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PubMed1984

Challenges for dietitians in a high tech/high touch society.

In our society, the coming decades will represent a period of great change and transition. Dietitians will come to realize that we have moved from an industrial to an information society. We are moving in the dual direction of high tech/high touch, matching each new technology with a compensatory human response. Institutional help will be replaced by self-reliance in all aspects of our lives. People whose lives are affected by a decision must be part of the process of arriving at that decision. We are giving up our dependence on hierarchical structures in favor of informal networks. For dietitians to prosper in this era of rapid technological change, they must more than keep pace; they must stay ahead, exploit technology aggressively and imaginatively, and apply it experimentally to new ideas.

Adolescent↗

PubMedDate not supplied

Nursing and technology.

Nursing began as an effort to provide care and comfort to the sick and injured. As our society developed, technological change began to increasingly affect the practice of nursing. Nurses found themselves caring for machines in addition to, or instead of, patients. All areas of nursing were affected by the technological explosion of the past 25 years. But nursing education and agency orientation programs have not prepared the nurse to work closely with sophisticated equipment. Conventional sex-role sterotyping contributes to the problem. Changes in academic training, employer practices, and nurses themselves are necessary. Nurses are the chief users of health care technology. They should have the skills to manage that technology.

Education, Nursing↗

PubMed1995

Achieving and sustaining full employment.

Human rights and public health considerations provide strong support for policies that maximize employment. Ample historical and conceptual evidence supports the feasibility of full employment policies. New factors affecting the labor force, the rate of technological change, and the globalization of economic activity require appropriate policies--international as well as national--but do not invalidate the ability of modern states to apply the measures needed. Among these the most important include: (I) systematic reduction in working time with no loss of income, (2) active labor market policies, (3) use of fiscal and monetary measures to sustain the needed level of aggregate demand, (4) restoration of equal bargaining power between labor and capital, (5) social investment in neglected and outmoded infrastructure, (6) accountability of corporations for decisions to shift or reduce capital investment, (7) major reductions in military spending, to be replaced by socially needed and economically productive expenditures, (8) direct public sector job creation, (9) reform of monetary policy to restore emphasis on minimizing unemployment and promoting full employment. None are without precedent in modern economies. The obstacles are ideological and political. To overcome them will require intellectual clarity and effective advocacy.

Economic Competition↗

PubMed1994

Research into hand-arm vibration syndrome and its prevention in Japan.

Research on vibration syndrome in Japan began in the 1930s with studies of the disorder among railway, mining and shipyard workers. In 1947, the Ministry of Labor decided vibration syndrome among operators of rock drills and riveters etc. was an occupational disease. Industrial developments in the 1950s and 1960s promoted the survey of vibration syndrome in mining, stone quarrying and forestry. The Ministry of Labor (1965) and the National Personnel Agency (1966) legally recognized vibration syndrome among chain saw operators as an occupational disease. Guidelines for prevention and early therapy were issued in the 1970s and 80s. From the late 1970s into the 1980s, research focused on the clinical picture, diagnostic methods and therapy. In pathophysiology, advances were made in research into the autonomic nervous system during the 1980s. The 1970s and 80s saw a steady reduction in risk from technological change and working conditions, and advances in medical care, education and meteorological forecasting. A comprehensive prevention system established in the 1980s in the Japanese forest industry involved: 1) work restrictions, 2) an improved health care system, 3) advances in the design of vibrating tools, handle-warming devices, and 4) improved worker education. This comprehensive preventive system was legally introduced into other industries, resulting in a rapid decrease in the incidence of vibration syndrome in Japan.

Arm↗

PubMed1994

The impact of clinical practice patterns on hospital charges for orthognathic surgery.

