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PubMed2004

Improvements in medical care and technology and reductions in traffic-related fatalities in Great Britain.

Great Britain has one of the lowest levels of traffic-related fatalities in the industrialized world with a current total of about 3500 fatalities per year. Large reductions have occurred over the last 20-30 years and the government has targets of achieving another 40% reduction by 2010. This paper analyzes some of the factors that have been statistically significant in helping to achieve those reductions with a focus on improvements in medical care and technology. Using a cross-sectional time-series of regional data a fixed effects negative binomial (NB) model is estimated which includes three proxies of medical care and technology changes. These are the average length of inpatient stay in the hospital, the per-capita level of National Health Service (NHS) staff, and number of people per-capita waiting for hospital treatment. All are statistically significant with the expected sign showing that improvements in medical technology have reduced total fatalities with less of an impact from changes in medical care. Other variables are also found to be significant, including the percent of elderly people in the population, per-capita expenditure on alcohol, motorway capacity, and average vehicle age. The latter shows a surprisingly unexpected effect, with more older vehicles in a region leading to fewer fatalities. Models evaluating effects on serious and slight injuries are also estimated and serve to confirm the expected effects of medical care and technology.

Accidents, Traffic↗
PubMed2002

Family caregiver training is needed to improve outcomes for older adults using home care technologies.

Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.

Aged↗
PubMed2003

The Oldowan industry of Peninj and its bearing on the reconstruction of the technological skills of Lower Pleistocene hominids.

The Oldowan technology has traditionally been assumed to reflect technical simplicity and limited planning by Plio-Pleistocene hominids. The analysis of the Oldowan technology from a set of 1.6-1.4 Ma sites (ST Site Complex) in Peninj adds new information regarding the curated behavior of early hominids. The present work introduces new data to the few published monographic works on East African Oldowan technology. Its relevance lies in its conclusions, since the Peninj Oldowan assemblages show complex technological skills for Lower Pleistocene hominids, which are more complex than has been previously inferred for the Oldowan stone tool industry. Reduced variability of tool types and complex use of cores for flaking are some of the most remarkable features that identify the Oldowan assemblages from Peninj. Hominids during this period seem to have already been experimenting with pre-determination of the flaked products from cores, a feature presently assumed to appear later in time. Planning and template structuring of flaked products are integral parts of the Oldowan at Peninj.

Animals↗
PubMed2003

The development of health technology assessment.

The field of health technology assessment (HTA) is still relatively new, but it has shown remarkable growth over the last decade, having spread first from the United States to Europe, and now to the entire world. HTA seeks to couple evidence with decision-making, and thus has similarities to evidence-based health care and evidence-based policy-making. The early history of HTA, beginning around 1975, reveals a first period of synthesising available evidence-principally that dealing with efficacy and cost-effectiveness of health care interventions-so as to put it in a format helpful to health policy-makers, especially those in national governments. From 1985 or so, the focus of the second period was on seeking more effective links with these policy-makers, particularly in Europe. The most recent period, beginning in the late 1990s, has been increasingly devoted to more effective dissemination and implementation in order to influence administrators and clinicians. While early assessments tended to focus on large, expensive, machine-based technologies, the scope has gradually widened to include smaller technologies, 'softer' technologies (such as counselling), and health care needs. Actual assessments have also taken on broader issues, such as organisational, social, and ethical implications. In the Member States of the European Union (EU), HTA activities are increasingly visible, and almost all now have a national focus for HTA associated with the Ministry of Health or its equivalent. Central and Eastern European countries are also developing HTA activities. Most recently, HTA has been highlighted by health policy documents from the European Commission. It seems likely that HTA will in the future be institutionalised in some form as part of EU activities.

Europe↗
PubMedDate not supplied

[The introduction of technologies in health care systems: from saying to doing].

INTRODUCTION: Health technology assessment (HTA) is a tool based on scientific evidence useful for making decisions about the introduction of technological advances in healthcare systems. However, there are multiple elements that influence the actual use of the results of HTA. These elements are related both to the characteristics of HTA and to the stakeholders involved -health professionals, politicians, and society. The aim of this article was to describe the main elements that influence the applicability of HTA in practice, as well as the use of HTA in clinical practice and health policy. METHODS: A literature search was performed in PubMed. The references retrieved, as well as additional bibliography and gray literature dealing with different aspects of HTA practice identified from the references retrieved, were reviewed. The results are presented descriptively, with analysis of the studies grouped according to the various HTA-related topics. RESULTS: Key elements that could be improved are standardization of the evaluation process, description of the organization's mission, prioritization of the technologies to be assessed, the clarity of the presentation of results, inclusion of values other than scientific evidence, such as social and cost-effectiveness values, and increased international coordination. CONCLUSIONS: For many people, the rationale for HTA is its explicit role in decision making, despite its problems. The immediate future of HTA would seem to include making the assessment process explicit, and the inclusion of HTA in decision making. This entails prioritization of technologies, setting limits on resource allocation and interrelation with political processes.

Delivery of Health Care↗
PubMed2003

Health technology assessment in its local contexts: studies of telehealthcare.

