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PubMed2002

The future of information technology for health in developing countries.

What is the future of communication technology for health in developing countries? This chapter sets out to answer this question by first considering the background and potential of information technology, identifying some of the issues and trends in communication, and finally following with some challenges and opportunities of how communication technologies can make a difference in health in developing countries. Past research has shown that communication can contribute to all aspects of population, health, and nutrition programs and is relevant in a number of contexts. Some of the trends in using information technology can be classified in the following categories: competition, cognitive-based presentations, comprehensive translation, convergence, and culture. Challenges include finding a way to include the South in the exchange of ideas and information. In addition, reaching a consensus on worldwide quality standards will not be easy. Yet, beyond these challenges, there are many opportunities being created for international development agencies to increase their capacity for impact.

Biomedical Technology↗
PubMed2000

Blood screening by nucleic acid amplification technology: current issues, future challenges.

BACKGROUND: Nucleic acid amplification technology (NAT) is presently being evaluated in US clinical trials to determine the safety and efficacy of mini-pool testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) RNA in the blood-donor population. Although the risk for transfusion-transmitted HIV and HCV infection is extremely low, there is still a small chance that blood donated by infected individuals before seroconversion can escape detection by current antibody-based assays. METHODS: This report describes the amplification technologies being used and reviews several issues surrounding NAT-based blood screening. The performance features of NAT and current enzyme immunoassay technologies are compared, and the benefits of NAT in reducing transfusion-transmitted infections are discussed. CONCLUSIONS: The current US clinical trials of mini-pool NAT testing for HIV and HCV RNA have successfully identified preseroconversion infectious blood units. Although the current NAT-based screening systems are semiautomated, mini-pool testing represents an unprecedented innovation among government and nongovernment agencies in the highly regulated blood transfusion industry. Despite cost-effectiveness issues, based on the public perception of infectious diseases acquired through blood transfusion, NAT-based screening of the blood supply is expected to become a standard in transfusion medicine.

Automation↗
PubMed2004

Robotics technology: a journey into the future.

Some major technologic improvements are needed for robotic technology to reach its ultimate potential, which includes better visualization, tactile sensing, diagnostic sensing, and miniaturization. This article gives a vision of the future of robotic technology with respect to these improvements.

Diagnostic Techniques and Procedures↗
PubMed2006

The future of forensic and crime scene science. Part I. A UK forensic science user and provider perspective.

This paper presents an overview of the views expressed by UK forensic science users and providers during the Centre for Forensic Investigation's 1 day conference 'The Future of Forensic and Crime Scene Science' and is set in the context of the changing national agenda and likely advances in current and future technology. It begins by examining the success of the Home Office DNA Expansion Programme and future demands of the Criminal Justice System, highlighting the changing use of forensic science both at the crime scene and within the forensic process itself. In particular, the use of forensic science at the early stages of an investigation to provide intelligence and support the decision making process is discussed together with the need to adopt a partnership approach to tackling crime and its causes. Key system and technological drivers for performance improvement and change are identified and the likely timescales and implications of their introduction are discussed. Finally, the Home Office plans to build on the success of the DNA Expansion Programme, through the introduction of the proposed Home Office Forensic Integration Strategy, are explored and the paper concludes by highlighting the benefits, implications and issues arising from the changing and developing use of forensic science.

Congresses as Topic↗
PubMed1993

The quality encounter between purchasers and providers: what to ask and how to answer.

It is not easy to lay prejudices aside, to find and face the facts, and to let the chips fall where they may. There is no need to wait for improvements in technology before beginning to use outcomes monitoring to guide the business exchange between purchasers and providers. Although future technological improvements will greatly improve the capacity to use objective data to differentiate among providers and to identify strengths and weaknesses within a health care organization, reasonable methods are available today to undertake these important tasks. All that is needed is the courage and willingness to embrace them. The future belongs to purchaser and provider organizations that are willing to seek enlightenment rather than blame.

Managed Care Programs↗
PubMed2004

Cross-national comparison of technology assessment processes.

