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PubMed2002

Health care for the elderly: two cases of technology diffusion.

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.

Adolescent↗
PubMed2003

Ultrasound screening in pregnancy: advancing technology, soft markers for fetal chromosomal aberrations, and unacknowledged ethical dilemmas.

Fetal ultrasound screening has become routine practice in many western countries. During the last decade, such screening has led to frequent situations characterised by clinical uncertainty due to the disclosure of soft markers in the unborn child. Soft markers are minor anatomical variations indicating a somewhat increased likelihood that the fetus has a chromosomal aberration, most frequently trisomy 21 (Down syndrome). This paper presents the results of a comprehensive literature search of the National Library of Medicine with emphasis on the chronological development of scientific knowledge in relation to soft markers and the link between advancing imaging technology and clinical counselling dilemmas. An analysis of the literature makes evident that many ultrasound examiners have counselled individual pregnant women on the basis of insufficient data. Moral dilemmas have thus emerged as a direct result of advancing medical technology, and healthy fetal lives prove to have been lost due to invasive diagnostic testing aimed at resolving clinical uncertainty. Ultrasound examiners have warned against a policy of disclosing all findings of soft markers to expectant parents, but no exploration of experiential aspects linked to the disclosure of fetal soft markers has yet been published in the medical literature. The emotional reactions of mothers are important to consider given their potential impact on the biological development of the fetus. In conclusion, this paper stresses the need for paying close attention to the crucial distinction between technology development and technology implementation in relation to prenatal testing. Furthermore, it provides strong arguments for scrutinising the interface between prenatal testing and human experience.

Biomarkers↗
PubMed1999

Application of remedy studies to the development of a soil washing pilot plant that uses mineral processing technology: a practical experience.

Soil washing employing mineral processing technology to treat radionuclide-contaminated soils has been examined as a remedy alternative to the exclusive excavation, transportation, and disposal of the soil. Successful application depends on a thorough remedy study, employing a systematic tiered approach that is efficient, self-limiting, and cost effective. The study includes: (1) site and soil characterization to determine the basic mineral and physical properties of both the soil and contaminants and to identify their relative associations; (2) treatment studies to evaluate the performance of process units for contaminant separation; (3) conceptual process design to develop a treatment pilot plant; and (4) engineering design to construct, test, and optimize the actual full-scale plant. A pilot plant using soil washing technology for the treatment of radium-contaminated soil was developed, tested, and demonstrated. The plant used particle-size separation to produced a remediated product that represented approximately 50% of the contaminated soil. Subsequently, it was modified for more effective performance and application to soil with alternate characteristics; it awaits further testing. The economic analysis of soil washing using the pilot plant as a model indicates that a remedy plan based on mineral processing technology is very competitive with the traditional alternative employing excavation, transportation, and disposal exclusively, even when disposal costs are modest or when recovery of remediated soil during treatment is low. This paper reviews the tiered approach as it applies to mineral processing technology to treat radionuclide-contaminated soils and a pilot plant developed to test the soil washing process.

Cost-Benefit Analysis↗
PubMed1999

DNA microarray technology: the anticipated impact on the study of human disease.

One can imagine that, one day, there will be a general requirement that relevant array data be deposited, at the time of publication of manuscripts in which they are described, into a single site made available for the storage and analysis of array data (modeled after the GenBank submission requirements for DNA sequence information). With this system in place, one can anticipate a time when data from thousands of gene expression experiments will be available for meta-analysis, which has the potential to balance out artifacts from many individual studies, thus leading to more robust results and subtle conclusions. This will require that data adhere to some type of uniform structure and format that would ideally be independent of the particular expression technology used to generate it. The pros and cons of various publication modalities for these large electronic data sets have been discussed elsewhere [12], but, practical difficulties aside, general depositing must occur for this technology to reach the broadest range of investigators. Finally, as mentioned at the beginning of this review, it is unfortunate that this important research tool remains largely restricted to a few laboratories that have developed expertise in this area and to a growing number of commercial interests. Ultimately the real value of microarray technology will only be realized when this approach is generally available. It is hoped that issues including platforms, instrumentation, clone availability, and patents [20] will be resolved shortly, making this technology accessible to the broadest range of scientists at the earliest possible moment.

