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PubMed1999

How to use articles about diagnostic technology: gastric tonometry.

PURPOSE: Periodic diagnostic tests and continuous and intermittent monitoring are integral to critical care medicine. The focus of this article is understanding the impact of existing diagnostic technology, as well as that of new diagnostic technology. DATA SYNTHESIS: We use literature about gastric tonometry to illustrate eight steps for assessing the value of diagnostic technology. METHODS: These steps focus on how the technology works in the laboratory, its range of uses and diagnostic accuracy, its impact on healthcare workers, the decision making process, and patient outcomes, as well as issues of access, cost, and application in your own setting. CONCLUSIONS: Awareness of the scope and quality of research evaluating new and existing diagnostic technology is central to modern critical care practice.

Canada↗
PubMed1989

Patient-centered high-technology home care.

High-technology home care is a reality in today's health care system. Nurses, as health professionals, will be involved in high-technology home care for many patients, regardless of age or diagnosis. The nurse's involvement may be in the predischarge setting or in the home actually providing care. High-technology home care cannot and should not merely be care of the technology (the "machines and tubes") at home; rather, it should emphasize the care of the patients and families who are receiving technically complex therapies. To provide care for the patient and entire family, all nurses involved with the patient need to be aware of where the patient and family are developmentally, the structure of family relationships, the expectations with regard to home therapy, and the ability of the patient and family to physically or emotionally manage the therapy. Incorporating this information into a care plan for patient and family teaching can enable the nurse to provide care to the patient and family that surpasses that of merely seeing that the high-technology procedure is done safely and correctly.

Adolescent↗
PubMedDate not supplied

A systems engineering approach to technology assessment.

This paper presents a technology assessment process based on systems engineering methodologies used in the aerospace and defense industries. Systems engineering, defined in the U.S. military manual for engineering management, is a logical sequence of activities and decisions transforming an operational need into a description of system performance parameters and a preferred system configuration. Like systems engineering, technology assessment is driven by a single, clear need. The objective of systems engineering is to design a new system configuration; technology assessment assesses existing technologies to address this need. A six-step technology assessment model based on systems engineering principles is presented, including: (1) needs assessment; (2) clinical feasibility analysis; (3) systems assessment; (4) approval; (5) implementation; and (6) follow-up/CQI.

Biomedical Engineering↗
PubMed2002

An assessment of the potential for reducing future combat deaths through medical technologies and training.

BACKGROUND: We examined clinical records of combat casualties that died subsequent to reaching a medical treatment facility in an effort to determine whether new medical technologies or enhanced training might contribute to a reduction in combat deaths. METHODS: Hospital records of 210 fatal combat casualties were independently reviewed by four surgeons. The surgeons assessed each fatality to determine whether it would be preventable if the trauma were sustained today and treated with currently available technology and training. RESULTS: In 8% of the cases, the four surgeons independently agreed that the deaths would be possibly preventable if the same traumas were incurred today. In an additional 17% of the cases, three of the four surgeons judged the deaths to be possibly preventable today. Causes of death viewed as most likely to be salvageable today included hemorrhage, severe burns, pulmonary edema, and sepsis. The medical technologies most often mentioned to have a potentially lifesaving effect were ventilators/respirators, computed tomographic scanners, ultrasound, and antibiotics. Areas of training most often mentioned to have a potential impact on the salvageability of the trauma cases reviewed were damage control, ventilator management, liver packing, respiratory distress management, and burn management. CONCLUSION: Surgeons reviewing records of past combat deaths indicated that reductions in the incidence of combat deaths through deployment of improved medical technologies and training is possible. Deployment of the noted technologies and proficiency in the cited training has the potential for reducing deaths by 8% to 25% when compared with the died-in-hospital incidence among casualties in the last sustained conflict.

Adult↗
PubMed1996

The Richard C. Schneider Lecture. New dimensions of neurosurgery in the realm of high technology: possibilities, practicalities, realities.