OBJECTIVES: To compare methods and results among four health technology assessment organizations in different countries. METHODS: All assessment reports published between 1999 and 2001 by VATAP (United States), NICE (United Kingdom), CCOHTA (Canada), and AETS (Spain), were reviewed. Detailed information about the organization, the technology assessed, the methods used, and the recommendations made were collected. A descriptive analysis of the variables, as well as comparisons of means and proportions, was performed. RESULTS: Sixty-one reports assessing seventy-six technologies were published: nine (11.8 percent) by VATAP, thirty-nine (51.3 percent) by NICE, twenty (26.3 percent) by CCOHTA, and eight (10.5 percent) by AETS. A total of 64.5 percent of the technologies assessed were related to a high prevalence disease in the corresponding country. Most of the assessments addressed treatments (73.7 percent) and were mostly drugs (56.6 percent) and devices (23.7 percent). Most organizations used reviews of effectiveness and economic evaluations (64.5 percent), systematic reviews (21.1 percent), and original economic evaluations (36.7 percent). In 38.1 percent, the technology was recommended; the rest of the cases had no formal recommendations. CONCLUSIONS: Critical issues for future technology assessment efforts are making assessment processes more consistent, transparent, and evidence-based; formalizing the inclusion of economic and ethical considerations; and making more explicit the prioritization process for selecting technologies for assessment and reassessment.

Canada↗
PubMed2003

The problematic role of 'irreversibility' in the definition of death.

Most definitions of death--whether cardiopulmonary, whole brain and brain stem, or just upper brain--include an irreversibility condition. Cessation of function is not enough to declare death. Irreversibility should be limited to an organism's ability to 'restart' itself after vital organs have ceased to function. However, this would mean that every hour people who cannot be revived without the intervention of medical personnel and their technology are coming back from the dead. However, the alternative of irreversibility being dependent upon technology will lead to even more counterintuitive results such as: some people are dead at a particular time and place, but others in more technologically advanced eras and locations are alive despite their being in identical physical states; in the future, millions of cryogeneically frozen human beings could spend centuries in a non-dead state because of the future technological breakthroughs; or large numbers of 'frozen' people are dead for aeons but coroners are not able to declare them so because they are unaware of what biological conditions science will never be able to reverse. So death should be defined only in non-relational biological terms, with a self-starting condition similar to that once advocated by Lawrence Becker.

Brain Death↗
PubMed1996

Design and implementation of a picture archiving and communication system: the second time.

This report describes the authors' experience in the design and implementation of two large scale picture archiving and communication systems (PACS) during the past 10 years. The first system, which is in daily clinical operation was developed at University of California, Los Angeles from 1983 to 1992. The second system, which continues evolving, has been in development at University of California, San Francisco (UCSF) since 1992. The report highlights the differences between the two systems and points out the gradual change in the PACS design concept during the past 10 years from a closed architecture to an open hospital-integrated system. Both systems focus on system reliability and data integrity, with 24-hour on-line service and no loss of images. The major difference between the two systems is that the UCSF PACS infrastructure design is a completely open architecture and the system implementation uses more advanced technologies in computer software, digital communication, system interface, and stable industry standards. Such a PACS can withstand future technology changes without rendering the system obsolete, an essential criterion in any PACS design.

Diagnostic Imaging↗
PubMed1992

High cost technology in health care: a benefit or a burden?

The influence of high cost technology goes beyond its consequences for the selected patient groups that benefit from its application. Past and future technological developments have a variety of social, economic and ethical implications which have to be taken into account when balancing its costs and benefits to society. Departing from an economic perspective we describe a number of mechanisms underlying the emergence of high cost technology which help us to understand some of the characteristics of high cost technology, such as its focus on quality enhancement rather than on economy. To assess the actual performance of high cost technology in terms of efficiency and equity is difficult as there may be debate about the perspective guiding such assessment and as there still is scarce information on high cost technology in terms of these economic indicators. The increasing technological opportunities have triggered a wider debate on the desired evolution of our health care systems. In some countries there is a tendency to diminish government involvement in health care and emphasize private (for profit) enterprise as a reaction to not being able to finance all new high cost technology. The risks of such strategies are discussed briefly. We conclude that the main actors in health care should adjust their behaviour in order to accomplish the introduction of more cost-effective technologies and to achieve a more socially efficient distribution of their benefits.

