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PubMedDate not supplied

Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques.

BACKGROUND: While potential benefits of robotic technology include decreased morbidity and improved recovery, some have suggested a prohibitively high cost. This study was undertaken to compare actual hospital costs of robotically assisted cardiac procedures with conventional techniques. METHODS: We conducted a retrospective review of clinical and financial data of 20 patients who underwent atrial septal defect (ASD) closure and 20 patients who underwent mitral valve repair (MVr) using either robotic techniques or a conventional approach with a sternotomy. Total hospital cost (actual resource consumption) was subdivided into operative and postoperative costs. RESULTS: Robotic technology did not significantly increase total hospital cost for ASD closure or MVr (p = 0.518 and p = 0.539). However, when including the initial capital investment for the robot through amortization of institutional costs, total hospital cost was increased by $3,773 for robotic ASD closure and $3,444 for robotic MVr (p = 0.021 and p = 0.004). The major driver of cost for robotic cases (operating room time) decreased over time. CONCLUSIONS: Robotic technology did not significantly increase hospital cost. While the absolute cost for robotic surgery was higher than conventional techniques after taking into account the institutional cost of the robot, the major driver of cost for robotic procedures will likely continue to decrease, as the surgical team becomes increasingly familiar with robotic technology. Furthermore, other benefits, such as improvement in postoperative quality of life and more expeditious return to work may make a robotic approach cost-effective. Thus, it is possible that the benefits of robotic surgery may justify investment in this technology.

Adult↗

PubMedDate not supplied

Technology and family-centered perinatal care: conflict or synergy?

Advances in technology have dramatically changed health care delivery and the experience of patients and families during the past 2 decades. Accompanying the explosion of new technology, particularly in perinatal and pediatric settings, has been movement toward humanizing the health care environment through an emphasis on family-centered care. The impact technology has had on patients, families, and caregivers is reviewed, and the evolution of family-centered care in relation to technological progress is chronicled. Recommendations are provided for ways in which technology and family-centered care can work together to improve perinatal health care.

Family↗

PubMedDate not supplied

Nurse versus machine: slaves or masters of technology?

As the millennium approaches nurses are challenged to reflect on the evolving role of technology on the profession. A preview of the technologies coming to the clinical arena in the not-so-distant future is provided. Eight guidelines for wise technology integration are offered to assist providers in appropriately using technology while preserving humanity in an increasingly high-technology world.

Female↗

PubMed1994

Impact of new information technologies on training and continuing education for rural health professionals.

Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele-education by briefly reviewing the effect of technology on health professionals' education, describing ongoing applications of tele-education, and discussing the likely effect of new technological developments on the future of tele-education. Tele-education has tremendous potential for improving the health care of rural Americans, and policy-makers must direct resources to its priority development in rural communities.

CD-ROM↗

PubMed1993

Diffusion of new technologies to treat renal stones in Australia.

Several new therapies for treating renal stones developed since the 1980s have considerably reduced the use of open surgery and endoscopy for this condition. Extracorporeal shock wave lithotripsy (ESWL) has made the biggest impact. Assessment of ESWL in the early stages of its development assisted in rational introduction of the technology in Australia. However, this effect was short-lived and Australia would now appear to have a significant overcapacity in this technology. Use of ESWL in recent years indicates that distance is a major factor in reducing access to this technology. These observations raise several issues that need addressing, including the limited ability to avoid inappropriate proliferation of a technology, uneven distribution of ESWL units, difficulties of access and the effects of overcapacity upon indications and upon the cost-effectiveness of a technology.

Australia↗

PubMed1999

Applied studies of the plant meridian system: II. Agri-wave technology increases the yield and quality of spinach and lettuce and enhances the disease resistant properties of spinach.

Agri-wave technology is composed of both a special frequency sound wave and a microelement fertilizer. In both components, the effect of sound waves on plants is more than that of fertilizers, but the best function is a combination of the two. Treatment by Agri-wave technology stimulated the growth rate and increased the yield of spinach. In small plot tests, the length and width of the treated spinach leaf was 50.8 cm and 20.3 cm, respectively, whereas the untreated leaves were 29.20 cm and 8.9 cm. The fresh weight of treated spinach was 0.42 kg. This was 5.5 times higher than that of the untreated spinach. In large area testing (17 hectares), the results of two tests show that the yields of the treated spinach were increased 22.7% and 22.2% over those of the control group. Sugar content of the treated spinach was increased by 37.5%, vitamin A, C, and B were increased 35.63%, 41.67% and 40.00%, respectively, above the levels of the control group. Niacin content was decreased by 7.69%. Of 33 elements analyzed in the spinach, 29 elements were increased by Agri-wave technology. The spinach was infected with "rot disease" in the control group while there was no disease present in the treated group. In greenhouse testing, the average weight of 3 species of lettuce treated by Agri-wave technology was increased 44.10% over that of the control group (P < 0.0001). The average weight of 3 species of lettuce by only sound and only fertilizer treated separately increased 29.92% and 16.19% above that of the control group (P < 0.0001). Sampling survey results in the field test were comparable to the above mentioned greenhouse test. The fresh weight of treated lettuce by Agri-wave technology was increased 41.67% over that of the control group (P < 0.0001). The fresh weight of treated lettuce by only sound and only fertilizer was increased 30.88% and 19.61%, respectively, over the control group (both P < 0.0001).

