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PubMed2006

Making sense of medical technology.

In seeking to explain contradictory reports that increased medical spending is both valuable and wasteful, Jonathan Skinner and colleagues rightly emphasize differences in regional practice patterns in response to constraints. However, it is more accurate to view the situation not as a choice between valuable but inexpensive care and more costly care with worse outcomes-as Skinner and colleagues theorize-but as a choice between responses to regional inefficiencies. Given that we do not know what will best improve the efficiency of medical care in a given area, experiments with financial incentives to both providers and individual patients should receive high priority.

Biomedical Technology↗
PubMed2007

Diffuse optical imaging and spectroscopy for cancer.

Visible light and near infrared light interact with biological tissue by absorption and scattering. Diffuse optical imaging and spectroscopy reconstructs tissue physiologic parameters based on noninvasive measurement of tissue optical properties. This technology can be used to differentiate physiologic and molecular signatures of both malignant and benign tissues, as they relate to the area of cancer research. Major advantages are the use of non-ionizing radiation, real-time continuous data acquisition, low cost, and portability. Limitations include low spatial resolution and limited reproducibility. This paper reviews the currently available state-of-the-art technologies for diffuse optical imaging and spectroscopy and their applications in cancer research.

Biomedical Technology↗
PubMed2001

A new system for understanding modes of mechanical ventilation.

Numerous ventilation modes and ventilation options have become available as new mechanical ventilators have reached the market. Ventilator manufacturers have no standardized terminology for ventilator modes and ventilation options, and ventilator operator's manuals do not help the clinician compare the modes of ventilators from different manufacturers. This article proposes a standardized system for classifying ventilation modes, based on general engineering principles and a small set of explicit definitions. Though there may be resistance by ventilator manufacturers to a standardized system of ventilation terminology, clinicians and health care equipment purchasers should adopt such a system in the interest of clear communication--the lack of which prevents clinicians from fully understanding the therapies they administer and could compromise the quality of patient care.

Biomedical Engineering↗
PubMed2002

Mental tools for thinking about DNA technologies in new ways.

OBJECTIVE: To investigate the nature of creative thinking in biomedical science with specific applications to molecular pathologies and DNA technologies. DATA SOURCES: Accounts of breakthroughs and inventions contained in autobiographies, biographies, interviews, and archival sources. STUDY SELECTION: Discoveries that have altered, or may yet alter, basic textbook accounts of biomedical sciences for which appropriate data sources exist. DATA EXTRACTION: Approximately 1000 data sources were analyzed, both within appropriate sciences and in other creative fields, such as the arts. DATA SYNTHESIS: The current analysis is based on a framework described in our previous book, Sparks of Genius, which outlines a general approach to understanding creative thinking. CONCLUSIONS: Creative thinking in all disciplines depends on a common mental "toolkit" that consists of 13 fundamental tools: observing, imaging, abstracting, pattern recognition, pattern forming, analogizing, body thinking, empathizing, dimensional thinking, modeling, playing, transforming, and synthesizing. Scientists recognize and solve problems by observing data that break the patterns established by theories; exploring a system by creating an abstract model with which they can play; and transforming data into feelings, sounds, and other forms that create surprising analogies to already-understood principles. The result of such personal thinking is knowledge combined with sensation and emotion--feeling and understanding synthesized into complete awareness. We illustrate some of these modes of thinking with reference to recent breakthroughs in DNA-related areas and suggest ways in which the use of "tools for thinking" can increase the probability of making further discoveries in the biomedical sciences.

Biotechnology↗
PubMed1993

Assessment of medical technology: the role of engineers.

Assessment of medical technologies is a multidisciplinary activity requiring the participation of engineers, clinicians and social scientists. The contribution of engineers has often been confined to the early stages of technical assessment. However, engineers have important inputs to make throughout the assessment process in their roles of developers, users and managers of technology. Engineers have found collaboration with clinical researchers possible through hospital-based work, but must also develop links with economists and other social scientists if they are to make a full contribution to comprehensive technology assessment.

