An overview of assistive technology for persons with multiple sclerosis

Multiple sclerosis (MS) is a progressive neurologic disease clinically characterized by episodes of focal disorder of the cranial nerves, spinal cord, and the brain. MS affects a significant number of young adults, and they most often face a future of progressive functional losses as more of their central nervous system and cranial nerves are affected. As the disease progresses, they have new impairments with accompanying limitations in activities, restrictions to their participation in life, and compromised quality of life. Assistive technology includes any item that is used to maintain or improve functional capabilities. The rehabilitation healthcare provider has many opportunities to intervene with assistive technologies to decrease activity limitations and participation restrictions. The purpose of this article is to (1) review the impairments and associated activity limitations and participations restrictions experienced by persons with MS, (2) provide an overview of high- and low-tech assistive technologies appropriate for persons with MS, (3) discuss funding opportunities for assistive technologies, (4) review current studies of assistive technology used for persons with MS and discuss future research directions, and (5) consider assistive technology as an intervention for disability prevention.

The Ocular Hypertension Treatment Study: reproducibility of cup/disk ratio measurements over time at an optic disc reading center

PURPOSE

To determine the reproducibility over time of visual estimates of the horizontal cup/disk ratio by trained technicians from optic disk stereophotographs.

METHODS

Baseline optic disk stereophotographs are graded at entry and regraded annually in a masked fashion. The 1,636 participants in the Ocular Hypertension Treatment Study (OHTS) undergo stereoscopic optic disk photography at study entry and annually thereafter. Stereophotographs are graded independently by two technicians at the Optic Disc Reading Center. If the readers' estimates of horizontal cup/disk ratio differ by more than 0.2 disk diameters (DD), they attempt to reach a consensus; if they cannot, the horizontal cup/disk ratio is adjudicated by a glaucoma specialist.

RESULTS

The percent of regradings differing by 0.2 DD or more from the estimate of horizontal cup/disk ratio made at entry was 4%, 6%, and 7%, respectively at years 1, 2, and 3. The percent differing by more than 0.2 DD was 1% or less at all years. Intraclass correlation coefficients were 0.93, 0.92, and 0.92, respectively. Estimates of horizontal cup/disk ratio from sequential full-frame photographs and simultaneous split-frame photographs appeared comparable and equally reproducible. Gradings by technicians were comparable to gradings by glaucoma specialists.

CONCLUSIONS

High reproducibility between repeated gradings of baseline horizontal cup/disk ratio was achieved by trained technicians adhering to a rigorous protocol. Horizontal cup/disk ratio measurements in OHTS are sufficiently reproducible to provide information about the relationship of cup/disk ratio to the prognosis of individuals with ocular hypertension.

2nd Sino-European Congress of Laboratory Medicine--strategies for laboratory diagnostics in medicine

During the 2nd Sino-European Congress in Shanghai in April 2001 the aim of the presentation was an overview on strategies and systems of laboratory diagnostic work. The main focus was to define the prerequisites and the different approaches in the diagnostic work in patients' treatment. In this paper, besides the area of emergency medicine with definition of vital functions and the routine work in deciding between healthy and ill individuals and in the control of therapy, the different aspects in the field of research and teaching are specified. Some aspects of workflow definition and optimization are discussed.

The problems and strategy relevant to the quality management of clinical laboratories

AIM

This study is aimed to discuss the present situation, existing problems, and relevant measures concerning the management of clinical laboratories in China.

METHODS

This study was carried out through the analysis of the problems relevant to the quality management of the laboratory medicine, based on the advanced experiences of ISO and developed countries in the management of clinical laboratories.

RESULTS

Many problems still remain unsolved concerning the quality management of clinical laboratories.

CONCLUSION

Only legalized and standardized management guarantees the quality of clinical inspection.