Agriculture↗

PubMed2001

High-throughput microarray technologies: from genomics to clinics.

BACKGROUND: Despite continuous research efforts in the past decades, there are still cancers where no effective treatment is available, such as advanced kidney cancer or hormone-refractory prostate cancer. A better understanding of the molecular mechanisms of cancer development and progression is the basis for the development of new diagnostic and therapeutic strategies. Current developments in genomics have a dramatic impact on the whole field of research. The sequence of the entire human genome will soon be fully sequenced and provide the 'book of life' as a basis for the understanding of human disease. METHODS AND RESULTS: New technologies have emerged to translate the human genome sequence into gene function and improved diagnostics or treatment modalities. New technologies such as microarrays are not only important for fundamental research, but will also be useful for diagnostic, prognostic or therapeutic purposes in individual patients. DNA microarrays make it possible to analyze the mRNA expression of thousands of genes simultaneously. The resulting comprehensive gene expression surveys lead to the identification of new genes and pathways with importance in cancer development and progression, or as targets for new therapies. The validation and prioritization of genes emerging from genome screening analyses in large series of clinical tumors has become a new bottleneck in research. Therefore, we have recently developed the tissue microarray (TMA) technology to efficiently test the clinical relevance of candidate genes. TMAs are microscope slides containing samples from hundreds of individual tumor specimens. They can be used for large-scale, massively parallel in situ analysis of genetic alterations on a DNA, RNA and protein level using in situ hybridization or immunohistochemistry on hundreds of tumor specimens at a time. Microarray technologies are already increasingly being used in urologic research, and will also have a strong impact on clinical urology. CONCLUSIONS: DNA microarrays and TMAs provide a powerful approach to identify large numbers of new candidate genes, and rapidly validate their clinical impact in large series of human tumors. These technologies will soon lead to a better molecular understanding of urologic tumors, and accelerate the identification of new prognostic markers or therapeutic targets.

Clinical Medicine↗

PubMed1991

Technological disasters--towards a preventive strategy: a review.

Technological or man-made disasters are a growth industry. Widely publicized industrial disasters like those in Bhopal and Chernobyl are only the tip of the iceberg of human and environmental risk from technological development. Other less well publicized disasters, including the contamination of food, water and air, have affected millions of people. The 'slow' technological disasters - like air pollution, pesticides, radiation, lead, asbestos and other industrial hazards - also compromise human intellectual, behavioural and physical development. Although it can be argued that there are hazards attached to virtually every industrial activity and that it is almost impossible to remove completely the risk of technological disasters, it is possible to reduce this risk by decentralizing or deconcentrating knowledge on technological processes. Global recommendations may provide a framework for priority action, but they are obviously not applicable everywhere with the same intensity. A measurement-based approach is described that is beginning to have an effect in several developing countries.

Accidents, Occupational↗

PubMed2005

Environmental cognitive remediation in schizophrenia: ethical implications of "smart home" technology.

OBJECTIVE: In light of the advent of new technologies, we proposed to reexamine certain challenges posed by cognitive remediation and social reintegration (that is, deinstitutionalization) of patients with severe and persistent mental disorders. METHOD: We reviewed literature on cognition, remediation, smart homes, as well as on objects and utilities, using medical and computer science electronic library and Internet searches. RESULTS: These technologies provide solutions for disabled persons with respect to care delivery, workload reduction, and socialization. Examples include home support, video conferencing, remote monitoring of medical parameters through sensors, teledetection of critical situations (for example, a fall or malaise), measures of daily living activities, and help with tasks of daily living. One of the key concepts unifying all these technologies is the health-smart home. We present the notion of the health-smart home in general and then examine it more specifically in relation to schizophrenia. CONCLUSION: Management of people with schizophrenia with cognitive deficits who are being rehabilitated in the community can be improved with the use of technology; however, such technology has ethical ramifications.

Cognitive Behavioral Therapy↗

PubMed2004

Challenges and recent developments in hearing aids. Part I. Speech understanding in noise, microphone technologies and noise reduction algorithms.

