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PubMed2004

Hepatic tissue engineering for adjunct and temporary liver support: critical technologies.

The severe donor liver shortage, high cost, and complexity of orthotopic liver transplantation have prompted the search for alternative treatment strategies for end-stage liver disease, which would require less donor material, be cheaper, and less invasive. Hepatic tissue engineering encompasses several approaches to develop adjunct internal liver support methods, such as hepatocyte transplantation and implantable hepatocyte-based devices, as well as temporary extracorporeal liver support techniques, such as bioartificial liver assist devices. Many tissue engineered liver support systems have passed the "proof of principle" test in preclinical and clinical studies; however, they have not yet been found sufficiently reliably effective for routine clinical use. In this review we describe, from an engineering perspective, the progress and remaining challenges that must be resolved in order to develop the next generation of implantable and extracorporeal devices for adjunct or temporary liver assist.

Biomedical Technology↗
PubMed2001

Re-introducing skills teaching to nurse education: an action research project.

A skills teaching programme for first year nursing students is being developed as an action research project with the participation of lecturers, practitioners of three NHS trusts and first year students. All branches of nursing are equally represented. During the first part of the action research cycle the skills to be taught were decided upon using anonymous questionnaires and branch specific group interviews. The selected skills related to aspects of communication, observation, care planning and nursing activities as well as health care and information technology. The professional and personal development of students was also considered. All branches were able to agree on a common skills teaching programme. During this first part of the action research cycle concerns about the organizational possibility of teaching skills to an ever-increasing number of nursing students and the necessary participation of many lecturers were raised. Nevertheless, all participants emphasized the need to continue the project, requesting the development, implementation and evaluation of a new curriculum based on this research as soon as possible. This research demonstrates how small schools of nursing without the resources of large metropolitan-based medical schools and teaching hospitals can improve or design and implement skills teaching programmes for their students in a logical and research based fashion.

Biomedical Technology↗
PubMed2004

Supernormal vision, high-resolution retinal imaging, multiphoton imaging and nanosurgery of the cornea--a review.

Wavelength-corrected, adaptive optics and their relevance for diagnostic procedures of the human retina are considered. First, it is shown that the compensation of errors of the dioptric apparatus of the eye allows sharp and high-contrast images of retinal elements, such as the photoreceptors, to be generated. This technology is expected to enable on the one hand an improved laser therapy by the application of laser spots of the size of single receptors as well as on the other a further understanding of the mechanisms of vision, in particular of colour vision by using colour stimuli not larger than the cones. Second, femtosecond laser pulses, emitted from lasers working in the near infrared, based on multiphoton effects allow both imaging and laser effects to be generated which are in the submicron range and which do not cause collateral damage (nanoimaging and nanosurgery). These procedures, related to experimental ophthalmology may be considered a milestone for the research of cell physiology, in particular in the subcellular range.

Biomedical Technology↗
PubMed2002

Medical advancements determine health-system capacity requirements.

As the rate of advancements in medical technology accelerates, healthcare executives need to anticipate the impact that these advancements will have on health-system demand and capacity requirements. Determining these requirements is critical but difficult. Many hospitals today are operating at capacity, particularly in such areas as the emergency department, operating room, and critical care unit. Key market forces are transforming the way health care is organized, delivered, and financed. One such market force is the escalating pace of medical advancement. The healthcare industry lacks a centralized resource that tracks such developments and assesses the impact on hospital service-line demand and capacity requirements. By following an approach designed to help determine these requirements, Yale-New Haven Hospital, New Haven, Connecticut, was able to forecast its future capacity requirements.

Biomedical Technology↗
PubMed2005

Integrated microelectronics for smart textiles.

The combination of textile fabrics with microelectronics will lead to completely new applications, thus achieving elements of ambient intelligence. The integration of sensor or actuator networks, using fabrics with conductive fibres as a textile motherboard enable the fabrication of large active areas. In this paper we describe an integration technology for the fabrication of a "smart textile" based on a wired peer-to-peer network of microcontrollers with integrated sensors or actuators. A self-organizing and fault-tolerant architecture is accomplished which detects the physical shape of the network. Routing paths are formed for data transmission, automatically circumventing defective or missing areas. The network architecture allows the smart textiles to be produced by reel-to-reel processes, cut into arbitrary shapes subsequently and implemented in systems at low installation costs. The possible applications are manifold, ranging from alarm systems to intelligent guidance systems, passenger recognition in car seats, air conditioning control in interior lining and smart wallpaper with software-defined light switches.