To assess the impact of changes in practice patterns, hospital charges (overall and component charges excluding professional fees) for 1992 were compared to 1985 data for three orthognathic surgical procedures: bilateral sagittal split osteotomy (BSSO), Le Fort I osteotomy (LFI), and a combination of both (BSSO/LFI). Data for 1992 were obtained for 59 patients (26 BSSO, 18 LFI, 15 BSSO/LFI). Secondary analysis of similar data for 1985 included 77 patients (27 BSSO, 16 LFI, 34 BSSO/LFI). Changes in clinical practice from 1985 to 1992 reduced mean length of stay (days): BSSO 3.2 to 1.2, LFI 3.7 to 1.4, BSSO/LFI 4.1 to 1.8. Mean total charges (dollars) increased: BSSO 3,086 to 5,023, LFI 3,538 to 6,784, BSSO/LFI 4,778 to 8,816. If 1992 charges are expressed in 1985 dollars, ancillary, pharmacy, and room charges all are reduced. Charges attendant to the surgical procedure (anesthesia, operating room, supply, and recovery) were just over half of total charges in 1985. By 1992, these components escalated to 80% of total charges. Most notable was the increase in supply charges. Charges for rigid fixation were a major component of increased supply charges in 1992. Surgeons minimally influence charges attendant to the operating room and postanesthesia recovery, the major components of total charges in 1992. Quality can be maintained with reduction in some charge categories, but these components total less than 25% of the patient's bill. Technology changes benefit patients, but a judgment must be made weighing benefits against increased health care costs.

Cost-Benefit Analysis↗

PubMed1994

[From the regional hospital to the Clinical Center in Sarajevo--100 years of work and development].

In the course of the past 100 years of the Regional Hospital, the Clinical Centre now experienced a number of organizational, functional and technological changes. There 6 striking periods: 1. Period of the Regional Hospital in Sarajevo, 1894-1918; 2. General State Hospital, 1919-1940; 3. World War 2, 1941-1945; 4. Clinical Hospital of the Medical Faculty in Sarajevo, 1946-1974; 5. University Medical Centre in Sarajevo, 1974-1992; 6. Clinical Centre of University in Sarajevo, since 1992 to the present days. From the modest building like pavilions, the Regional Hospital in Sarajevo became a modern Clinical Centre, 40 units, Institute of Research Work and the developed secondary and terciary health protection, except cardiosurgery. The Clinical Centre and its staff are the true heroes of the war, who succeed in the past two years to extend over a million of helps, nearly 20,000 surgical operations, over 1,5 million of diagnostic treatments, more than 100,000 psychotherapeutical treatments, more than 3,000 deliveries, etc. All that was performed in the extra-ordinary difficult circumstances, without electricity, the damaged equipment, reduced medical staff and shortage of the medical materials and drugs. The Clinical Centre was awarded by the UN for humanity and human rights, 1983 and the Humanist of the Year in B&H in 1993.

Bosnia and Herzegovina↗

PubMed1994

The role of quality assurance in computer inspections.

Changing technology affords the Quality Assurance auditor with the challenge of applying computer validation concepts to a variety of computer system types. In addition, these technology changes have caused the developers role to change as well. In an innovative research facility, the developer may include an in-house professional group, a vendor, or an end-user. With these issues in mind, the QA auditor needs a tool to accomplish the task of inspecting systems as they are being created. The prospective inspection process is the tool for accomplishing this task. This inspection involves the QA auditor's involvement in the development of a new system, as a member of the development team, from the initial creation through the implementation of the computer system. This presentation will focus on illustrating the steps in conducting the prospective inspection process, from expected deliverables and document reviews to final report and management notification. The benefits of QA involvement in the development process will also be discussed.

Clinical Laboratory Information Systems↗

PubMed1994

The advance of technology as a prelude to the laboratory of the twenty-first century.

