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Radiology 1984. A conflict of high technology and high cost.

Radiology is confronted now by exciting but challenging times. The excitement derives from dramatic technological advance; the challenge from the economic constraints on health care delivery. The large and growing expense of providing health care is readily apparent and high technology medicine can too easily be blamed for the growth. The pressures for improved service at no extra cost will demand much of the negotiating skills of our specialty and our ability to survive administrative confusion and fragmentation. Equally, manpower planning is a feature of modern medicine. Often this is done from inadequate data and as a specialty we must continue to think constructively about our own future in this context, not least in recognizing the contribution of women to our specialty. Forces also to be recognized are decentralization, electronic information transfer, concerns about radiation exposure and litigation. Not least we need to be better able to define our specialty as its scope is now changing rapidly. For the future I hope that we can be part of the development of the controls which we must inevitably face; we should lead in instituting cost-accounting in our departments; we must be at the leading edge of technological change in both imaging and data transfer, and we must be both more business-like as well as act effectively as the patient's advocate. Radiology has an important and growing responsibility in patient care and most of the technological advances both improve that care and can be justified economically. I am proud to be a radiologist in 1984.

Canada↗

Dental technology program administrators' attitudes toward credentialing health manpower.

The purpose of this study was to identify the attitudes of administrators of dental technology programs toward health manpower credentialing. A survey instrument was developed by allied health professionals knowledgeable in the credentialing process. The instrument contained 32 items that were categorized into three subscales and sought information about academic program accreditation, certification, and the licensure of dental technicians. The survey was sent to the directors of the 57 dental technology programs accredited by the American Dental Association, Usable returns totaled 49, or 86 percent. The data indicated that dental technology program administrators support the concept and practice of health manpower credentialing. The data also indicated that these administrators felt that academic program accreditation was of value in meeting demands for quality assurance in dental technology, and that certification of technicians, while beneficial, had been of little value in terms of rewards (recognition and economic gains) for the credential holder. In addition, licensure of dental technicians was found to be desirable.

Accreditation↗

Nutritional realities--where does technology fit?

Food technology involves much more than fortification. It encompasses processing, i.e., a means of maintaining food in an acceptable, safe, and nutritious form for an extended period. Preservation processes free us from dependence on solely fresh foods. Thus, technology provides us with a stable food supply the year round and removes the threat of seasonal starvation. By increasing food acceptability through technology, the nutritional status of a population can be raised since the food will actually be eaten. To make technology the servant, rather than the master, however, more research is needed--for example, to establish the bioavailability of fortification nutrients.

Community Participation↗

[Trends in the development of the technologies of field pharmacy].

One of the actual trends of the researches in Medical Service of Russian Armed Forces is the improvement of medical supplies on the basis of the development and application of new pharmacy technologies. The development of such technologies of dual-purpose facilities for stationary and field needs is economically effective. The social and economic effect of these technologies also is of great significance due to the possibilities of training of pharmaceutical personnel in the conditions of peaceful time. The integral index of quality of the applied technologies is from 3 to 38 depending on the quantity of modules.

Military Medicine↗

The irruption of new technologies: a new challenge for ergonomics and anthropotechnology.

The irruption of New Technologies in South-East Asia has dreadful social effects such as unemployment and the rejection of former worker skills, but is also an opportunity to show that ergonomics has resources which have been neglected so far in this part of the world. The outstanding feature of these resources, which are vital for the successful transfer of these New Technologies, is that they are both technically and economically indispensable. Although the well-being, health and safety of workers may be sadly overlooked without drastic economic effects, this is not the case when using New Technologies, since costly mistakes may arise if the operators are unable to use computerized systems properly. Cognitive ergonomics associated with situated cognition may then make a great contribution. Since New Technologies are generally imported from Europe, the United States or Japan, they include special features which originate from these industrialized societies. Thanks to Ergonomic Work Analysis, we can discover the difficulties encountered in the importing country and find solutions based on anthropotechnology concepts, methodologies and knowledge.

Adaptation, Psychological↗

Technology assessment: analytical product research.

In this series on health technology assessment, not only will technology design, scientifically validated therapeutic efficacy and relative cost efficiency be evaluated, but also the medical ethical challenges of technology introduction will be explored. Ideally, these considerations can form the foundation for a technology assessment team's discussions.

Cost-Benefit Analysis↗

Health technology assessment.

This paper discusses the role of technology assessment in health care. The definition of health technology and its effect on health care in the Australian setting is reviewed. In particular, emphasis is placed on the work of the Australian Health Technology Advisory Committee and its approach to providing advice to clinicians on technology based healthcare services. Specific issues relating to laparoscopic services, radiation oncology, ultrasound, molecular biology and gene therapy, telemedicine and magnetic resonance imaging are outlined. The issue of the explosion of growth in the diagnostic services is also outlined.

Australia↗

From R&D to the mouth--a viable roadmap for the technology era.