Fueled by a buoyant economy, popular attitudes and demands, and parallel progress in transferable technical and biological areas, neurosurgery has enjoyed a remarkable quarter of a century of progress. Developmental trends in the discipline have included the following: 1) a refinement of preoperative definition of the structural substrate, 2) miniaturization of operative corridors, 3) reduction of operative trauma, 4) increased effectiveness at the target site, and 5) incorporation of improved technical adjuvants and physical operative tools into treatment protocols. In particular, the computer has become a formidable ally in diagnostic and surgical events. Trends in technical development indicate that we are entering an exciting era of advanced surgery of the human cerebrum, which is heralded by the following: 1) current developments in areas of imaging, sensors, and visualization; 2) new devices for localization and navigation; 3) new capabilities for action at the target point; and 4) innovative concepts related to advanced operative venues. Imaging has provided structurally based surgical maps, which now are being given the new dimension of function in complex and integrated formats for preoperative planning and intraoperative tactical direction. Cerebral localization and navigation based on these advances promise to provide further refinement to the field of stereotactic neurosurgery, as linked systems are superseded by more flexible nonlinked methodologies in functionally defined volume-oriented navigational databases. Target point action now includes not only ablative capabilities through micro-operative methods and the use of stereotactically directed high-energy forms but also the emergence of restorative capabilities through applications of principles of genetic engineering in the areas of molecular and cellular neurosurgery. Complex, dedicated, and self-contained operative venues will be required to optimize the emergence and development of these computer-oriented micro/stereotactic capabilities, which appear to be unavoidably required as locales for the practice and development of virtual reality-based stations for operative rehearsal, simulation, training, and, ultimately, enhancement of operative events through robotic interfaces. Primary impetus for progress has relied upon new combinations of technologies, disciplines, and industries. Philosophical and practical problems include the spectrum of availability of these methods to the population at large, the training of individuals to properly administer these methods, defining the acceptable envelope of expertise, and maintaining suitable delivery and progress while containing spiraling costs. Advanced neurological surgery and the use and development of high-technology adjuvants require a robust economy that has a populace willing to invest in the luxury of such developments. The current socioeconomic situation is fragile from the standpoint of both economics and attitudes of the patients and health care providers, with diversion of economic resources, redistribution of funding bases, modification of patient referrals, practice styles, and service attitudes undermining progress. Economic pressures have brought high-technology methods under great scrutiny regarding their effectiveness and cost-effectiveness. Reform proposals have specifically targeted technology-oriented services, and the Office of Technology Assessment has recommended increasing the use of managed care providers who look to information on cost-effectiveness and clinical practice guidelines to establish efficient management strategies and issue "report cards." Although the premise is laudable and "gimmickry" needs to be identified, it might be argued that such scrutiny and control might be overbearing and overused, impeding appropriate delivery and progress.

Cost-Benefit Analysis↗
PubMedDate not supplied

New technology continues to invade healthcare. What are the strategic implications/outcomes?

Healthcare technology continues to advance and be implemented in healthcare organizations. Nurse executives must strategically evaluate the effectiveness of each proposed system or device using a strategic planning process. Clinical information systems, computer-chip-based clinical monitoring devices, advanced Web-based applications with remote, wireless communication devices, clinical decision support software--all compete for capital and registered nurse salary dollars. The concept of clinical transformation is developed with new models of care delivery being supported by technology rather than driving care delivery. Senior nursing leadership's role in clinical transformation and healthcare technology implementation is developed. Proposed standards, expert group action, business and consumer groups, and legislation are reviewed as strategic drivers in the development of an electronic health record and healthcare technology. A matrix of advancing technology and strategic decision-making parameters are outlined.

Delivery of Health Care↗
PubMedDate not supplied

Technology. Possibilities and pitfalls.

An amazing growing area in healthcare is the increase in the development of technology that is designed to augment human functioning and decrease an individual's dependence on others to provide personal care. Yet, what does it mean to extend a person's life through technology? Within the context of a hypothetical case, this article considers ethical questions raised by new and futuristic technologies designed to augment human functioning. These ethical issues are grounded within the context of the possibilities and the pitfalls of technology. When providing care to patients and families, nurses must recognize and understand the significant ways in which quality of life, personhood, accessibility, and cost may be challenged by the promises of new technologies.