Determination of tumor markers in serum. Pitfalls and good practice

The determination of tumor markers may have consequences for the patients' treatment, which requires special attention to the analysis and to the expression of the results. In addition to the factors usually dealt with in the pre-analytical phase (identification, quality and storage of the sample) and in the analytical phase (interference, endogenous antibodies, hook effect), we must consider factors such as normal values (which depend heavily on the used techniques), threshold values defining other characteristics (sensitivity, specificity, positive and negative predictive value) and kinetics. Knowledge of the limitations of the tumor marker analysis, in particular tumor markers for non-cancerous diseases leading to possible increases (false positives), is also indispensable. All of this led to the definition of guidelines for good practice, including the design of quality control, rules for requesting, validation and interpretation of results, and the setting up of a serum library.

Midwives' perceptions of the use of technology in assisting childbirth in Northern Ireland

AIM OF THE PAPER

The aim of this paper is to report a survey of midwives' views on the use of technology in assisting births.

BACKGROUND

The research was designed to provide a deeper understanding of the integration of technology into midwives' practice and to identify and examine aspects of training needs.

METHODS

Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women's choice in whether the progress of their delivery is technologically monitored.

FINDINGS

The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula.

CONCLUSIONS

If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present.

[From bioethics to the new technology ethics]

Just as what we can all "technoscience" is emerging in our everyday life, a reflection should be conducted concerning the implications of the scientific and technical progress within our society from now on globalised. We will tackle successively: 1. The ambiguities and paradoxes related to the development of new technologies: in the field of bioethics: artificial reproduction, mammal cloning, genetically modified organisms. towards the ethics of new technologies: ethics of information and communication technologies and ethics of space policy; 2. Nature, foundation and characteristics of the ethical approach; the precaution principle must be completed with two other principles: the principle of experience and the principle of vigilance; 3. The modalities of a democratic management of the ethical approach: it is a matter of defining the role of the three main actors, i.e.: experts, politicians and citizens representing public opinion. It is necessary to promote the ethical approach within a democratic context, that is to ensure a dialogue between experts, policy decision-makers and public opinion on all of the applications of science and technology. It is from such a permanent and renewed dialogue that will emerge the image we give from ourselves in the present world.

Conducting effective performance appraisals

According to experts, performance appraisals rate just below firing someone as the least favorite thing managers do. Many factors contribute to this view--one is that current systems do a poor job of evaluating performance and in fact often impede both evaluation and performance. When used as part of an ongoing supportive process of goal setting and feedback, performance appraisals can enhance performance and morale. One alternative to traditional employee evaluation methods is full-circle or 360-degree feedback. Contained in this issue are practical suggestions for preparing employees for performance appraisals which, when followed daily, encourage employees to put their best feet forward as part of their regular routine. Also included is a template specific to assessing the performance of clinical laboratory technologists . Additionally, numerous resources are provided to help you refine appraisal systems to fit your needs. Full-circle feedback is proving to be a boon to managers. It relieves them from being the exclusive "heavies" in evaluating performance, integrates appraisal input from several sources, and incorporates increasing employee skills, competencies, and satisfaction, thus improving productivity of people and processes. And aren't integration and continuous improvement what the laboratory is all about?

[The control survey of Japanese Association of Medical Technologists (JAMT) and its possibility of the standardization for the survey]

External quality control survey of JAMT (Japanese Association of Medical Technologists) carries out 9 sections of clinical chemistry, hematology, bacteriology, serology, cytology, urology, physiology-pathology, blood transfusion and genetics. In two sections of biochemistry and urology, the control survey sample have been certified which was target value and allowance limits of error by the reference method. These standardized items are utilized in order to know the degree of the accuracy of the participation laboratories. We carried out the investigation for putting the focus at 2 sections of biochemistry and serology in order to execute the standardization of the external quality control. The multiple laboratories were carried out certified using both of common pooled serum and the reference serum for a proficiency test. On the standardization items, the result showed that the external quality survey assessment was possible by the accuracy. On items of biochemistry and serology test, there have compatibility which the results of same control survey of other group. It judged possible the standardization of the external quality control assessment by the integration of the research method.