This article serves as an overview of the status of dental technology as the profession approaches a new century. Its purpose is to define various ways in which dental manufacturers and marketers can better understand the thinking of the dental professional, those factors that influence their thought processes and how to use this information to develop more effective and predictive marketing strategies. With the advent of more complex and expensive dental technologies, e.g., video imaging, digitized radiology, electronic data transmission, etc., the dentist is faced with a variety of decisions relating to purchasing, implementation and costs/benefits analysis that go beyond the normal daily concerns of delivering competent dental care. It is no longer enough for a manufacturer to make a good product; successful marketing strategies must also include a means for guiding the dentist in the successful integration of these technologies into their offices. In order for dental marketers to meet the competitive demands of this advanced technology era, there must be a commitment to the development of strategic information through the use of third party, customized marketing research. Too much of the input currently used to develop marketing strategies is anecdotal, inherently biased and often not representative of the target market as a whole. It is hoped that this article will effectively challenge the reader to look at the development of dental products and services from a somewhat different, less traditional perspective and that it will provide the impetus and direction for creating better targeted and more rewarding marketing strategies.

Cost-Benefit Analysis↗

Role of emerging technology in the era of cost containment.

In this era of cost containment, new technologies will play the same role that they did before, improvement in the quality of care. Application of these new technologies in medical practice, however, will be scrutinized much more closely. The previous requirement of proving that a new technology is efficacious and safe will no longer be adequate. Physicians will be required to provide data that reflect the costs and overall effectiveness of the new technology. This article briefly discusses some key concepts of cost-effectiveness analysis.

Cost Control↗

Seniors-on-line: introducing older people to technology.

Retired Engineers are playing an important role in ensuring that older people are not excluded from the benefits of technological advances. Technology is playing an increasingly important role in the lives of older people as it is incorporated into assistive devices, home security, access to health care, banking, communication and many other areas. However, if older people are unfamiliar with new technologies and find them daunting, they may not benefit fully from these advances. In order to minimize difficulties arising from unfamiliarity with technology, an introductory computer course was offered to people aged 55 and over. Teaching methods appropriate to the needs of older people were used: small classes, students and instructors from same age cohort, slow pace of presentation and ample opportunity to ask questions. Retired Engineers make up the majority of instructors. Three hundred and sixty nine older people have participated in the course and most plan to continue using a computer.

Aged↗

[Biochemical and technological characteristics of the milk from Black-and White Dutch].

Studied were the composition and the technologic properties of the milk of Dutch Black pied cattle under this country's conditions. Milk samples were taken for analysis once in a month on a cow farm founded in 1964 with a total of 67 impregnated heifers and having at the time of investigation 88 cows, twelve of them remaining from the initial animals imported from Holland and the others being the offspring of the herd. It was established that the annual milk yield per forage cow, amounting to 44881 has the following index values; dry matter--12.63 +/- 0.48 per cent; butterfat per cent--4.07 +/- 0.2%; total protein--3.37 +/- 0.16 per cent; casein--2.56 +/- 0.16; slids-nonfat--8.54 +/- 0.24 per cent; calcium--0.126 +/- 0.002 per cent; phosphorus--0.079 +/- 0.003 per cent. The technologic properties of milk proved unsatisfactory: coagulation capacity--359 s; rheologic value--112.93 X 1.10(-5) V/cm3; and technologic coeficient--1.32. The data on the composition and the technologic properties of Dutch Black-pied cow's milk showed, on the whole, that most profitable is its processing into butter as against processing into cheese in which case the yields would be unsatisfactory.

Animals↗

Empowering children and families with information technology.

Patient empowerment is the enhanced ability of patients to actively understand and influence their health status. Information is the key to patient empowerment. Without information, children and families cannot engage in meaningful discussions or make thoughtful decisions regarding medical care. Information sharing is a model for patient interaction with the health care system that may significantly improve the care of children and families. This article focuses on information technologies that utilize user-centered design principles and interactive capabilities to facilitate information sharing and to empower children and families. Examples include electronic pediatric personal medical records, customized health information systems, and interactive physician offices with electronic mail (e-mail) and telemedicine capabilities. Ideally, these systems would all be integrated. Successful implementation of new technologies will require thoughtful attention and balanced solutions to tensions between information sharing vs security, and curatorship vs censorship. Issues related to access and the digital divide must also be addressed. Acceptance and usability of new technologies is predicated on close collaboration among physicians, researchers in informatics, librarians, educators, and other professionals with expertise in the human-computer interface. Child and family empowerment will be both the driving force and ultimate outcome of information-sharing technologies.

Child↗

The impact of new technology on hepatic resection for malignancy.