Algorithms↗
PubMed2002

Affective medicine: technology with emotional intelligence.

For a long time people have kept emotions out of the deliberate tools of medicine and science; scientists, physicians, and patients have often felt and sometimes expressed emotion, but no tools could sense, measure, and respond to their affective information. A series of recent studies indicates that emotions, particularly stress, anger, and depression, are important factors with serious and significant implications for health. This paper highlights research at the MIT Media Lab aimed at giving computers the ability to comfortably sense, recognize, and respond to certain aspects of human emotion, especially affective states such as frustration, confusion, interest, stress, anger, and joy. Examples of recently developed systems are shown, including computer systems that are wearable and computers that respond to people with a kind of active listening, empathy, and sympathy. Results are reported for computer recognition of emotion, for teaching affective skills to autistics, and for having computers help users manage emotions such as frustration.

Biomedical Technology↗
PubMedDate not supplied

Assessment of medical technology students' perceptions of clinical site rotations and job choice criteria.

This study reflects an assessment conducted at the University of Utah to determine medical laboratory science students' perceptions and influence of clinical rotations on job choice criteria. A mixed method design was used, incorporating semistructured interviews and mailed questionnaires. This study identified both favorable as well as unfavorable factors that influence students' employment choices. Clinical managers should: 1) foster a positive organizational climate; 2) encourage constructive employee-student interaction and respect; 3) promote the clinical facilities' reputation of excellence in health care; and 4) continue to offer competitive wages and employee benefits. Clinical managers should avoid: 1) a lack of positive attitudes toward students; and 2) a lack of respect for the student's knowledge. This study provides crucial information for laboratory directors, managers, and supervisors who are interested in creating an ideal climate in which to recruit graduating medical laboratory science (MLS) students.

Adult↗
PubMed2001

[Current approaches for the implementation of guidelines by means of information technologies].

Clinical practice guidelines (CPGs) play an increasingly important role in the harmonisation process of health care delivery and disease management. It is known that nationally or internationally produced guidelines that have no consistent implementation strategy, have limited impact in changing physicians' behaviour and patterns of care. The literature provides evidence for the effectiveness of computerisation of CPGs for increasing compliance and improving patient outcomes. The integration of knowledge-based functions for decision support or monitoring in clinical information systems is one effective way. Another approach relies on the original, mostly text-based, guidelines. By structuring these resources with the eXtensible Markup Language (XML) we are able to improve the availability of clinically relevant knowledge at the point of care. XML allows for in-context searching and the customized presentation of guideline content. We are confident that this new approach will improve the acceptance and the benefits of the increasing number of guidelines in medicine.

Biomedical Technology↗
PubMed2006

Minimally invasive diagnostics and treatment using micro/nano machining.

Several medical tools with various functions have been developed for minimally invasive diagnostics and treatment. Microfabrication techniques such as MEMS technology are useful for the realization of high-performance multifunctional minimally invasive medical tools with small sizes. An ultra-miniature pressure sensor and an intravascular ultrasonic forward-viewing imager have been developed as microsensors for use in the human body. Active bending catheters have been developed for steering catheter tips without using traction of wires from outside the body. An ultrasonic therapeutic tool for sonodynamic therapy and sonoporation, and a micro scanner for precise laser treatment have been developed as therapeutic tools for use in the human body. High-functionalized endoscopic tools and catheters will enable more precise and safe diagnostics and therapy, as well as novel diagnostics and treatment which have been impossible to date.

Alloys↗
PubMed2006

Parents' experiences of negotiating care for their technology-dependent child.

