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Information technology in the future of health care.

Technology advances have changed the face of health care. This paradigm shift blurred the boundaries between public health, acute care, and prevention. Technology's role in the diagnosis, treatment assignment, follow-ups, and prevention will be reviewed and future impact projected. The understanding of shift in our expectation for each aspect of health care is critical so that levels of success are understood. Technology advances in health care delivery will be discussed. Specific applications are presented and explained and future trends discussed. Four applications are defined, and related to categories of technologies and their attributes.

Artificial Intelligence↗

An inquiry concerning future health care technology: methods and general results.

New and future health care technology has important implications for the delivery and organization of health care. Furthermore, advances in health care technology are increasingly associated with social, ethical, and economic issues. Effective health planning needs to anticipate future health care technology and take into account such implications. This paper concerns an analysis of future health care technology undertaken in the Netherlands. The study involved: (a) the early identification of future developments in health care technology; and (b) prospective assessments of a number of high-priority technologies. The paper concludes that technology forecasting in health care should become an integral part of overall technology assessment activities in industrialized countries.

Forecasting↗

Enhancing literacy development through AAC technologies.

There is a critical need to understand teaching and technology supports that enable students who use augmentative and alternative communication (AAC) systems to engage in meaningful literacy experiences and foster conventional literacy skills. To thrive in classroom environments, they must have access to tools that can support them in active and independent literacy learning. These students need technology that allows them to move seamlessly between reading, writing, and communicating. They require technology that takes into account access needs, individual learning needs, the learning demands of technology, and literacy development across grades. Families and school teams need information that will assist them in providing the best tools and the most appropriate content within these tools throughout the school day. Teachers need information that supports them in providing exemplary literacy instruction to students who use AAC systems. This article explores and summarizes factors impacting literacy learning, including literacy capabilities of school-age students who use AAC, communication in literacy learning and use, reading and writing instruction in general education classrooms, and technology to support literacy learning. It is important that future technology tools provide a platform for levels of literacy learning: The power of technology will be reflected in its ability to provide access to and display the right content at the right time for students who use AAC. This article summarizes current factors thought to influence literacy learning and discusses priorities for future research and technology development.

Communication Devices for People with Disabilities↗

[Rational of oncological surgery in multimodality treatment of cancers].

The infiltrative cancers permanently swarm circulating cancer cells, and in 2006 it is no more possible to consider that localized cancer exists. So, we must question our self about the place of a treatment like surgery, which is localized in the time and in the space. Moreover, it is now proved that surgery increases the number of circulating cancers cells, gives a transient immunodepression which promotes cancer implantations, and that the cicatrisation stimulates growth factors, which act also on tumor growth. In spite of these deleterious effects, the oncological surgery stays an important tool by achieving an optimal cytoreductive surgery which facilitates the effect of the adjuvant treatments, by eliminating the vascular sanctuaries present in the center of any big tumor, and because it is a striking-force very localized in the space and in the time. The role of the oncological surgery must be integrated in the new aspect of the biology of the tumors and must take in account the recent improvements concerning functional imaging, genomic and proteomic. It is currently only one of the different compounds of the multimodality treatments for cancers, and its modalities, as its timing must be reconsidered. At last, considering the future technologies, we must elaborate the future modalities of the oncological surgery.

Chemotherapy, Adjuvant↗

Clinical applications of two-dimensional/Doppler echocardiography.

The number of clinical applications for which Doppler echocardiography can, or could, be used is substantial. We must acknowledge that in our institution, the use of pulsed Doppler echocardiography is relatively routine, and we are enthusiastic about its contributions to diagnostic echocardiography. Having used Doppler echocardiography in our laboratory for a number of years, we are impressed that the study of intracardiac flow disturbances helps us understand clinical cardiac disorders more fully, and we believe the technique will become more widespread over the next few years. At present, we believe pulsed Doppler to be a useful and often necessary part of the echocardiographic evaluation of patients with valvular and congenital heart disease. Moreover, the prospects for using Doppler echocardiography to quantitate volume flow and ventricular function appear intriguing and promising. Other potential applications which we discussed, though only speculative at present, may well be realized as future technologic improvements occur. Thus, the future of pulsed Doppler echocardiography appears exciting.

