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At least 37 records · Page 2Linked to original sources
PubMed2005

Measuring functional skills in preschool children at risk for neurodevelopmental disabilities.

Approximately 400,000 preschool children have a major neurodevelopmental disorder impacting on mobility, cognitive-adaptive, or communicative skills. As many as 1 in 3 children live at psychosocial disadvantage because of poverty, parental mental illness or substance misuse, or low parental educational (i.e. less than high school). In the past decade over 500,000 preschool children have survived being born with very low birth weight (1001-1500 g) or extremely low birth weight status (< or =1000 g). Given the scope of these risks and the importance of optimizing outcomes for vulnerable children, this review will highlight advances in functional assessment using adaptive and multiattribute health-related quality of life measures. A framework based on the International Classification of Functioning, (ICF) World Health Organization and the Dynamic Kaleidoscope Model of the Institute of Medicine (IOM) will be described and illustrated with examples of children receiving new biomedical technologies. Assessment scales were chosen for review if they measured adaptive skills or multiattribute health status and had been used in child disability populations. Instruments reviewed include the Infant and Toddler Quality of Life Questionnaire (ITQOL), The Netherlands Office of Prevention Assessment of Preschool Quality of Life (TAPQOL), the Health Status Classification System-PreSchool (HSCS-PS), the Pediatric Evaluation of Disability Inventory (PEDI), the Vineland Adaptive Behavior Scale (VABS), the Warner Inventory of Developmental and Emerging Adaptive and Functional Skills (Warner IDEA-FS), the Scales of Independent Behavior Revised (SIB-R) Early Development Form, the Pediatric Functional Independence Measure (WeeFIM), and the Pediatric Quality of Life Inventory Version 4 (PedsQL 4.0). By measuring functional and adaptive skills and health-related quality of life, we can help devise intervention strategies that optimize developmental independence, family supports, and community participation among children who are at risk for neurodevelopmental disabilities or who have evolving established neurodevelopmental disabilities.

Child, Preschool↗
PubMed1990

Laser reimbursement: who pays for progress?

Leland Kaiser, a noted health care futurist, asserts that, to the degree to which medical technology can improve human life, there is no limit. Likewise, there is no limit to the amount of money people will be willing to spend on this technology. The ASLMS is at the focal point of the debate and needs to make its voice heard clearly based on a well thought out plan, based on reliable data, and considerate of the various economic, social, legal, and ethical constraints placed on the practicing clinician. If we don't take hold of the process, the technological imperative will quickly overwhelm us.

Insurance, Health, Reimbursement↗
PubMed2004

A fibrous-bed bioreactor for continuous production of monoclonal antibody by hybridoma.

A fibrous-bed bioreactor (FBB) has been developed to culture hybridoma cells for long-term continuous production of monoclonal antibody (MAb). A non-woven polyester fibrous matrix was used to immobilize the cells to reach a high viable cell density of 3 x 10(8) cells cm(-3) packed bed, which gave a high volumetric MAb productivity of 1 g L(-1) day(-1) under continuous feed conditions with the medium containing 10% serum. Reducing the medium serum content to 1% increased MAb production to 6.5 g L(-1) day(-1) in a repeated batch FBB culture. MAb production was higher at higher dissolved oxygen (DO) levels in the range between 10% and 70% of air saturation, although DO did not significantly affect glucose metabolism and lactate production. The medium LDH (lactate dehydrogenase) level increased dramatically when the DO level was decreased from 30% to 10%, suggesting that a critical DO level of approximately 30% is necessary for maintaining the FBB culture for long-term operation. Compared with suspension cultures in T-flasks and spinner flasks, the FBB culture had a lower lactate yield from glucose (0.80 vs. 0.91 g g(-1), produced MAb at a higher concentration (up to 442 mg L(-1) vs. 83.5 mg L(-1), and was stable for continuous long-term operation (more than 1 month). The superior FBB performance was attributed to the highly porous fibrous matrix that enabled the efficient mass transfer, cell immobilization, and continued growth and regeneration that are critical to maintaining a high density of viable and productive cell populations. The cells immobilized in the fibrous matrix had high viability (>85%) even though many of them were in growth arrest (G1/G0 phase) as indicated by their smaller cell size (<10 microm). Scanning electron microscopic studies of the cell-matrix showed that the high density of cells formed large clumps within the interstitial spaces of the fibrous matrix. Their close contact and interaction with each other might have contributed to their ability to survive well under adverse conditions such as low DO and low serum content in the medium. It was also found that the cells present inside the fibrous matrix had a higher viability and lower apoptosis than those present in the liquid suspension, indicating that the fibrous matrix had selectively retained healthy, nonapoptotic cells and dislodged apoptotic and dead cells; this also might have contributed to the stability of the long-term culture. This work demonstrated that the FBB originally developed for microbial fermentation also gave excellent results in achieving high cell density, productivity, and product concentrations, and should have a good potential for industrial animal cell culture applications.