Technological changes in the clinical laboratory are usually driven by the goal of patient care optimization. In the last decade, the trend appeared to be directed at clinical laboratory decentralization. A new generation of analytical instruments, the biosensors, is redirecting laboratory testing closer to the patient, at the bedside, in the physician's office, and by the patient at home. These miniaturized biosensors are easy to operate, require small specimen size, and provide reliable results with rapid TAT. Thus far, bedside testing using biosensor technology appears to offer unique opportunities for earlier availability of clinical laboratory data, decision making, and more specific diagnosis, and faster and more frequent monitoring; these may translate into improved patient care and reduced hospital costs. It is likely that this trend will continue into the twenty-first century. Electrochemical sensors (e.g., for electrolytes, glucose, urea, and hematocrit) and pulse oximetry, having gained clinical acceptance, will probably be the leading instrumentation for bedside testing. Continuous monitoring either by near-infrared sensing technology or with an implantable sensor is valuable in the care of the critically ill patient. Acceptance for clinical use will depend on complete data integration and a favorable cost-benefit ratio.

Biosensing Techniques↗

PubMedDate not supplied

[Relations between mental health and work. Review of the literature].

Interest in occupational mental illness has increased as a result also of the technological changes at the workplace. A total of 22 epidemiological studies on this topic were reviewed on the following basis: subject of the study, epidemiological design, type of psychometric scale, results. The authors discuss the methods and constraints of these studies, especially the lack of knowledge on occupational exposure and its relationship to mental health. The need for further studies in order to improve prevention of mental illness at the workplace is stressed.

Cross-Over Studies↗

PubMed1995

Allied health professional manpower in Louisiana.

In recent decades there has been a virtual transformation of medicine. A host of factors including technological change and increasing governmental intrusion and requirements as well as complex changes in the private sector have made the practice of medicine dramatically different than in the past. A concomitant change has been the virtual explosion in the number, complexity, and legal status of what are commonly termed the allied health professions. The following article was designed to present a historical overview of 10 of the most common such occupations and to discuss their unique training and employment status in the state. Implications for the future of medicine in the state are discussed.

Allied Health Personnel↗

PubMed1995

ICU for the '90s: the "intensive customer unit".

Health care in the '90s is more complex and costly than ever before, and the healthcare consumer is knowledgeable and discriminating. Critical care nurses, who have always been responsive to technological change, must now be more responsive to consumer needs. This requires a change in mindset and a commitment to satisfying the "healthcare consumer". This article identifies nursing's customers, defines customer service and details a five-step plan for building an intensive customer unit. A successful customer service program in the intensive care unit leads to economic stability for both unit and institution, to humanistic integrity and to professional advancement for nurses.

Critical Care↗

PubMed1994

Physician resource planning: quest for answers.

The average annual rate of physician growth in Canada, just over 4% prior to 1989, has fallen to about 2% since 1990, approximating the average annual growth rate of the Canadian population. The growth rate is not uniform for all specialties, with surgical specialties experiencing the smallest increases. Sub-specialist growth in the past 5 y has occurred preferentially in disciplines identified as areas of need and those identified as emerging specialties. Assessment of average workloads of physicians derived from full-time equivalent measurements, reported by the National Physician Data Base, indicates increasing workloads in the specialist group, which is most marked in the surgical specialties. Among a number of factors influencing workload measures, which might explain differences noted among specialty groups, are age, gender, lifestyle choices, technology changes, physician growth rates, and saturation of the market place balancing physician availability with "demand" for services. All such factors, along with the impact of current health care reform initiatives, must be considered when forecasting and managing physician resources.

Canada↗

PubMed1994

[Plasma fractionation. Progress, problems and perspectives].

