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PubMed2005

One of these things is not like the others: the idea of precedence in health technology assessment and coverage decisions.

Health plans often deliberate covering technologies with challenging purposes, effects, or costs. They must integrate quantitative evidence (e.g., how well a technology works) with qualitative, normative assessments (e.g., whether it works well enough for a worthwhile purpose). Arguments from analogy and precedent help integrate these criteria and establish standards for their policy application. Examples of arguments are described for three technologies (ICSI, genetic tests, and Viagra). Drawing lessons from law, ethics, philosophy, and the social sciences, a framework is developed for case-based evaluation of new technologies. The decision-making cycle includes (1) taking stock of past decisions and formulating precedents, (2) deciding new cases, and (3) assimilating decisions into the case history and evaluation framework. Each stage requires distinctive decision maker roles, information, and methods.

Canada↗
PubMed2000

Priority setting for new technologies in medicine: qualitative case study.

OBJECTIVE: To describe priority setting for new technologies in medicine. DESIGN: Qualitative study using case studies and grounded theory. SETTING: Two committees advising on priorities for new technologies in cancer and cardiac care in Ontario, Canada. PARTICIPANTS: The two committees and their 26 members. MAIN OUTCOME MEASURES: Accounts of priority setting decision making gathered by reviewing documents, interviewing members, and observing meetings. RESULTS: Six interrelated domains were identified for priority setting for new technologies in medicine: the institutions in which the decision are made, the people who make the decisions, the factors they consider, the reasons for the decisions, the process of decision making, and the appeals mechanism for challenging the decisions. CONCLUSION: These domains constitute a model of priority setting for new technologies in medicine. The next step will be to harmonise this description of how priority setting decisions are made with ethical accounts of how they should be made.

Costs and Cost Analysis↗
PubMedDate not supplied

Students' and residents' perceptions regarding technology in medical training.

OBJECTIVE: This pilot study provides firsthand feedback from medical students and residents in training regarding their perceptions of technology in medicine. METHOD: The authors distributed an e-mail invitation to an anonymous Web-based survey to medical students and residents in two different U.S. training institutions. RESULTS: Respondents unanimously expressed that technology skills were important in medical training and felt it most important to learn about electronic medical records and accessing scientific information on the Internet. At the point of patient care, trainees' preferred reference sources were the Internet and PDA, in that order. Most clinical trainees felt PDAs were critical in patient care and met their clinical needs, and they were most likely to use them for medication reference. The majority of trainees preferred printed media over digital media for initial learning, but the converse for referencing. Instructor-led small groups were viewed as the best environment in which to receive instruction. CONCLUSIONS: Trainees in medical education are technologically savvy and provide invaluable feedback regarding initiation, development and refinement of technological systems in medical training.

Attitude↗
PubMed2004

Emerging genetic technologies in clinical and research settings.

With the rapid expansion of genomic health care, nurses are exposed to emerging genetic technologies in a wide variety of clinical and research settings; however, nurses have limited knowledge about these technologies. The polymerase chain reaction procedure, which is the foundation of current molecular genetic technologies, real-time polymerase chain reaction, and microarray analysis are described in this article. The applications, strengths, and limitations of each technology are discussed.

Gene Expression↗
PubMed1989

Theoretical and empirical problems in the assessment of alternative medical technologies.

Critical situations help to clarify and define otherwise indistinct and vague phenomena. The paradigm-collision which occurs when assessing alternative medical phenomena against the background of a medical school paradigm is analogous to a critical situation. An analysis of the conditions for such an appraisal has helped to highlight aspects which are not normally ascribed any great significance in the assessment of technology. It turns out that theoretical requirements, the specific concept and certain irrational elements play a large role in the assessment of medical and alternative medical technology. One conclusion is that in the appraisal of e.g. alternative medical technology, one must take into account these conditions for forming a judgement, as a basic requirement for an objective appraisal of the technology in question.

Attitude of Health Personnel↗
PubMed2005

Technological developments and the need for technical competencies in food services.