This review discusses the challenges in hearing aid design and fitting and the recent developments in advanced signal processing technologies to meet these challenges. The first part of the review discusses the basic concepts and the building blocks of digital signal processing algorithms, namely, the signal detection and analysis unit, the decision rules, and the time constants involved in the execution of the decision. In addition, mechanisms and the differences in the implementation of various strategies used to reduce the negative effects of noise are discussed. These technologies include the microphone technologies that take advantage of the spatial differences between speech and noise and the noise reduction algorithms that take advantage of the spectral difference and temporal separation between speech and noise. The specific technologies discussed in this paper include first-order directional microphones, adaptive directional microphones, second-order directional microphones, microphone matching algorithms, array microphones, multichannel adaptive noise reduction algorithms, and synchrony detection noise reduction algorithms. Verification data for these technologies, if available, are also summarized.

Algorithms↗

PubMed2000

Novel fluorescent technology platform for high throughput cytotoxicity and proliferation assays.

We have developed a novel fluorescent Oxygen BioSensor technology platform adaptable to many applications in the area of drug discovery and development, particularly cell-based assays. This biosensor technology requires no additional reagents or incubations, and affords continuous real-time readout of dissolved oxygen concentrations. Since the level of oxygen dissolved in an assay's medium correlates to the number and viability of the cells in the medium, this technology is ideally suited for monitoring cell viability, proliferation, or death. The technology is particularly well suited to investigating cells' kinetic responses to proliferative or toxic stimuli, such as drugs. When incorporated into a 96- or 384-well microplate format, it is compatible with standard laboratory automation systems. Here we present data illustrating the application of the Oxygen BioSensor technology for rapid, homogeneous detection and evaluation of metabolic activity of a variety of eukaryotic and prokaryotic cells, including mammalian cells, insect cells, yeast, and bacteria. In the absence of toxic substances, we find a good correlation between cell number and signal over a wide range of cell concentrations and growth times. To evaluate the usefulness of the Oxygen BioSensor for cytotoxicity assays, we have performed a series of experiments using a range of toxic agents and cell types, including both bacteria and mammalian cell lines. In a side-by-side comparison to standard MTT assays using HL60 cells, comparable IC(50) values were found with the Oxygen BioSensor for five different toxins or drugs. This assay method does not have the need for additional reagents, handling steps, or incubation periods required by the MTT assays.

Animals↗

PubMed2002

Comparison of assay technologies for a tyrosine kinase assay generates different results in high throughput screening.

In today's high-throughput screening (HTS) environment, an increasing number of assay detection technologies are routinely utilized in lead finding programs. Because of the relatively broad applicability of several of these technologies, one is often faced with a choice of which technology to utilize for a specific assay. The aim of this study was to address the question of whether the same compounds would be identified from screening a set of samples in three different versions of an HTS assay. Here, three different versions of a tyrosine kinase assay were established using scintillation proximity assay (SPA), homogeneous time-resolved fluorescence resonance energy transfer (HTR-FRET), and fluorescence polarization (FP) technologies. In this study, 30,000 compounds were evaluated in each version of the kinase assay in primary screening, deconvolution, and dose-response experiments. From this effort, there was only a small degree of overlap of active compounds identified subsequent to the deconvolution experiment. When all active compounds were then profiled in all three assays, 100 and 101 active compounds were identified in the HTR-FRET and FP assays, respectively. In contrast, 40 compounds were identified in the SPA version of the kinase assay, whereas all of these compounds were detected in the HTR-FRET assay only 35 were active in the FP assay. Although there was good correlation between the IC(50) values obtained in the HTR-FRET and FP assays, poor correlations were obtained with the IC(50) values obtained in the SPA assay. These findings suggest that significant differences can be observed from HTS depending on the assay technology that is utilized, particularly in assays with high hit rates.

Biological Assay↗

PubMed2003

Comparison of assay technologies for a nuclear receptor assay screen reveals differences in the sets of identified functional antagonists.

Many assay technologies currently exist to develop high-throughput screening assays, and the number of choices continues to increase. Results from a previous study comparing assay technologies in our laboratory do not support the common assumption that the same hits would be found regardless of which assay technology is used. To extend this investigation, a nuclear receptor antagonist assay was developed using 3 assay formats: AlphaScreen, time-resolved fluorescence (TRF), and time-resolved fluorescence resonance energy transfer (TR-FRET). Compounds ( approximately 42000) from the Novartis library were evaluated in all 3 assay formats. A total of 128 compounds were evaluated in dose-response experiments, and 109 compounds were confirmed active from all 3 formats. The AlphaScreen, TRF, and TR-FRET assay technologies identified 104, 23, and 57 active compounds, respectively, with only 18 compounds active in all 3 assay formats. A total of 128 compounds were evaluated in a cell-based functional assay, and 35 compounds demonstrated activity in this cellular assay. Furthermore, 34, 11, and 16 hits that were originally identified in the dose-response experiment by AlphaScreen, TRF, and TR-FRET assay technologies, respectively, were functionally active. The results of the study indicated that AlphaScreen identified the greatest number of functional antagonists.

