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PubMed2005

Medical technology horizon scanning.

Horizon scanning is becoming particularly important in the medical industry, in the identification and evaluation of emerging technologies. This paper examines the role biomedical engineers may have in horizon scanning new medical technologies and considers whether this is a useful activity for biomedical engineers. A horizon scanning methodology for conducting studies of emerging medical technologies is introduced, consisting of the three main phases of (a) a systematic literature review, in which a set approach is taken to the gathering of information; (b) scanning for publications across a range of different sources; and (c) consideration of the literature in relation to fixed benchmarks to indicate the quality of published information and reported achievements. This methodology has been successfully applied by the authors in a horizon scanning study for the purpose of advising a Government agency on the status of remote patient monitoring technology.

Australia↗
PubMed2001

[New technologies in laparoscopic surgery].

The technology associated with endoscopic surgery continues to evolve as a result of industrial R & D and research within academic surgical departments with interest in surgical endoscopic and remote handling technology. Some of the developments in the last ten years are reviewed. The problem concerning health technology assessment (HTA) in relation to new devices/instrumentation and procedures is discussed. Randomised controlled clinical trials are unsuited for the initial HTA of technology-dependent interventions, and for this reason, an alternative system, controlled stepwise evaluation (CSE) is proposed.

Clinical Trials as Topic↗
PubMed2000

Acceptance and use of technological solutions by the elderly in the outdoor environment: findings from a European survey.

This article examines the use and acceptance of ticket machines, automatic teller machines (ATMs) and telephone cards by the elderly in four European regions. The analyses are based on data from an international project entitled "Keeping the Elderly Mobile", collected in Mannheim (former West Germany; N = 404 home-dwelling respondents), Chemnitz (former East Germany; N = 400), Ancona (Italy; N = 600), and Jyväskylä (Finland; N = 618). The random sample was stratified by age and gender in each country. Two generations of men and women (aged 55-74 and 75+ years, respectively) participated in the study. Results show that respondents generally made little use of the three technologies under investigation: in fact, the majority of respondents does not use them at all. The most frequently used devices were ATMs in Chemnitz and ticket machines and telephone cards in Mannheim. On the basis of logistic regression analysis, age was the most important explanatory factor for the three technologies and for all four regions, i.e., the users were mostly the "young-old." Education was a more important variable than gender. In all four regions, the majority of the respondents who used the technologies assessed felt that each of them made life easier; nevertheless, ticket machines make life more difficult to almost every third user in Mannheim. Interesting differences and similarities among the towns were also found. The present study exhibits preliminary results regarding elderly and technology which future research should investigate in greater depth.

Activities of Daily Living↗
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↗
PubMed1987

Economic evaluation and the rational diffusion and use of health technology.

In principle, economic evaluation provides a suitable framework for the assessment of the costs and benefits of health technologies. However, despite a rapid growth in the publication of cost-effectiveness and cost-benefit analysis in health care, there is little evidence that economic evaluation has yet become part of an integrated approach to technology assessment. This paper, based on the findings of a European Community project on economic appraisal of health technology, discusses how the design and conduct of economic evaluations can be improved so as to increase their relevance to health care decision making, and how policies on the diffusion and use of health technology can be devised so as to make fuller use of the economic evaluations that are carried out.

Communication↗
PubMed1988

Technology assessment in health care: the U.S. perspective.

Formal programs in medical technology assessment in the United States have become increasingly prominent in health care during the last 10 years in large part stimulated by remarkable technologic innovation, expansion in medical knowledge and increasing health care expenditures. The establishment of the Consensus Development Program of the National Institutes of Health initiated a decade of activities in technology assessment in both the public and private sectors and it was intensified by efforts to contain expenditures, particularly the Prospective Payment System. However, in spite of the wide range of evaluation activities, deficiencies remain which will have to be remedied if medical and policy decisions regarding technologies are to be made on sound bases.

Diffusion of Innovation↗
PubMedDate not supplied

Future health care technology and the hospital.

