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PubMed1996

Halfway technologies.

An extraordinary gamut of medical and surgical therapies could be considered "halfway technologies," addressing mere symptoms or manifestations of disease, rather than the underlying pathogenesis. When a "halfway" technology is also lifesaving, its value cannot be underestimated by the individual patient. The example of organ transplantation explored in this column represents a halfway technology. It does not treat the underlying disease itself, but reflects the absolute failure of all efforts at medical and conservative therapy and is a last ditch, gerry-rigged lifesaving solution. And what about "quarter technologies"--the bridge to transplant devices--designed to get the patient halfway to the final halfway procedure?

Health Knowledge, Attitudes, Practice↗
PubMed1997

A primer on the assessment of medical technologies.

As health care costs continue to escalate, the assessment and management of medical technologies have become vitally important to health care providers. Evaluation and comparison of the safety, effectiveness, efficiency, cost, and clinical outcomes of new and existing technologies provide the critical information necessary to make appropriate clinical resource decisions in an increasingly cost-conscious environment. Technologies to be assessed include pharmaceuticals, devices, medical and surgical procedures, and health care delivery systems. Clinical trial results, literature reviews, expert opinions, and group consensus are used in preparing technology use decisions, which often include the preparation of background information, specific recommendations, use guidelines, and reimbursement analyses.

Decision Making, Organizational↗
PubMed1983

Policy implications of the diffusion and control of medical technology.

Medical technology has become a controversial national policy issue, largely because of rapidly rising national health expenditures and their relation to medical technology. These costs are increasingly viewed in relation to benefits or effectiveness. Attempts to control medical technology, to consider benefits in relation to costs, have largely been regulatory, and have failed to ameliorate cost rises. This failure has stimulated consideration of the reimbursement system as a controlling device. The Medicare program already has developed a rather formal process for making reimbursement decisions based on technology assessments. However, fundamental reform of the reimbursement system seems necessary to counter perverse incentives built into payment. Recent proposals to shift to prospective payment is an example of such a change. However, the basically private nature of the health care system and the limited leverage of the Medicare program limits the power of the federal government to make change.

Communication↗
PubMed2002

Assessing the learning curve effect in health technologies. Lessons from the nonclinical literature.

INTRODUCTION: Many health technologies exhibit some from of learning effect, and this represents a barrier to rigorous assessment. It has been shown that the statistical methods used are relatively crude. Methods to describe learning curves in fields outside medicine, for example, psychology and engineering, may be better. METHODS: To systematically search non-health technology assessment literature (for example, PsycLit and Econlit databases) to identify novel statistical techniques applied to learning curves. RESULTS: The search retrieved 9,431 abstracts for assessment, of which 18 used a statistical technique for analyzing learning effects that had not previously been identified in the clinical literature. The newly identified methods were combined with those previously used in health technology assessment, and categorized into four groups of increasing complexity: a) exploratory data analysis; b) simple data analysis; c) complex data analysis; and d) generic methods. All the complex structured data techniques for analyzing learning effects were identified in the nonclinical literature, and these emphasized the importance of estimating intra- and interindividual learning effects. CONCLUSION: A good dividend of more sophisticated methods was obtained by searching in nonclinical fields. These methods now require formal testing on health technology data sets.

Biomedical Technology↗
PubMed2002

The future of information technology for health in developing countries.

What is the future of communication technology for health in developing countries? This chapter sets out to answer this question by first considering the background and potential of information technology, identifying some of the issues and trends in communication, and finally following with some challenges and opportunities of how communication technologies can make a difference in health in developing countries. Past research has shown that communication can contribute to all aspects of population, health, and nutrition programs and is relevant in a number of contexts. Some of the trends in using information technology can be classified in the following categories: competition, cognitive-based presentations, comprehensive translation, convergence, and culture. Challenges include finding a way to include the South in the exchange of ideas and information. In addition, reaching a consensus on worldwide quality standards will not be easy. Yet, beyond these challenges, there are many opportunities being created for international development agencies to increase their capacity for impact.

Biomedical Technology↗
PubMedDate not supplied

New caries detection technologies and modern caries management: merging the strategies.

Literature over the past decade has suggested that dental caries be treated as a curable and preventable infectious disease. The emphasis is placed on early detection and intervention, including chemical therapies and minimally invasive strategies. There are now new detection technologies commercially available to help detect carious lesions early; however, what seems to be lacking is a clear strategy on how to merge these new technologies in a way consistent with today's changing paradigm of caries management. There is a real danger that these early detection technologies may be used to unnecessarily and overaggressively "drill and fill" using Black's "extension for prevention" preparations. This paper will review the literature and key strategies for caries management and early detection and suggest one way (not necessarily the only way) in which they may be used in harmony. Two relatively new detection technologies (DIAGNOdent and DIFOTI) will be reviewed.

Anti-Infective Agents, Local↗
PubMed2005

Technology strategy and the balance sheet: 3 points to consider.

