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At least 1,153 records · Page 64Linked to original sources
PubMed1995

"How dare you sport thus with life?": Frankensteinian fictions as case studies in scientific ethics.

Fictional scenarios involving "hard" science offer what are in effect case studies of scientific ethics. From his analysis of Shelley's novel, biologist Leonard Isaacs constructed a model of a "Frankenstein scenario," applicable to the dilemmas posed by the advancement of science in our time, as well as to fiction about science by such contemporary writers as Robin Cook and Michael Crichton. The special contribution of fiction to the study of ethics is that it both reflects and evaluates reality's infinite permutations. In reflecting and judging, the fictional scenarios engage our moral imagination and compel us to confront our personal ethos in relation to the evolving ethos of science.

Biomedical Research↗
PubMed2006

Market structure and technology: evidence from the Italian National Health Service.

Sutton (1991, Sunk costs and market structure. Cambridge: MIT Press; 1998, Technology and market structure. Cambridge: MIT Press) theorised that industries evolve into distinct market configurations in terms of concentration, depending upon product homogeneity and whether R&D or advertising are relevant relative to set-up costs. This paper tests the existence of such a relationship between technological profiles and market structure empirically, using the health care services provided by the Italian National Health Service as the specific economic framework. Our results support the empirical predictions made by Sutton. In particular, in markets where the technological intensity is low the lower bound to concentration converges monotonically to zero when the market size increases, for any level of product homogeneity. Conversely, in markets where the technological intensity is high the lower bound of concentration converges to some positive (non-zero) value when market size increases, while the lower bound increases (from zero) when the level of product homogeneity increases.

Biomedical Technology↗
PubMed1995

Ethical issues in discharge planning for vulnerable infants and children.

Discharge planning for vulnerable infants and children is a collaborative, interdisciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process may be concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations.

Adolescent↗
PubMed2006

Defining and implementing a national policy for science, technology, and innovation in health: lessons from the Brazilian experience.

The need for clearly-defined health research policies and priorities has been emphasized in the international scenario. In Brazil, this process began in 2003, when a group appointed by the National Health Council proposed 20 sub-agendas to account for the various health research specificities. The second step was to identify research priorities for each sub-agenda during national seminars involving 510 researchers and policymakers. The 2nd National Conference on Science, Technology, and Innovation in Health was held in July 2004. During the preparatory phase, 307 cities and 24 States organized local conferences, involving 15,000 participants. Some 360 health sector delegates were appointed during the local conferences, in addition to those from the education and science and technology sectors. During the Conference, the national policy was approved and 3 other sub-agendas were introduced and approved. The national policy and the priority agenda are currently guiding investments by the Ministry of Health for research and development, and to a certain extent those from the Ministry of Science and Technology as well. From 2003 to 2005, 24 calls for proposals were launched; as a result, 3,962 research projects were submitted and 1,300 financed.

Biomedical Research↗
PubMed2006

Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.

BACKGROUND: Experts consider health information technology key to improving efficiency and quality of health care. PURPOSE: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. DATA SOURCES: The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. STUDY SELECTION: Descriptive and comparative studies and systematic reviews of health information technology. DATA EXTRACTION: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. DATA SYNTHESIS: 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. LIMITATIONS: Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. CONCLUSIONS: Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.

Biomedical Technology↗
PubMed2004

What if... [the consequences of innovation].

Innovations that could turn health care upside down are already here, in use or in development. These technological or clinical "wild cards" so resemble science fiction that they are easily dismissed--for example, brain implants to help the disabled control remote appliances or human arteries grown from scratch. Ignore them at your own risk.

Biomedical Technology↗
PubMed2004

[Light technologies as guidelines for the work process in health services].

This article presents a reflection about the main characteristics of a techno-assistential model of Health Surveillance and Life Protection, suggesting light technologies (acceptance, bond, search for autonomy and management, as goals for the work process) as guidelines for the practices in healthcare, in search of life quality for the service users.

Biomedical Technology↗
PubMed2003

Lab-on-a-chip for drug development.