Adult↗
PubMed2006

User involvement in healthcare technology development and assessment: structured literature review.

PURPOSE: Medical device users are one of the principal medical device technology stakeholders. The involvement of users in medical device technology development and assessment is central to meet their needs. This study aims to examine this issue. DESIGN/METHODOLOGY/APPROACH: A structured review of the literature published from 1980 to 2005 in peer-reviewed journals was carried out from a social science perspective to investigate user involvement practice in the development and assessment of medical device technologies. This was followed by a qualitative thematic analysis. FINDINGS: Medical device users include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of: design > testing and trials > deployment > concept stages. The methods most commonly used for capturing users' perspectives are usability tests, interviews and questionnaire surveys. RESEARCH LIMITATIONS/IMPLICATIONS: The relevant engineering, medical and nursing literature, which might have been useful, was not reviewed. However, useful findings emerge that apply to health care generally. ORIGINALITY/VALUE: This study shows that medical device users are not homogeneous but heterogeneous in several aspects, such as needs, skills and working environments. This is an important consideration for incorporating users' perspectives in medical device technologies.

Community Participation↗
PubMed1996

Assessment of medical technology and the challenge for health reform in Africa.

Introduces an African perspective to existing research and scholarship on the relationship between western medical technology and health care planning in Africa. Examining the broader issues of development and underdevelopment, contends that the present health care system, fashioned after western medical systems (focusing on hospital and curative care), has failed to make significant impact by reducing mortality rates in Africa. Describes the already precarious health conditions in Africa and argues that, while Africa can benefit from the application of western medical technology, the irrelevance of current strategies to people's needs and the widespread abuse of medical resources have rendered western technology ineffective in Africa. Concludes by calling for the creation of a council of technological assessment in Africa to review requirements and recommend to African governments appropriate and efficient medical technologies to meet the health needs of Africans.

Africa↗
PubMed2004

Technology--an actor in the ICU: a study in workplace research tradition.

BACKGROUND: The present study focuses on human-machine interaction in an intensive care unit in the West of Sweden. AIMS: The aim of the present study was to explore how technology intervenes and challenges the ICU staff's knowing in practice. THEORETICAL PERSPECTIVE: The study's theoretical starting point draws on workplace research tradition. Workplace studies encompass the interaction between the actors' situated activities and the technological tools that make their activities possible. METHOD: Fieldwork or in situ studies of everyday practice in an intensive care unit documented in written field notes constituted the data. RESULTS: The findings show first how technology intervenes in the division of labour when the taken-for-granted "old" everyday practice is disrupted when a new machine intervenes in the morning's work; secondly, it reveal how technology challenges practical knowing and thirdly, it shows how technology reformulates practice. Staff members' awareness of routine problems is often connected to the ability to see, which is always related to cultural/contextual competence. CONCLUSION: It is concluded that it is not talk alone that helps the caregivers to "(dis)solve" the problems. The ability to see the problems, the work environment and to find the relevant supporting tools for "(dis)solving" the routine problems is also crucial. But it is not possible to say that it is the skillful work of humans that solve problems, nor do we claim it is the tools that do so. Humans and tools are interwoven in the problem-solving process. Relevance to clinical practice. Routine problems in the intensive care unit are not "(dis)solved" through the cognitive work of individual staff members alone. Problems are also "(dis)solved" jointly with other staff members. Staff members "borrow" the knowing from each other and problems are re-represented through communication. The knowing has to be distributed among the intensive care unit staff to make the everyday work flexible.

Anthropology, Cultural↗
PubMed2005

Influence of new educational technology on problem-based learning at Harvard Medical School.

