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At least 1,621 records · Page 90Linked to original sources
PubMed1995

Physician use of information technology in ambulatory medicine: an overview.

Physicians practicing ambulatory medicine have never had more opportunities to use information technology to help them in their everyday practice. In parallel, evolving health care industry dynamics are increasing the need for clinical computer applications, which help improve the quality, efficiency, and the cost-effectiveness of patient care. This article examines: (1) the information needs of practicing physicians, (2) current and emerging technologies that can improve clinical decision making at the point of care, and (3) the impact of these technologies on clinical quality, medical costs, and physician practice efficiency. The article uses patient case scenarios to illustrate the emerging role of information technology in patient care.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Enhancing efficiency and quality of ambulatory care through telehealth technology.

Technology has made great strides in healthcare, but has been slow in reaching a Senior's home or residence. At 35 million and growing, the Senior population is making it known that home is where they want to stay. Technology advancements in devices, communications, and wireless capability are now making possible the delivery of customized telehealth solutions to provide Seniors with "enabled independence," allowing them to confidently "age in place" at home or residence for much longer, with improved health outcomes and quality of life. Combined with traditional ambulatory care services, integrating telehealth technology services now allows delivery of "virtual assisted living" services at home that can more efficiently meet Senior health requirements, and can simplify other aspects of a Senior's life that can play a role in extending time at home. To be successful, an integrated service must be able to usefully address a range of activities of daily living-instrumental activities of daily living, and enhanced activities of daily living-requirements. Already proven in other areas such as radiology, intensive care units, prisons, and rural communities, companies are working to develop practical telehealth service offerings designed for the home or residence. These services must be (a) packaged to meet individual Senior needs and (b) reviewed and revised regularly to match changes in Senior requirements over time. A core element of this service is the use of regular "virtual visits" between healthcare professionals and a Senior at home or residence, which have been shown to both increase efficiency and Senior health outcomes. Another important element is centralizing key data from the telehealth technology into a single database to improve information delivered to a Senior's doctor, family, and other ambulatory care providers. North Shore eCare and other companies are conducting extensive market tests and pilot efforts to make sure service offerings meet Senior needs, and can be delivered cost-effectively.

Activities of Daily Living↗
PubMed1996

Nursing and technology: a dialectic.

Caring and expertise are fundamental to nursing. Technology, although often viewed as inimical to these human qualities in the provision of care, has the potential to support caring and enhance expertise. Nurses whose expertise embraces both technology and nursing can design and implement technologies that will help them fulfill their commitments to patients. Appropriate, well-designed, flexible technologies can improve the care of individuals and enlarge the store of nursing knowledge and expertise.

Clinical Competence↗
PubMed1998

Technology and true presence in nursing.

If there is to be a future for nursing in the next millenium, it must be dictated not by technologic advances directly but by the manner in which technology relates with persons in health and illness. Technology enables nurses to care for persons in a more efficient and cost-effective manner. True presence, as articulated in the human becoming theory, affords members of the profession opportunities to be with persons in ways that make a difference to their quality of life. The article illustrates the recognition of the link between technology and true presence through the use of a nurse-person encounter.

Aged↗
PubMedDate not supplied

Videoconferencing and telehealth technologies can provide a reliable approach to remote assessment and teaching without compromising quality.

Cardiovascular disease remains a significant chronic healthcare problem in this country, with considerable associated economic and quality-of-life challenges. Along with these challenges, there is high demand for healthcare provider time, particularly in the areas of management of complex healthcare needs and patient education. At the same time, a critical nursing shortage exists. Telehealth technologies provide opportunities to meet the rapidly growing needs of consumers and healthcare practitioners. Many in need of services have limited access to high-end technologies. An argument has been made that the lowest level of technology needed to carry out a task should be used, if it is capable of providing the necessary services. Videoconferencing capabilities allow healthcare practitioners to engage in virtual face-to-face encounters with patients or other healthcare providers. A variety of levels of sophistication in these videoconferencing systems are available. In an effort to evaluate the effectiveness and consumer satisfaction with videoconferencing, 3 pilot studies were conducted to compare face-to-face, low-bandwidth, and high-bandwidth approaches to performing common assessments and patient education activities. In one study, a variety of experienced healthcare practitioners performed functional assessments of stroke subjects using a collection of validated scales by varying approaches (face-to-face, low-bandwidth, and high-bandwidth videoconferencing) in a randomized order. In a second study, undergraduate nursing students performed similar performance measures and taught an unfamiliar individual how to program and use an intravenous pump device, take a tympanic temperature, or to draw up insulin in a syringe. In the third study, advanced practice nursing students assessed vital signs and performed cardiopulmonary assessments on community-dwelling subjects using low-bandwidth and face-to-face approaches. Healthcare practitioners and students generally preferred high-bandwidth approaches over low-bandwidth alternatives when videoconferencing was performed; however, most participants and practitioners were satisfied with the encounters, regardless of the level of technology used.