Health technology assessment (HTA) is one of the major research enterprises of late modernity, reaching into fields of previously autonomous professional practice, and critically interrogating the organisation and delivery of health care. The 'evaluation' of new health technologies within the field of HTA is increasingly a normative political expectation, as discourses of 'evidence-based' practice run through health policy in the UK and elsewhere. Despite its importance in governing the direction of innovation in health care delivery, there are hardly any empirical studies of HTA in practice. In this paper, we draw on two ethnographic studies of telehealthcare implementation and evaluation in the UK to explore the practical conduct of HTA, and we focus specifically on the social organisation and conduct of randomised controlled trials of these new technologies. The paper examines how evaluation forms a mediating set of practices that make the embedding or normalisation of a new technology possible; and present a simple model of the social and technical contingencies within the evaluation process.

Anthropology, Cultural↗
PubMed2003

Health inequality and users' risk-taking: a longitudinal analysis in a French reproductive technology centre.

This article sets out to provide a demographic analysis of the production of social inequality through IVF trajectories in a reproductive technology centre of a French hospital. However specific this example may be, it reveals one of the paradoxes of social inequalities in health: lay experience of risk in reproductive technology shows profound inequalities related to social status, despite the fact that equality would seem to be guaranteed in France, since the social security system covers the full cost of the treatments. We will try to understand this paradox through a lifecourse approach. Thus, it will be shown that social inequality in reproductive health is deeply rooted in social scenarios of infertility that lead to differentiated medical experience: there is little benefit and even a worsening in the situation of lower class women, who were faced with unpredictable risks related to the collective testing of these new technologies. Conversely, the possibility of inventing new lifestories, which may or may not include motherhood, was given to upper class women who take calculated risks to delay the scheduling of their pregnancies. In short, this study confirms that the production of social inequality in reproductive health can only be understood in connection with the social dynamics of lifestyles, resulting in specific medical patterns. This paper also leads to the assumption that these social scenarios are related to attempts to enhance the different forms of capital: economic, cultural and social capital. In addition, the presence of risks aggravates this inequality process. This raises another question: do reproductive technologies result in reinforcing social inequality?

Adult↗
PubMed1997

Economic evaluation of medical technologies in Sweden.

This paper reviews the use of economic evaluations in the Swedish health care system. The most important actors are defined and examples are given how economic evaluations have played a role in the decision making process. The introduction of extracorporal shock-wave lithotripsy (ESWL) is used as an example on how economic evaluation was used for recommendations to the county councils to adopt this technology. Mammography is used as an example of how the evaluation is used in the political process following an initiative in the parliament. A study of the cost-effectiveness of hypertension treatment illustrates how economic evaluations are included as part of a medical technology assessment by SBU, the Swedish Council on Technology Assessment in Health Care. The role of economic evaluations for drug reimbursement and pricing is also reviewed. The main conclusions are that economic evaluations are one of several factors influencing a decision making process that have a strong strive for consensus. It is thus difficult to make a definitive statement of the contribution of such study to the outcome of the decision making process, and there is no evidence that the evaluation was the decisive factor. However, a number of changes in the way resources are allocated in the Swedish health care system speaks for an increasing role for such studies in the future. The county councils are identified as the main target for economic evaluations, and SBU has a key role in supplying the county councils with high quality assessment of new and old technologies.

Cost-Benefit Analysis↗
PubMed1995

Technology acquisition in Canadian hospitals: how are we doing?

We surveyed attitudes of decision makers involved in making decisions about technology acquisition in hospitals, receiving replies from 989 (72%) anglophone respondents and 201 (68%) from francophone respondents. Respondents split on whether to try unverified procedures, strongly agreed that medical technology should be evaluated, and expressed a desire for technology assessment data. The quality of health care, need, and compatibility with the institution's role and mission were seen as the most important factors affecting acquisitions. Our study suggests that half the battle has been won; decision makers appear convinced that technologies must be evaluated. Organizational mechanisms, however, may still be required to ensure implementation.

Adult↗
PubMed2003

Biochips beyond DNA: technologies and applications.

Technological advances in miniaturization have found a niche in biology and signal the beginning of a new revolution. Most of the attention and advances have been made with DNA chips yet a lot of progress is being made in the use of other biomolecules and cells. A variety of reviews have covered only different aspects and technologies but leading to the shared terminology of "biochips." This review provides a basic introduction and an in-depth survey of the different technologies and applications involving the use of non-DNA molecules such as proteins and cells. The review focuses on microarrays and microfluidics, but also describes some cellular systems (studies involving patterning and sensor chips) and nanotechnology. The principles of each technology including parameters involved in biochip design and operation are outlined. A discussion of the different biological and biomedical applications illustrates the significance of biochips in biotechnology.

Biosensing Techniques↗
PubMed2003

The cancer technology appraisal programme of the UK's National Institute for Clinical Excellence.