Cell Line↗
PubMed2002

Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial re-entrant tachycardia in patients with congenital heart disease.

OBJECTIVES: The goal of this study was to identify factors associated with radiofrequency catheter ablation (RFCA) outcomes of intra-atrial re-entrant tachycardia (IART). BACKGROUND: Radiofrequency catheter ablation of IART is difficult. The influence of patient and procedural factors and novel technologies on outcomes is unknown. METHODS: Acute and chronic RFCA outcomes were studied in patients with congenital heart disease and IART. Clinical status was measured using a multiaxis severity score. Multivariate analyses identified associations of clinical, procedural and technological factors with outcomes. RESULTS: A total of 177 procedures were performed in 134 patients; 139 procedures (79%) resulted in RFCA of > or =1 IART circuit and 117 (66%) in RFCA of all targeted circuits. Multivariate analysis associated acute success with irrigated ablation and absence of atrial fibrillation. Twenty-two complications were noted, nine related to vascular access. Electroanatomic mapping failed to decrease procedure or fluoroscopy time. Improvement in clinical status occurred in most patients (severity score preablation: 6.2 +/- 1.6, postablation: 3.0 +/- 2.3, p < 0.0001). At mean follow-up of 25 +/- 11 months, 42% of patients had IART recurrence and 28% required cardioversion. Six deaths occurred (1.8%/patient-year), and two patients underwent transplant. Chronic outcomes were associated with higher right atrial saturations, use of electroanatomic mapping, fewer IART circuits encountered and acute procedural success. CONCLUSIONS: Improvement of acute RFCA outcomes was contemporaneous with introduction of novel technologies. Intra-atrial re-entrant tachycardia recurrence was common, and no effect on mortality was discerned, but most patients had effective palliation of symptoms. Chronic outcome predictors included the underlying disease severity, application of novel technologies and successful ablation of all targeted arrhythmia circuits.

Age Factors↗
PubMed2001

Limitations to veterinary applications of new technologies in treatment and diagnostics.

Technology promises to improve the lifestyle and life quality of humankind. As a rule, wherever human medicine goes, veterinary medicine is sure to follow. Nevertheless, the promise of technologic advances does not shine as bright for veterinarians as for human physicians. This trend is echoed in the business of animal health as pharmaceutic company after pharmaceutic company spins off or otherwise eliminates their animal health division. Instead, a small group of strictly animal health-oriented companies compete for the animal health dollar, promising that fewer and fewer expensive technologies are likely to be incorporated into the standard of veterinary practice. All is not lost, however, because as progress is made in the field of human biotechnology, the cost of the technology should eventually come down, permitting at least some of the advances in human medicine to become available to the veterinarian.

Animals↗
PubMed2000

PACE+: interactive communication technology for behavior change in clinical settings.

BACKGROUND: Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults. METHODS: The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers. RESULTS: The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified. CONCLUSIONS: Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.

Adolescent↗
PubMed1999

Well-being of families with healthy and technology-assisted infants in the home: a comparative study.

This descriptive, correlation study was guided by the Double ABCX Model of Family Adjustment and Adaptation. The purpose was to explore the relationships between stressors/strains, coping, and well-being of families with healthy and technology-assisted infants. A total of 172 families participated in the study (Healthy: n = 87; Technology-assisted: n = 85). The families completed a demographic instrument, Family Inventory of Life Events; Family Crisis Oriented Personal Evaluation Scale; and Family Well-Being Assessment Scale. Increased stressors/strains were related to decreased family well-being. There were significant differences between families with healthy and technology-assisted infants. Families with technology-assisted infants experienced more stressors/strains and lower well-being than families with healthy infants. However, level of coping for both groups was high; there was no significant difference between the two groups with regard to family coping.

