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PubMed2004

Experience with virtual reality-based technology in teaching restorative dental procedures.

This article reports on extensive experience with advanced simulation at the University of Pennsylvania, School of Dental Medicine (UPSDM). Virtual reality-based technology (VRBT) or advanced simulation is currently available for the instruction of dental students in preclinical restorative procedures. UPSDM was one of the first schools in the world to have extensive experience with VRBT technology using an advanced simulation unit (DentSim) from DenX, Ltd. UPSDM's experience consists of several years of research using control and experimental groups, employing students to participate in an investigative project, and using the units for remediation and a supplement to the preclinical laboratory. Currently, all first-year students (Class of 2007 and Class of 2008) are receiving most of their preparative operative training on the VRBT units. UPSDM started with one (beta) version unit in 1998, which was later updated and expanded first to four units and recently to fifteen units. This communication is presenting the studies that were of fundamental importance in making the decision to acquire fifteen units in 2003. The areas of main interest to the SDM concerning this technology were its use in teaching, refreshing, and remediating students in restorative procedures and its effectiveness as a teaching methodology in relation to time, efficiency, and faculty. Several studies with varying parameters were performed at various time points. The limited statistical analysis conducted was not conclusive for all measures, and in some cases the data only suggest areas of possible significance. This is due to the low number of students who could access the limited number of available units and the change of protocols in response to student and faculty input. Overall, the results do suggest, however, that students learn faster, arrive at the same level of performance, accomplish more practice procedures per hour, and request more evaluations per procedure or per hour than in our traditional laboratories. Students' attitudes, as measured by surveys, group interviews, and private interviews, are mixed. Our overall evaluation of our experience with this technology has been positive and led to the purchase of additional units, its full incorporation into our curriculum, and curriculum revision to maximize its potential. Our conclusion is that this technology offers significant potential in the field of dental education and that further use and investigation are both desired and justified.

Computer Simulation↗
PubMed2005

The digital pen and paper technology: implementation and use in an existing clinical information system.

OBJECTIVE: Evaluation of the technical feasibility of tight integration of the digital pen and paper technology in an existing computerized patient record.Technology: The digital pen is a normal pen able to record all actions of the user and to analyze a micro pattern printed on the paper. The digital paper is a normal paper printed with an almost invisible micro pattern of small dots encoding information such as position and identifiers. We report our experience in the implementation and the use of this technology in an existing large clinical information system for acquiring clinical information. DISCUSSION: It is possible to print uniquely identified forms using the digital paper technology. These forms can be pre-filled with clinical readable information about the patient. When care providers complete these forms using the digital pen, it is possible to acquire the data in a structured computerized patient record. The technology is easy to integrate in a component-based architecture based on Web Services. CONCLUSION: The digital pen and paper is a cost-effective technology that can be integrated in an existing clinical information system and allows fast and easy bedside clinical information acquisition without the need for an expensive infrastructure based on traditional portable devices or wireless devices.

Humans↗
PubMed2005

Benefits and costs of integrating technology into undergraduate nursing programs.

Advances in technology over the last decade have resulted in increased opportunities for educators to become more innovative in classroom and clinical teaching. These innovations have allowed students and faculty to access essential clinical information at the point of care/need. By capitalizing on technologies such as personal digital assistants and course delivery shells, faculty and students have both portable and remote access to information that can guide practice and learning activities in clinical, classroom, and distance settings. For instance, a student can use a personal digital assistant to research a patient's new medication at the bedside, study course information, access references during class in response to a question, or download clinical materials from home. Although the benefits of having ready access to information seem obvious, there are costs and strategic planning activities associated with implementing these projects. Clearly, the objective of any academic nursing program is to develop skills among students so they can efficiently access information and use that information to guide their nursing practice. To do so, academic nursing administrators must have the forethought to envision how new technologies can support achieving this goal as well as the ability to put in place the infrastructure supports needed for success. This article presents a case study of how one institution developed the necessary infrastructure and garnished the appropriate resources to implement an ambitious technology initiative integrated throughout a large undergraduate nursing program. In addition, how the integration of technology, online and mobile, can enhance clinical learning will be discussed.

Computers, Handheld↗
PubMedDate not supplied

Critical care nurses' experiences when technology malfunctions.

When caring for critically ill patients, critical care nurses work with technology every day. Technology and equipment malfunctions can have a profound effect on nurses' practice and self-image. In this article, a descriptive phenomenological methodology was chosen to explicate the experience of seven critical care nurses. While participants realized that machines might malfunction, they experienced surprise, shock, and feelings of being "let down" and inadequate when malfunctions occurred. They questioned their competence and felt malfunctioning technology jeopardized their credibility and professional image. These findings are useful when structuring educational sessions on technology and in facilitating a supportive environment for critical care nurses when technology malfunctions.