The growing scale of institutional and commercial food services poses a technological challenge of producing large quantities of high quality meals in terms of their safety, sensory and nutritional attributes. Developments in food service technology and systems (cook-freeze, cook-chill and others) allow the replacement of fast food with the service of cooked meals, which are often nutritionally superior. Reliance on equipment, packaging and technological 'know-how' makes food service operations more complex. Operators have to minimise the impact of the numerous steps in the production process, the fundamental weaknesses of cook-chill food safety design, coupled with the practical limitations of Hazard Analysis Critical Control Points management, the potential unevenness of temperature distribution and product deterioration during storage. The fundamental knowledge of food science and microbiology, engineering and packaging technologies is needed. At present, the 'high tech' options, which can improve a product's nutritional value, such as natural preservation hurdles or functional meals, are not used in practice.

Cooking↗
PubMed1996

Studies of risks associated with technological development in Nigeria.

This paper attempts to assess the magnitude of the risks associated with industrial and transportation technologies in Nigeria using data from various governmental agencies and private organisations. The minimum annual averages of injured persons and data from accidents associated with technological risks in Nigeria were as follows: factories-402.4 injured persons and 5.8 deaths; petroleum industry - 106.5 injured and 45.3 deaths; road traffic accidents - 25,262 injured persons and 9,117 deaths; and railways 170.5 injured persons and 43.2 deaths. Of the eleven plane crashes reported between 1978 and 1991 the nine crashes for which information was disclosed claimed 352 lives. The highest technological risk is from road traffic accidents. The annual average death from road traffic accidents (9,117) was 1.05 times the annual average death (8,662) from communicable diseases and 1.2 times the number of deaths (7,711) from cholera epidemics in 1991. Between 1988 and 1991 there were 855 reported cases of occupational diseases with an annual average of 214 cases. Conjunctivitis, dermatitis, chronic bronchitis and bronchial asthma accounted for 91% of the 855 reported cases. The observations reflect the technological risk situation in Nigeria, and the need for improvements in both reducing risks and increasing the recording of risk statistics.

Accidents↗
PubMed2006

High-throughput genomic technology in research and clinical management of breast cancer. Exploiting the potential of gene expression profiling: is it ready for the clinic?

Gene expression profiling is a relatively new technology for the study of breast cancers, but within the past few years there has been a rapid rise in interest in its potential to improve the clinical management of breast cancer. This technology has contributed to our knowledge of the molecular pathology of breast tumours and shows promise as a tool to predict response to therapy and outcome, such as risk of metastasis. Microarray technology is continually developing and it is becoming apparent that, despite the various platforms available, robust conclusions can still be drawn that apply across the different array types. Gene expression profiling is beginning to appear in the breast cancer clinic but it is not yet fully evaluated. This review explores the questions that must be addressed before this technology can become an everyday clinical tool.

Breast Neoplasms↗
PubMed2006

Key advances in critical care in the out-of-hospital setting: the evolving role of laypersons and technology.

During the past decade, critical care in the out-of-hospital setting has transcended the original emphasis on on-scene advanced life support interventions by doctors, paramedics, and nurses. Many of the life-saving efforts and advances in critical care situations have now begun to focus more and more on how, through evolving technology, the average person can save lives and perhaps even spare precious intensive care unit (ICU) resources. A striking example was the recent study conducted at the Chicago airports at which automated external defibrillators (AEDs) were deployed throughout the airline terminals for use by the public at large. Not only did random bystanders on the concourses save an extremely high percentage of cardiac arrest patients with the AEDs, most patients rapidly awakened, even before the arrival of professional rescuers. Thus, this technology-assisted intervention, performed by an average person, pre-empted the need for many other critical care interventions and prolonged care in the ICU. Equipped with automated prompts to improve performance, new technology also exists to help to monitor the inadequacies and too-frequent interruption of life-saving chest compressions during basic cardiopulmonary resuscitation. As a result of these technological advances, survival rates for cardiac arrest are now expected to improve significantly.

Ambulatory Care↗
PubMed2006

An interdisciplinary approach to evaluating the need for assistive technology reduces equipment abandonment.