The past decades have been a time of rapid technological change in health care, but technological change will probably accelerate during the next decade or so. This will bring problems, but it will also present certain opportunities. In particular, the health care system is faced with the need to spend its limited resources more effectively. The number of hospital beds is being reduced, and lengths of stay are falling. In the future, the health care system will have to care for an increasing number of elderly people, both with chronic disease and also with dependency because of frailty and functional problems. The hospital of the future will probably be smaller and more intensive in the nature of its care. In part, this is because many present and future clinical technologies can be delivered outside of the hospital setting. And communication technologies offer the possibility of tying the various parts of the health care system into one true system. This would mean that the future hospital would have a more active role in supervising technical care outside of the hospital, and in making specialized knowledge accessible in all parts of the health system.

Computer Systems↗
PubMedDate not supplied

Health care technology in France.

The French health care system combines freedom of medical practice with nation-wide social security. The system is centrally regulated with specific attention to technology. Prices and budgets are also regulated. Despite these controls, concerns about quality of care began to appear in France in the 1970s. At the same time, increasing costs became an issue. Health care technology assessment has been under discussion as part of the solution to these problems since the early 1980s, but little was done until 1989, when a national agency was established to develop and coordinate health care technology assessment in France. In 1991, a new law on hospitalization strengthened the role of the government in health care and required extensive evaluation activities. The law has made legal requirements for the health care system and the government at all levels, as well as establishing specific institutions and public grants to support evaluation and related activities. While further evolution of the health care system is inevitable, it seems clear that technology assessment is becoming one of the key tools for addressing problems of quality of care and rising costs.

Cost-Benefit Analysis↗
PubMedDate not supplied

Health care technology in the United Kingdom.

The UK National Health Service (NHS) is based on the principle that everyone is entitled to any kind of medical treatment for any condition, free of charge. The NHS is funded primarily from general tax revenues. The health service is presently in the middle of a profound change in philosophy and practice. Health authorities have been given specific responsibility for identifying their population's health needs and for using public money to buy services under a specific contract so as to meet those needs. Health care technology assessment (TA) has also developed very rapidly in the UK recently. While the limited budgets of the NHS have controlled expenditures for health care, there has not been a coherent policy for technology development until very recently. During the past decade, awareness of the concepts of appropriateness, effectiveness, and cost-benefit analysis have moved to center stage on the agenda of policy makers. A new R&D strategy in the NHS is emphasizing technology assessment as an aid to choice and management of technology. The increased necessity for making choices, and the increasing availability of results from health care TA, seem to indicate that such research will have an increasing impact on health care and its management.

Health Care Reform↗
PubMedDate not supplied

Health care technology in the United States.

The US health care system reflects the free market of the US economy--there is no fixed budget and no limit on expenditures in the loosely structured matrix of largely private-sector health industry components. Mainly because of the inaccessibility of adequate health care for a large segment of the population, and because of the enormous cost of care threatens financial ruin for many more people, the first major reform of the system was debated in Congress for most of 1994, though, in the end, no leglislation was passed. One focus of the debate on spending has been the problem of excessive use of expensive medical technology and the need for some control, which, by and large, is lacking in the existing system. Health care technology assessment itself is a thriving industry in the United States, used by government, insurers, medical societies, hospitals, and other groups for their own purposes. At the national policy level, few opportunities for technology assessment to affect the health care industry exist, so most effort is directed at trying to affect medical practice at the level of the individual hospital and practitioner. The discernible effect of technology assessment has been minimal.

Delivery of Health Care↗
PubMed1996

An integrated approach to Smart House technology for people with disabilities.

It is now commonly accepted that 'Smart House' technology can play a significant part in helping both elderly and disabled people enjoy a greater degree of independence in the near future. In order to realize this aspiration, it is necessary to examine a number of factors: the development of the appropriate Home Bus technologies and supported devices; the development of the appropriate user interfaces that will allow people with a range of special needs use the system; the incorporation of the requirements of the 'Smart House' controller with the other technological needs of the user; and the development of mainstream technologies that will affect the cost and availability of devices to the user. This paper will examine the above points and suggest appropriate actions and trends. It will draw upon the work of a four-member consortium currently finalizing a technical development project under the EC TIDE program, the experience of research and commercial organizations engaged in development work in associated areas and the experiences of the Dublin-based, Central Remedial Clinic and in particular, its Client Technical Services Unit. The CTSU have been actively engaged in the development of systems for clients and direct clinical assessments for the last 12 years.