PURPOSE: Computers with 50-inch, wall-mounted plasma screens and broadband Internet access were installed in all small group tutorial rooms at Harvard Medical School. This study examines how the introduction of this educational technology impacted on the problem-based learning tutorials. METHOD: A total of 37 tutorial groups, stratified by year of student, were observed at separate timepoints (autumn 2002, spring 2003) to document the patterns of use of the technologies. Based on these observations, end-of-course surveys were developed and distributed to students and tutors. Observational field notes and open-ended survey responses were qualitatively analysed for themes. RESULTS: Using a 5-point rating scale, both students and tutors indicated that the technologies had a positive impact on their tutorials. In autumn 2002, plasma screens were used for an average of 17.8 and 22.1 minutes per 1-hour observation in Year 1 and 2 tutorials, respectively; in spring 2003, usage declined to 6.9 and 5.9 minutes, respectively. Resources utilised included Internet sites (54% total use time), PowerPoint presentations by students (22%), and course-specific postings (24%). Marked course-specific variation in usage was noted. Observational and survey data revealed that the technologies interrupted the flow of tutorial discussion. Students and tutors expressed concerns that the plasma screens might be altering the process of problem solving in the tutorials. CONCLUSIONS: Both students and tutors reported that the introduction of computers and wall-mounted plasma screens had impacted positively on tutorials. Questions were raised as to how this technology might alter tutorial dynamics. Further research will be needed to investigate these pedagogical concerns.

Attitude↗
PubMedDate not supplied

Rearing the child who is technology dependent: perceptions of parents and home care nurses.

ISSUES AND PURPOSE: Most children who are dependent on technology for survival live with their families at home. This study explores the perceptions of parents and home care nurses regarding rearing the technology-dependent child. DESIGN AND METHODS: In this qualitative study, interviews were conducted with 16 parents whose child is technology dependent and 15 registered nurses who provided home care. RESULTS: Rearing the child who is technology dependent is similar to but different from raising other children. Parental communication and negotiation of child-rearing expectations with home care nurses is essential. PRACTICE IMPLICATIONS: Improved collaboration and communication between parents and nurses may reduce parental stress and enhance development for children who are dependent on technology.

Adult↗
PubMed2005

Uptake of rotary NiTi technology within Australia.

BACKGROUND: Rotary NiTi technology was introduced into Australia approximately 10 years ago. Little information is available in the dental literature to explain the adoption of new technology in dentistry. The aim of this paper is to identify and describe demographic features in the uptake of rotary NiTi technology within Australia. METHODS: In 2001, a questionnaire survey was mailed to a stratified systematic sample of general dentists and endodontists in Australia. The numbers of dentists in each state adopting the new technology were recorded and the results tabulated and graphed. RESULTS: The response rate for the survey was 87 per cent. Overall, 26 per cent of responders used rotary NiTi instruments with a significantly higher proportion of endodontists (64 per cent) than general dentists (22 per cent). A significantly lower proportion of South Australian metropolitan general dentists used rotary NiTi compared with metropolitan dentists in all other states combined. The rate of uptake by South Australian dentists was lower than the other states. A significantly higher proportion of Queensland endodontists were using rotary NiTi compared with endodontists in New South Wales. A significantly greater proportion of rural dentists had tried and abandoned the new technology than metropolitan dentists. CONCLUSIONS: The adoption of rotary NiTi in Australia appears to conform to diffusion of innovation theory and has reached a critical mass making it self-sustaining.

Attitude of Health Personnel↗
PubMed2005

Patenting and licensing of university-based genetic inventions--a view from experience at Stanford University's Office of Technology Licensing.

University technology transfer offices license inventions created at universities to companies looking for tools, additions to their product pipelines, improvements or start-up opportunities. This paper will cover the motivations for conducting university technology transfer, an overview of Stanford's Office of Technology Licensing and its patenting and licensing practices, models of royalty sharing at university technology transfer offices, and patenting and licensing genetic information inventions at Stanford University. The terms 'invention' and 'technology' are used interchangeably throughout the paper.

California↗
PubMedDate not supplied

Assessment of clinical skills using simulator technologies.