Biomedical Engineering↗
PubMed2005

A critical review of economic valuation studies of externalities from incineration and landfilling.

The primary objective of this study was to assist waste management researchers, decision-makers and waste managers at national, regional and local levels, in their decision-making processes, with most recent valuations on the environmental and social costs of externalities associated with various pollutants and disamenities related to landfilling and incineration of municipal solid waste. The aim was achieved by mapping, gathering, analysing, comparing and synthesizing various valuation estimates, based on a thorough review of existing literature. This study provides the first comprehensive review and analysis focused on primary and secondary valuation studies, conducted since 1990. The second objective was to assess the appropriateness and reliability of the valuation methods and techniques that were performed in the reviewed studies. The results of the review are summarized in tables, organized by topics and units of measure and in addition a classified list that describes the profile of the reviewed studies is provided. The results are then analysed and compared, and recommended ranges of the values are presented. The study reveals inconsistency in part of the estimates across the reviewed studies and provides reasonable explanations for the variations. Given the nature of uncertainty, and the difficulties associated with transferring values among different places and cases, these values should be considered mostly as an indication for the order of magnitude of the externalities. Nevertheless, these essential estimates of the external costs can beneficially be used with proper adjustment for each individual case to address important policy questions regarding landfilling and incineration of waste.

Animals↗
PubMedDate not supplied

Technology's implications for health care quality. A clinical engineering perspective.

Bill Gates states in Business @ The Speed of Thought that "the 2000s will be about velocity." This "decade of velocity" is driven by the flow of digital information. Health care organizations should develop a "digital nervous system" that is distinguished from a network of computers by the accuracy, immediacy, and richness of the information it brings to health care workers and by the insight and collaboration made possible by this information. This article provides a clinical engineering perspective on technology in health care in an era of rapid change. It discusses how clinical engineers work with health care professionals to manage and adapt to technological, economic, social, and regulatory forces that are redefining our approach to health care delivery.

Biomedical Engineering↗
PubMed1983

[Analysis of the criteria of choice of hospital materials and technologies].

Decision-making in hospital, when a biomedical instrumentation investment has to be decided, is not simple because of the large amount of criteria which should be considered. To show the most important criteria in decision-making, their respective weight and their interdependencies, we used multi-dimensional analysis methods. A quasi-exhaustive list of criteria has been constructed and sent to all the heads of medical departments, the directors and the clinical engineers of the French university hospitals, in order to obtain their appreciation of the influence of these criteria in their own decision-making experience. The application of factorial analysis methods to the answers gives two main results. There is no characteristic behaviour of professional groups, such as engineers, directors, surgeons, radiologist, etc.... A list of 21 criteria, which are the most influential in decision-making, can be identified. This result will be emphasized in order to develop a tool which allows one to measure the adequacy of a biomedical instrument that shows a clinical need.

Decision Making↗
PubMed1996

A multiparameter, PC-based telemetry unit for biomedical signals.

A low-cost, general-purpose telemetry system was developed for use in rural health centres, hospitals, ambulances and clinics. It was designed to transmit a range of analogue biomedical signals using various communications media. The system was tested using different telephone systems, including mobile telephony. The results showed a maximum sample rate of 1.6 kHz using the public telephone network. With three data channels the system produced sample rates of 500 Hz at 8 bit/sample. Typical overall delay times were below 100 ms. Mobile tests showed that the GSM telephone was superior to the Nordic mobile telephone (NMT 900). In field tests, sample rates of 990 Hz were obtained using GSM telephony. Bit error rates were less than 10(-7) for all applications and high-fidelity regeneration was obtained at the receiver. The tests showed that the system was well suited for telemetry of analogue biomedical signals in a broad range of telemedicine applications.

Ambulances↗
PubMed1991

What administrators need to know about clinical engineers. Understanding the equipment manager's responsibilities and concerns.