On writing for publication

Every action people take has a ripple effect on others. Whether they work at the bench, as a manager, as an educator, or in some other position, laboratorians make a difference in the lives of patients, colleagues, students, and the general public. We need to talk with others about professional issues, inside and outside our profession. One way to connect with others is through writing articles. This article streamlines writing processes for laboratorians (regardless of whether they are experienced writers, writing novices, or have never written anything for publication before) by presenting useful checklists and suggestions that can ease the way to writing for publication.

Using evidence-based practice to improve intrapartum care

The Cochrane Data Base (www.cochranelibrary. com/clibhome/clib.htm, retrieved February 23, 2001), a comprehensive international review of current medical and obstetric practices, demonstrates that birth outcomes improve with one-to-one labor support but not necessarily with continuous fetal monitoring. Because of a cultural bias toward technology, however, few extrinsic rewards exist for nurses who provide individualized labor support. Clinical scholarship in the obstetric setting is one way to begin changing ritualized practices, incorporating evidence-based practice, and improving nursing care.

[Development of standardization and certification of the quality of medical devices]

Some issues of harmonization of the Russian standards for medical articles with the international standards, including the European Engineering Legislation are considered. Under the present conditions, the rules and procedures of certification of medical articles are associated with the consumer quality controlling system. A list of new Russian standards in the above area is given.

What can technology do to, and for, family medicine?

Medical technology can be divided into information technology, diagnostic technology, and therapeutic technology. These technologies can enhance the care of patients in a family practice; they also have the potential to diminish or fragment family practice when the technologies can only be provided by specialists. While some family physicians have an aversion to technological advances, we believe it is imperative that family physicians participate in the development of technologies that enhance family practice and improve patient outcomes in primary care practice. These include electronic medical records, decision support systems, tools for managing medical information, and others. Criteria are presented to help determine when these new technologies should be adopted into practice.

[Medical-economic analysis: a necessary complement to "evidence based medicine"]

After an extraordinary technical development, medicine is under close scrutiny and requested to prove that its diagnostic and therapeutic procedures are "efficient, appropriate, and economical". Evidence based medicine allows the optimal use of existing data in the literature, but focuses only on health care benefits. Economical analyses take into account the health care resources needed to get these benefits. The various types of costs, perspectives of analysis, and techniques for assessing benefits and uncertainty about cost estimates, are presented and illustrated with two examples drawn from the fields of primary care and advanced technology. Because the cost benefit ratio of a diagnostic or therapeutic procedure is heavily dependent on the type of patients to which it is applied, as well as on the stage of technological progress, the two types of information are necessary to fully assess medical procedures.

[The precautionary principle and the obligation of medical action]

Since Antiquity, medicine has been based upon the principle of prudence. In recent years, the principle of precaution has stolen over the medical conscience and has especially been forced on doctors under pressure from a Society searching for a new Holy Grail; the utopia of zero risk and the fear for magical power of an omnipotent medicine. The principle of precaution should be capable of warding off all these evils of techno-scientific progress applied to Health. Thus, in a few years, a new norm has established itself first for the environment but which has today extended to the domain of medical decisions. It is essential that the medical authorities attract the attention of politics and of the judiciary to the dangers of blindly transposing the principle of precaution in ecology to the world of medicine. The risks of deviation are numerous, the eventual perverse effects would be detrimental to patients and health security would be endangered by paralysis and conservatism. Medicine is neither the Art of Curing nor the Art of not Harming, ... it is the Art of Caring! ...

