into youth development experiences in order to better prepare older youth for the challenges and responsibilities ahead. Facilitating older youth's acquisition of technology skills must continue to be a principal goal of policymakers, city leaders, and youth program providers. This chapter looks at the integration of technology skill building into youth development experiences with consideration of gender and races differences in technology access and utilization, along with challenges that at-risk teens face.

Adolescent↗

PubMed1995

Technology assessment of anaesthesia monitors: problems and future directions.

Specific factors have limited the interpretation of studies regarding the efficacy, effectiveness and efficiency of technology in anaesthesia. Some of these problems are reviewed, including the lack of specific outcomes necessitating the use of intermediate measures (e.g., hypoxaemia, myocardial ischaemia), which are not necessarily related to ultimate patient outcomes. This emphasizes the need for anaesthesia investigators to define fundamental issues specifically and design studies accordingly. With respect to anaesthesia monitors, the "lead time" or early warning provided by a monitor relative to that required to alter therapy effectively needs to be defined better and compared with the "lead time" without the monitor. After defining the benefit of a monitor, investigators should analyze the cost relative to alternatives (cost-benefit and cost-effectiveness). A hierarchical model to guide technology assessment is presented that addresses in order, the scientific basis of the technology, and the influence on the patient followed by societal issues. Anaesthetists have relied on traditional methods of technology assessment adopted from other disciplines. These methodologies do not address specific issues related to anaesthesia practice (such as "lead time"). In defining problems specific to the specialty of anaesthesia, new outcome measures that focus on the human factors related to decision-making in the operating room need to be developed. Future evaluations of anaesthesia technology require innovative approaches that address specific anaesthesia-related problems. One such approach is the use of simulation-based studies of response patterns to critical incidents.

Anesthesiology↗

PubMed2003

Heidegger's relevance for engineering: questioning technology.

Heidegger affirmed traditional technology, but was opposed to science-based modern technology, in which everything (including man) is considered to be a mere "resource". This opposition was expressed in the form of deep questioning and a suspicion of superficial evaluation, because the true nature of things was often concealed, though disclosed at times. Ways in which engineers should question technology are proposed, highlighting some of the hazards and injustices associated with technology and also its subtle sociological and psychological influences. The demands of engineering ethics and the use of metaphor in design are other ways in which a narrowly rationalistic technological outlook can be confronted.

Engineering↗

PubMed1996

Technology and nursing: an anatomy of definition.

This paper discusses technology in relation to nursing practice development in order to demonstrate the need to apprehend nursing within the context of technological advancement. Issues pertinent to formulating an understanding of technology are reviewed and four common approaches to the definition of technology within the domain of nursing are critiqued. The purpose of the paper is to analyse issues relevant to defining technology, and to make obvious the limitations of current nursing literature.

Attitude of Health Personnel↗

PubMed1988

Medical technology assessment: adequate questions, appropriate methods, valuable answers.

Medical Technology Assessment begins with carefully posing the appropriate questions to be examined. Specification of the critical assessment provides the framework for the design to provide the answers. This paper addresses the Technology Assessment process as a sequence of the above steps. The practical requisites of the diversity of questions, the economic, and study design considerations generated are addressed in a systems analysis model of input-process-outcome. Applications and the relative merits of such design consideration are discussed and illustrated. The questions related to medical technologies may come from different groups of people directly or indirectly interested, and having active or passive relationship to a given technology. There are 4 basic issues from which the detailed questions derive. These are the issues of need, effectiveness, safety and cost. The timing of asking questions in the life-cycle of a technology and the adequacy of the answers determines the choice of methods, the extent of an evaluation and the quality of the responses. The reliability, external validity, generalizability, and the clarity of conclusions are the characteristics of a practical and valuable assessment.

Cost-Benefit Analysis↗

PubMed1989

Possibilities and problems in the development of home care technology.

Limited resources for health care and increasing health care costs have led to proposals to expand home care services. Presently, home care technology is rather primitive. Its development and use have been largely unplanned. Nonetheless, home care technology is growing in response to obvious needs, and a number of experiments in the Netherlands have begun to demonstrate some potentials in this area. As technological developments accelerate, opportunities for supporting people in their homes will greatly increase. The major problem with the introduction of technology into home care is the lack of an integrated home care system that can select, provide, and assess technology. Without such a system, industrial developments in this area will probably continue to be slow.

