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PubMed2005

The development of minimally invasive continuous Metabolic Monitoring Technologies in the U.S. Army TMM Research Program.

The Technologies for Metabolic Monitoring and Julia Weaver Fund Research Program (TMM) promotes the development of minimally invasive, innovative technologies for the monitoring and assessment of metabolic changes that are important to the management of diabetes. This program also promotes the advancement of biological monitoring technologies for healthy individuals operating in extreme environments, such as soldiers and astronauts. These technologies have focused on measurements of analytes in interstitial fluids and functional outcomes related to glucose regulation. TMM investigators have advanced new sensing methods and are working to overcome technological barriers to long-term implants. This paper reviews the current goals, research areas, and future direction of the program.

Algorithms↗

PubMed1996

What can progress in reproductive technology mean for women?

This article critically evaluates the central claims of the various feminist responses to new reproductive arrangements and technologies. Proponents of a "progressivism" object to naive technological optimism and raise questions about the control of such technology. Others, such as the FINRRAGE group, raise concerns about the potentially damaging consequences of the new technologies for women. While a central concern is whether these technologies reinforce harmful biologically determinist stereotypes of women, it may be that these critiques function with a devastating gender blindness that puts women at risk in other, heretofore unnoticed, ways.

Contraception↗

PubMed2004

Comprehensive comparison of six microarray technologies.

Microarray technology is extensively used in biological research. The applied technologies vary greatly between laboratories, and outstanding questions remain regarding the degree of correlation among approaches. Recently, there has been a drive toward ensuring high-quality microarray data by the implementation of MIAME (Minimal Information About a Microarray Experiment) guidelines and an emphasis on ensuring public-availability to all datasets. However, despite its current widespread use and availability, very little is known about the extent to which application of the different technologies influences the outcome of transcriptional profiles and differential expression. The results among the handful of published studies are conflicting. Here, we present a comprehensive evaluation encompassing different reporter systems (short oligonucleotides, long oligonucleotides and cDNAs), labelling techniques and hybridization protocols. We used four oligonucleotide and two cDNA platforms to compare gene expression between two sample types. We determined the overall consistency (reproducibility) within each platform, and correlation among replicates within and between technologies. We find that the top performing platforms show low levels of technical variability that result in an increased ability to detect differential expression. Most importantly, we show the top four platforms are highly correlated with biological, rather than technological, differences accounting for the majority of variation in the data.

Animals↗

PubMed1992

New technologies in interventional cardiology.

This review confines itself to the new technologies that are widely used and that are being tested in formal trials. To date there have been few well-performed trials to compare the technologies, a fact that may have opened the way for the inappropriate use of some of these new technologies. This has allowed enthusiasts to perform procedures with as yet unproven tools no better and possibly worse than balloon angioplasty. New technologies can be broadly divided into three categories depending on their intended role: 1) mechanical removal, such as directional atherectomy, extractional atherectomy, and rotational atherectomy, that is designed to debulk lesions and remove atheromatous material, 2) high-energy removal by laser technologies designed to disobliterate lesions without producing the theoretically damaging lateral stretching of normal balloon angioplasty, 3) intraluminal scaffolding through the use of stents designed to give intravascular support, eg, balloon expandable, self-expanding, and temporary removable devices.

Angioplasty, Balloon, Coronary↗

PubMed1998

Technologic competence as caring in critical care nursing.

The article describes technologic competence as caring in critical care nursing, a framework grounded in the perspective of nursing as caring. The achievement of technologic competence is an exercise in the process of knowing the wholeness of persons in the moment. Nurturing persons toward well-being is the focus of nursing. Technology, caring, and competence are core concepts that constitute the framework of technologic competence as caring in critical care nursing. Technologic competence epitomizes critical care nursing and assumes an indispensable position in contemporary nursing practice.

Clinical Competence↗

PubMedDate not supplied

Caregiving effectiveness in families managing complex technology at home: replication of a model.

