The emerging federalism of U.S. biotechnology policy.
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OBJECTIVES: To describe the methods used for involving consumers in a needs-led health research programme, and to discuss facilitators, barriers and goals. DESIGN: In a short action research pilot study, we involved consumers in all stages of the Health Technology Assessment (HTA) Programme: identifying and prioritizing research topics; commissioning and reporting research; and communicating openly about the programme. We drew on the experience of campaigning, self-help and patients' representative groups, national charities, health information services, consumer researchers and journalists for various tasks. We explored consumer literature as a potential source for research questions, and as a route for disseminating research findings. These innovations were complemented by training, one-to-one support and discussion. A reflective approach included interviews with consumers, co-ordinating staff, external observers and other programme contributors, document analysis and multidisciplinary discussion (including consumers) amongst programme contributors. RESULTS: When seeking research topics, face-to-face discussion with a consumer group was more productive than scanning consumer research reports or contacting consumer health information services. Consumers were willing and able to play active roles as panel members in refining and prioritizing topics, and in commenting on research plans and reports. Training programmes for consumer involvement in service planning were readily adapted for a research programme. Challenges to be overcome were cultural divides, language barriers and a need for skill development amongst consumers and others. Involving consumers highlighted a need for support and training for all contributors to the programme. CONCLUSIONS: Consumers made unique contributions to the HTA Programme. Their involvement exposed processes which needed further thought and development. Consumer involvement benefited from the National Co-ordinating Centre for Health Technology Assessment (NCCHTA) staff being comfortable with innovation, participative development and team learning. Neither recruitment nor research capacity were insurmountable challenges, but ongoing effort is required if consumer involvement is to be sustained.
This paper discusses the current incorporation of the subject of humanization of care in the current context of Brazilian nursing. The relation between nursing and technology is approached, in this study, from a historical perspective. The study also develops the proposition of "human re-signification", having as reference the concept of Cyborg, considering the way this concept has been employed in the contemporary cultural and feminist theoretical framework.
GE Healthcare has launched a multi-phase marketing campaign aimed at promoting the technological breakthroughs and state-of-the-art equipment that it provides hospitals and health systems to ensure that patients are given the best care possible. The campaign boasts four new commercials and an interactive Web site designed to illustrate healthy living on a global scale.
"Smart homes" are defined as residences equipped with sensors and other advanced technology applications that enhance residents' independence and can be used for aging in place. The objective of this study is to determine design specifications for smart residences as defined by professional groups involved both in care delivery to senior citizens and development of devices and technologies to support aging. We assessed the importance of specific devices and sensors and their advantages and disadvantages as perceived by the interdisciplinary expert team. This work lays the ground for the implementation of smart home residencies and confirms that only an interdisciplinary design approach can address all the technical, clinical and human factors related challenges associated with home-based technologies that support aging. Our findings indicate that the use of adaptive technology that can be installed in the home environment has the potential to not only support but also empower individual senior users.
Technological solutions to problems of knowledge and practice in health care are routinely advocated. This paper explores the ways that new systems of practice are being deployed as intermediaries in interactions between clinicians and their patients. Central to this analysis is the apparent conflict between two important ways of organizing ideas about practice in primary care. First, a shift away from the medical objectification of the patient, towards patient-centred clinical practice in which patients'heterogeneous experiences and narratives of ill-health are qualitatively engaged and enrolled in decisions about the management of illness trajectories. Second the mobilization of evidence about large populations of experimental subjects revealed through an impetus towards evidence-based medicine, in which quantitative knowledge is engaged and enrolled to guide the management of illness, and is mediated through clinical guidelines. The tension between these two ways of organizing ideas about clinical practice is a strong one, but both impulses are embodied in new 'technological' solutions to the management of heterogeneity in the clinical encounter. Technological solutions themselves, we argue, embody and enact these tensions, but may also be opening up a new array of practices--technogovernance--in which the heterogeneous narratives of the patient-centred encounter can be resituated and guided.
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Per capita real income on the demand-side and technological change, proxied by total R&D and health R&D spending, on the supply-side are hypothesized as major drivers of per capita real health care expenditure in the US during the 1960-1997 period. The findings are robust to a battery of unit root and cointegration tests. They support the Newhouse [Journal of Economic Perspectives 6 (1992) 3] conjecture that technological change is a major escalator of health care expenditure and confirm a significant and stable long-run relationship among per capita real health care expenditure, per capita real income and broad-based R&D expenditures. Policy implications are noted.