Coronary Circulation↗

Computerized medical records: the need for a standard.

Major concepts introduced in this paper are as follows. 1) Organization, with its attendant qualities of accuracy, consistency, legibility, completeness, and simplicity, is the heart of the medical record. Technology should not be allowed to obscure this goal. 2) The main function of the computerized medical record is data storage with the qualities of organization noted above. This function must be clearly separated from condensation, analysis, or other secondary manipulation of data. 3) Many aspects of data manipulation call for the judgment of a physician. This judgement may be aided by computer software, but not replaced by it. 4) Present technological barriers, most notably speed, permanent large storage, and voice input should not influence the design of the effective computerized record. Future technology will be able to service the carefully designed medical record. 5) Textual parts of the computerized medical record can follow a simple and machine independent outline format. All parts of the record should use a textual introduction emphasizing patient and record identification. 6) A patient profile is central to each patient file. Updating this profile as needed must be recognized as a primary function of the physician at every patient encounter. 7) Acceptance of a standard for the computerized medical record now, before technology has matured and software diversified, will avoid a pitfall commonly experienced in other fields and save substantial healthcare funds. This standard should be geared to the needs of physicians and patients, not to the constraints of technology. The future of medical computing is bright. Obstacles to the practical use of the computerized medical record exist, but we may expect these to vanish within a few years. The great challenge to physicians now is to take this opportunity to control a new technology, rather than to be driven by it. The soul of good medicine is not in the equipment available, but in the rational and carefully thoughtout use of those tools at hand. We must recognize now the need for a uniform style of computerized medical record before the technological establishment besieges us with a flood of specialized, non-interchangeable, and expensive machines. Indeed, a bit of careful thought now as the foundation is laid can prevent the tangled confusion so typical of new technology. We have a golden opportunity to avoid a new round of escalating medical costs.

Data Display↗

Instrumentation for urologic laser surgery.

Carbon dioxide, neodymium:yttrium-aluminum-garnet, ruby, and argon lasers are the only commercially available lasers with wavelengths suitable for laser surgery. Consequently, researchers have attempted to make the tool fit the clinical need. A pediatric #6 bronchoscope was fitted to a carbon dioxide laser endoscopic coupler to form a modified cystoscopic laser delivery system. This instrument was able to vaporize small condylomata of the distal male urethra. However, the restricted visibility of this crude adaptation represents an inferior solution compared with the endless possibilities of sophisticated fiberoptic technology. Future prospects in infrared optical fiber technology portend a breakthrough for transurethral carbon dioxide laser surgery. Adapting the Nd:YAG laser for urologic surgery is attractive because it can be easily incorporated into conventional cystoscopes. The argon laser's capacity to absorb blood and traverse water suggests future importance for transurethral surgery. Investigation is needed to develop a surgical laser adaptable to both open and transurethral urologic surgery.

Argon↗

Recent advances in biomarkers for cancer diagnosis and treatment.

With the availability of new technologies and the increased interest of medical practitioners to use molecular biomarkers in early detection and diagnosis, and in the prediction of therapeutic treatment efficacy and clinical outcomes, the academic and research institutions, as well as the pharmaceutical industry, have increased their efforts to develop novel molecular biomarkers for several human diseases, including cancer. The identification of molecular biomarkers also enables the development of a new generation of diagnostic products and to integrate diagnostics and therapeutics. This integrated approach will aid in 'individualizing' the medical practice. Here, we address issues related to the development of biomarkers, novel technological platforms used for drug development, future technologies and strategies for validating biomarkers for their clinical utility.

Biomarkers, Tumor↗