Cardiovascular Diseases↗
PubMed1983

Obstetric practice in Finland, 1950-1980. Changes in technology and its relation to health.

The purposes of the paper are to describe changes in the technologic methods used in Finnish obstetric practice and to relate them to some measures of infant and mother health. Antenatal care in Finland still largely retains its original low-technology character, but changes toward more technology-oriented care can be seen. The management of labor and deliveries changed dramatically in the latter half of the 1960s and in the 1970s. More and more births occurred in large, specialized hospitals instead of in small, local hospitals. Electronic fetal monitoring, drug treatment of labor (oxytocin and analgesia), deliveries with instruments, and cesarean sections became common. Comparisons of perinatal mortality by county and by hospital suggest that the correlations between the technologic methods studied, especially cesarean sections, and decreasing perinatal mortality probably do not reflect direct causal relationships.

Delivery, Obstetric↗
PubMedDate not supplied

The softer side of technology: how IT helps nursing care.

Few would argue the efficiencies made possible by technology. However, technology goes beyond efficiency in healthcare, to actually help nurses provide better care. This article will examine the historical relationship among nursing, caring, and technology while explaining how technology reinforces--rather than destroys--the unique and intangible quality of caring in nursing.

Attitude of Health Personnel↗
PubMedDate not supplied

Patient and nurse safety: how information technology makes a difference.

The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

Automation↗
PubMed2000

Wall Street's assessment of plastic surgery--related technology: a clinical and financial analysis.

Many plastic surgeons develop technologies that are manufactured by Wall Street-financed companies. Others participate in the stock market as investors. This study examines the bioengineered skin industry to determine whether it integrates clinical and financial information as Wall Street tenets would predict, and to see whether the financial performance of these companies provides any lessons for practicing plastic surgeons. In efficient markets, the assumptions on which independent financial analysts base their company sales and earnings projections are clinically reasonable, the volatility of a company's stock price does not irrationally differ from that of its industry sector, and the buy/sell recommendations of analysts are roughly congruent. For the companies in this study, these key financial parameters were compared with a benchmark index of 69 biotech companies of similar age and annual revenues (Student's t test). Five bioengineered skin companies were included in the study. Analysts estimated that each company would sell its product to between 24 and 45 percent of its target clinical population. The average stock price volatility was significantly higher for study companies than for those in the benchmark index (p < 0.05). Similarly, buy/sell recommendations of analysts for the study companies were significantly less congruent than those for the benchmark companies (p < 0.05). These results indicate clinically unrealistic projections for market penetration, significantly high price volatility, and significantly high discordance among professional analysts. In all cases, the market is inefficient-an unusual finding on Wall Street. A likely explanation for this market failure is a cycle of poor clinical correlation when assigning sales projections, which in turn leads to price volatility and discordance of buy/sell recommendations. This study's findings have implications for plastic surgeons who develop new technology or who participate in the equities markets as investors. Plastic surgeons who develop new medical devices or technology cannot universally depend on the market to drive clinically reasonable financial performance. Although inflated sales estimates have benefits in the short term, failure to meet projections exacts severe financial penalties. Plastic surgeons who invest in the stock market, because of their unique clinical experience, may sometimes be in the position to evaluate new technologies and companies better than Wall Street experts. Well-timed trades that use this expertise can result in opportunities for profit.

Biomedical Engineering↗
PubMedDate not supplied

Telecommunications technology as an aid to family caregivers of persons with dementia.