Medical technology is valuable if the benefits of medical advances exceed the costs. We analyze technological change in five conditions to determine if this is so. In four of the conditions--heart attacks, low-birthweight infants, depression, and cataracts--the estimated benefit of technological change is much greater than the cost. In the fifth condition, breast cancer, costs and benefits are about of equal magnitude. We conclude that medical spending as a whole is worth the increased cost of care. This has many implications for public policy.
Recent innovations in biomedicine seem poised to revolutionize medical practice. At the same time, disease and disability are increasing among younger populations. This paper considers how these confluent trends will affect the elderly's health status and health care spending over the next thirty years. Because healthier people live longer, cumulative Medicare spending varies little with a beneficiary's disease and disability status upon entering Medicare. On the other hand, ten of the most promising medical technologies are forecast to increase spending greatly. It is unlikely that a "silver bullet" will emerge to both improve health and dramatically reduce medical spending.
The aim of the review is to establish whether, on the basis of previous published evidence, current accepted guidance for health economic evaluation needs to be adapted to evaluate healthcare based on use of genetic information. Online literature search strategies were designed (using PubMed and the NHS Economic Evaluation Database [NHS EED], among others) to gather papers carrying out or discussing economic evaluation and genetics. Papers meeting the inclusion criteria were obtained and reviewed. The papers purporting to be economic analyses were classified using the criteria of the NHS EED and the British Medical Journal (BMJ) working party on peer review of health economic literature. Of 120 English-language papers that met the criteria for review, only 37 were economic evaluations according to the criteria set out by the NHS EED and BMJ working party on economic evaluations. Of these 37, only 33 papers discussed economic evaluation methodologies in the genetics context. The economic evaluation papers did not seem to tackle any of the problems discussed in the methodological papers. Economic evaluation methods offer a structured approach for evaluation of changes but may need to change in order to assess the new technologies. We have found that such studies have not been widely reported, and that those that have been reported do not depart from current economic methods. We have identified a need for better skills and guidance in health economics within this growing area of research.
Ubiquitous computing is shifting healthcare from treatment by professionals in hospitals to self-care, mobile care, home care and preventive care. In order to support the healthcare evolution, a global healthcare system, which links healthcare service providers to an individual's personal and physical spaces, is expected to provide personalized healthcare services at the right time, right place and right manner. This paper presents an overall architecture for such a context-aware healthcare system. The key technologies such as device self-sensing mechanism, context processing framework and a service interoperability platform are identified and elaborated. A personalized healthcare adviser service has been described to illustrate how personalized healthcare can be well supported by the proposed infrastructure.
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The potential of biotechnology has just began to emerge in the 20th century. After the full knowledge of human genomes is available, biotechnology is going to play a major role in shaping the concept of future drug discovery, drug delivery, diagnostic methodology, clinical trials, and to a great extent the major lifestyle of the human society. This article is a comprehensive review of the major impact of biotechnology in diagnostics, antibiotics, r-proteins, vaccines, and antibodies production. It also highlights the future aspects of gene therapy in the management of healthcare. A comprehensive list of biotech products in healthcare management has been given. Also, the growth of biotechnology throughout the world at large and in the Indian industries in particular has been highlighted. Constraints, concerns and difficulties in biotechnology in India have been addressed mainly related to human resources, training institutions in India, funding in biotechnology, patent-related issues and regulatory hurdles. Like in information technology, India has great potential in bioinformatics as well. Some of the recent information on bioinformatics centers in India has been summarized. Indian biotechnology industries have the potential to use the modern discoveries in life sciences to reach an enviable position in the world of biotechnology.
A high-value doctor-patient relationship is based on a set of parameters which include the interpersonal relationship between the patient and the doctor. Based on the Primary Care Assessment Survey model, measures of the interpersonal relationship are associated with communication, interpersonal care, contextual knowledge of the patient, and trust. Despite the proven value of the doctor-patient relationship, current trends indicate that the quality of these relationships is on the decline. The advent of communication and information technologies has greatly affected the way in which health care is delivered and the relationship between doctors and patients. The convergence of communication and information technology with biomedical informatics offers an opportunity to affect the character of the doctor-patient relationship positively. This paper examines the intersection of the key features of the doctor-patient relationship and a variety of Internet-based, clinical, and administrative applications used in dental practice. This paper discusses the role of dental informatics research vis-à-vis the doctor-patient relationship and explores how it may inform the next generation of information technologies used in dental practice.