Biomedical Engineering↗
PubMed2005

Challenges and opportunities for enhancing biotechnology and technology transfer in developing countries.

Biotechnological innovation is gaining increased recognition as an important tool for improving global health. The challenge, however, lies in defining the role of technology transfer to develop therapies for diseases prevalent in developing countries. During the past decade, a large disparity emerged between the developed and developing world in accessing affordable medicines because of the pharmaceutical industry's focus on health areas bearing greatest profits. Discussed herein are several mechanisms that provide partial solutions to this challenge. The Office of Technology Transfer of the US National Institutes of Health has increased its technology licensing pertaining to neglected diseases to partners in developing regions. Establishing partnerships through the transfer of technologies and assisting indigenous institutions build R and D capacity may positively impact policies on protection of intellectual property rights and increase multinational company investments in lesser-developed countries. This will most probably result in the development of more accessible therapies for those in need.

Biotechnology↗
PubMed2005

Priority setting for horizon scanning of new health technologies in Denmark: views of health care stakeholders and health economists.

In the context of the establishment of a Danish Horizon Scanning System (HSS) the views of health care stakeholders and health economists were solicited by means of postal surveys on the need for adaptation of a priority setting instrument for health technology assessment (HTA). The aim was to investigate if the instrument needed adaptation for priority setting in the context of a Danish HSS and, if so, how the instrument should be changed. A literature study served to enhance interpretation of the findings of the surveys and to formulate changes in the instrument that synthesize or bridge any differing views between the two groups. The results show that the instrument should apply a health care perspective, and that technologies should be prioritised on the basis of the criteria: marginal benefits, marginal costs, budget impact, impact on access to care, and additional criteria with an impact on health policy, such as the educational needs and organisational changes associated with the new technology. The proposed changes are regarded as an intermediate step in the process of producing a fully adapted instrument that can serve as a formal support for priority setting of new health technologies for assessment in the Danish HSS.

Attitude of Health Personnel↗
PubMed2005

Impact of clinical information-retrieval technology on physicians: a literature review of quantitative, qualitative and mixed methods studies.

PURPOSE: This paper appraises empirical studies examining the impact of clinical information-retrieval technology on physicians and medical students. METHODS: The world literature was reviewed up to February 2004. Two reviewers independently identified studies by scrutinising 3368 and 3249 references from bibliographic databases. Additional studies were retrieved by hand searches, and by searching ISI Web of Science for citations of articles. Six hundred and five paper-based articles were assessed for relevance. Of those, 40 (6.6%) were independently appraised by two reviewers for relevance and methodological quality. These articles were quantitative, qualitative or of mixed methods, and 26 (4.3%) were retained for further analysis. For each retained article, two teams used content analysis to review extracted textual material (quantitative results and qualitative findings). RESULTS: Observational studies suggest that nearly one-third of searches using information-retrieval technology may have a positive impact on physicians. Two experimental and three laboratory studies do not reach consensus in support of a greater impact of this technology compared with other sources of information, notably printed educational material. Clinical information-retrieval technology may affect physicians, and further research is needed to examine its impact in everyday practice.

Attitude of Health Personnel↗
PubMed2005

Microencapsulation by solvent extraction/evaporation: reviewing the state of the art of microsphere preparation process technology.

The therapeutic benefit of microencapsulated drugs and vaccines brought forth the need to prepare such particles in larger quantities and in sufficient quality suitable for clinical trials and commercialisation. Very commonly, microencapsulation processes are based on the principle of so-called "solvent extraction/evaporation". While initial lab-scale experiments are frequently performed in simple beaker/stirrer setups, clinical trials and market introduction require more sophisticated technologies, allowing for economic, robust, well-controllable and aseptic production of microspheres. To this aim, various technologies have been examined for microsphere preparation, among them are static mixing, extrusion through needles, membranes and microfabricated microchannel devices, dripping using electrostatic forces and ultrasonic jet excitation. This article reviews the current state of the art in solvent extraction/evaporation-based microencapsulation technologies. Its focus is on process-related aspects, as described in the scientific and patent literature. Our findings will be outlined according to the four major substeps of microsphere preparation by solvent extraction/evaporation, namely, (i) incorporation of the bioactive compound, (ii) formation of the microdroplets, (iii) solvent removal and (iv) harvesting and drying the particles. Both, well-established and more advanced technologies will be reviewed.

