Update on methods & simulators for evaluation of noninvasive blood pressure monitors

The development of methods and simulators for evaluating noninvasive blood pressure (NIBP) monitors has been dynamic during the past few years. As a complement to a previous review paper in this journal, several additional developments are reported in this paper. These include evaluation methods developed in Australia, the United States and Europe, as well as NIBP simulators developed in Germany and the United States.

The Joint Commission's Agenda for Change: what does it mean for equipment managers?

As the Agenda for Change unfolds, several major changes will take place. Organizations seeking accreditation will face potentially greater pressure to improve as accreditation and performance data become more available to the public and payers. Future accreditation decisions will be based more on observed, demonstrated, and measured performance than on statements of policy and practice. Key to this in the survey process are the new unit-based survey and the use of indicators. Finally, accreditation evaluation activities provided by the Joint Commission will become a more persistent part of the life of accredited organizations. New activities will include an annual contact to update demographic information, the random, unannounced survey process, and frequent data and information exchanges based on the indicator database. The goal of these changes is to get closer to the real work of patient care through measurement and assessment of organizational competence, performance, and ability to change. The challenge facing clinical engineers as equipment or technology managers is to extend their vision of the equipment management process beyond the engineering needs of medical equipment. The key focus of the new Joint Commission standards and accreditation process is the acquisition and use of information. Equipment, as it becomes more complex, requires more user knowledge to be applied effectively. As part of the information highway, the clinical engineer of tomorrow must focus on the information content of the equipment being introduced and determine the most effective method of transferring the information into user "brainwave."

The dynamics of technological change in medicine

This paper contrasts a dynamic and interactive view of technological change with the linear model of medical innovation that is still so deeply ingrained in many policy discussions. In particular, it focuses on the role of feedback mechanisms between the users and the developers of medical technology and the demand and supply forces (including competition among medical specialties) determining this feedback. It explores three distinct mechanisms by which technological change may contribute to rising health care spending: intensity of use of existing technology, introduction of new technologies, and expanded application of these new technologies.

Concepts in headwall selection and design

The headwall is the interface between the patient and critical care technology. This article lists headwall components, outlines various types of headwall systems, and discusses factors in selecting the type of headwall to support the desired model of care.

Polypropylene serving the medical sector

Polypropylene has a range of properties that make it suitable for use in the manufacture of health care products. These properties can be varied to suit different applications and this has led to its increasing market share in the health care sector. This article discusses recent developments in polypropylene technology and some new applications, highlighting the benefits of polypropylene over the more traditional materials.

Technology dependency and iatrogenic injuries

Research on iatrogenic injuries and technology dependency is sparse in light of the expansive use of technology in health care today. Many of the publications are single case reports of an iatrogenic injury related to a specific type of device. Little has been done to analyze these reports in a collective fashion. Nursing research is especially limited, and most studies were located in the medical literature. The majority of research has been done in pediatric populations with major emphasis on respiratory and nutritional technology. In contrast, little research has been done with adults who are ventilator dependent. Perhaps the paucity of research in this area is related to the Food and Drug Administration (FDA) requirements for technology safety before placement of a device on the health care market with the subsequent assumption by health care personnel that the technology is safe and effective. The challenge for the future is to build programs of nursing research that (1) describe the incidence and nature of iatrogenic injuries associated with technologies that are of high volume and for which many patients are dependent and (2) to tests ways to prevent iatrogenic injuries associated with technologies often used in nursing practice.

Job roles of assistive technology service providers in the United States

The purpose of this study was to identify empirically the roles of assistive technology service providers in the United States. Via factor analysis, the following six job roles were identified: (a) Device Selection and Maintenance Activities, (b) Environmental Modification Activities, (c) Dissemination of Information on Assistive Technology Activities, (d) Evaluation of Suitability of Assistive Device Activities, (e) Administration Activities, and (f) Product Development Activities. The identified roles can provide a potential guide for the development of education or training curricula for assistive technology service providers. Those job role categories can be considered to be required areas of knowledge in a curriculum for assistive technology specialists. The identified roles can also be utilized to help define the profession of assistive technology. That definition could help guide the development of eligibility criterion and examination content for a credentialing programme for qualified assistive technology service providers in the future. A clear description of the job of assistive technology service providers can help administrators create needed positions within service delivery organizations such as state department of rehabilitation services and a rehabilitation hospital. The results could be valuable to the administrators responsible for setting job role criteria for assistive technology service providers. Such criteria are necessary for making effective hiring and employee evaluation decisions. In addition, the results can provide other professionals who utilize assistive technology services with an accurate picture of the services available from assistive technology service providers. When professionals on a rehabilitation team know what to expect of each other, clients are better served. Thus a better understanding of the roles of assistive technology service providers can contribute to better utilization of their services by a multidisciplinary team. This would in turn increase the chances of assistive technology services being offered to clients. Replication of the present study is encouraged to verify the obtained results. A future study should also focus on examining the roles of assistive technology service providers by directly observing their daily work activities. The task inventory used in the present study (ATTI) might be utilized to help guide such observations.

The influence of high technology care on patients, their relatives and nurses

This article focuses on the potentially dichotomous relationship of caring for critically ill patients in a high technology environment. Does technology enhance or hinder the quality of patient care delivered by nurses in such an environment? The discussion within this article is initially at a societal level before focusing at an interpersonal level within a specific care setting. The author argues for finding a balance between high technology and humanity within the intensive care environment by highlighting the psychological impact that this may have on patients, relatives and nurses. Guidance as to how a balance may be achieved is also provided. Technology is an explicit theme within the text, whilst the concept of power that technology holds is discussed in an implicit manner.

Clean room technologies of the 1990s

The design and operation of clean rooms is a subject of interest to many professionals, and if all the sectors that use clean rooms are considered, it is a very complex technology. Great benefits can be gained if the different sectors of industry study the developments going on in other areas. In this article, the author presents a review of the developments that have taken place in the past forty years. Information on general standards, guidelines, and specific standards for the medical device and pharmaceutical industries is provided, together with an update on work that is currently being undertaken on new standards.