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Future directions of research in statistical genetics.

From a global perspective, two external developments are having dramatic effects upon the field of statistical genetics: improved genetic data, for example, human DNA sequence, and new technologies, for example, microarray technology. Meiotic mapping techniques will have to be adapted to benefit from the improved data, for example, allelic association studies have to be extended to multiple markers to profit from the new genetic map of SNP markers. Changing technology has led to ever-increasing knowledge about gene function which has enabled novel gene mapping strategies which we refer to as functional mapping. Functional mapping has great potential for mapping complex disease genes since it uses pathway fractions to intermediate between genotype and phenotype information. Methods used in whole-genome gene expression studies are used to illustrate concepts of functional mapping.

Biomedical Technology↗

Laparoscopic surgery: current status, issues and future developments.

Laparoscopic surgery has come a long way since its introduction two decades ago. In essence it represents a new era of technology-dependent surgical interventions, and to some extent its future progress depends on the growth of interventional technologies and devices (facilitative, enabling and additive). Laparoscopic surgery has had a significant impact on all surgical disciplines and is now firmly embedded in routine surgical practice. There remain, however, several outstanding issues that need to be addressed. These concern mainly quality assurance, training, resource allocation, assessment of competence and tiers of laparoscopic surgical practice in line with the changing situation facing the next generation of surgeons.

Biomedical Technology↗

The BMET (biomedical equipment technician) career: academic curricula, hospital needs, & employee perceptions.

Research conducted over a two-year (1988-1989) period compared the concepts of job performance of Biomedical Equipment Technicians (BMETs) with the job descriptions and academic requirements of healthcare organizations and the current academic curricula used to teach biomedical equipment technology. This study indicated that, while the BMETs and healthcare organizations held similar views of job performance requirements, there was disparity concerning the BMET's academic requirements as viewed by healthcare organizations when compared to the BMET's perception of academic preparedness. There was an even greater disparity between those perceptions and requirements when compared to the academic programs currently in place.

Attitude of Health Personnel↗

Medicare program; payments for new medical services and new technologies under the acute care hospital inpatient prospective payment system. Final rule.

This final rule establishes a mechanism for increased Medicare payments for new medical services and technologies furnished to Medicare beneficiaries under the acute care hospital inpatient prospective payment system. The rule implements section 533 of the Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Benefits Improvement and Protection Act of 2000; and finalizes related regulatory provisions that were addressed in a proposed rule published in the Federal Register on May 4, 2001 (66 FR 22646).

Biomedical Technology↗

Technology to promote safe mobility in the elderly.

New technologies designed to help prevent adverse events related to the mobility of geriatric patients (ie, patient falls, bed-rail entrapment, patient handling, and wandering) are described. Technology offers the potential to eliminate or mitigate preventable adverse events that interfere with treatment, delay rehabilitation, potentiate impairment, and compromise patient safety. Unchecked, these adverse events can have a negative impact on patient health, functional status, and quality of life. It is not surprising that the elderly constitute the population at highest risk for adverse events, based on poor health, chronic conditions, long hospitalizations, and institutional care. Patient falls are a high-risk, high-volume, and high-cost adverse event. Key technologies to prevent falls and fall-related injuries include hip protectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids. Bed-rail entrapment is a serious adverse event, which includes patients being trapped, entangled, or strangled in beds. New technologies to prevent bed-rail entrapment include new hospital bed designs, height-adjustable low beds, devices to close gaps in legacy beds, and bedside floor mats. Patients with mobility impairments necessitate physical assistance in transfers and other patient-handling tasks, which increases risk for the caregiver and the patient. Featured technologies to prevent patient handling injuries include innovations in floor-based lifts, new ceiling-mounted patient lifts, and improvements in powered standing lifts, new friction-reducing devices, and new patient transport technology. Wandering affects 39% of cognitively impaired nursing home residents and up to 70% of community-residing elderly persons with cognitive impairments. New technologies to prevent adverse events associated with wandering include door alarms and signal-transmitting devices. Nurses in geriatric settings would benefit from exposure to technologies that could improve patient and caregiver safety. To maximize the benefits of technology, it is critical that front-line nursing staff be involved in the testing and selection of devices that will be used in their practice. Further, to reap the full benefits of technology, a careful plan for implementation needs to be developed that would include integrating the new technology with existing infrastructure. Training needs to be provided for all staff who will be using the technology, and efforts to ensure competency over time is needed. A major barrier to widespread use of new technology is cost. Further research is needed to demonstrate the cost effectiveness of these devices. Results from these studies will help to build a business case, demonstrating that initial capital investments will result in cost savings, improved quality of care, and other benefits.

Accident Prevention↗

Medical technology: a Pandora's box?