BACKGROUND: Original testing of the Caregiving Effectiveness Model, in a randomly drawn national sample (n = 111) of family caregivers, explained variance in the home care outcomes of patient physical condition, technology side effects, and quality of life. The variables in the resulting model reflected the challenges specific to family caregivers managing complex home care for the growing populations of technology-dependent patients. OBJECTIVE: To seek further empirical verification of the relationships among home care outcomes and the variables in the original trimmed model. METHOD: Data were collected from family caregivers (n = 31) and adult patients (n = 31) requiring lifelong daily total parenteral nutrition (TPN) infusion technology for nonmalignant bowel disease. Hierarchical regression was used with variables entered in the two stages that coincided with the model configuration of Caregiving and Adaptive concepts, with a criteria of alpha = .05 at a power of > .80. RESULTS: The model variables explained variance in all four outcomes. Specifically, Caregiving and Adaptive concept variables contributed to the explained variance in quality of life of both caregivers (R2 = .559, F = 4.65, p = .003) and patients (R2 = .464, F = 5.17, p = .04). Variance in patients' physical condition (R2 = .345, F = 6.37, p = .032) and the technological side effects outcomes (R2 = .357, F = 3.60, p = .018) were accounted for by variables in the model. CONCLUSIONS: In this sample, the Caregiving Effectiveness Model concepts accounted for significant variance in home care outcomes (quality in patients' and caregivers' lives, patients' physical condition, and technological side effect). Longitudinal study of this sample will determine if variables explain variance over time, as in the original model testing.

Adolescent↗

PubMedDate not supplied

Ethical considerations for the utilization of tele-health technologies in home and hospice care by the nursing profession.

Home care, including hospice care, is a growing component of the current healthcare system and pertains to care services that are provided to individuals, their family members, and caregivers in their own residence. Both domains face funding limitations as life expectancy and the segment of the population older than 65 years increase. Tele-health, defined as the use of advanced telecommunication technologies to enable communication between patients and healthcare providers separated by geographic distance, is perceived as a concept that can enhance both home and hospice care and address some of the current challenges. This article discusses ethical challenges associated with the utilization of tele-health technologies by the nursing profession in the home setting. These factors form a framework for the ethical considerations that result from the introduction of these technologies in nursing practice. Specifically, the article discusses the issue of privacy and confidentiality of patient data, informed consent, equity of access, promoting dependency versus independence, the lack of human touch and the impact of technology on the nurse-patient relationship, and the medicalization of the home environment. These issues constitute a road map both for nursing practitioners who are aiming to provide an efficient delivery of services in the home and for nursing administrators who are asked to make judgments about the use of tele-health technology as a supplement to traditional care and as a cost-saving tool.

Confidentiality↗

PubMed2001

Technologic advances for evaluation of cervical cytology: is newer better?

Among those women who have cervical cancer and have been screened, 14% to 33% of the cases represent failure to detect abnormalities that existed at the time of screening. New technologies intended to improve detection of cytologic abnormalities include liquid-based, thin-layer cytology (ThinPrep, AutoCyte), computerized rescreening (PAPNET), and algorithm-based computer rescreening (AutoPap). This report combines evidence reviews conducted for the U.S. Preventive Services Task Force and the Agency for Healthcare Research and Quality, in which we systematically identified articles on cervical neoplasia, cervical dysplasia, and screening published between January 1966 and March 2001. We note the challenges for improving screening methods, providing an overview of methods for collecting and evaluating cytologic samples, and examining the evidence about the diagnostic performance of new technologies for detecting cervical lesions. Using standard criteria for evaluation of the diagnostic tests, we determined that knowledge about the sensitivity, specificity, and predictive values of new technologies is meager. Only one study of liquid-based cytology used a reference standard of colposcopy, with histology as indicated, to assess participants with normal screening results. Lack of an adequate reference standard is the overwhelming reason that test characteristics cannot be properly assessed or compared. Most publications compare results of screening using the new technology with expert panel review of the cytologic specimen. In that case, the tests are not independent measures and do nothing to relate the screening test findings to the true status of the cervix, making determination of false-negatives, and thus sensitivity, specificity, and negative predictive value, impossible. We did not identify any literature about health outcomes or cost effectiveness of using these tools in a system of screening. For the purposes of guiding decision making about choice of screening tools, the current evidence is inadequate to gauge whether new technologies are "better" than conventional cytology..