Most hospitals use technology strategically to differentiate themselves from their competition. The rapid rate of change in healthcare technologies necessitates development of a technology life-cycle management program. Having access to flexible sources of capital appropriate to each category of technology assets allows liabilities and assets to be matched on a "balanced" balance sheet.

Accounting↗
PubMed2006

[Hi-tech trends in future dentistry--part A: computerized technologies].

Growing knowledge and information in the field of dentistry has had a great impact on dental education, management and practice. A prominent change is the digital revolution, which presents new computed technologies and accessible means of communication for sharing written and visual information. Biotechnology, yet another innovated field, will change dentistry even further. This article presents dental innovations forwarded by Israeli Hi-Tech companies. An overview of some advances in technology in the field of dentistry is presented. Part of the described technologies is in R&D phase, part is under preliminary clinical evaluation, and a few have undergone short-term clinical studies. Part A of the article discusses the application of computerized imaging systems to educational purposes, diagnostics and treatment; part B presents other diagnostic and therapeutic technologies.

Computer Systems↗
PubMed1987

Assessment of changing technologies in medicine.

Technology is the outcome of man's use of tools and reason to change the environment to his benefit. New technology creates opportunities for some and threats for others. New technology will be dramatically influenced by the political, social, economic, and ethical milieu in which it develops. An overriding concern in the near future may be cost. Cost-benefit analysis/cost-effectiveness analysis can be a helpful planning tool but should not be used exclusively to plan for technological change. Knowledge of the humanities as well as a science will be essential if we are to make the decisions needed as we approach the 21st century.

Cost-Benefit Analysis↗
PubMed1996

Emerging technology in critical care: continuous intra-arterial blood gas monitoring.

The blood-conserving technology of continuous intra-arterial blood gas monitoring has recently been introduced into the field of critical care. This type of monitoring is a real-time method for concomitantly assessing oxygenation, ventilation, and acid-base status in pediatric and adult populations through an indwelling (in vivo) sensor residing in a peripheral artery. This article examines the technology underpinning in vivo blood gas monitoring and reviews research documenting clinical performance, as well as benefits and clinical applications of three-analyte systems in critically ill patients. A majority of research has revealed clinically acceptable accuracy and reliability of in vivo blood gas sensors in critically ill adults subjected to a variety of adverse, but common, physiological conditions. Although most clinical research in critically ill adults has revealed good clinical performance of in vivo blood gas sensors, reports of aberrant blood gas values and sensor problems remain; no reports have been published to date evaluating continuous intra-arterial blood gas monitoring in children or infants. Many benefits of this technology have been postulated, and research examining its effect on patient and cost outcomes in critically ill populations is pending. Clinicians in critical care must keep abreast of this emerging technology, because it holds significant potential for improving the quality of care and outcomes of critically ill patients.

Adult↗
PubMed1999

Simulation technology for health care professional skills training and assessment.

Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.

Anesthesiology↗
PubMed1988

Nutritional and technological characteristics of new broad bean flaked products.

The effects of the technological processes (soaking in water or alkaline solutions, drying, puree preparation) and the supplementation with maize flour on the nutritional value and on the organoleptic characteristics of broad bean (Vicia faba, L. major) flakes have been studied. Protein content was not affected by technological process. The addition of maize flour decreased the protein content of the final product depending on the amount of the maize flour added. Amino acid composition showed a decrease of tryptophan due to technological processing. Supplementation with maize flour improved the amino acid pattern and, except for tryptophan, the amount of essential amino acids in the flakes supplemented with 25% or more maize flour well compared with the provisional pattern by F.A.O. In vitro digestibility trials did not evidence significant changes due to technological processes or to integration of broad beans with maize flour. Broad bean toxic factors (vicine and convicine glycosides) were only slightly affected by the alkaline treatment of the flakes. Glycosides content decreased with the increasing supplementation with maize flour but the relationship was not linear. The organoleptic tests were positive for texture and taste, whereas the appearance of the products should be improved.

Amino Acids↗
PubMed2002

Developing a sustainable energy strategy for a water utility. Part II: A review of potential technologies and approaches.

Environmental legislation is increasing the amounts of bought-in electricity required for sewage treatment, and generating larger volumes of sewage sludge to be treated and disposed of. Concurrently, concerns over global warming and food safety from sewage sludge recycling on agricultural land is augmenting the costs of conventional sewage and sludge treatment technologies and practices. This paper reviews some emerging technologies and practices that may assist in mitigating these problems in the future. In addition, a number of potential renewable energy technologies available to water companies are reviewed. Results suggest that through the take-up of new technologies, current and future water quality standards could be delivered in a more sustainable way. However, this series of papers also highlights that institutional and political conflicts may have inadvertently failed to recognise the wider effects of improving water quality and lessened the financial support necessary for their widespread take-up. It is also suggested that through the use of a Strategic Environmental Assessment (SEA) approach, stakeholders could gain a better understanding of the broader environmental effects of achieving certain water quality standards and develop policy and long-term investment strategies accordingly. However, to fulfill the information requirements of an SEA, an appropriate appraisal tool that considers many of these factors in unison is required, and a possible technique is suggested.