Adult↗
PubMed1992

Health care utilization patterns in developing countries: role of the technology environment in "deriving" the demand for health care.

Health care services, in combination with several intermediate (proximate) determinants of health such as environmental sanitation and nutrition, directly influence health status. In the economics literature, this is referred to as the health production technology. Although many studies recognize that demand for health care depends on the health production technology, otherwise known as a "derived" demand, this review indicates that few of them have so far been able to fully incorporate this technology in estimating significant determinants of health care use. Understanding the technology environment could help explain why substantial portions of the population do not gain access to care even when financial factors do not appear to be a barrier. Also, low utilization of health services may simply reflect the low productivity of these services when other complementary factors such as nutrition or clean water and sanitation are lacking. Finally, since health-producing technology is often a multistep (multivisit) process, health care demand studies generally offer an incomplete picture of health care utilization patterns because they focus on a single event such as the first visit of an illness episode. Researchers should obtain more complete information on the interaction between all health production inputs, their availability and access to them. Multidisciplinary methodologies are likely to be useful.

Developing Countries↗
PubMed1991

High-technology i.v. infusion devices.

Some of the newer high-technology infusion devices commercially available or under development are described. The range of infusion devices includes both controllers and pumps; pumps can be classified by mechanism of operation (peristaltic, syringe, cassette, elastomeric reservoir), frequency or type of drug delivery (continuous or intermittent infusion, bolus dosing, single- or multiple-solution delivery), or therapeutic application (such as the patient-controlled analgesia, or PCA, pump). Advances in infusion technology and computer technology have led to the development of devices with extremely sophisticated drug-delivery capabilities (multiple-rate or multiple-solution programming, operation as pump or controller, or both, and interchangeable applications and settings). Current research in infusion-device technology is focusing on implantable pumps, pumps with chronobiological applications, osmotic-pressure devices, and open- and closed-loop systems. Pharmacists need to keep abreast of the rapidly changing intravenous device marketplace to provide clinical expertise and leadership in the review and evaluation of high-technology drug delivery systems.

Analgesia, Patient-Controlled↗
PubMed1991

New technology, physical facilities and the environment.

Technology assessment is already a powerful tool for dealing with issues of appropriateness and effectiveness of clinical technology; it can be significantly enhanced as a valuable process if it is extended to deal with issues of how best to integrate the considered technology with the physical environment and facilities in which it will be used. These issues include: staff and patient safety and comfort; code compliance; effective accommodation of work flow; staff training; and ongoing operational costs. The methodology of technology assessment can effectively assist health facility administrators in evaluating the appropriateness and effectiveness of energy conservation projects and in addressing environmental concerns. The constraints in funding available to the health care system will continue to challenge the creative energies of our managers to encourage them to develop innovative ways, using technology assessment, to make the physical facilities and environment safe, economical and comfortable for patients and staff.

British Columbia↗
PubMed1990

Improving food quality through new technology.

New technological developments make it possible to improve the quality of animal disease therapy, prophylaxis and diagnosis, and to improve animals' growth and fertility. The term 'quality' includes not only objective measurements, such as the fatness or leanness of meat, but also organoleptic factors such as flavour and others which are of increasing importance to consumers, such as animal welfare. Is new technology consistent with the improvement of quality? For example, beta-agonists and porcine somatotrophin reduce the fatness and increase the protein content of carcases, but there are also subtle positive relationships between fatness and eating quality. In contrast, bovine somatotrophin appears to have no effect on milk composition but there are indications that it may affect the perception of milk quality by some consumers. Improved vaccines can increase food quality by improving animal health and welfare and increasing the uniformity of the product; immunological techniques may also be used to improve meat quality. A gulf has developed between the benefits from new technology and consumer perceptions; indeed there is evidence of political resistance to some technological advances. Despite the stringent regulation of veterinary medicinal products in the United Kingdom and other countries, there is continued pressure for greater political control over their approval. The exchange of information between scientists, industry, the legal regulators and consumers must be improved so that advances in technology are acceptable to the majority and used to the advantage of all.

Animal Feed↗
PubMed1989

[School feeding program in Guatemala: technology transfer to artisan bakers, producers of the nutritionally improved cookie].

