Technology and nursing: an anatomy of definition

This paper discusses technology in relation to nursing practice development in order to demonstrate the need to apprehend nursing within the context of technological advancement. Issues pertinent to formulating an understanding of technology are reviewed and four common approaches to the definition of technology within the domain of nursing are critiqued. The purpose of the paper is to analyse issues relevant to defining technology, and to make obvious the limitations of current nursing literature.

Effective contracting of high-tech health care for patients at home

High-technology treatments such as total parenteral nutrition or intravenous antibiotics may increasingly be provided to patients at home. In the past, these services have been funded by the NHS prescribing budget. The aim of the Department of Health's Executive letter EL(95)5, Purchasing High Tech Healthcare for Patients at Home was to ensure that contracts placed by health authority purchasers maintain effective patient services and obtain better value for money by encouraging competition between potential homecare providers. Examines contracting for high-tech health care for patients at home and suggests that efficiency could be improved when contracting with commercial home-care organizations by lead purchasing arrangements. In the long-term, contracting with NHS tertiary centres is most likely to ensure continuity of care and appropriate clinical monitoring of patients.

[Approaches to shaping the modern technologies of producing expertise and to regulating the expert process]

The author proposes transfer to new technology of expert evaluations and of management of the forensic medical service of a region. This will appreciably improve the quality of expert assessment, accelerate it, and improve labor productivity.

National structures in the delivery of rehabilitation technology services

The delivery of rehabilitation services requires an infrastructure if service provision is to be given any priority. This article discusses some characteristics of handicaps, technical aids, the service delivery process, and habilitation/rehabilitation, and recommends developments of national structures for service delivery based upon the characteristics of rehabilitation technology, user need, and the country frameworks.

Justifying and tracking BMET training

We have outlined the importance of BMET training and how it is a crucial investment for not only the health care facility but also clinical engineering and individual BMETs. Training methods and funding mechanisms are also important aspects of the continuing education process. Being aware of the alternatives helps to achieve the goals of the clinical engineering program. We have also demonstrated management techniques of acquiring training, evaluating courses, and keeping statistics. Courstat manages statistics of training intensity among BMETs. This kind of tool provides managers with an overall picture of departmental expertise.

[The scientific support of public health institutions with the technology for the sociomedical assessment of the health of miners]

Analysis of the scientific research activities of the Donetsk Research Centre of Occupational Hygiene and Prevention of Traumatism was carried out, which offered a basis for the development of technology for medicosocial assessment of morbidity involving temporary unfitness for work, occupational morbidity, invalidism and mortality among coal miners, risk for development of nonoccupational and occupational diseases, prevalence of IHD and other non-infectious diseases, functional status of the organism according to psychophysiological indices for those going to work in the mine, as well as of the state of undue fatigue and overstrain experienced by the miners. The analysis permits the above technology to be inaugurated in the health care establishments and research institutes.

Medical technologies in developing countries: a feasibility study on the maintenance of medical equipment in Ethiopia

The authors report the results of a feasibility study, sponsored by the Italian Foreign Ministry, of setting up a Regional Centre for the Management and Maintenance of Medical Technologies in Ethiopia. After some general considerations regarding the problems of co-operation in this field, the authors draft some concrete proposals for an operative programme.

A survey of CE/BMET attitudes

This article presents the results of a survey designed to assess current Biomedical/Clinical Engineering attitudes. Issues discussed include separating biomedical/clinical services from engineering/maintenance services; certification; factors affecting salary levels; and whether technicians should use the "engineer" title. The opinions presented are meant to stimulate discussion among individual BMETs and CEs, and within clinical engineering departments.

[Example of organizing a middle-size business in medical industry]

The paper deals with the organization of activities of a joint venture in diagnostic medical equipment under the conditions of arising market relations in Russia. A block diagram of the enterprise is proposed, which ensures rather effective research, production, and commerce activities. The tasks facing a marketing sector are given in detail.

The pivotal role of the academic health center

Academic health centers (AHCs) now play major roles in the development, adoption, and evaluation of medical technologies; the provision of advice to other entities involved in medical innovation; and the education of current and future practitioners. However, recent and potential health care reform initiatives could make it increasingly difficult for AHCs to continue to play their historical roles in medical innovation. Policymakers are examining specific options that would explicitly cover the cost of some of these services but could take away some of the autonomy AHCs have enjoyed and could change the role of AHCs in technological innovation.

[Medical equipment companies and their ties with technology development centers in Mexico]

The purpose of this study was to determine the characteristics of the companies that produce, distribute, and service medical equipment in Mexico and the factors related to whether or not they had established ties with research and technology development centers. The data analyzed came from a survey of such companies carried out in Mexico City and environs in 1989. The information was updated in 1991. Multivariate analyses were carried out in order to identify the characteristics of companies that had established ties or wished to do so and the areas of interest of those companies. Of 208 companies surveyed, only 23% had ties with research centers. The companies that had such ties or were interested in establishing them tended to invest in research and to have made plans for expansion. The establishment of ties appeared to be a two-way process, with positive consequences for the companies involved, the research centers, and the health sector. It was concluded that it would be advantageous to design programs to promote ties with companies having the characteristics mentioned.

Medical technologists using molecular epidemiology as part of the infection control team

Two medical technologists were appointed as permanent members of a new epidemiology section in the diagnostic microbiology laboratory of a large Veterans Administration Medical Center in the fall of 1989. These positions accounted for 9% of the total microbiology staff and were created on a temporary basis 2 years earlier from a need to have dedicated technical expertise for use in the culture, isolation, and typing of nosocomial organisms. The technologists have evaluated outbreaks due to Clostridium difficile, methicillin-susceptible Staphylococcus aureus, and Serratia marcescens, and have begun work on a methicillin-resistant Staphylococcus aureus (MRSA)-typing scheme. Their major responsibility has been the development and application of molecular biology techniques for the typing of nosocomial isolates, including restriction enzyme analysis of genomic DNA, plasmid profiling with and without restriction enzyme analysis, ribosomal RNA probing of restricted genomic DNA, and selected DNA sequencing of target organisms. Medical supervision rests jointly between the directors of the infection control program and the microbiology laboratory. During their tenure, infections due to C. difficile have dropped from 95 cases per year to 57 cases annually, treatment of MRSA colonization with systemic agents has been curtailed, and a case control investigation involving S. marcescens was avoided. The inclusion of medical technologists in the infection control practice of large medical care facilities, particularly with the availability of molecular epidemiologic techniques and the emergence of increasing numbers of multiply-drug-resistant pathogens, will become an essential component of these programs.