Durable Medical Equipment↗

PubMedDate not supplied

Health care technology in Canada (with special reference to Quebec).

In Canada, all citizens are insured for health services. Health care is a provincial responsibility. The federal role is limited to health care financing, health protection including regulation of pharmaceuticals, and environmental health. The health care system represents a balance among government direction, consumer choice, and provider autonomy. Canada has largely controlled the costs of health care by funding and management mechanisms, the most important of which is the global budget formula used to fund hospitals. This paper discusses the Canadian health care system, with particular emphasis on the province of Quebec. In 1988, the provincial government of Quebec established the first Canadian body dedicated to technology assessment. Since then, a national coordinating office and several other provincial bodies have developed. The work of these and other evaluation efforts has had a growing influence on technology management decisions, particularly those dealing with procurement of capital-intensive technologies. Expanding this influence into the realm of technology use, especially for low-cost, high-volume technologies, remains a challenge.

Canada↗

PubMedDate not supplied

Health care technology in The Netherlands.

The Dutch health care system has been described as a 'patchwork quilt'. It is a complicated system that has evolved from a constant adding and changing of institutions, regulations and responsibilities. Every citizen of the Netherlands has an entitlement to health care. The government authorities in the Netherlands have focused on creating favourable conditions in which the already existing private sector could expand or improve services. Although health care is provided largely through private institutions and practitioners, the system is considered to have a high degree of regulation. Until the 1980s, the Dutch health care authorities had no clearly defined philosophy of controlling the development and use of health care technology. Since the mid-1980s, however, a number of initiatives have been taken, policy instruments for controlling technology have been used in a more coordinated manner, and health care technology assessment had developed rapidly. The immediate future will see increasingly explicit use of the benefit package to control introduction of new technologies, as well as a growing influence of technology assessment itself.

Delivery of Health Care↗

PubMedDate not supplied

Health care technology in Sweden.

Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed by these different levels provide a clear hierarchy for acquisition of sophisticated new technologies. In practice, certain problems have emerged, especially rigidity of the system. Reforms are underway. Sweden was one of the first countries to become involved in the assessment of health care technology. From the beginning, technologies were assessed to determine if they were 'consistent with proven scientific knowledge and good experience'. Sweden has a national program in health care technology assessment (TA), and TA is increasingly visible to policy makers and physicians. Health care TA has been effectively institutionalized in Sweden and has a bright future. The greatest problem in the Swedish context is the large number of unassessed technologies. Because of this, international cooperation is essential.

Delivery of Health Care↗

PubMed1994

Technology assessment of PACS in Osaka University Hospital.

This paper describes a methodology of PACS technology assessment and gives examples of the results of measurement of 24 items of PACS-related situations of image diagnosis systems in Osaka University Hospital before a PACS is installed. These data are to be compared with the data which will be measured after PACS is installed in the new Osaka University Hospital, in order to complete our technology assessment. We propose common variables, units, and conditions of measurement, in order to establish a standard method of data comparison between before and after PACS installation in hospitals at large. We designed our PACS taking technology assessment into account. We do not stop the technology assessment at the efficacy evaluation, because PACS must be more than a tool for radiological practice. We extend the technology assessment into the effectiveness evaluation, so that PACS is a part of radiological practice itself, and diagnostic accuracy, economy and efficiency are the results of PACS operation.

Diagnostic Imaging↗

PubMed1986

Guidelines for the clinical and economic evaluation of health care technologies.

The health care system is routinely confronted with promising new technologies. In the past, most new technologies have been integrated into clinical practice without a rigorous demonstration of their effectiveness or efficiency. In order to provide a more rational approach to the adoption and utilization of health technology a comprehensive set of guidelines for both clinical and economic evaluation is proposed. While conceived of as an ideal that is unlikely to be universally met in practice, it is argued that decision making can be improved by striving towards this goal. The clinical guidelines stress the advantages of subjecting major new technologies to randomized controlled trials and insisting upon a demonstration of patient benefit in the application of diagnostic technologies. The economic guidelines stress comparisons with relevant alternative uses of the resources and the assessment of the impact on the quality of life. While application of the guidelines will produce rigorous and useful evidence, the final decisions concerning the allocation of health care resources must rest fundamentally on social value judgements and not solely, or even primarily, on informed expert opinion.

Clinical Trials as Topic↗

PubMed2006

Technology transfer of Sabin-IPV to new developing country markets.