The Ministry of Education of Guatemala requested from the Institute of Nutrition of Central America and Panama (INCAP), the development of a solid food for delivery to school children who attend the official schools throughout the country. INCAP developed and transferred the processing technology to produce a nutritionally improved cookie to artisan bakers from the different regions of the country. The present paper describes the technological process, focusing on the training, supervision and quality control actions executed with approximately 100 micro baking enterprises, in 1988 and 1989. These actions have had a positive impact on the bakeries, a fact evidenced by the significant improvement of the conditions and processes of the nutritionally improved cookie production. The performance of the above-mentioned activities has allowed us to detect necessities, for the solution of which research and development of technologies are most important for their immediate transference to artisan bakers. Nevertheless, it is necessary to monitor and control the transferred technology, and efforts must continue to increase the effectiveness of the whole system which involves technology transference model, created for this project.

Child↗
PubMed1989

High-technology i.v. infusion devices.

Some of the newer high-technology infusion devices commercially available or under development are described. The range of infusion devices includes both controllers and pumps; pumps can be classified by mechanism of operation (peristaltic, syringe, cassette, elastomeric reservoir), frequency or type of drug delivery (continuous or intermittent infusion, bolus dosing, single- or multiple-solution delivery), or therapeutic application (such as the patient-controlled analgesia, or PCA, pump). Advances in infusion technology and computer technology have led to the development of devices with extremely sophisticated drug-delivery capabilities (multiple-rate or multiple-solution programming, operation as pump or controller, or both, and interchangeable applications and settings). Current research in infusion-device technology is focusing on implantable pumps, pumps with chronobiological applications, osmotic-pressure devices, and open- and closed-loop systems. Pharmacists need to keep abreast of the rapidly changing intravenous device marketplace to provide clinical expertise and leadership in the review and evaluation of high-technology drug delivery systems.

Ambulatory Care↗
PubMed1986

Technology assessment. How effective is medical care?

Technology assessment helps the physician by determining which technologies are most apt to benefit the patient, allowing the physician to recommend a prudent course of action. Technology assessment should encourage skepticism of new technology, causing the clinician to be more rigorous about accepting the latest invention. By shunning the useless technologies, physicians can prevent rationing of the useful techniques and avoid being caught in the ethical dilemma of doing what is best for the patient but is detrimental to society.

Aged↗
PubMed1987

The impact of technology upon medical history research: the past, the problems, the potential.

The stereotypical view of the historian is that of a stodgy, bespectacled individual poring over tomes of printed text, dusty manuscripts, and thousands of index cards. In the twentieth century, however, many historians have relied increasingly on technological aids to assist in research. This paper focuses on technological developments of this century that have had some impact on medical history research, beginning with the photostat early in this century. It is argued that online bibliographic databases, although relatively recent and not yet fully developed, are only the beginning of technological aids to historical research. Other computer-assisted historiographical applications are examined and the potentials of developing technologies are explored. The specific and inherent problems of using technology in historical research are also presented, as is the need for an evolving role of libraries in dealing with these problems.

Computers↗
PubMed1986

A framework for clinical evaluation of diagnostic technologies.

Most new diagnostic technologies have not been adequately assessed to determine whether their application improves health. Comprehensive evaluation of diagnostic technologies includes establishing technologic capability and determining the range of possible uses, diagnostic accuracy, impact on the health care provider, therapeutic impact and impact on patient outcome. Guidelines to determine whether each of these criteria have been met adequately are presented. Diagnostic technologies should be disseminated only if they are less expensive, produce fewer untoward effects and are at least as accurate as existing methods, if they eliminate the need for other investigations without loss of accuracy, or if they lead to institution of effective therapy. Establishing patient benefit often requires a randomized controlled trial in which patients receive the new test or an alternative diagnostic strategy. Other study designs are logistically less difficult but may not provide accurate assessment of benefit. Rigorous assessment of diagnostic technologies is needed for efficient use of health care resources.

Clinical Trials as Topic↗
PubMedDate not supplied

Technology assessment in health care: group process and decision theory.

As biomedical technologies proliferate, it is incumbent upon the scientific community to monitor, validate, and encourage adoption of worthwhile procedures, drugs, and devices across the interface from research to practice. As the largest U.S. sponsor of biomedical research, the National Institutes of Health (NIH) formally established the Consensus Development Program and the Office of Medical Applications of Research (OMAR), in order to foster and improve the translation of biomedical research results into knowledge useful in the practice of medicine and public health. Individual technology assessments are conducted through a succession of consensus development conferences, which convene expert biomedical scientists, practicing clinicians, and public representatives in an effort to assess safety and efficacy, and to recommend clinical application of important medical technologies. The Consensus Development Program has evolved through three distinct stages. The "first generation," from 1977-82, initiated the experimental, untested concept of consensus development; the "second generation" (1982-84) stressed formulation of the code of standard operating principles enunciated above; and the ongoing "third generation" is testing the utility of formal data synthesis to augment assessments. OMAR is experimenting with an explicit, normative and analytic approach to aid technology assessments. Real-time microcomputer-based decision models are created to help the panel explore the implications of the data. This paper describes and discusses decision analysis and its potential applicability to medical technology assessment and consensus development. It explores OMAR's experience in testing the model during several consensus development conferences, as well as plans and projections for future investigation and implementation.