[The European aptitude test for cervical cytopathology]

The EFCS/QUATE aptitude test is an important measure for evaluating quality in cervical cytopathology and for assessing the level of experience and competence in cervical cancer screening. The test, set up in the 1990s by the ECTP/CCS working party, has been performed since 1992 in several European countries: United Kingdom, The Netherlands, Germany, Denmark, Portugal, Slovenia, Hungary and Italy. In Italy, the test has been performed at the Istituto Superiore di Sanità in 1992 and 1993 and in some Italian universities (Padua 1993, Turin 1994, Sassari 1995, Naples 1996, Messina 1998) and in one hospital (Genoa 1997). The minimum passing score is 60/100 (60% in all sections). The aptitude test for cytotechnologists includes: a written test (50 multiple choice questions); a practical test (screening 10 unmarked cervical smears; spot test of 20 slides with a fixed field of view); and an oral test, for borderline candidates when necessary (60%) or for the diploma with 'distinction' (95%). Successful candidates receive the Certificate of Aptitude in Gynecological Cytotechnology and are entitled to use the initials CT (EFCS-GYN) after their names for professional purposes. The aptitude test for anatomopathologists includes an oral test and a practical test (screening 5 unmarked cervical smears, spot test of 20 slides with a fixed field of view, and reading and diagnosing 3 complex cases). Successful candidates receive the certificate of gynecological cytopathology. The first aptitude test for anatomopathologists in Italy, organized and endorsed by the Istituto Superiore di Sanità in collaboration with SIAPEC (Italian Society of Pathological Anatomy and Cytopathology) and in agreement with the European guidelines for cervical cancer screening, was performed on 18 December 1997 in Rome. The total number of aptitude tests carried out in Europe is 15 for cytotechnologists and 4 for anatomopathologists. A total of 317 cytotechnologists and 73 anatomopathologists has taken the test; the success rates are 77% and 70%, respectively.

Outcome measurement of problem-based learning

OBJECTIVE

To determine if there is a significant difference in the national certification examination scores, and in comments received from clinical faculty, between PBL and pre-PBL groups.

DESIGN

Retrospective analyses of national certification examination scores and clinical faculty evaluation files.

PARTICIPANTS

Medical technology students at the University of Hawaii.

MAIN OUTCOME MEASURES

Means of a national certification examination scores of PBL and pre-PBL groups are statistically compared. Types of clinical faculty comments are rank-ordered and compared between the two groups.

RESULTS

PBL group did significantly better in the Urinalysis section of the national certification examination. Pre-PBL group received more "Quiet but got better" comments from clinical faculty.

CONCLUSION

PBL can affect student outcomes in both national certification exams and perception by clinical faculty.

Technology assessment: measuring the outcomes of laboratory practice

The collision of explosive growth in biomedical technology and pressure to contain cost requires that managers of health-care services base decisions to introduce new technology on hard evidence that the benefits outweigh the costs of the new technology. Outcomes research measures the impact of new technology and changes in clinical practice on patient well-being or financial performance. Outcomes research in the clinical laboratory requires a systematic collection of data that is best accomplished in conjunction with a broader health services research effort that includes a multi-disciplinary team of laboratorians, clinicians, administrators, and statisticians. The major requirement for successful outcomes research is an integrated information system that includes clinical, demographic, administrative, claims, financial, and survey information.

[The systematic review is the foundation of evidence based medicine. One of the most important contributions to clinical medicine of the past decade]

The traditional narrative review has been shown repeatedly to be biased, mostly towards exaggerated treatment size effects. In contrast, the systematic review follows a strict protocol regarding focused questions, explicit criteria for literature searches, inclusion and exclusion criteria, critical appraisal and a synthesis which is quantitative when appropriate. There is empirical evidence that bias is reduced and that the conclusions reached have greater validity for the construction of treatment guidelines. In this paper three sources of systematic reviews are identified: the Cochrane Library, reviews published in peer-reviewed journals, and assessments of health technology (HTA-reports). Editors are encouraged to publish systematic reviews after proper critical appraisal, and readers are advised to search for such reviews when in need of guidance on important clinical questions.