Conservation of Natural Resources↗
PubMed2025

How Have Massively Parallel Sequencing Technologies Furthered Our Understanding of Oncogenesis and Cancer Progression?

Massively parallel sequencing technologies have been a boon to many fields of biological science, including oncology. Cancer is an umbrella term for many diseases featuring abnormal cellular growth due to genetic and epigenetic aberrations. Advances in sequencing technology allow for interrogation of the DNA and RNA of cancer cells and other cells in the tumor microenvironment down to a single-base resolution. However, these strides come after a rich history of ground-breaking biological assays, like the discovery of the Philadelphia chromosome in the context of leukemia. Many specific genetic and epigenetic modifications have been implicated in oncogenesis, cancer progression, and response to treatment. Sequencing technologies have also helped to associate populations of bacteria in the microbiome to cancer development and prognosis. However, all this new information, especially when procured via high-throughput methods, comes at the cost of being more computationally and staff-resource intensive. There is also more risk to the privacy of the individuals with sequenced genomes. Notwithstanding, the overall benefit of sequencing technologies can greatly outweigh the risks with careful advancements and continued focus on the goal: helping those affected by cancer via precision medicine. Cancer biology has been and will continue to be elucidated by sequencing innovations in ways unimaginable without it.

Humans↗
PubMed1992

Technology assessment of anesthesia monitors.

This essay argues that optimal utilization of anesthesia monitors requires careful technology assessment. This careful assessment is important because monitors may produce spurious or uninterpretable values, or they may damage patients. In addition, resources should be spent only for truly beneficial devices. The types of evidence that this essay describes for use in technology assessment include questions concerning data reliability, data interpretability, and data outcome. Considerable evidence bearing on technology assessment has already been amassed. I propose synthesizing this evidence by meta-analysis. Additional primary studies of technology assessment are also needed.

Anesthesiology↗
PubMed1993

Technology assessment in healthcare: a means for pursuing the goals of biomedical engineering.

The goals of biomedical engineering include the improvement of health and life quality of mankind. However, the contribution of biomedical engineering to those worthy ends must be more clearly related. Biomedical engineers should become more active in demonstrating to policymakers and other parties in healthcare the value of the contributions of healthcare technology. Technology assessment (TA) is a form of investigation designed to identify and evaluate the implications of technologies so as to inform policymaking. Among the important trends in TA that should be of special interest to biomedical engineers are the increasingly higher methodological standards for accepting evidence from clinical investigations, and the use of quality-of-life measures for determining how technologies affect people's lives.

Biomedical Engineering↗
PubMed1993

Technology assessment and biomedical engineering education.

Technology assessment is research that is intended to help decisionmakers deal with the development, acquisition and utilisation of healthcare technologies. Healthcare professionals now recognise the need for assessment information in decisionmaking. Among these professionals are biomedical and clinical engineers who need to manage technology assessment activities and use assessment information appropriately. It is imperative therefore that proper educational programmes be developed to prepare engineers for a broader role in healthcare. The paper elaborates on aspects of technology assessment and the need for training of engineers in specific concepts and principles.

Biomedical Engineering↗
PubMed2000

Using technology assessment as the picture archiving and communication system spreads outside radiology to the enterprise.

Picture archiving and communication systems (PACS) are being implemented within radiology departments, and many facilities are entering the next stage of PACS use by deploying PACS to departments outside of radiology and to other facilities located at a distance. Many PACS vendors and department administrators have based cost-justification analyses on the anticipated savings from expanding PACS to these areas. However, many of these cost-savings analyses can be highly suspect in their assumptions and findings. Technology assessment (TA) at the hospital/health system level is an organized, systematic approach to examining the efficacy of a technology in relation to the health system's mission and clinical needs. It can be an organized and unifying approach to aid in the distribution of limited capital resources. As extra-radiology PACS deployment is a costly endeavor, TA may be used to plan for PACS implementation throughout the enterprise. In many organizations, PACS is thought of as a radiology domain as its first uses were centered on this image-producing service. Now, as PACS technology spreads to other service areas, such as cardiology, dermatology, pathology, orthopedics, obstetrics, etc, the need to incorporate other viewpoints in a system-based PACS is necessary to avoid having independent PACS that may duplicate archives and may not communicate with each other. How to meet the diverse PACS needs of clinical services can be a challenging task; a TA program has been demonstrated to effectively handle the clinical needs, demands, and timeframes of PACS planning and support throughout hospitals and health systems. A hospital-based TA program can assist health care organizations to present PACS as a system-wide need and program rather than a radiology-based program gobbling up the capital budget. Submitting PACS to the TA review process can identify essential elements in planning and help avoid many of the pitfalls of PACS implementation and operations. Thorough cost and/or return on investment analyses, phasing decisions, workflow re-engineering, and outcomes assessment programs are a few of the issues that a TA program can address to help in the transition to a complete electronic image environment. The TA process includes clinician selection, evaluation criteria and their selection for technologies under review, a policy for review/authorization/denial, and measurement of expected outcomes.

Cost Savings↗