Colposcopy↗

PubMedDate not supplied

What adolescents with type I diabetes and their parents want from testing technology: a qualitative study.

The presence of diabetes in an adolescent can significantly affect his/her normal development. Mobile technology may offer the ability to lessen this negative impact. We wished to learn from adolescents with diabetes and their parents how monitoring systems that incorporated mobile communication technology could potentially help to reduce hassles associated with testing, improve compliance, and ease adolescent-parent conflict about testing behavior. We recruited adolescents between the ages of 13 and 18 years, living with type 1 diabetes mellitus and their parents for focus groups. Qualitative analysis of the focus group data followed a set procedure. From the discussions, the following themes were identified: issues with blood glucose monitoring and desired technology. Elements of desired technology included hardware requirements, software requirements, communication, and miscellaneous requirements. The reported needs of this end-user group can help others to leverage maximally the capabilities of new and existing technology to care for children managing chronic disease.

Adolescent↗

PubMed2006

Imprinting disorders after assisted reproductive technologies.

PURPOSE OF REVIEW: To assess the evidence of an increased risk of imprinting diseases in children born after use of assisted reproductive technologies. RECENT FINDINGS: Imprinting disorders occur when the epigenetic programming during gametogenesis is disturbed, or when this programming is not sufficiently sustained during the process of fertilization and early embryonic development. Ten case or case-reference reports have been published suggesting that compared with reference populations, a higher proportion of children with imprinting diseases were conceived by assisted reproductive technologies. These reports are inconsistent in linking the risk to a specific assisted reproductive technology, and a cytogenetic examination assessing the exact genetic imprinting mechanism was not always provided. Two national systematic follow-up studies on 6052 Danish and 16,280 Swedish in-vitro fertilization children found none and two children with imprinting diseases, respectively. These figures correspond approximately to the expected number of children with imprinting disease from the general population. SUMMARY: The evidence of an increased risk of imprinting diseases in children conceived by assisted reproductive technologies is limited. The published case reports, however, call for a systematic multinational long-term follow-up of children born after assisted reproductive technologies.

Animals↗

PubMed2006

Ultrasonic technology facilitates minimal access thyroid surgery.

OBJECTIVES: Options for controlling the vasculature during thyroid surgery include suture ligatures, vessel clips, and bipolar cautery. Ultrasonic technology represents an alternative to conventional techniques in which the vessels are simultaneously sealed and divided. We sought to determine the safety and efficacy of thyroidectomy with ultrasonic technology. DESIGN: Nonrandomized, prospective analysis of a series of patients undergoing thyroidectomy at the Medical College of Georgia. METHODS AND MATERIALS: The records of 51 consecutive patients who underwent thyroid surgery between December 2004 and June 2005 were reviewed. Patients in whom ultrasonic technology (Harmonic-ACE, Ethicon Endo-Surgery, Cincinnati, OH) was used comprised the study population. RESULTS: Forty-four of 51 patients underwent thyroidectomy with the assistance of ultrasonic technology. There were 4 males and 40 females with a mean age of 43.5 +/- 15.8 years. Twenty-two patients had a total thyroidectomy, 18 underwent unilateral lobectomy, and 4 underwent completion thyroidectomy. The overall mean incision length was 5.0 +/- 2.6 (range 2-12) cm. A subgroup of patients underwent minimally invasive video-assisted thyroidectomy (n = 13) and had a mean incision length of 29.3 +/- 0.8 mm. There were no cases of permanent injury to the recurrent laryngeal nerve and no cases of persistent hypoparathyroidism. Blood loss ranged from 5 mL to 100 mL, with a mean of 26.7 +/- 21.8 mL. CONCLUSIONS: Ultrasonic technology facilitates thyroid surgery, particularly when a minimally invasive approach is undertaken. It reliably seals and divides the thyroid vasculature and will likely replace other methods of managing the thyroid blood supply.

Adult↗

PubMed2001

Rapid diagnostics: the detection of neuraminidase activity as a technology for high-specificity targets.