Despite the proliferance of computer systems in hospitals, many administrators--both new and experienced--have only a passing knowledge of technology management and managers. To make both the administrators' and the clinical engineers' jobs less difficult and more effective, the authors offer a profile of the "typical" clinical engineer. In the process, they underscore how health-care-administration programs need to increase students' exposure to and training in technology management.

Biomedical Engineering↗
PubMed2006

Cell-free artificial liver support: design of appropriate clinical studies.

The clinical use of cell-free liver support devices is dependent upon proof of safety and efficacy in clinical trials. The current published data to support their use is limited in both quantity and quality. In most studies, the methodology is such that the effects of these devices are difficult to establish with certainty. Bias might be introduced by the use of uncontrolled studies, and in randomized controlled trials limited size, poorly matched control groups or medical therapy or the use of clinically inappropriate endpoints might be important. Guidelines are now available to provide a framework for the design and execution of such trials, specifically to minimize the systematic errors that are frequently present and that might result in biased estimates of treatment effects. In the present review, the limitations of current studies are discussed and suggestions made as to the design and conduct of future clinical trials.

Biomedical Research↗
PubMed2000

Social and professional influences of the technology of electronic fetal monitoring on obstetrical nursing.

Electronic fetal monitoring (EFM) is one example of a biomedical technology that rapidly diffused from an experimental innovation into a standard medical practice. First developed in the 1950s, EFM became commercially available in the early 1970s and quickly transformed intrapartum obstetrical practice. Assessments and interventions, which practitioners had previously based primarily on laboring women's subjective reports of bodily sensations, were now being based on quantifiable objective data from uterine activity and fetal heart rate transducers. Despite concerns of over-medicalization of the natural event of birth, iatrogenesis related to the increased incidence of operative deliveries, and escalating costs, EFM became widely accepted as routine and necessary by both practitioners and patients. By presenting the confident expectations and cautious reservations of various practitioners and patients to EFM, this article explores the rapid diffusion of EFM within the social context of the 1970s. A special focus is given to the perspective of intrapartum obstetrical nurses, because they have been the primary users of this perinatal technology since its introduction.

Diffusion of Innovation↗
PubMed1988

Marketing new medical devices.

The marketing concept says that a firm should focus all of its efforts on satisfying its customers, at a profit. This is really a a new philosophy of business, replacing a production-oriented philosophy which focused on organizing a firm's resources to make products and then selling them. The marketing concept calls for reorienting the firm's ways of doing things. Instead of trying to get customers to buy what the firm has produced, a marketing-oriented firm would try to sell what the customers want. The underlying principle of the marketing concept is that a firm should seek to meet the needs of customers, at a profit, rather than place its main emphasis on its own internal activities and utilization of its resources. These latter factors are also important, of course, but those who believe in the marketing concept feel that customers' needs should be the firm's primary focus and that resources should be organized to satisfy those needs. Give the customer what he needs--this may seem so obvious and logical that it is difficult to understand why the marketing concept is considered such a breakthrough. However, people haven't always done the logical and obvious. In a typical company, production men thought mainly about getting the product out. Accountants were only interested in balancing the books. Financial people were absorbed in the company's cash position. And salesmen were mainly concerned with getting orders. No one was particularly concerned with whether the whole system made sense. As long as the company made a profit, each department went merrily on its independent way, "doing its own thing." Unfortunately, they still do in the majority of companies today. Finding out customer's attitudes can avoid prejudices and stereotypes commonly found in the typical organization. The need for market research to avoid stereotypes can be dramatized by the following results from a large-scale survey of European adults: The average Frenchman uses almost twice as many cosmetics and beauty aids as his wife. The Germans and the French eat more spaghetti than the Italians. French and Italian housewives are not as interested in cooking as their counterparts in Luxembourg and Belgium. No firm can conduct its business successfully without trying to measure the actual size of markets, present and future. Quantitative measurements are essential for the analysis of market opportunity, the planning of marketing programs, and the control of marketing effort. The firm may make many measures of demand, varying in the level of product aggregation, the time dimension,a nd the space dimension.(ABSTRACT TRUNCATED AT 400 WORDS)

Accounting↗