Antibodies, Monoclonal↗
PubMed1999

Clinical services assessment and reengineering: lessons learned.

Healthcare enterprises often "acquire and install" picture archiving and communications systems (PACS) without examining many of the care delivery processes and information flows that will be affected. Many times these unexamined factors can delay or be the cause of failure of the PACS project. This article presents issues that were worked through as part of a PACS clinical services assessment and reengineering analysis for several US military medical treatment facilities.

Alaska↗
PubMed1996

[Effectiveness and cost effectiveness of innovative medical techniques in public health].

Electromedical technology and systems are an integral part of health services and contribute to their costs. Despite the sometimes high capital costs, they have proved to be effective and efficient for health services. Technological assessment with respect to benefit and cost aspects has been well and systematically evaluated, but requires much work in detail. In many cases less sophisticated procedures are sufficiently effective for a reliable evaluation. Corresponding results that show the cost-saving potential of advanced technology for radiology are reported.

Capital Expenditures↗
PubMed1996

[Digital radiography. Cost-benefit analysis].

Due to its high dynamic range and contrast discernibility, digital radiography offers substantial advantages compared with conventional film-screen systems. Moreover, further advantages can be assumed for radiation protection. Digital radiography also allows conventional image data to be included in PACS (Picture Archiving Communication System). These well-known advantages are faced with legal questions which are not yet settled. Cost effectiveness in using systems of digital radiography and PACS are also under discussion. By means of examining economic efficiency and cost analysis of digital radiography systems, economic effectiveness was assessed. This was also compared with conventional alternatives. As a result, it may be assumed that amortization is reached in three to four years. Based on lower costs for films, digital systems are more cost effective than conventional systems after this period.

Cost-Benefit Analysis↗
PubMed2004

Biomolecular features of clinical relevance in breast cancer.

Breast cancer is a heterogeneous disease and its consequent complexity is a major challenge for physicians and biologists. Notwithstanding its potential curability due to the availability of treatment modalities which are effective in the presence of favourable clinical or pathobiological features, there is still a great deal of controversy over its clinical management. In recent decades, tumour biomarkers that are indicative of or related to cell traits characterising malignancy--that is self-sufficiency in proliferative growth signals, insensitivity to growth inhibitory signals, evasion of apoptosis, limitless replicative potential, and activation of pathways leading to neo-angiogenesis, invasion and metastasis--have provided information that has been proven to be associated with disease progression. However, when these biomarkers have been analysed individually, their prognostic relevance has been found to be modest, the only remaining clinically useful biomarkers being cell proliferation and plasminogen activation-related factors for prognosis, and steroid hormone receptors and the oncogene HER2/neu for prediction of response to hormonal therapy or to the novel targeted anti-HER2/neu therapy. It therefore remains necessary to reduce the intrinsic complexity of breast cancer in order to improve its clinical outcome. One way to achieve this objective derives directly from the concept that cancer is a genetic disease at the somatic level and from the recent availability of high-throughput post-genomic analytical tools such as gene and protein expression techniques for global gene expression analysis. Following these novel approaches, a number of recent studies have produced gene expression profiles in breast cancer that are markedly associated with disease progression and directed to answer different clinical and biological questions. However, the outcome of these novel studies still needs to be validated, which will entail cooperation between different specialists and integration of all the different skills involved in translational research in oncology.

Biomarkers, Tumor↗
PubMed1986

The role of before-after studies of therapeutic impact in the evaluation of diagnostic technologies.

Studies in which clinicians' therapeutic plans are determined before and after application of a new test offer an attractive alternative to randomized trials as a strategy for establishing the usefulness of diagnostic technologies. To maximize scientific credibility such studies should include a number of design features: specific clinical questions should be addressed; consecutive patients presenting with a clinical problem should be entered; the test's accuracy should be assessed; and changes in therapy should be described in sufficient detail to allow an estimate of the impact on patient outcome. Even with attention to these issues, the validity of before-after studies of therapeutic impact is limited by possible discrepancies between clinicians' stated plans and actual behavior, and by the often tenuous link between change in therapy and patient benefit. Before-after designs will be most useful in primary investigations which, if positive, should be followed by more rigorous studies to establish patient benefit.

Diagnosis↗
PubMed1990

Health care technology in Australia and New Zealand: contrasts and cooperation.

Australia and New Zealand are neighbouring countries with similarities due to their settlement by Europeans, but with major differences in their economies, populations, geography and political systems. These differences have led to contrasting approaches to the introduction and control of health care technologies. New Zealand has historically had greater success in limiting the use of health technologies which have often been adopted more widely and rapidly in Australia. Recent initiatives in health technology assessment have involved participation by both countries, giving the potential for a joint approach to policy formulation on use of some medical devices and procedures.