The accurate detection of influenza by clinical symptoms is challenging since multiple pathogenic viruses and bacteria mimic similar symptoms in a patient. With new and more effective influenza therapeutics available, there is a growing need for highly accurate and rapid diagnosis of influenza, particularly when the window of opportunity for proper treatment is measured in hours. A parallel technology, which is also used in the treatment of influenza, was developed for the rapid diagnosis of influenza by exploiting the enzymatic activity of influenza neuraminidase. This technology, which is called Pathozyme, offers the high specificity inherent from the conservation of the neuraminidase active site. The ZstatFlu test uses a small molecule derivative of sialic acid chemically coupled to a reporter group together with simple point-of-care reagents for directly detecting influenza from a patient specimen with high specificity. A second-generation platform technology using this neuraminidase detection system coupled with a more sensitive chemiluminescent reporter has been developed and formatted for reading on high-speed instant film. This modification resulted in a platform technology many-fold more sensitive than the former while maintaining its inherent high specificity. Preliminary data from a prototype tested during the mild 2000-2001 influenza season demonstrated that an optimized chemiluminescent test system could approach the accuracy of 14 day viral culture in a convenient 10-20 min test. This platform technology is currently being explored for the rapid detection of other pathogenic organisms where sensitivity, specificity and speed are essential in a point-of-care setting.

Amino Acid Sequence↗

PubMed2005

Capacitive micromachined ultrasonic transducers: fabrication technology.

Capacitive micromachined ultrasonic transducer (cMUT) technology is a prime candidate for next generation imaging systems. Medical and underwater imaging and the nondestructive evaluation (NDE) societies have expressed growing interest in cMUTs over the years. Capacitive micromachined ultrasonic transducer technology is expected to make a strong impact on imaging technologies, especially volumetric imaging, and to appear in commercial products in the near future. This paper focuses on fabrication technologies for cMUTs and reviews and compares variations in the production processes. We have developed two main approaches to the fabrication of cMUTs: the sacrificial release process and the recently introduced wafer-bonding method. This paper gives a thorough review of the sacrificial release processes, and it describes the new wafer-bonding method in detail. Process variations are compared qualitatively and quantitatively whenever possible. Through these comparisons, it was concluded that wafer-bonded cMUT technology was superior in terms of process control, yield, and uniformity. Because the number of steps and consequent process time were reduced (from six-mask process to four-mask process), turn-around time was improved significantly.

Biotechnology↗

PubMed2004

DNA microarray technology and its applications in dermatology.

The use of DNA microarray technology in biomedical research has dramatically increased during the past years. In the present report, we provide an overview on the basic DNA microarray technology and biostatistical methods for gene expression analysis. A focus is then put on its applications in dermatological research. In recent years, a series of gene expression studies have been performed for various dermatological diseases, such as malignant melanoma, psoriasis and lupus erythematosus. These analyses have identified interesting target genes as well as putative disease susceptibility loci. However, further functional studies will be needed for a more complete understanding of the pathogenesis of these diseases. This may be performed by means of the recently developed RNA interference technology. Besides its role in large-scale gene expression studies, DNA microarray technology has proved to be a valuable tool for genomic screens of genetic alterations, e.g. single nucleotide polymorphisms. These play a role in tumour development and progression, and also function as genetic markers for disease susceptibility. Taken together, DNA microarray technology opens enormous perspectives for dermatologists. It may help us understand the complex pathogenesis of a wide variety of dermatologic diseases and identify their genetic background.

Cell Differentiation↗

PubMed2006

New technology for transfusion safety.