Animals↗

PubMed2005

Further comparison of primary hit identification by different assay technologies and effects of assay measurement variability.

High-throughput screening (HTS) has grown rapidly in the past decade, with many advances in new assay formats, detection technologies, and laboratory automation. Recently, several studies have shown that the choice of assay technology used for the screening process is particularly important and can yield quite different primary screening outcomes. However, because the screening assays in these previous studies were performed in a single-point determination, it is not clear to what extent the difference observed in the screening results between different assay technologies is attributable to inherent assay variability and day-to-day measurement variation. To address this question, a nuclear receptor coactivator recruitment assay was carried out in 2 different assay formats, namely, AlphaScreen and time-resolved fluorescence resonance energy transfer, which probed the same biochemical binding events but with different detection technologies. For each assay format, 4 independent screening runs in a typical HTS setting were completed to evaluate the run-to-run screening variability. These multiple tests with 2 assay formats allow an unambiguous comparison between the discrepancies of different assay formats and the effects of the variability of assay and screening measurements on the screening outcomes. The results provide further support that the choice of assay format or technology is a critical factor in HTS assay development.

Animals↗

PubMed2005

Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study.

BACKGROUND: Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge. METHODS: Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD. RESULTS: Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0-13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases. CONCLUSION: Technology-dependency is common among children discharged from a children's hospital.

Adolescent↗

PubMed2006

Grid technology in tissue-based diagnosis: fundamentals and potential developments.

Tissue-based diagnosis still remains the most reliable and specific diagnostic medical procedure. It is involved in all technological developments in medicine and biology and incorporates tools of quite different applications. These range from molecular genetics to image acquisition and recognition algorithms (for image analysis), or from tissue culture to electronic communication services. Grid technology seems to possess all features to efficiently target specific constellations of an individual patient in order to obtain a detailed and accurate diagnosis in providing all relevant information and references. Grid technology can be briefly explained by so-called nodes that are linked together and share certain communication rules in using open standards. The number of nodes can vary as well as their functionality, depending on the needs of a specific user at a given point in time. In the beginning of grid technology, the nodes were used as supercomputers in combining and enhancing the computation power. At present, at least five different Grid functions can be distinguished, that comprise 1) computation services, 2) data services, 3) application services, 4) information services, and 5) knowledge services. The general structures and functions of a Grid are described, and their potential implementation into virtual tissue-based diagnosis is analyzed. As a result Grid technology offers a new dimension to access distributed information and knowledge and to improving the quality in tissue-based diagnosis and therefore improving the medical quality.

Journal Article↗

PubMed2004

American Society of Clinical Oncology Technology Assessment: chemotherapy sensitivity and resistance assays.

PURPOSE: To develop a technology assessment of chemotherapy sensitivity and resistance assays in order to define the role of these tests in routine oncology practice. METHODS: The American Society of Clinical Oncology (ASCO) established a Working Group to develop the technology assessment. The Working Group collaborated with the Blue Cross and Blue Shield Association (BCBSA) Technology Evaluation Center. The Working Group developed independent criteria for selecting articles for inclusion in the ASCO assessment, and developed a structured data abstraction tool to facilitate review of selected manuscripts. One Working Group member and an ASCO staff member independently reviewed the 1,139 abstracts identified by the BCBSA comprehensive literature search, and by an updated literature search performed by ASCO using the BCBSA search strategy (1966 to January 2004). Of the 12 articles included in this technology assessment, eight were identified by the original BCBSA systematic review, one was provided by industry, and three were identified by the ASCO updated literature review. RESULTS: Review of the literature does not identify any CSRAs for which the evidence base is sufficient to support use in oncology practice. RECOMMENDATIONS: The use of chemotherapy sensitivity and resistance assays to select chemotherapeutic agents for individual patients is not recommended outside of the clinical trial setting. Oncologists should make chemotherapy treatment recommendations on the basis of published reports of clinical trials and a patient's health status and treatment preferences. Because the in vitro analytic strategy has potential importance, participation in clinical trials evaluating these technologies remains a priority.

Antineoplastic Agents↗

PubMed1998

Rationalizing decision-making through computer technology: a critical appraisal.

As human services become more complex and multifaceted, sound decision-making guiding the service delivery process becomes critical. Administrators and others view computer technology as a means to rationalize the decision-making process at all levels of organizational life. The Management Information System (MIS) and program evaluations are viewed as technologies particularly useful for enhancing the decision-making process through computer technology. The strengths and limitations of computer technology are discussed. Strategies for using computer technology responsibly are offered.

Data Collection↗