Assistive technology makes up a substantial portion of the direct cost of multiple sclerosis (MS). Equipment abandonment results in the needs of the disabled individual being unmet and places stress on the resources available for the funding of such equipment. The aim of the study was to demonstrate whether an interdisciplinary approach to evaluating and prescribing assistive technology reduces equipment abandonment in persons with MS. Data concerning assistive devices acquired by patients being followed at a rehabilitation centre in northern Italy from January 1997 to December 2002, were included in the study. Through December 1999, a physician in physical medicine and rehabilitation prescribed equipment based on a recommendation from the physical therapist. From 2000 to 2002, patients were evaluated following a standardized protocol implemented by an interdisciplinary team comprised of a physical therapist, occupational therapist, physician in physical medicine and rehabilitation and psychologist. Assistive technology obtained during the study period was divided into two datasets based on the year that the aid was obtained: pre-intervention (January 1997 to December 1999) and intervention (January 2000 to December 2002). The analysis included a comparison of the two datasets on number and types of equipment abandoned, timing of abandonment and reasons why devices were abandoned. Fifty-four subjects obtained 151 assistive devices during the study period, 67 devices during pre-intervention and 84 with the intervention. The majority of devices were abandoned immediately or within the first year following obtainment in both groups. A comparison of the number of devices obtained during pre-intervention with those obtained during the intervention showed that the rate of equipment abandonment decreased significantly from 37.3 to 9.5%. An interdisciplinary approach to evaluating assistive technology needs does decrease the risk of equipment abandonment, although it does not completely solve the problem.

Costs and Cost Analysis↗
PubMed1996

Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. American Society of Clinical Oncology.

In 1993, the Health Services Research Committee of the American Society of Clinical Oncology (ASCO) charged an Outcomes Working Group with defining the outcomes of adult and pediatric cancer treatment to be used for technology assessment and development of cancer treatment guidelines. The Working Group defined by consensus outcomes for technology assessment and guideline development, focusing on cancer treatments. The Working Group considered a variety of perspectives on outcomes, including those of patients, physicians, clinical investigators, ASCO, and policy makers. Because ASCO's guidelines will define what constitutes the best treatment and not whether that treatment should be paid for, the Working Group gave higher priority to the clinical and clinical research perspectives than to the health policy perspective. Survival is the most important outcome of cancer treatment. An improvement in at least disease-free survival is a prerequisite for recommending adjuvant therapy. In the case of metastatic cancer, treatment can be recommended even without an improvement in survival, if it improves quality of life. Quality of life includes global quality of life, as well as its physical, psychologic, and social dimensions. To be an outcome of cancer treatment, quality-of-life measures must be sensitive to clinically meaningful changes produced by treatment; evaluations must control for placebo effects and determinants of quality of life not related to cancer or its treatment. Toxicity, both short and long term, is vitally important, with the latter being particularly critical in children. The value of cancer outcomes like tumor response (eg, complete or partial response) and biomarkers (eg, CA-125) for technology assessment and guideline development depends on their ability to predict patient outcomes (survival and quality of life) or to influence decisions about treatment. Complete response is an important outcome when it predicts survival. Progression is important because it signals the need to change or stop treatment. Cost-effectiveness is an especially important outcome to consider when the benefits of treatment are modest or the costs are high. Patient outcomes (eg, survival and quality of life) should receive higher priority than cancer outcomes (eg, response rate), but both types of outcomes are important in technology assessment and guideline development. Multiple outcomes should be considered because no single outcome adequately describes the results of cancer treatment. In general, there is no minimum benefit above which treatments are justified; rather, benefits should be balanced against toxicity and cost.

Adult↗
PubMed1979

Wisdom, technology, and the good life.

Wisdom lies in extraction of good from new and old. Wisdom alone produces a society of wise men unable to leave their caves. Technology alone produces a society ruled by cold, despotic facts. A proper combination of wisdom and technology can produce the good life. That requires recognition of our ambivalence toward technology, a move away from our superspecialization of technologists and nontechnologists and toward a clearer understanding of technology as a most important servant of man.