The aim of this exploratory study was to understand the negotiation of care as experienced by the parents of technology-dependent children in a hospital context. Qualitative semi-structured interviews were undertaken with a group of six parents. Parents felt that their roles as parents were not considered enough by nurses and they tended to be seen as carers, not parents. Negotiation of care was not always apparent. Instead, nurses often made assumptions about parental involvement in care. Parents wanted to carry out care when in hospital, but were not always given choices. Parents also reported a desire for more confident nurses. This study highlights the need to gain insight into parents' experiences, in order that nurses can provide care in a way negotiated to suit the individual family. Suggestions for further research in this area are offered.

Attitude of Health Personnel↗
PubMed2006

Medical informatics in population health: building Wisconsin's strategic framework for health information technology.

Medicine is increasingly practiced through the application of information sciences. Medical informatics deals with optimal information use within bioinformatics, imaging, clinical, and population health domains. Population health informatics plays an important role in that it critically informs practice in each of the other domains. Proper functioning of health care systems requires an advanced health information network that supports clinical care, personal health management, population health, and research. But this infrastructure does not yet exist in the United States. A number of federal initiatives are underway to address this problem, including the development of a framework for a national health information network and funding for implementation. This network will be facilitated by federal leadership, but public and private partnerships, and state, regional, and local implementation and policy development will play a critical role. In this article, we describe several Wisconsin initiatives that are keys to developing a strategic framework and building the state's electronic health information infrastructure.

Biomedical Technology↗
PubMedDate not supplied

The axis and nexus of e-health alliances in 2020.

Strategic partnerships between the health care and Information Communication Technology (ICT) sectors are the wave of the future, as e-health systems are implemented. Divergent perspectives between ICT and health care executives impose central challenges in forging productive strategic alliances. Bridging these perceptual differences requires strong leadership and vision, financial resources, and care provider support. Together these form the axis upon which tomorrow's e-health alliances will rest. The growth of e-health systems is inexorable. The strength of governance leadership continues to influence its rate of growth and positive impact on health care systems. The extent to which strategic partnerships with the ICT sector will evolve into dynamic e-health alliances is directly related to the quality of national and regional governance leadership--the ultimate nexus of evolving e-health systems of 2020.

Biomedical Technology↗
PubMed2003

Priority setting in surgery: improve the process and share the learning.

Surgeons and surgical programs encounter priority-setting challenges every day, such as in regard to purchasing new technologies or managing waiting lists for elective surgery. The purpose of this paper was to explore priority setting in surgery. Traditionally in surgery, priority-setting decisions for new technologies have been based on evidence of effectiveness and cost-effectiveness; and decisions about managing waiting lists for elective surgery have been based on urgency rating scores. The fairness of priority-setting processes in surgical programs should be enhanced to permit all relevant information and values to be considered. The quality of these decisions can be improved by using an approach that captures and shares lessons from each priority-setting experience. The approach we propose in this paper- describe, evaluate, and improve using a leading conceptual framework for priority setting, called "accountability for reasonableness"-can be used by any surgical program to improve its priority setting, share lessons with others, and develop an evidence base for how these important health policy decisions should be made.

Biomedical Technology↗
PubMed1988

Balancing cost and benefit in treatment of late cancer.

Developed nations overall have failed to moderate the spiralling expenditure on high-technology medical investigation and treatment. In the absence of open public and political discussion on how best to ration scarce resources, a short-term solution can be achieved by health professionals. In the case of cancer management, physicians can regulate their expenditure by clinical budgeting and by selecting treatment which is clinically appropriate for each individual patient. As resources are limited, it is no longer justifiable for one physician to spend twice as much money as another on treating patients with similar diseases. The leaders of the profession in the UK have accepted the need for instruction of physicians on the relative values of different procedures for clinical investigation and treatment. Leading medical journals in Britain have begun to point out that "doctors will need to...integrate costs into clinical decision making"....

Biomedical Technology↗
PubMed2004

New concepts and technologies in home care and ambulatory monitoring.