Significant advances have been made in the development of micro-scale technologies for biomedical and drug discovery applications. The first generation of microfluidics-based analytical devices have been designed and are already functional. Microfluidic devices offer unique advantages in sample handling, reagent mixing, separation, and detection. We introduce and review microfluidic concepts, microconstruction techniques, and methods such as flow-injection analysis, electrokinesis, and cell manipulation. Advances in micro-device technology for proteomics, sample preconditioning, immunoassays, electrospray ionization mass spectrometry, and polymerase chain reaction are also reviewed.

Animals↗
PubMed2004

Diffusion of new technology in health care: the case of aorto-iliac occlusive disease.

BACKGROUND: The objective of the current study was to characterize temporal trends in the treatment of aorto-iliac occlusive disease (AIOD) and the impact of the introduction of less invasive therapy on overall intervention rates. METHODS: Patients with diagnostic codes for AIOD, and procedure codes for aortofemoral bypass (AFB) or iliac artery angioplasty and stenting were selected from the Nationwide Inpatient Sample for 1996 to 2000. Utilization rates of both intervention types were determined. Outcome variables including in-hospital mortality and duration of stay were assessed. RESULTS: The rate of iliac artery angioplasty and stenting increased 850%, from 0.4 to 3.4 cases per 100,000 adults (P <.001). The rate of AFB declined 15.5%, from 5.8 to 4.9 cases per 100,000 adults (P <.005). Older age, white race, and higher-income patients were more likely to undergo angioplasty and stenting. AFB had a higher mortality rate, longer duration of stay, and higher hospital charges compared to angioplasty and stenting. CONCLUSIONS: Iliac artery angioplasty and stenting has rapidly gained a large market share in the treatment of AIOD. Acceptable clinical outcomes have likely lowered the threshold for treatment and contributed to the rapid diffusion of this technology for the treatment of AIOD.

Aged↗
PubMed2000

Technology and the management of trust in insurance medicine.

This article deals with the question how technology contributed to the performing of objective assessments of health risks and to the public trust in the insurance institution. Many authors have pointed to the relevance of medical or statistical technology with regard to the constitution of objectivity, because these technologies should be capable of diminishing the influence of social interactions--the "human element"--on the process of producing knowledge about health risks. However, in this article it is shown that the constitution of objective risk assessments and public trust cannot be seen as the product of one particular type of technology, but that it is the product of a socio-technical network, in which several heterogeneous elements become interrelated and interdependant. The historical reconstruction of this network also sheds a new light on the role of 'the human element' in the constitution of objectivity and trust. It shows that elements in the network which regulate the social interaction between the subjects involved are of no less importance to generate trust than technologies which tend to abstract from this interaction. In other words, objective and subjective elements are intertwined much more than is often recognized, and public trust is to a fairly large degree depends on conventions in social interaction.

Biomedical Technology↗
PubMed2005

GammaKnife surgery: safety and the identity of users.

In this study we investigated safety-related usability issues of an advanced medical technology, a radiosurgery system. We were interested in which criteria are important for users when a system's usability and safety is to be improved. The data collection was based on interviews and observations at three different sites where the Leksell GammaKnife is used. The analysis was qualitative. The main finding was that the user's identity or professional background has a significant impact both on how he or she views his or her role in the clinical setting, and on how he or she defines what improvements are necessary and general safety issues. In fact, the opinion even of users experienced in safety-related problems was highly influenced by how they related to the technology and its development. None of the users actually considered Leksell GammaKnife as lacking in safety, instead, their assessment was directed towards potential future system improvements. Our findings suggest that the importance of user identity or professional background cannot be neglected during the development of advanced technology. They also suggest that the user feedback should always be related to user background and identity in order to understand how important different issues are for particular users.

Attitude of Health Personnel↗
PubMed2006

Using ultrasonic technology to manufacture products.

The use of ultrasonics in medical device manufacturing is gaining momentum as designers and engineers take advantage of the benefits it offers. A number of example medical applications are described that demonstrate the utility of ultrasonic processing in their manufacturer.

Biomedical Engineering↗
PubMed2001

Using health outcomes data to inform decision-making: government agency perspective.