OBJECTIVE: Simulation technologies are used to assess and teach competencies through the provision of reproducible stimuli. They have exceptional utility in assessing responses to clinical stimuli that occur sporadically or infrequently. In this article, the authors describe the utility of emerging simulation technologies, and discuss critical issues in simulator-based skills assessment and appropriate results analysis. METHOD: Based on literature search and expert consensus, the authors discuss three simulation technologies: standardized patients and the objective structured clinical examination; the integrated high fidelity mannequin; virtual clinical stations and the objective structured virtual examination. RESULTS: The authors explore the current state of these technologies: uses, cost, limitations, and likely future applications. For instance, tele-standardized patients may test learners' communication/management approach to challenges during tele-consultation, such as a suicidal patient several hundred miles away. Integrated mannequins may test leadership skills during psychiatric emergencies. Case-based interactive virtual clinical assessment tools may test learners' decision-making skills or self-reflection. However, these exciting tools must be implemented systematically. Specifically, educators must define the competencies of interest precisely. Appropriate data analysis will generate dependable results, ascribing the correct proportion of outcome variability to individual learner behavior. Careful analysis and utilization of results will allow justification of the costs to major stakeholders. CONCLUSIONS: Simulation technologies offer exciting possibilities for skills evaluation and clinical practice improvement. When used creatively and appropriately, they form a useful adjunct in the armament of educators addressing the question, "Is this physician competent?"

Clinical Competence↗
PubMedDate not supplied

Using assistive technology adaptations to include students with learning disabilities in cooperative learning activities.

Cooperative learning (CL) is a common instructional arrangement that is used by classroom teachers to foster academic achievement and social acceptance of students with and without learning disabilities. Cooperative learning is appealing to classroom teachers because it can provide an opportunity for more instruction and feedback by peers than can be provided by teachers to individual students who require extra assistance. Recent studies suggest that students with LD may need adaptations during cooperative learning activities. The use of assistive technology adaptations may be necessary to help some students with LD compensate for their specific learning difficulties so that they can engage more readily in cooperative learning activities. A process for integrating technology adaptations into cooperative learning activities is discussed in terms of three components: selecting adaptations, monitoring the use of the adaptations during cooperative learning activities, and evaluating the adaptations' effectiveness. The article concludes with comments regarding barriers to and support systems for technology integration, technology and effective instructional practices, and the need to consider technology adaptations for students who have learning disabilities.

Cooperative Behavior↗
PubMed2002

Evaluating the effects of information technology on problem-oriented-policing. If it doesn't fit, must we quit?

Technologies promise to make our organizations more productive, efficient or effective. But our experience does not always fulfill this promise. Public safety agencies are the target of a barrage of new information technologies offering better performance, many of which are attractive because they can be financed through federal grants. But when evaluations are performed of these technologies, improvements do not always result. This article describes the experiences of a state police agency (SPA) during its use of cellular digital packet data (CDPD) systems to support its problem-oriented policing (POP) project. The CDPD system should have improved the SPA's POP operations; in practice, it was not as clear. Although participants believed the CDPD technology worthwhile, there were only a few minor differences between POP officers that did and did not use it. This evaluation suggests the need for better databases to measure performance as well as more informed federal funding of ways to assess the impact of technologies.

Efficiency↗
PubMed2004

[Social consensus on medical technology policy: ethical issues and citizen participation].

Social consensus is considered to be a necessary condition for a policy to be introduced and implemented effectively. This is the case with the approval, regulation and prohibition of certain advanced medical research and technology, especially when they could invoke moral disputes in society. Public policies on organ transplantation, definition of death, euthanasia, genetic screening and diagnosis, and human stem cell research are recent examples. The concept of consensus, however, is elusive, along with the measures to secure it. Technocratic decision making, as a paternalistic activity frequently led by experts, sometimes poses a challenge to democratic decision making, supposedly based on a well-informed and rational public. It also remains to be proved whether public involvement in policymaking can be a solution to ethical value conflicts in society. From the perspective of policy sciences, this paper first introduces the concept of consensus, especially consensus on moral issues in pluralistic societies, and its implications to public policy, including citizen participation in decision making. Then, it briefly explains the historical background with which social consensus and public involvement have increasingly flourished in the field of technology assessments and technology policy making, including biomedical technology. Next, major institutions, governmental and nongovernmental, involved in the ethical aspects of medical research and technology, are presented along with their efforts for citizen participation. Finally, the paper discusses some of the future agendas on this issue.

Bioethics↗