The Netherlands Vaccine Institute (NVI) developed the micro-carrier technology for large-scale production of IPV in the late 1960s and has used this technology successfully to produce IPV as well as DTP-IPV for the national immunization program in the Netherlands. As a public sector organization, and as one of the Millennium Development Goals, NVI has supported over the years access to vaccine technology like DTP and Hib for vaccine manufacturers in developing countries. In line with this role as a resource institute, NVI has recently been approached by a number of vaccine manufacturers, predominantly from developing countries, for transfer of IPV technology to meet the anticipated increase in demand for IPV following OPV cessation. Since WHO encourages new manufacturers to use the attenuated Sabin virus instead of wild polio strains in the production of IPV, NVI decided to respond positively to this WHO policy. The existing NVI experience in large-scale production of IPV and OPV using Vero cell based micro-carrier technology and its experience with experimental Sabin-IPV is an attractive start for the development of Sabin-IPV. This paper discusses the approach followed and the experience already gained in the project, as well as factors critical to its success.

Animals↗

PubMed2006

The fate and management of high mercury-containing lamps from high technology industry.

This study investigated the fate and management of high mercury-contained lamps, such as cold cathode fluorescent lamps (CCFLs), ultraviolet lamps (UV lamps), and super high pressure mercury lamps (SHPs), from high technology industries in Taiwan, using material flow analysis (MFA) method. Several organizations, such as Taiwan Environmental Protection Administration, Taiwan External Trade Development Council, the light sources manufactories, mercury-containing lamps importer, high technology industrial user, and waste mercury-containing lamps treatment facilities were interviewed in this study. According to this survey, the total mercury contained in CCFLs, UV lamps, and SHPs produced in Taiwan or imported from other countries was 886kg in year 2004. Among the various lamps containing mercury, 57kg mercury was exported as primary CCFLs, 7kg mercury was wasted as defective CCFLs, and 820kg mercury was used in the high technology industries, including 463kg mercury contained in exported industrial products using CCFLs as components. On the contrary, only 59kg of mercury was exported, including 57kg in CCFLs and 2kg in UV lamps. It reveals that 364kg mercury was consumed in Taiwan during year 2004. In addition, 140kg of the 364kg mercury contained in lamps used by high technology industry was well treated through industrial waste treatment system. Among the waste mercury from high technology industry, 80kg (57%), 53kg (38%), and 7kg (5%) of mercury were through domestic treatment, offshore treatment, and emission in air, respectively. Unfortunately, 224kg waste mercury was not suitable treated, including 199kg mercury contained in CCFL, which is a component of monitor for personal computer and liquid crystal display television, and 25kg non-treated mercury. Thus, how to recover the mercury from the waste monitors is an important challenge of zero wastage policy in Taiwan.

Industrial Waste↗

PubMed1992

The need for technology assessment in the reproductive sciences.

OBJECTIVE: The problem confronting medicine is the rapid diffusion of technology without prior broad-based critical peer review. Laser therapy is an archetype of this problem. STUDY DESIGN: Guidelines are needed to identify those medical and surgical procedures that are experimental and those that are truly "state-of-the-art" technology. To be cogent these guidelines must cover nonbiomedical issues and include comparisons with alternative modes of therapy. RESULTS: Steps must be taken to augment the number of individuals in our discipline who can provide leadership in technology assessment and health services research. Joint ventures between professional societies and third-party payers are a logical approach to developing and funding technology assessment programs. CONCLUSIONS: These steps should help ensure that clinical decision analysis and operations research develop as a bona fide scientific discipline within the reproductive sciences. Scientific resources developed in this way should help to improve health care by eliminating ineffective procedures and retaining the technologies that are most effective and economic.

Evaluation Studies as Topic↗

PubMed2002

Beyond effectiveness: the evaluation of information systems using A Comprehensive Health Technology Assessment Framework.

A Comprehensive Health Technology Assessment Framework is presented as a conceptual tool for decision-making about health technologies, including information technologies. The aim of the model is to provide an empirical, evidence-based foundation for health technology decisions. The major framework dimensions are (1) population at risk, (2) population impact, (3) economic concerns, (4) social context (including ethical, legal, and political concerns), and (5) technology assessment information. This multi-disciplinary approach provides guidelines on use of appropriate information in aligning 'stakeholder wants' and 'population needs'.

Decision Making, Organizational↗