Biomedical Research↗
PubMed1991

Sequence-tagged site (STS) content mapping of human chromosomes: theoretical considerations and early experiences.

The magnitude of the effort required to complete the human genome project will require constant refinements of the tools available for the large-scale study of DNA. Such improvements must include both the development of more powerful technologies and the reformulation of the theoretical strategies that account for the changing experimental capabilities. The two technological advances described here, PCR and YAC cloning, have rapidly become incorporated into the standard armamentarium of genome analysis and represent key examples of how technological developments continue to drive experimental strategies in molecular biology. Because of its high sensitivity, specificity, and potential for automation, PCR is transforming many aspects of DNA mapping. Similarly, by providing the means to isolate and study larger pieces of DNA, YAC cloning has made practical the achievement of megabase-level continuity in physical maps. Taken together, these two technologies can be envisioned as providing a powerful strategy for constructing physical maps of whole chromosomes. Undoubtedly, future technological developments will promote even more effective mapping strategies. Nonetheless, the theoretical projections and practical experience described here suggest that constructing YAC-based STS-content maps of whole human chromosomes is now possible. Random STSs can be efficiently generated and used to screen collections of YAC clones, and contiguous YAC coverage of regions exceeding 2 Mb can be readily obtained. While the predicted laboratory effort required for mapping whole human chromosomes remains daunting, it is clearly feasible.

Chromosome Mapping↗
PubMed1996

The technological reengineering of health information management departments: myth or reality?

Data from this study indicate that health information professionals are poised to take on greater responsibility in the design, evaluation, and application of information systems within healthcare. Whether or not health information management will move into these areas and begin to control future technological reengineering, however, remains unanswered from findings in this study. Future studies on healthcare administrator attitudes toward HIM professionals, curricular emphasis on information system design and analysis, and health information professionals in nonacute care settings are necessary to understand the direction of the HIM profession and its role in information systems.

Attitude of Health Personnel↗
PubMed1983

The impact of technology on the future of health/illness education.

The impact of technological advancement and societal pressure for comprehensive, cost effective health care are two current trends which will determine the future of health/illness education. This article predicts a future of health/illness education based on these trends. The issues of depersonalization, cost, privacy, and control involved in the use of computers in health care are identified and discussed.

Attitude of Health Personnel↗
PubMed1986

The artificial heart. Costs, risks, and benefits--an update.

As discussed above, approximately 32,500 persons aged 55 to 70 years with end-stage heart disease may be potential candidates for the artificial heart each year. However, continued application of a protocol that requires informed consent by the patient effectively limits the pool to 12,000 annually. Estimates of the cost of the artificial heart include charges for the surgical procedure, device and console, and continuing medical surveillance. These estimates range from a low of $100,000 to a high of $300,000 per patient in the initial year. Assuming a five-year, 51% survival and an initial cost of $100,000, total program costs in the fifth year are projected to be $1.3 billion for a pool of 12,000 patients, and $3.8 billion for 32,500 patients. These projected costs are associated with anticipated increases in life expectancy. For those individuals destined to develop heart disease, the anticipated average increase is approximately half a year. In comparison, heart transplant patients who meet the surgical criteria but who do not receive a new heart do not survival beyond six months. In an era of limited resources, it is imperative that such a potentially expensive innovation as the artificial heart be compared carefully with other social and medical programs designed to extend life and improve its quality. Such a comparison will require a full understanding of the likely costs and benefits of the device. A viable artificial heart would greatly alter current treatment for end-stage cardiac disease. More patients would benefit from this therapy than currently benefit from heart transplants, and the costs of caring for these patients would increase substantially. The current state of development of the artificial heart provides an opportunity to collect data on investigational artificial heart performance, clinical results, patient status, and economic and social costs. This knowledge base would be invaluable for future technology assessments and policy decisions regarding third party reimbursement. Insofar as we may be faced with a multi-billion dollar annual investment in the future, detailed assessments of the artificial heart should be performed.

Cost-Benefit Analysis↗
PubMed2005

Bioengineering solutions for hearing loss and related disorders.