Chemistry, Pharmaceutical↗
PubMed2006

Purity and the dangers of regenerative medicine: regulatory innovation of human tissue-engineered technology.

This paper examines the development of innovation in human tissue technologies as a form of regenerative medicine, firstly by applying 'pollution ideas' to contemporary trends in its risk regulation and to the processes of regulatory policy formation, and secondly by analysing the classificatory processes deployed in regulatory policy. The analysis draws upon data from fieldwork and documentary materials with a focus on the UK and EU (2002-05) and explores four arenas: governance and regulatory policy; commercialisation and the market; 'evidentiality' manifest in evidence-based policy; and publics' and technology users' values and ethics. The analysis suggests that there is a trend toward 'purification' across these arenas, both material and socio-political. A common process of partitioning is found in stakeholders' attempts to define a clear terrain, which the field of tissue-engineered technology might occupy. We conclude that pollution ideas and partitioning processes are useful in understanding regulatory ordering and innovation in the emerging technological zone of human tissue engineering.

Biomedical Technology↗
PubMed2005

Introducing new technology into the operating room: measuring the impact on job performance and satisfaction.

BACKGROUND: The Massachusetts General Hospital (MGH) Operating Room of the Future (ORF) project is a test site for evaluating new surgical technologies and processes. Here we evaluate the effect on staff satisfaction and burnout of introducing a set of new technologies. METHODS: Staff satisfaction and burnout were measured via sequential surveys based on the Maslach Burnout Inventory during the introduction of a new technology system. Functional behavior of the OR was measured in terms of flow time (time to transit the OR) and wait time (time to access the OR). These data were gathered using time-motion analysis methods. RESULTS: Significant functional improvements were found in the ORF (more than 35% reduction in flow time and wait time, P < .05). During the same period, more exposure to the ORF resulted in greater sense of personal accomplishment among surgeons, a worse sense of personal accomplishment among nurses, more emotional exhaustion among surgeons, and less emotional exhaustion among nurses. However, the responses for emotional exhaustion were reversed the greater the time from exposure to the ORF. Staff with 6 to 10 years' experience were at highest risk for burnout across all categories. General surgeons experienced more emotional exhaustion than other physicians. CONCLUSIONS: Tracking the response of all users and identifying groups at high risk for burnout when exposed to new systems should be a central part of any new technology project.

Burnout, Professional↗
PubMed2004

Technologies that make administration of vaccines safer.

There is an ever-expanding technology that is aimed at making the administration of vaccines safer. Conventional ways of administering vaccines are being upgraded, modified or replaced by a wide variety of innovations. The paradigm of liquid vaccines, needles and syringes is slow to change, but already developments are occurring that will change for ever the way vaccines are administered and will improve the safety record of immunization. The oral route of vaccine administration has generally been thought of as safe, but until now only the polio vaccine has been widely used in this way. The conventional method of vaccine administration is by injection. Many ingenious devices have become available that now make injecting safer. Inventors are now looking imaginatively to alternative routes and technologies for delivering vaccines. Vaccines are generally manufactured to extremely high standards and rarely are shown to be the cause of safety issues. People remain the weakest safety link is vaccine administration. Technologies that bypasses the ability of man to make bad decisions or to behave incorrectly are of tremendous value. The vaccine world is in the middle of a radical re-think about how vaccines might best be administered. The presentation of the vaccine can be altered to fit new technologies such as powder jet guns, or skin patches. Even the conventional needle and syringe have evolved to much safer versions, and are set to continue this evolution. All this means even safer vaccines and their delivery.

Drug Compounding↗