The National Institute for Clinical Excellence (NICE) was established to ensure faster and more equitable uptake of new technologies by the NHS, through the provision of guidance on clinical and cost-effectiveness. The treatment of cancer is one of the UK government's priority areas and a range of guidance products have been developed by NICE to support implementation of national plans for managing patients with cancer in England and Wales. In its first 3 years, NICE's main activity was the "Technology Appraisals Programme" and it has created considerable interest and some controversy. 15 (out of a total of 56) technology appraisals related to oncology have been completed and another four are in preparation. The open, transparent, and inclusive approach NICE has adopted in reaching its decisions highlights the difficult ethical issues that need to be addressed in seeking to balance individual desires with public-health requirements. In this review we describe the process of appraising technologies, and address the recent criticism of the appraisal programme with regard to treatment of patients with cancer.

Academies and Institutes↗
PubMed1988

Assessment of clinical technologies. Importance for provision and use.

The author contends that the diffusion and use of modern medical technologies has had a profound impact on the hospital environment, the doctor-patient relationship, and the humanity of the patient. On these grounds the author argues for a rigorous, comprehensive, and ongoing assessment of diagnostic and therapeutic technologies. He stresses the importance of developing standards by which to judge the human and economic impact of particular technologies. These studies would decrease the inappropriate use of medical technology and would provide guidelines to improve current use.

Clinical Trials as Topic↗
PubMed1993

Perspectives on health technology assessment in Latin America. The case of perinatal care in the literature.

The possibility of referring to the medical literature to support technology assessments in perinatal care was studied by examining more than 40,000 references contained in the Index Medicus of Latin America for the period 1984-88. A total of 1,074 references addressed perinatal technologies, but with irregular distribution. Information on effectiveness, safety, costs, and social impact of perinatal technologies was extremely limited. These results led to the conclusion that immediate action needs to be taken to create the necessary conditions for health technology assessment in Latin America.

Developing Countries↗
PubMed1988

The state of the art versus the state of the science. The diffusion of new medical technologies into practice.

This paper offers a theory to explain the diffusion of new medical technologies into local practice. Based on several hundred interviews with community hospital physicians, it anchors technology decisions in the norms and relationships of local practice. Physician descriptions of their use of different types of assessment information provide insight into the way in which local consenses on appropriate practice are formed, guide behavior, and change. To understand new technology adoption, it is necessary to (a) differentiate "formed" (complete) and "dynamic" (still developing) technologies, and (b) appreciate the extent to which medical practice is locally organized. Concepts from organizational literature, then, become useful in explaining the penetration of these medical communities and the circumstances under which a new modality takes hold in them. Within the framework presented, previously puzzling findings regarding variations in local practice and the poor relationship between practice behavior and the published literature become understandable.

Attitude of Health Personnel↗
PubMed1988

When must a new approach to treatment be introduced? The ethics of technology assessment.

Prior to the nationwide diffusion of a new technology, evidence must be assembled to demonstrate that a new technology is, in the terminology of WHO, appropriate. Not everything that is new in health technology is good; not all that is good is needed. It is by no means unethical to demand adequate assessment of new technology before it is diffused. On the contrary, it is unethical to squander resources on hazardous and uneffective treatment. Of the methods available for assessment, the randomized clinical trial is among the most valuable. Randomized clinical trials cannot, however, solve all problems. Speed is a critical element. It is not ethical to permit excessive delay. Balanced, relevant, and informative studies must be conducted as quickly as possible and with a maximum of international collaboration. WHO has a valuable role to play in advising on, coordinating, supporting, and disseminating the findings of such studies.

Clinical Trials as Topic↗
PubMed1988

Medical technology in the United Kingdom.

This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.

Communication↗
PubMed1988

Emerging policies for controlling medical technology in Italy.

This article begins the sketching out the constitutional arrangements in Italy for the distribution of powers among different levels of government. The more important characteristics of the health system are then examined in some detail, the aim being to provide a sufficient basis for understanding the analysis of technology policy which follows later. The mechanisms used for funding medical technology are next described, after which data available on the diffusion of medical equipment are illustrated. Medical technology policies at the national and regional level are examined and an attempt made to appraise their effectiveness. The article concludes with a brief analysis of the possible role played by private medicine in the diffusion of medical technology in Italy.

Capital Expenditures↗
PubMed1988

Medical devices and biomaterials pathology. Primary data for health care technology assessment.

Through the postmortem examination, pathologists offer the ultimate clinico-pathologic assessment of the efficacy of medical care. Similarly, pathologists can offer a clinico-pathologic assessment of the efficacy of health care technology. Assessment by pathologists has diagnostic authority because it draws on the resources of the laboratories of surgical and necropsy pathology. In this essay we argue for enhancing the accuracy of medical device and biomaterials technology assessment by systematically collecting pathology-oriented data. We recommend the establishment of a pathology-based medical device registry to assess implantable medical device technology by accumulating reports routinely issued by pathology departments throughout the country. We further suggest that establishment of a university-based, industry-supported Medical Device and Biomaterials Pathology Institute to operate the registry, collect recovered, used health care devices, and generate definitive, pathology-based, primary data for health care technology assessment.

Autopsy↗