Advances in digital signal processing, microelectronics, and power technology have produced devices that have contributed significantly to the quality of life and communication abilities of individuals with hearing impairment and tinnitus. Future technological developments will expand the benefits of current devices and offer new treatments for otologic disorders.

Adult↗
PubMed2001

Microencapsulation: its application in nutrition.

The development of new functional foods requires technologies for incorporating health-promoting ingredients into food without reducing their bioavailability or functionality. In many cases, microencapsulation can provide the necessary protection for these compounds, but in all cases bioavailability should be carefully studied. The present paper gives an overview of the application of various microencapsulation technologies to nutritionally-important compounds, i.e. vitamins, n-3 polyunsaturated fatty acids, Ca, Fe and antioxidants. It also gives a view on future technologies and trends in microencapsulation technology for nutritional applications.

Antioxidants↗
PubMed2003

Intraoperative spinal navigation.

STUDY DESIGN: Review article. OBJECTIVES: To provide a detailed overview of current methods for intraoperative spinal navigation using image-guided surgical technology. SUMMARY OF BACKGROUND DATA: The development of novel intraoperative navigational techniques has been an important advancement in the field of spine surgery. These techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous, multiplanar views of spinal anatomy. They can be used for detailed preoperative planning and allow the spinal surgeon to track the position of surgical instruments in real time. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. METHODS: The relevant medical literature was reviewed, as was the authors' clinical and laboratory experience with intraoperative spinal navigation. RESULTS: Image-guided spinal instrumentation procedures in the cervical, thoracic, and lumbar spine have lower rates of screw misplacement than do those performed without image guidance. In a typical IGS spinal procedure, surgical instruments are tracked in the operating room, and their positions are superimposed onto preoperatively acquired computed tomography scans (CT-based image guidance) or intraoperatively acquired fluoroscopic images (virtual fluoroscopy). A new development, the combination of isocentric C-arm fluoroscopy with computer-assisted image guidance, allows the C-arm to create intraoperative CT images that can be used for image-guided navigation without the need for a surgeon-dependent registration step. Each of these technologies has distinct advantages and limitations. CONCLUSIONS: Intraoperative spinal navigation has advanced rapidly in recent years, beneficially affecting a variety of surgical procedures. Future technological developments will widen its clinical application and minimize its shortcomings.

Adult↗
PubMed2001

Promoting patient safety: is technology the solution?

BACKGROUND: On April 30, 2001, the Cleveland Clinic Foundation and Cleveland Clinic Health System Quality Institute sponsored a 1-day conference focused on technology in patient safety. PATIENT SAFETY-A CALL TO ACTION: Kenneth W. Kizer focused on ten high-priority patient safety strategies identified by the National Quality Forum-including implementing recognized "safe practices", recognizing and dealing with professional misconduct, and supporting efforts to create a nonpunitive environment for health care error reporting. CULTURAL IMPLICATIONS OF INTRODUCING NEW TECHNOLOGY: Randolph A. Miller described a computerized clinician order-entry system used to provide decision support, reduce excess test ordering, introduce cost savings, and meet regulations for inpatient radiology and cardiology tests. USING BAR CODES TO ELIMINATE MEDICATION ERRORS: Jeff Ramirez reported on the Veterans Health Administration's use of bar coding technology for point-of-care validation of medication administration, which has resulted in improvements in response time; the efficiency of the dispensing, delivery, and administration process; and patient care. HOW TO MAKE COMPUTERS TEAM PLAYERS: The knowledge base exists to design computers as team players that expand human expertise and help health care practitioners better create safety. Yet David D. Woods challenged the audience to anticipate the changing shape of iatrogenic risk as a result of increasing dependence on automation in health care. TECHNOLOGY AND MEDICATION SYSTEMS: Mark Neuenschwander spoke about automating various steps within the medication use system, through computerized prescriber order entry and bedside scanning. FUTURE TECHNOLOGICAL POSSIBILITIES: Charles Denham suggested how technology may aid health care professionals in their care of patients, such as in using predictive modeling to identify the risks of therapeutic intervention.

Equipment Safety↗