This paper examines the development of medical technology in terms of Max Weber's theory of rationalization. It argues that medical technology is a part of the general process of social, political and economic changes in modern Western societies. Medical technology today keeps many people alive who, in the past, would have died from their illness. In recent years, burgeoning technological achievements in medicine have been regarded as a threat to the individual's freedom to die. Many people believe that the prolongation of life only adds to the suffering of the patient and to the emotional distress of the family. They argue that a quiet death is preferable to the indignities inflicted by mechanical life support. This paper addresses these issues in light of Weber's theoretical arguments.

Biomedical Technology↗

Advanced technology program: information infrastructure for healthcare focused program.

This paper describes an initiative begun by the Advanced Technology Program in 1994 referred to as the Information Infrastructure for Healthcare (IIH) focused program. The IIH focus program began with an initial exchange of ideas among members of the private and public sectors (industry's submission of "white papers"; workshops conducted by the ATP; meetings held between individuals from both groups) to identify those technologies necessary for the development of a national information infrastructure in healthcare. A discussion of the development of the focus program through a "white paper" process notes differences that existed between what the ATP had hoped to gain through this method and how the private sector responded. A statistical description of the participants as well as a brief discussion of the ATP review and selection process is included.

Biomedical Technology↗

The future of imaging techniques for cancer patients in The Netherlands : A Delphi study.

There is a need in The Netherlands to understand the future prospects of imaging techniques in cancer care to deal with current and expected capacity decisions. For this, a Delphi research was performed with a panel of 35 noted experts. The panel anticipates that the application of imaging techniques (e.g., CT, MRI, PET) will gradually change; especially, their use will also include earlier stages, i.e., cancer screening and treatment. The increasing need and investments for these techniques will be partly balanced by new developments (e.g., faster technology). There will be a substantial decrease in the use of ultrasound, CT (except for screening), and conventional radiographic diagnostics. Radical new techniques and/or developments are not expected. The panel foresees increasing partial task substitution and subspecialization. Further, a profound impact on imaging techniques is expected from developments outside the imaging field such as digitalization, changing patient demands, and commercialization.

Biomedical Technology↗

Health management technology for catastrophic medical conditions.

BACKGROUND: The excessive growth of health care expenditures in the United States is widely acknowledged. Costs are anticipated to double by the year 2006. The intractable issue which remains before health care leaders is how to appropriately restrain these costs while not sacrificing a desired level of care quality. A variety of management approaches have been developed in pursuit of more rational and cost-effective use of health resources. Current management approaches have proven inadequate in stemming health care cost inflation and have raised increasing concerns about their negative impact on the quality of health care. METHOD: One group has created and operated a data and structured, expert consensus-driven health management technology for the management of catastrophic medical conditions, including severe brain and spinal cord injury and severe multiple trauma and burns, since 1992 and has recently applied this same technology to high risk neonates and organ transplants. This integrated, severity risk adjusted, delivery system incorporates adequate clinical data capture and analysis, coupled with empirically derived management principles and consensus expert clinical judgment. INTERPRETATION: Preliminary data analysis indicates that patients treated under the ParadigmHealth model experienced an improvement in the health care process, improved quality in health care delivery and outcomes, and overall cost reduction.

Biomedical Technology↗

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↗

Prognosis for year 2013.

New knowledge from biotechnology and new capabilities provided by the evolving global information infrastructure are already transforming health care. Three clusters of technologies hold particular promise: grid computing, intimate computing, and micro laboratory computing. The confluence of these technologies will change clinical laboratory equipment into portable devices, easing the administrative details involved in delivering care and ushering in a new age of monitoring clinical states. Two vignettes, an office visit and a clinical trial, are offered as prognosis for clinical care in 2013. New capabilities hold the power to transform health care, making it truly patient centered as the Institute of Medicine (IOM) has urged.

Adult↗

Ethics, deafness, and new medical technologies.

In the last 50 years, several new technologies have become enormously important within the Deaf community and have helped significantly to improve deaf people's lives in a hearing world. Current public attention and admiration, however, seems unduly focused on medical technologies that promise to solve "the problem" of being deaf. One reason for this interest, we argue, is the public's preoccupation with deafness as a disability and promises that technological breakthroughs such as the cochlear implant will "cure" deafness. Pressure on parents to make quick and early decisions and lack of adequate information about alternatives often leave them unprepared for the consequences of these decisions. To allow deaf individuals and their families to make better informed decisions about their lives and their futures, we argue finally that professionals who interact with these families adopt inclusive and individualizing ethics.

Biomedical Technology↗

[M-health: trends in wearable medical devices].

This paper focuses on the trends in wearable medical devices for the applications in m-health. The state-of-art technologies for the continuous and noninvasive measurements of physiological parameters, implementation platforms of wearable medical devices - e-textile, and body sensor networks are reviewed here with examples of related recent research projects conducted in different countries. In addition, we introduce our recent research project on the e-textile-based health shirt (h-shirt), which can measure arterial blood pressure noninvasively, continuously and cufflessly.

Biomedical Technology↗