OBJECTIVE: The aging of the population implies that an increased number of people are going to need some form of care or assistance. Caregiving poses a range of physical, emotional, and financial demands and often causes burden and stress for family members. This article describes how technology can be used to provide support to caregivers and increase the quality of life for both caregivers and care recipients. Preliminary data from an ongoing study of dementia caregivers is provided to demonstrate the feasibility of using technological interventions for this population. METHODS: The intervention involves a telecommunications system designed to augment a family therapy intervention by enhancing access to formal and informal support services. Specifically the system is intended to facilitate linkages between caregivers and other family members, friends, and other caregivers as well as to facilitate access to information on available resources. A total of 76 caregivers of dementia patients, including Cuban American and white American caregivers, received the telecommunications intervention. Data include real-time usage data and measures of usability at 6 months, 12 months, and 18 months after the initiation of the intervention. RESULTS: The data reported in this article are based on responses to the usability questionnaire at 6 months from a sample of 44 caregivers. Overall the results indicate that the system is easy to use and the caregivers find it valuable. The most common reason that the caregivers use the system is to communicate with other caregivers, especially those who are not nearby. The caregivers, especially the Cuban Americans, reported that the system facilitated their ability to communicate with family members and their therapist. The caregivers also indicated that they found participation in the "online discussion" groups to be very valuable and also found the "online resource guide"useful. CONCLUSIONS: The results demonstrate how current information and communication technologies can be used to help caregivers meet the challenges of caregiving and improve the quality of life for caregivers. The potential benefit of this type of technology for health care providers is also discussed.

Aged↗
PubMed1996

Diagnostic accuracy of technologies used in low back pain assessment. Thermography, triaxial dynamometry, spinoscopy, and clinical examination.

STUDY DESIGN: A prospective blind study compared three new technologies to assess back pain. OBJECTIVE: To assess the diagnostic accuracy and comparability of thermography, triaxial dynamometry, and spinoscopy in the assessment of recent onset work-related low back pain. SUMMARY OF BACKGROUND DATA: The role of these technologies in assessing patients with low back pain is unproved. METHODS: Forty-one patients with low back pain and 46 control subjects were assessed by each technology and by two clinical examiners blind to clinical status. Twenty patients were trained to simulate a healthy back without low back pain, and 50% of the control subjects were trained to simulate the presence of a low back pain disorder. Each technology was interpreted on two occasions by each of two readers. RESULTS: Thermography performed significantly worse than did triaxial dynamometry, spinoscopy, and clinical examination. The diagnostic accuracy of the last three was similar, and inter-rater comparability did not differ significantly. Among simulators, the diagnostic accuracy of triaxial dynamometry and spinoscopy was significantly higher than that of clinical examination, although considerable inaccuracy remained in assessing individual subjects. CONCLUSIONS: The diagnostic accuracy of thermography in recent onset low back pain does not support its use. Among those simulating normality or low back pain, triaxial dynamometry and spinoscopy have greater diagnostic accuracy than does a single clinical evaluation. However, for an individual, the inaccuracy that remains limits the use of triaxial dynamometry or spinoscopy for diagnosis in recent onset low back pain.

Adult↗
PubMedDate not supplied

The evolution and evaluation of videoconferencing technology for graduate nursing education.

The Integrated Services Digital Network H.323 (ISDN), which has been in use for the past 20 years often requires a dedicated telephone line and other equipment to implement. Consequently, expansion of ISDN-based videoconferencing requires infrastructure not always accessible in those areas that are most in need of technological connections. New H.323 technology using Internet Protocol H.320 (IP) connectivity can accommodate the use in a variety of videoconferencing software and fill this void as demonstrated by an experiment conducted live at the Syllabus Web '99 conference. When a faculty group were unable to secure ISDN connections to demonstrate their clinical evaluation of Family Nurse Practitioner (FNP) students using videoconferencing technology, an ad hoc group of computer experts, educators, instructional design specialists, and corporate sponsors collaborated to design a multipoint PC-based connection using IP connectivity. This article describes the first application of this technology, the evolution of ISDN and IP systems in nursing education and practice, and suggests appropriate future trends for their utility in nursing.

Computer-Assisted Instruction↗
PubMedDate not supplied

Prevention of secondary brain injury: targeting technology.

Use of technology in the management of the severely brain-injured patient has increased over the past decade and can be confusing and overwhelming to the critical care nurse clinicians who are new to the field of neurology. This article will describe normal physiology and cerebral dynamics and potential abnormal physiology encountered after brain injury. The technology reviewed will include intracranial pressure monitoring, cerebral blood flow monitoring and autoregulation, cerebral oxygen consumption and tissue oxygen monitoring, metabolism, sedation, and temperature monitoring. Integration of appropriate technology into patient management will be discussed using a case study to explore the utility of information at the bedside. Recognizing the difficult task of trying to control secondary injury in our patients is the first step to better outcomes. Implementing the use of technology to mitigate the situation must be done with careful consideration and a team approach to achieve the greatest benefit for the patient.