Economics↗
PubMedDate not supplied

Technology in palliative care: steering a new direction or accidental drift?

Technological advances have been helpful in alleviating the suffering of many dying patients. For some, however, use of technology appears to augment distress. This article presents a discussion of issues associated with use of technology in palliative care nursing: pain management approaches, use of invasive procedures, decision-making concerns, the ways in which technology may serve as replacement for other types of care, and cost considerations.

Biomedical Technology↗
PubMed1990

The introduction of new technology: health implications for workers.

Several data sources were used to examine the relationship between the introduction of technology into the workplace and resulting symptoms of stress. Data from open-ended surveys with 75 workers in three settings revealed planning deficiencies (among other issues) that seemed to cause more difficulty for the workers involved. Surveys of 162 secretaries were used to explore the resulting hypothesis that these planning deficiencies (i.e., not including the worker in the planning, introducing too little equipment, expecting too much work from the technology) would result in symptoms of stress. The results supported the hypothesis; symptoms found in previous studies of VDT operators did increase with these planning deficiencies. Specific suggestions are made that may help to reduce the amount of stress among workers being introduced to new technologies. Results suggest that worker control, particularly input into decision-making is one factor affecting how workers will react to workplace stresses, particularly to the introduction of new technology.

Diffusion of Innovation↗
PubMed2000

A ten year update on the marketing life cycle for hospital information technologies.

This is a 1999 update of an original article based on 1989-90 data published in the Journal of Hospital Marketing. The adoption of hospital information technologies shows that most of these technologies were no longer in the innovator or early adopter stages. Infrastructure building technologies such as clinical information links, PC networking with the mainframe, MD links between doctors and hospital and E-mail showed the highest percentage of increase. Bar coding for inventory (transactional) also made great increases. Opinions on barriers to the adoption of hospital information technology are ranked and are studied by age of respondent, public vs. private hospitals, and job function.

Attitude of Health Personnel↗
PubMed1994

Health care cost containment: rationing medical technology.

Effective and efficient delivery of health care is one of the critical issues facing the nation today. Currently, nearly 13% of the nation's GDP in spent on Health Care. Perhaps one-half of the increase in health care costs have been linked to the acquisition of new medical technology. This paper examines some of the issues relating to the acquisition and dissemination of the use of medical technology by acute care and outpatient facilities and discusses the rationing of medical technology. The paper concludes by identifying some of the approaches to controlling health care costs through the rationing of technology that have been presented in the literature and outlines the evolving new paradigm that is being advanced to address the issues of cost containment and access to health care.

Canada↗
PubMed2005

Use of electronic technologies by people with intellectual disabilities.

Today's electronic technologies, including computers, cell phones, Internet, and electronic organizers, hold great promise for individuals with intellectual disabilities, yet little research has been conducted to explore patterns of use among this population. Drawing upon a survey of 83 adults with intellectual disabilities, we examined factors affecting use for three key electronic technologies: computer, Internet, and electronic organizers. Forty-one percent of participants used a computer; 25%, the Internet; and 11%, electronic organizers. Age, work setting, and self-perceived ability to manually copy information affected likelihood of use. Primary barriers reported by participants included lack of access, training and support, and expense of technologies. Interest in using such technologies was high, and participants offered suggestions for improved accessibility.

Adolescent↗
PubMed2001

Integration of computers and related technologies into deaf education teacher preparation programs.

The study examined how computer technology is used, modeled, and taught in programs that prepare future teachers of students who are deaf or hard of hearing. Data were collected through two self-reported survey instruments sent to participants from two different groups: (a) deaf education faculty (n = 233) and (b) administrators of programs serving students who are deaf or hard of hearing (n = 100). Among the faculty who responded to the survey, 99% said they used computers and printers for instruction during class, 84% said they used VCRs for instruction during class, and 56% said they used video cameras for instruction during class. The information that was reported on how technology was being used for instruction and how its use was being taught to students in deaf education teacher preparation programs indicates that the need persists for integration of technology into these programs. A need likewise continues for improved instructional strategies relative to computers and technology.

Computer-Assisted Instruction↗