[Diagnosis and the technology for optimizing the medical support of a troop unit]

The work is devoted to investigation of the system of military unit medical support with the use of principles and states of organizational diagnosis; development of the method allowing to assess its functional activity; and determination of optimization trends. Basing on the conducted organizational diagnosis and expert inquiry the informative criteria were determined which characterize the stages of functioning of the military unit medical support system. To evaluate the success of military unit medical support the complex multi-criteria pattern was developed and algorithm of this process optimization was substantiated. Using the results obtained, particularly realization of principles and states of decision taking theory in machine program it is possible to solve more complex problem of comparison between any number of military units: to dispose them according to priority decrease; to select the programmed number of the best and worst; to determine the trends of activity optimization in corresponding medical service personnel.

Benchmarking laboratory operations

OBJECTIVE

Explain why benchmarking is a valued management tool and what ratios or percentages are most useful in benchmarking laboratory operations. Review the major benchmarking subscription products currently available to laboratory managers in the United States.

DATA SOURCES

Current literature and Internet sites.

CONCLUSIONS

The process of comparing laboratory operations over time with peer groups using statistical tools and benchmarking can provide valuable insights into areas of operation that need improvement.

["What an ideal clinical microbiological laboratory should be"--from the position of medical technologist]

The evolution of the microbiology laboratory is necessary for correspondence to the transfiguration of infection and contribution to clinical applications. Especially, the correspondence of emergency tests such as smear strain and antigen detection, the report added value and the infection surveillance in team medical treatment are indispensable. Also, medical technologists need to be knowledge able about techniques related to infection overall, and participation in infection diagnosis and social responsibility are indispensable.

[Proceeding of the workshop "What an ideal clinical microbiological laboratory should be". The 33rd in-service training course for medical technologists of university hospitals in 1999]

In the workshop of the 33rd in-service training course for University Hospital Medical Technologists in 1999(sponsorship: the ministry of Education), all groups of participants were charged with discussing an ideal clinical microbiology laboratory. In conclusion, the successful operation of the ideal system of clinical microbiology should require a high level of competence in every staff member of the hospital. It must not be focused solely on the sophistication of laboratory methods. We must modify our behavior effectively and establish a good collaborative partnership with physicians and other health care professionals.

Great regulatory expectations

In a remarkably short time, the European regulatory landscape for medical devices has changed dramatically and permanently. The speed of this change will continue to accelerate until a fully matured body of rules is in place. This article will examine the current status of regulations in Europe, and some areas that will need to be addressed in the next century.

[New technology of medical service for patients with tuberculosis in outpatient facilities]

The paper summarizes experience in using a new technology of health care provided to patients from antituberculous dispensaries (ATD), which has been developed by the Russian Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation. The new procedure was used at the ATD of 114 districts, towns, and cities of 6 Russian administrative regions over 5 years. The areas under study covered more than 7 million adults. The procedure enhances the efficiency of ATD patient service and health care mainly by fixing the optimum time of basic complex therapy of patients with pulmonary tuberculosis (PT), by decreasing the time of recovery by 1-2 years and the follow-up duration for control outpatient groups (III, VII ATD groups), by drastically reducing the number of persons to be medically treated for preventive purposes by 58-70%. The proposed procedure for ATD follow-up care may be useful in the areas of the Russian Federation and requires no material and technical means and resources.

New medical technology: to what does it lead?

In this paper I first discuss the concept of medical technology. (I thank Knut Arnesen, Arvid Fennefoss, and Aslaug Høye for many informative and educational conversations about problems pertaining to technology). Then, I review some different meanings of the term, and then discuss the relationship between ethics and the scientific method. Finally, the understanding that emerges from this account is applied to a special problem: the relationship between technology and deafness.

Laboratory sampling. Does the process affect the outcome?

With the rapidly changing healthcare environment, one of the many increasing tasks for the intravenous team is blood sampling. Laboratory test results are based on the quality of the patient's blood specimen. The preanalytic phase of laboratory testing accounts for 46% of laboratory testing errors, so it needs to be managed effectively to eliminate costly, inefficient, and sometimes life-threatening outcomes to patients. The use of quality blood collection procedures and an awareness of preanalytic errors are presented to lead to quality patient outcomes.