Algorithms↗
PubMedDate not supplied

Electronic managed care: the utilization of information technology in a managed care environment.

Health care managers must use information technology in managed care negotiations with all players in the managed care model-employers, managed care organizations, providers, and patients. Information technology effectuates these negotiations, provides a value added to all those involved in terms of efficiency and communication, and helps managers remain within regulations. This article describes each phase of the managed care model and how information technology is used. It also provides an operational overview of how to integrate the technology into health care settings.

Health Facility Administrators↗
PubMedDate not supplied

Pros and cons of healthcare information technology implementation: the pros win.

Countless studies and investigations have been performed siding either for or against the implementation of technology in the healthcare setting. This article presents both sides of this debate, with an obvious conclusion that the pros of this debate win. The practice of information technology in the medical domain lags behind its knowledge and discovery by at least 7 years. The key to closing this gap is to show, through various studies, how information technology systems provide decision support to users at the point in time when decisions are needed. What the reader will obtain from this article is that the pros for information technology implementation in healthcare settings weigh much more and have a greater effect than the cons.

Cost-Benefit Analysis↗
PubMed2004

New technology and the orthopaedic surgeon: are you protecting your patients?

The treatment of patients with musculoskeletal disease will be revolutionized during the next two decades by advances in technology. Orthopaedic surgeons are eager to incorporate new technology into their practices to improve patient outcomes and practice efficiency. However, as the orthopaedic community embraces new technology and innovative surgical procedures, there is an increased need to consider issues of patient safety and to determine the best way to incorporate technology into our practices.

Conflict of Interest↗
PubMed2005

Apply innovative technologies to explore cancer genome.

PURPOSE OF REVIEW: Molecular genetic alterations characterize the development of human cancer. Recent advances in molecular genetic technology and the success of the human genome project have empowered investigators with new tools in dissecting the cancer genome for discovery of new cancer-associated genes. The purpose of this review is to highlight the emerging molecular genetic methodologies and summarize their principles, applications, and potential technical challenges. The critical issue in sample preparation and a strategy that combines different molecular techniques to facilitate the identification of novel cancer-associated genes will be discussed. RECENT FINDINGS: Digital karyotyping and array-based techniques including array comparative genomic hybridization and representational oligonucleotide microarray analysis have been recently developed to study the genomic landscape in human cancer. These innovations provide tools to quantitatively measure DNA copy number changes in cancer and to map those changes directly onto the human genome. Digital karyotyping is based on counting the sequence tags that are distributed in the human genome and thus, it provides a digital readout to precisely outline the amplified and deleted chromosomal regions. Array-based technologies, on the other hand, compare the content of cancer and reference genomes followed by localizing the amplified or deleted signals in chromosomal regions using an array hybridization technique. In addition, a high-throughput mutational analysis platform has been available for a large-scale mutational analysis by using an automated capillary sequencing device and sophisticated bioinformatic tools. A number of examples have demonstrated the promise of these new molecular genetic approaches in identifying several potential new oncogenes and tumor suppressors. SUMMARY: As compared with conventional cytogenetics methods, digital karyotyping, array comparative genomic hybridization, and representational oligonucleotide microarray analysis provide an unprecedented mapping resolution that allows a precise localization of the amplified and deleted chromosomal regions. These technologies can be combined with gene expression profiling and high-throughput mutational analysis to facilitate the search for new cancer-associated genes. It is expected that applying these new technologies will lead to discovery of a host of novel oncogenes and tumor suppressors, which will have a significant impact in our understanding of tumorigenesis and in the clinical management of cancer patients.

Cytogenetics↗
PubMed2005

Molecular genetic testing of polymorphisms associated with venous thrombosis: a review of molecular technologies.

The growing knowledge of genetic polymorphisms predisposing to venous thrombosis has increased the demand for genetic testing of associated risk factors. This has prompted the need for simple, fast, reliable, and cost-effective genotyping methods for identification of those mutations. In the past decade, a large variety of DNA mutation analysis methods have been developed for detection of genetic variants associated with venous thrombosis, including PCR-based and PCR-independent technologies. Each of these technologies possesses unique advantages, but all have a common goal of simplifying and expediting mutation analysis. This review describes some of the commonly used technologies and commercially available platforms employed in clinical laboratories for genetic testing of thrombophilia. The choice of a technology for each individual laboratory would primarily depend on the specific requirements for the assay's accuracy, reliability, speed, throughput, and cost-effectiveness.

DNA Mutational Analysis↗