Adaptation, Psychological↗
PubMed1998

Challenges of teaching graduate psychiatric-mental health nursing with distance education technologies.

As student demographics change and distance educational technology continues to evolve, faculty teaching advanced psychiatric-mental health nursing are attempting to meet the needs of students at distant sites through telecommunications. Graduate education in psychiatric-mental health nursing at the University of Minnesota School of Nursing has used distance education technology since 1994. The use of technology, such as interactive television, audio and audio/video telephone conferencing, facsimile, and electronic mail to teach has been exciting and challenging. This article discusses challenges related to connectedness, confidentiality, and communication; describes approaches to address these challenges; and identifies student, faculty, and environmental attributes that help make teaching with this technology successful.

Education, Nursing, Graduate↗
PubMed1997

Biosensor technology and surface plasmon resonance for real-time detection of HIV-1 genomic sequences amplified by polymerase chain reaction.

BACKGROUND: The recent development of biosensor technologies for biospecific interaction analysis enables the monitoring of a variety of molecular reactions in real time by surface plasmon resonance (SPR). If the ligand is a biotinylated single stranded DNA, this technology could monitor DNA-DNA hybridization. This approach could be of great interest in virology, since the hybridization step is oftenly required to confirm specificity of molecular diagnosis. OBJECTIVES: To determine whether real-time molecular diagnosis of human immunodeficiency virus type I (HIV-1) could be performed using biosensors and SPR technology. STUDY DESIGN: Specific hybridization of a biotinylated HIV-1 oligonucleotide probe immobilized on a sensor chip to single stranded DNA obtained by asymmetric polymerase-chain reaction (PCR) was determined using the BIAcore biosensor. RESULTS: Direct injection of asymmetric PCR to a sensor chip carrying an internal HIV-1 oligonucleotide probe allows detection of hybridization by SPR using biosensor technology. This enabled us to apply a real-time, one-step, non-radioactive protocol to demonstrate the specificity of amplification of HIV-1 genomic sequences by PCR. CONCLUSION: The procedure described in this study for HIV-1 detection is simple, fast (PCR and SPR analyses take 30 min), reproducible and could be proposed as an integral part of automated diagnostic systems based on the use of laboratory workstations and biosensors for DNA isolation, preparation of PCR reactions and analysis of PCR products.

Biosensing Techniques↗
PubMed1998

Reflections on technology: increasing the science but diminishing the art of nursing?

Technology has had a huge impact on the delivery of health care over the last 10-20 years and although this has been, in general, in the Intensive Care (ICU) environment, the Accident and Emergency (A & E) department has not been immune from technical developments and innovations, a trend that looks destined to continue. The impact of technological developments has given rise to much nursing literature relating to the effects technology has had in 'dehumanizing' the patients in their care, as critical care nurses in all fields endeavour to balance the need for technical competence with the traditional and still important traditional arts of nursing. This paper explores some of the definitions and terminology surrounding technology, nursing, art and science in an attempt to illustrate that technical proficiency, scientific knowledge and nursing artistry can be combined by skilled nurses to achieve a balance of care which preserves the humanity and dignity of patients and their relatives in a critical care environment.

Art↗
PubMed1998

The art of midwifery: lost to technology?

This paper looks at how the art of midwifery is affected by the increasing availability and use of sophisticated technology. The use of the cardiotocograph is an example of how overuse of such technology can have detrimental affects, not only for the midwife but also for the woman in labour. While this technology has made a great impact in obstetric nursing, the effects on the low-risk pregnancy need to be evaluated. Midwives need to be research-based in their clinical practice and question the overuse of technology, such as the cardiotocograph, in cases where it is not warranted.

Australia↗
PubMed2003

Future technology for off-pump coronary artery bypass (OPCAB).