In the last few years, plasma fractionation has been subjected to major technological changes which have contributed to improve the viral safety and overall purity of plasma derivatives. New viral inactivation treatments, primarily solvent-detergent and pasteurization, have been introduced in the manufacturing processes of plasma derivatives to ensure the inactivation of major plasma-borne viruses, including HIV and hepatitis B and C viruses. Concurrently, new highly purified products obtained by chromatographic methods (mainly ion exchange and/or immunopurification) have been developed in the last five years and have replaced former preparations, providing a significantly higher safety level in terms of purity and viral risks. For an example, the new generation of Factor VIII and Factor IX concentrates (to treat hemophilia A and hemophilia B, respectively), which have been introduced in the last five years, are purified over 10,000- to 20,000-fold from plasma, as compared to only 50- to 100-fold for the former products. Similarly, new, standardized, clotting factor or protease inhibitor concentrates have been made available, thus permitting to carry out selective hemotherapy of specific diseases. Examples include the development of von Willebrand factor, factor XI, protein C, or alpha 1-antitrypsin concentrates for the substitutive therapy of congenital or acquired deficiencies. In addition, the concept of good manufacturing practices has been implemented, whereas carefully controlled, validated processes are contributing to the consistency in the quality of those products. Current major problems in plasma fractionation relate to the potential occurrence of new pathogenic agents that could resist present viral inactivation treatments and to the potential effect of given purification technologies on the development of immunogenic properties of proteins. Current trends indicate that significant progress in viral safety of plasma derivatives (for example through the introduction of new concept such as viral filtration) are to be expected very soon. Further research in this very important field is mandatory as plasma should remain the starting material of important therapeutic products in the coming years.

Cell Fractionation↗

PubMed1993

Technology assessment and cost management.

Endoscopic, less-invasive surgery has reshaped health care. The skill of correctly assessing purchases and leases is critical to a surgical service's success. Video technology changes rapidly, and systems become obsolete in months, not years. Each update presents new learning curves, thus additional educational costs. Choosing reusable instrumentation may include hidden costs not fully appreciated, whereas disposables may create waste management and environmental problems. Assessing and managing the costs related to less-invasive surgery require in-depth analyses of an institution's specific needs and of available and future technology.

Costs and Cost Analysis↗

PubMed1993

[Automation in hematologic cytology].

Automation in hematological cytology can identify blood cells in suspension by new parameters: electrical field variations, light intensity modifications absorbtion or diffraction by one or two lasers, fluorescence intensity, cytochemical reactions or specific lysis. The new technology change the strategy of hematological laboratories. Automation realizes perfectly the white blood cell differential and modifies hematological language with respect to anemia and white blood cells diseases.

Automation↗

PubMed1993

Communication in the physician-patient relationship.

Political, legal, ethical, social, economic, and technological changes in the twentieth century have produced a profound effect on the health care and health status of Americans and the way in which physicians and patients communicate. In the latter half of this century, the responsibility for individual health care has shifted from a physician-oriented, paternalistic approach to a patient-centered one. Patients now assume two identities: health consumers and active participants in the medical decision-making process. This phenomenon has created an environment where consumer demand for information has shifted from a single focus on symptoms, diagnosis, and treatment of diseases to an increasing preoccupation with cost, quality, and access to health care. This shift emphasizes the critical role played by medical librarians in the dissemination of needed information, and it challenges librarians to take a leadership role in opening newer channels of communication between physicians and patients. The 1992 Janet Doe Lecture analyzes the evolutionary change in the physician-patient relationship and its modes of communication, projects future roles for medical librarians, and provides an extensive list of references for further reading.

Communication↗

PubMed1996

[Aging, family relations and life course].

Integration of sociological research findings into the study of late life individual development is attempted. The human lifecourse is presenting itself as de-standardized and individualized. Phases of renewed learning and selfmanaged changes become requirements for fulfilment in late life. The labor market and technological change contribute to the fragmentation of the life course. More attention has to be payed to train for a learning of re-learning, and for the capacities of the self to respond creatively to changes in the biography. One important element in increased endeavour in this context is the attempt to face intergenerational differences and to learn to grow with conflict even in old age.

Adaptation, Psychological↗

PubMed1996

Converging technologies and their impact on the clinical laboratory.

Rapid technological change is transforming the world in which we live. Because laboratory services are defined by available products and tools of technology, this "technological revolution" is having a significant and profound effect on how clinical laboratories are organized, staffed, equipped, and operated. In this review, I discuss individually and collectively the advances and developments being made in the general areas of measurement, digital, communication, and transportation technology and demonstrate how the convergence of the products evolving from these technologies is affecting the clinical laboratory.

Clinical Laboratory Techniques↗