The world is becoming more and more health conscious. Society, health policy and patients' needs are all changing dramatically. The challenges society is currently facing are related to the increase in the aging population, changes in lifestyle, the need for healthcare cost containment and the need for improvement and monitoring of healthcare quality. The emphasis is put on prevention rather than on treatment. In addition, patients and health consumers are waiting for non-invasive or minimally-invasive diagnosis and treatment methods, for home care, short stays in hospital, enhancement of rehabilitation, information and involvement in their own treatment. Progress in science and technology offers, today, miniaturization, speed, intelligence, sophistication and new materials at lower cost. In this new landscape, microtechnologies, information technologies and telecommunications are key factors. Telemedicine has also evolved. Used initially to exchange patients' files, radiographic data and other information between health providers, today telemedicine contributes to new trends in "hospital extension" through all-day monitoring of vital signs, professional activities, entertainment and home-based activities. The new possibilities for home care and ambulatory monitoring are provided at 4 levels: a) Microsensors. Microtechnologies offer the possibility of small size, but also of intelligent, active devices, working with low energy, wireless and non-invasive or minimally-invasive; b) Wrist devices are particularly user friendly and combine sensors, circuits, supply, display and wireless transmission in a single box, very convenient for common physical activities; c) Health smart clothes make contact with 90 % of the skin and offer many possibilities for the location of sensors. These sensors have to be thin, flexible and compatible with textiles, or made using textile technologies, such as new fibers with specific (mechanical, electrical and optical) properties; d) Health smart homes. The aim of this method is to improve the patient's living conditions and to avoid the cost of long hospitalization. "Exosensors" are used for measurement of the activity and behavior of the patient. The field of applications is very large, e.g. continuous monitoring of elderly populations, professional and military activities, athletes performance and condition, and people with disabilities. This new healthcare approach has to take into account lifestyle for improving prevention. For the patient to be more and more involved in his/her own therapy, new responsibilities and ethics have to be defined. A "societal health education" has to be provided to physicians and to patients to get all the benefits of this new context.

Biomedical Technology↗
PubMed2001

Nanofabrication: conventional and nonconventional methods.

Nanofabrication is playing an ever increasing role in science and technology on the nanometer scale and will soon allow us to build systems of the same complexity as found in nature. Conventional methods that emerged from microelectronics are now used for the fabrication of structures for integrated circuits, microelectro-mechanical systems, microoptics and microanalytical devices. Nonconventional or alternative approaches have changed the way we pattern very fine structures and have brought about a new appreciation of simple and low-cost techniques. We present an overview of some of these methods, paying particular attention to those which enable large-scale production of lithographic patterns. We preface the review with a brief primer on lithography and pattern transfer concepts. After reviewing the various patterning techniques, we discuss some recent application issues in the fields of microelectronics, optoelectronics, magnetism as well as in biology and biochemistry.

Biomedical Technology↗
PubMed2004

Optimizing workflow and knowledge in healthcare through innovation.

People's desire is to stay healthy during the entire course of their live. Innovations in medicine in care and technology have always contributed significantly to meet this desire as close as possible. Today, healthcare systems are faced with huge additional challenges. The focus of nearly every healthcare debate is on costs. But is this debate target-oriented and does it support the struggle for further enhancing the quality of care? The implementation of IT assisted workflow and knowledge supporting tools throughout the entire healthcare process--prevention to cure--leads to care which would be much more focused on people's needs and efficiency. The information gained from monitoring and wearable devices has to be included to these tools for delivering comprehensive patient information to the point of care. Then the puzzle of the different components in healthcare linked by IT will be complete, and the care process could be continuously optimized in an efficient way.

Biomedical Technology↗
PubMed1996

Death in technological time: locating the end of meaningful life.

This article demonstrates how debate about technologically manipulated death is elaborated in radically different forms in the scientifically sophisticated spaces of Japan and North America. Using recent historical materials and contemporary medical, philosophical, and media publications, I argue that the institutionalization and legitimization of "brain death" as the end of life in North America have been justified by a dominant discourse in which it is asserted that if certain measurable criteria are fulfilled, an individual can be declared scientifically dead. In Japan, by contrast, death is interpreted primarily as a social and not an individual event, and efforts to scientifically define the end of life as a measurable point in time are rejected outright by the majority, including many clinicians. The margins between nature and culture are debated in both cultural spaces, but assigned different moral status in the respective dominant discourse.

Anthropology, Cultural↗