Physical performance of diagnostic imaging modalities.
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The use of instruments to measure health-related quality of life has become commonplace in medical research, although their use is still unusual in the evaluation of diagnostic technologies. Dr Greenfield has pointed out the potential to abuse as well as use these methods. The cautions that Dr Greenfield has outlined apply to any such research, whether one is evaluating a new drug or a new imaging device. Even though the chain of events from diagnostic technology to patient outcome is longer than for therapeutic interventions, we maintain that quality-of-life instruments are potentially valuable tools for evaluating any of the links in this chain.
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Culture sets our values and norms. It is a way of thinking that determines our behaviours, decisions, actions and knowledge. Technology transfer and integration are basically the exchange of the knowledge, know-how and skills through which technology was created and on which its use depends. Culture is deeply rooted in ourselves. We are usually unaware of its influence on our professional activity. Cultures are diverse, and their encounter through technology exchange triggers conflicts that are expressed in objective terms. We need to detect and resolve those conflicts at the right level, i.e. at the cultural level instead of only focusing on the visible 'obstacles' to the deployment of telematics applications. This paper summarises the basic concepts on which we ground a practical approach to detecting and resolving culture-based conflicts in technology transfer and integration. It investigates the relation between cultural preferences and actions. Culture is translated and reduced to a seven dimensions framework. Cultural preferences influence the decision-making process that leads to tangible actions. The structure and dynamics of that process are described as a Change Governance Framework. It considers the control aspects of decision making that are sensitive to cultural preferences, i.e. the way decisions are taken, why, by whom.
The author examines the Australian health care system by surveying the financing techniques, physical organization, and government activity. He explains the impact of the public and private sectors and comments on the effectiveness of current evaluation procedures. While the author believes that the system is relatively healthy and cost effective, he recognizes a need for more comprehensive and scientific oversight. Using regression analysis and focusing on the installation of medical technology in hospitals, the author attempts to determine the specific factors that influence technology diffusion. He concludes by stressing that further studies analyzing the actual use of specific technologies are vital.
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The contrasting cycles of changing caries prevalence in developing and industrialized countries are described, as they relate to differing needs in technology. Using this contrast as a background, the selective needs for technology in measurement, adequate quality of treatment and materials, appropriate personnel, and simplicity and mobility in equipment are discussed.
This article reviews the development, composition, chemistry, recent technological advances, and extent of use of composite resin restorative materials, adhesives, and pit and fissure sealants. The problems related to the clinical behavior of these materials in the oral environment are dealt with, and methods of minimizing their present deficiencies are suggested. Future directions that might be taken to improve these materials and solve some of the inadequacies that these materials exhibit are also discussed.
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This article provides a comprehensive analysis of the social, cultural and economic factors which have led to the present pattern of technology utilization in Japan. It is divided into five sections. The first provides the historical framework; the second, an overview of the health care delivery context and its economic incentive structure; the third, an analysis of the various contenders involved in the process of resource allocation; the fourth, a description of the technology areas which have been emphasized in Japan; and the fifth, an examination of future issues.
This study describes decision making regarding the acquisition of technology in 12 major medical centers. The financial impact of a project was the most widely cited criterion of decision, but financial considerations were less important than either the impact of a technology on the quality of clinical care or its contribution to teaching and research. Rarely were criteria set out explicitly or in advance. Although exemplary models exist, the technology assessment process at most institutions is described as "political," "informal," or "ad hoc."
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