Australia↗
PubMed1992

Do the benefits outweigh the costs of PACS? The results of an International Workshop on Technology Assessment of PACS.

On May 26-27, 1991, an International Workshop on the Technology Assessment of PACS was held at Enkhuizen, The Netherlands. During this workshop 35 experts in the field, from 13 different countries, discussed amongst others the required functionality of PACS, diagnostic aspects and the quality of care and organizational aspects. The key question was whether, when and how PACS is feasible, both from a financial and a clinical point of view. Data which were collected with the aid of the software tool CAPACITY formed the starting point of this meeting. This paper gives an outline of the discussions during this workshop. The main conclusion is that more clinical research is needed, to get a better insight into the costs and the clinical benefits of PACS. Because of the high costs of the PACS technology, international cooperation in this field is requested. It is recommended that the CAPACITY project, which is set up to stimulate the international dialogue and data exchange on PACS, is continued.

Cost-Benefit Analysis↗
PubMed2004

Three new tools for parathyroid surgery: expensive and unnecessary?

BACKGROUND: The intraoperative quick parathyroid hormone assay, the intraoperative gamma probe, and endoscopic parathyroidectomy are three very new techniques developed to facilitate parathyroid surgery. Some hospitals do not have the necessary equipment, and many, like ours, continue to operate in the time-honored way. STUDY DESIGN: We performed a retrospective chart review of 34 such operations, done with the use of Sestamibi scans, but entirely without the newer modalities. RESULTS: Four-gland exploration was carried out on all patients. Operative times ranged from 15 to 165 minutes, with a mean of 47 minutes, and incision lengths ranged from 2 to 3 cm, with a mean of 2.8 cm. There was no mortality, no reoperation, and no vocal cord or recurrent laryngeal nerve injury. Our cure rate was 100%, as determined by a fall in postoperative calcium and parathormone levels. CONCLUSIONS: In our view, the intraoperative parathyroid hormone assay, gamma probe, and endoscopic parathyroidectomy add an entirely unnecessary cost to an operation that can be completed satisfactorily with a preoperative Sestamibi scan and a thorough four-gland exploration.

Adult↗
PubMed2003

Grounding a new information technology implementation framework in behavioral science: a systematic analysis of the literature on IT use.

Many interventions to improve the success of information technology (IT) implementations are grounded in behavioral science, using theories, and models to identify conditions and determinants of successful use. However, each model in the IT literature has evolved to address specific theoretical problems of particular disciplinary concerns, and each model has been tested and has evolved using, in most cases, a more or less restricted set of IT implementation procedures. Functionally, this limits the perspective for taking into account the multiple factors at the individual, group, and organizational levels that influence use behavior. While a rich body of literature has emerged, employing prominent models such as the Technology Adoption Model, Social-Cognitive Theory, and Diffusion of Innovation Theory, the complexity of defining a suitable multi-level intervention has largely been overlooked. A gap exists between the implementation of IT and the integration of theories and models that can be utilized to develop multi-level approaches to identify factors that impede usage behavior. We present a novel framework that is intended to guide synthesis of more than one theoretical perspective for the purpose of planning multi-level interventions to enhance IT use. This integrative framework is adapted from PRECEDE/PROCEDE, a conceptual framework used by health planners in hundreds of published studies to direct interventions that account for the multiple determinants of behavior. Since we claim that the literature on IT use behavior does not now include a multi-level approach, we undertook a systematic literature analysis to confirm this assertion. Our framework facilitated organizing this literature synthesis and our analysis was aimed at determining if the IT implementation approaches in the published literature were characterized by an approach that considered at least two levels of IT usage determinants. We found that while 61% of studies mentioned or referred to theory, none considered two or more levels. In other words, although the researchers employ behavioral theory, they omit two fundamental propositions: (1) IT usage is influenced by multiple factors and (2) interventions must be multi-dimensional. Our literature synthesis may provide additional insight into the reason for high failure rates associated with underutilized systems, and underscores the need to move beyond the current dominant approach that employs a single model to guide IT implementation plans that aim to address factors associated with IT acceptance and subsequent positive use behavior.

Attitude to Computers↗
PubMed2004

The myth of the biotech revolution.

The existence of a medicinal 'biotech revolution' has been widely accepted and promoted by academics, consultants, industry and government. This has generated expectations about significant improvements in the drug discovery process, healthcare and economic development that influence a considerable amount of policy-making. Here we present empirical evidence, from a variety of indicators, that shows that a range of outputs have failed to keep pace with increased research and development spending. Rather than producing revolutionary changes, medicinal biotechnology is following a well-established pattern of slow and incremental technology diffusion. Consequently, many expectations are wildly optimistic and over-estimate the speed and extent of the impact of biotechnology, suggesting that the assumptions underpinning much contemporary policymaking need to be rethought.

Attitude to Health↗