Hemovigilance programs from around the world document that the greatest risk to recipients of blood transfusion is human error, resulting in transfusion of the incorrect blood component. Errors in transfusion care have strong parallels with errors in medication administration. Errors often result from 'lapse' or 'slip' mistakes in which details of patient identification are overlooked. Three areas of transfusion are focal points for improved care: the labelling of the patient's pre-transfusion sample, the decision to transfuse and the final bedside check designed to prevent mis-transfusion. Both barcodes and radio-frequency identification technology, each ideally suited to matching alpha-numeric identifiers, are being implemented in order to improve performance sample labelling and the bedside check. The decision to transfuse should ultimately be enhanced through the use of nanotechnology sensors, computerised order entry and decision support systems. Obstacles to the deployment of new technology include resistance to change, confusion regarding the best technology, and uncertainty regarding the return-on-investment. By focusing on overall transfusion safety, deploying validated systems appropriate for both medication and blood administration, thoughtful integration of technology into bedside practice and demonstration of improved performance, the application of new technologies will improve care for patients in need of transfusion therapy.

Blood Grouping and Crossmatching↗

PubMed2004

How information retrieval technology may impact on physician practice: an organizational case study in family medicine.

RATIONALE: Information retrieval technology tends to become nothing less than crucial in physician daily practice, notably in family medicine. Nevertheless, few studies examine impacts of this technology and their results appear controversial. AIMS AND OBJECTIVES: Our article aims to explore these impacts using the medical literature, an organizational case study and the literature on organizations. METHODS: The case study was embedded in an evaluation of the implementation of medical and pharmaceutical databases on handheld computers in a Canadian family medicine centre. Six physicians were interviewed on specific events relative to the use of these databases and on their general perception of impacts of this use on clinical decision making and the doctor-patient relationship. A thematic data analysis was performed concomitantly by both authors. RESULTS AND CONCLUSION: Findings indicate six types of impact: practice improvement, reassurance, learning, confirmation, recall and frustration. These findings are interpreted in accordance with both a medical and organizational perspective. The fit with the literature on inter-organizational memory supports the transferability of the findings. In turn, this fit suggests how information retrieval technology may change physician routine. This study suggests a new basis for evaluating the impact of information retrieval technology in daily clinical practice. In conclusion, our paper encourages policy-makers to develop, and physicians to use, this technology.

Canada↗

PubMed2006

Technological dependency--the experience of using home ventilators and long-term oxygen therapy: patients' and families' perspective.

Technological dependency is defined as a short or long-term reliance on machines and techniques to evaluate, satisfy or resolve health problems. In nursing technological dependency has been explored in the context of caring. Hitherto it has been maintained that technology and caring are contradictory, but a more prominent view is that technology and caring can and must be reconciled to provide high-quality care. This study describes patients' and families' experience of long-term home treatment with noninvasive ventilation during sleep with or without additional oxygen therapy. Considering the potential burden of undergoing this treatment the research question is: What is patients' and families' experience of being dependent on technical breathing assistance during sleep? The methodological approach draws from interpretive phenomenology and narrative analysis. Participants were six patients aged 45-70, five spouses and one daughter. Data, generated through two 1-hour semi-structured interviews with each pair of participants, were analysed into themes. Results are presented by the following narratives: (i) mixed blessing: life-saving treatment - meaningless exertion; (ii) compassion and understanding central amid use of complex machines; (iii) listening to the body; (iv) wanting to be seen as healthy; (v) dominance of technological thinking; and (vi) sustained work in maintaining the treatment. It is concluded that being dependent on technical breathing assistance during sleep, with or without oxygen, was a major life event for participants. The treatment was experienced as constraining and intrusive, particularly at the beginning, but concurrently it dramatically relieved difficulties for most participants. Regardless of its usefulness it provoked questions on purpose, indicating that the way to implement the treatment is crucial. Professionals need to pay close attention to how they introduce noninvasive ventilation technique, putting caring concern and respect for unique needs of patients and their families at the forefront.

Adaptation, Psychological↗

PubMed1993

Assistive technology policy: a road to independence for individuals with disabilities.

This article identifies and analyzes equity issues in assistive technology policy for adults with disabilities in the United States and makes recommendations for further research and advocacy. The following equity issues are considered: (a) who has access to assistive technology, (b) which technology is available, (c) who decides on the technology, and (d) who controls or determines the allocation of assistive technology. The discussion considers the role of stereotyping and discrimination in policy-making and how these affect equity. There is a need to rethink the concepts of normal and abnormal, and to reformulate policy more on the basis of the values of empowerment, independence, and community integration.

Adult↗