Decision Theory↗
PubMed1983

Technology and Society.

Technology has had a great impact on changes in life-style during the past. Urgent requirements concerning alimentation, health care, traffic and communication have been met by means of technology. The physical, sensory and intelligent strength of man have been multiplied by the utilization of natural resources, and the average lifetime has been increased considerably. However, technology is always combined with undesired side-effects, such as environmental pollution and cost explosion, as long as it has to meet the increasing requirements of mankind. Physicists and engineers were paying attention to these side-effects long before the so-called critical intelligentsia appeared on the scene. It is noteworthy that, especially in Germany, the natural sciences could never be integrated into culture. As a result of this, many scholars argue against technology without presenting solutions for the actual problems that are at present created by the ever-increasing numbers of people in the world and their high demands. Only science and technology can help to overcome these difficulties if they are applied in a reasonable way.

Agriculture↗
PubMedDate not supplied

Opportunities and obstacles in the implementation of barrier technology.

This paper was developed from the keynote address given at the Isolation Technology Users Group (ITUG) meeting held in Raleigh, North Carolina in December of 1993. Present at the meeting were over 100 individuals representing a cross section of users and suppliers. Unfortunately not all suppliers of isolation technology equipment were represented at this meeting. Subsequent to the meeting, ITUG has decided to operate as a special interest group within the Parenteral Drug Association and attendance will be open to all PDA members. I anticipate that the affiliation of ITUG within PDA will facilitate the free exchange of ideas and information among those interested in barrier technology without interference from commercial considerations. My hope is that we can nurture within the industry a common effort among all users and suppliers to overcome the obstacles and realize the opportunities inherent in isolation technology. While it could be construed that certain of my comments represent an endorsement or a chastisement of certain suppliers of isolator systems that was certainly not my intent. It was prepared in a spirit of egalitarianism to assist the industry at large with what I believe to be a technology of great promise.

Drug Contamination↗
PubMed1994

Critical science and the critique of technology.

Environmental and occupational epidemiology are in the tradition of "critical science." Critical science is a mode of science in which scientific methods are used to critique the adverse consequences of technological development. Critical science should be explicitly recognized as a paradigm in interdisciplinary research. It is the "mode" in which environmental and occupational epidemiology function and the role that these and related disciplines play in society. As the feedback to society on the performance of technology, critical science has assumed a major role in modern society by providing an acceptable critique of technological development. The close association between scientific research and technology of the last three and one-half centuries has been the exception to the historical rule. Intelligent guidance of technology in modern society makes public participation and education in scientific, biomedical, and technical affairs imperative. Critical science in its interdisciplinary dimension is imperative to this public process. Truly interdisciplinary work can only be accomplished when the disciplinary underpinnings are strong and when individual investigators are encouraged to pursue their individual priorities. Critical science is no exception and requires encouragement of skepticism on the part of the investigator toward conventional assumptions.

Ecology↗
PubMed1993

The effect of point of care technology on the quality of patient care.

It is thought that new technologies like computers at the patient's bedside, or point of care technology (PCT) improve nursing productivity, documentation, patient satisfaction and decrease costs. Using the Health Care Technology Assessment (HCTA) framework, (safety, cost, effectiveness, social impact), a descriptive and quasi-experimental study was performed to test the effectiveness and explain the social impact of PCT. A sample of 90 patients from five nursing units in three hospitals were obtained for the study. Half of the patients had computers at their bedside. Data were collected on a hospital pretest/posttest unit and two comparison and experimental units. The main null hypothesis was: There is no difference in the quality of patient care on nursing units with and without PCT. Quality of patient care was measured by patient satisfaction and a nursing care documentation instruments. This hypothesis was rejected. While patients were generally very satisfied with their nursing care on all units, when controlling for time and the presence of the computer, patients who did not have PCT were more satisfied than patients in rooms with PCT. Furthermore, the charts of patients with PCT were less compliant to documentation standards. Conversely, a sub sample of these same patients expressed positive responses to the bedside computer and technologies in their room and this concurred with the current literature. The benefits of the technology were found to outweigh the costs of PCT from the literature review. There was not enough in the literature to draw conclusions about the safety of PCT. In summary, the quality of patient care did not improve with the implementation of PCT in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