Over the past 5 years, many coronary artery surgeons have embraced technology and advanced the field of beating heart surgery to the point where off-pump coronary artery bypass (OPCAB) is becoming a mature procedure. Enabling technologies are now available for all stages of the procedure, including cardiac positioning, coronary artery stabilization, coronary artery visualization, and performance of the proximal and distal anastomoses. Despite these successes, only a minority of cardiac surgeons performs this procedure routinely. Proponents of OPCAB and the medical device industry will need to continue to develop new technologies to make OPCAB less technically challenging and more widely accepted. Progress towards routine single-vessel off-pump totally endoscopic coronary artery bypass has been slow. Translating the benefits of multivessel OPCAB to an endoscopic setting remains a formidable challenge that will require further technologic breakthroughs.

Anastomosis, Surgical↗
PubMed1998

Changing technology in health: product liability.

Greater health consumer awareness and increasing levels of concern for the rights of patients have led to patient care technology being more strictly regulated. This article analyses both the general law issues and the particular statutes that will be of relevance to those involved in evaluating and implementing such technologies. There are three main elements to this analysis. Firstly, there is the issue of liability for a product fault, which will in many cases be directed by legislation back to the manufacturer of the goods. Secondly, those involved in placement of patient care technology should be aware of anti-discrimination legislation when making placement decisions. Finally, occupational health and safety legislation sets minimum standards for technology used in healthcare facilities. The author suggests ways of complying with the laws for each regulatory regime.

Australia↗
PubMed2000

In vitro display technologies - new tools for drug discovery.

Over the past decade, several ligand discovery techniques have been developed that mimic the process of natural evolution. Phage display technology is the most established of these methods and has been applied to numerous technological problems including the discovery of novel drugs. More recently, some new display technologies have emerged which, unlike phage display, operate entirely in vitro and have concomitant advantages. This review describes this new generation of display technologies and indicates how they might fit into the modern drug discovery process.

Journal Article↗
PubMed2001

Miniaturized HTS technologies - uHTS.

The transition from slow, manual, low-throughput screening to industrialized robotic ultra-high throughput screening (uHTS) in the past few years has made it possible to screen hundreds of thousands of chemical entities against a biological target in a short time-frame. The need to minimize the cost of screening has been addressed primarily by reducing the volume of sample to be screened. This, in turn, has resulted in the miniaturization of HTS technology as a whole. Miniaturization requires new technologies and strategies for compound handling, assay development, assay adaptation, liquid handling and automation in addition to refinement of the technologies used for detection systems and data management. This review summarizes current trends in the field of uHTS and illustrates the technological developments that are necessary to enable the routine application of miniaturized uHTS systems within an industrial environment.

Journal Article↗
PubMed2002

High-throughput cell analysis using multiplexed array technologies.

The desire for more biologically relevant data from primary screening has resulted in a dramatic increase of cell-based assays in HTS labs. Consequently, new cell-array technologies are being developed to increase the quality and quantity of data emerging from such screens. These technologies take the form of both positional and non-positional formats, each with their own advantages. Notably, screens using these technologies generate databases of high-quality data that can be analyzed in ways currently not possible. The power of cell-based assays combined with new array and analytical technologies will enable the condensation of serial drug discovery processes, thereby decreasing the time and cost of taking a hit compound into clinical trials. Here, we compare array strategies being developed towards the goal of integrating multiplexed cell-based assays into HTS.

Animals↗
PubMed2002

Antibody arrays: an embryonic but rapidly growing technology.

Protein arrays are now an attractive proposition as they can measure a diverse range of protein interactions not possible with traditional DNA arrays. Antibody arrays are a specific subset of this technology. Originally conceived as multi-analyte detectors, antibody arrays are now used in a wide variety of applications. For instance, the potential of this technology to diagnose human diseases, such as leukemia, breast cancer and, potentially, heart failure, has stimulated much interest. Furthermore, identification of new protein targets in particular disease states will prove to be an invaluable tool in drug discovery and development. Patient prognosis and treatment are also potential applications of the technology. Antibody arrays have proved to be dynamic in response to these broad range of possibilities. This review examines variations in antibody array design and discusses current and potential applications of this novel and interesting technology.

Animals↗