HYPOTHESIS: Relatively high morbidity rates remain problematic in hepatic resection for malignant neoplasms. Technological innovations coupled with surgical expertise can ameliorate morbidity and mortality rates. DESIGN: Medical records survey. SETTING: Tertiary care university hospital. PATIENTS: Five hundred one patients underwent liver resection at our hospital from March 1, 1988, through November 30, 1999. Three hundred twenty-one patients (64.1%) had primary carcinoma, whereas 180 (35.9%) had metastatic disease, mainly colorectal secondary disease (83.3%). Morbidity and mortality rates were compared with those of a previous series in the same setting. MAIN OUTCOME MEASURES: Special attention was paid to the impact of new technology (eg, newer imaging techniques, ultrasonic aspiration, intraoperative ultrasonography, argon beam coagulation, and autotransfusion) and improved anesthetic and surgical management on mortality and morbidity rates. RESULTS: Five patients died after liver resection and 93 patients had various complications, representing mortality and morbidity rates of 1.0% and 18.6%, respectively. These results compare favorably with the results of a previous unpublished series (mortality, 5/55 [9.1%]; morbidity, 28/55 [50.9%]). Intraoperative ultrasonography resulted in a change in operative strategy in 7 (17.5%) of a recent group of 40 patients. CONCLUSIONS: Morbidity after major hepatic resection for malignancy can be reduced considerably by applying newer technologies to preoperative and intraoperative decision making. Advanced technology also assists in reducing intraoperative risk by minimizing bleeding during resection of the hepatic parenchyma.

Aged↗

Office automation technology and functions: an overview.

Office automation is the progeny of technological imperatives coupled with bureaucratic realities. Advances in computer, photographic, and telecommunication technologies have made it possible to collect, edit, store, distribute, and copy documentary information at ever decreasing cost. The need for training, acceptance, cooperation, and effective use of the technology has filtered out many proposed systems. This article describes the opportunities and limitations inherent in the technologies, focusing on media conversions and equipment compatibility. It also describes the differing needs of convenience users and dedicated users, document preparers, and archivists. The systems that are emerging for use within organizations are compared to systems for use in communication between organizations.

Automation↗

Information providers and videodisc/optical disk technology.

Although industrial and consumer videodisc technology has been available since 1978, information providers are now just beginning to explore the possibilities of using videodisc and optical disk technology as publishing media. Firms involved in the design, development, and delivery of information products and services are looking at these technologies as new business opportunities and distribution channels. The areas in which information providers are using videodisc and optical disk technology are covered briefly.

Information Systems↗

Benefits of the advances in cardiac pacemaker technology.

Pacemaker technology has expanded rapidly in the last thirty years. Each phase of development has been marked by both improvements in clinical benefit and disadvantageous interactions of physiology and technology. Each phase of development has led to smaller, more reliable devices with greater programmability. Advances in generator technology and battery design have increased longevity of devices. The first devices used asynchronous pacing which had a significant effect in reducing the mortality of surgically induced complete heart block. Ventricular demand pacemakers overcame the problems of asynchronous competitive pacing, but exposed the pacemaker syndrome. Atrioventricular sequential pacing restored atrioventricular synchrony, resulting in hemodynamic improvement, but created the phenomenon of pacemaker-mediated tachycardia. Alternative dual chamber modes and algorithms have largely resolved this. Adaptive-rate devices have been of benefit to patients with chronotropic incompetence, and are now incorporating an increasing variety of biosensors. Almost all the problems of pacing have been overcome, but the increasing complexity of pacemaker technology is now a major limitation to its proper use.

Arrhythmias, Cardiac↗

Social and related implications of DNA fingerprinting and other new DNA technologies.

The discovery of the structure DNA at the beginning of this half of the century, and the recognition that it is virtually the universal genetic material, made it imperative for man, sooner or later, to apply this knowledge for unexpected ends. Genetic engineering, DNA fingerprinting, sequencing of whole genomes (be they of man, plants or microorganisms), or exploitation of the differences between the DNA of the male and the female (for example, of the X and the Y sperm) have thus all been historical imperatives. Today, many such predicted technologies are a reality or have come close to being so. Such DNA-based technologies have enormous social implications, discussed in this article. The impact of these technologies on different societies is likely to be different, in view of the different social conditions that prevail, and the different historical background and cultural traditions. In India, for example, the use of DNA fingerprinting could prevent the large-scale exploitation of women, and several kinds of litigation. On a global scale, the availability of this technique and its refinement to a stage where it would become virtually foolproof could act as a deterrent to certain kinds of crime. There will also be unprecedented benefits to agriculture but also new problems that will need to be faced and resolved. Wisdom demands that we prepare ourselves for a large-scale application of the new DNA technologies that are a historical imperative, understand the problems that are likely to arise, and plan to cope with them before they descend on us in full force.

Agriculture↗

Computer-based technological applications in psychotherapy training.

Despite obvious and documented advantages of technological applications in education, psychotherapy training based on information technology is either still rare or limited to technical innovations such as videotape recordings. This article outlines opportunities new computer-based learning technology create for psychotherapy training. First, approaches that include computer-mediated communication between trainees and teachers/supervisors are presented. Then, computer-based learning technology for self-study purposes is discussed in the context of educational approaches to learning. Computer-based tools that have been developed and evaluated in the context of psychotherapy training are described. Evaluations of the tools are discussed.

Computer-Assisted Instruction↗