In the developed world, the demand for healthcare is rising faster than supply, so that governments are faced with the need to allocate limited resources for maximum benefit. Many governments are responding to these pressures by developing health technology assessment agencies, which evaluate the cost effectiveness of new pharmaceutical and medical products relative to existing interventions. In England and Wales, the agency concerned with health technology assessment is the National Institute for Clinical Excellence (NICE). NICE brings together evidence of clinical and cost effectiveness to judge the value of the treatment relative to alternative uses of National Health Service (NHS) resources and makes recommendations on use of the treatment by the NHS in England and Wales. NICE evaluates technologies where they may result in significant impact on NHS resources or key healthcare policy. The health technology assessment includes a review of the clinical effectiveness, cost effectiveness and service impact of the technology under consideration. This health technology assessment report, together with submissions from the technology manufacturer, and patient and healthcare professionals groups, is then considered by an appraisal committee that formulates guidance to the NHS and is ultimately published by NICE. A number of countries have formal guidelines on the use of outcome measures and economic evaluations in the submissions required for health technology assessment prior to market access. These guidelines vary in both the detail and level of mandatory requirement to be followed by technology manufacturers. NICE has recently updated its guidance to technology manufacturers on their submissions. These guidelines, developed in consultation with the healthcare industry, provide detailed specification of the requirements of NICE for health outcomes data and economic evaluation. These details are described in more detail in this paper.

Biomedical Technology↗
PubMed2005

Homecare service perspective in Tuscany: vision and new user centred services.

"With medical knowledge expanding every day, no physician can keep up without help. By using high-tech medical communication, high-performance computers, high resolution video, and fibre-optic information "superhighways," we have been able to put the entire world of medical science at the fingertips of even the most isolated rural family doctor." [1] This quote by a former Surgeon General encapsulates the promise and potential for healthcare technology. Service organization and stakeholders' commitment are the real crucial issues for actual e-Health services deployment. In such a contest Homecare services start playing such a role of services integration and new care models development.

Biomedical Technology↗
PubMed2003

New technologies and potential cost savings related to morbidity and mortality reduction in Class III/IV heart failure patients in Canada.

BACKGROUND: Heart failure affects 1-2% of the Canadian population. The 1-year mortality rates in New York Heart Association Class III/IV heart failure patients range from 11 to 44%. This study evaluates costs associated with current management of Class III/IV heart failure and potential savings if morbidity and mortality are reduced. OBJECTIVES: To construct an economic model to evaluate the components of treating Class III/IV heart failure patients in Canada and the resulting direct medical costs. The model also estimates the potential savings that could result from the introduction of a new technology such as cardiac resynchronization therapy that reduces morbidity and mortality. METHODS: The model evaluates costs of pharmacological therapy, medical care, laboratory and diagnostic tests, and complications, most commonly hospitalization. Estimates are based on a literature review, expert opinion, and standard cost sources using widely accepted health economic methods. RESULTS: The model, under conservative assumptions, estimates that Class III/IV heart failure costs between CAD$1.4 billion and CAD$2.3 billion in Canada overall. Costs are substantial on the provincial level as well and are estimated to be approximately CAD$700 million, CAD$500 million, and CAD$300 million in Ontario, Québec, and British Columbia, respectively. New treatments could bring substantial savings depending on their effectiveness-measured as reduction in morbidity and mortality-and the number of patients who receive that treatment. Potential savings in Canada could reduce the total annual costs for this group of patients by approximately 10% or up to CAD$200 million annually. CONCLUSIONS: The high level of morbidity and mortality in Class III/IV heart failure patients and costs associated with their care are an impetus for the development of new therapies such as cardiac resynchronization therapy, that could deliver long-term benefits including increased exercise tolerance, reduced hospitalizations, and improved quality of life. Successful therapies could provide substantial savings and present a favorable economic profile in the treatment of heart failure. In order to ensure that appropriate technologies are commercialized and marketed, prospective evaluation of new therapies should include critical assessment of direct medical costs in addition to evaluating morbidity, quality of life and survival.

Biomedical Technology↗