Evaluation Of New Technologies Research Articles

Should be NICE have a Spanish NICE?

Cancer is the second leading cause of death in Spain, accounting for 25 % of all deaths. One out of three men and one out of four women will have a cancer during their lives, a proportion that will increase with progressive ageing of the general population. The direct cost of cancer in our country was €3.8 billion in 2002–2003, which represents 6.5 % of the total health budget (59.3 billion) [1] and is similar to that of other European countries. The percentage ranges from 4.1 in Holland to 7 % in Sweden, through 5.6 % in UK and 5 % in the USA [2]. However, the change over time is alarming: for instance, in the USA the direct medical expense of cancer has increased from about $27 billion in 1990 to more than $90 billion in 2008 [3]. There are no figures for Spain in this regard, although the expense has at least doubled. The main reason for this trend is the increasing cost of new drugs, the use of drugs in new indications and the incorporation of modern technologies to the clinic. Cost escalation seems to be out of proportion considering the small benefit that brings in many instances. For example, the incorporation of new agents to the classical combination 5-fluorouracil and leucovorin in colorectal cancer has doubled survival, but at the expense of a 340-fold increase in cost [4]. As a result, therapy for the commonest types of cancer may mean €30,000–60,000 per drug and patient, with a minor impact on survival. The inevitable question rises whether our society can afford increasing health costs. Considering also the current economical crisis, with national and regional restrictions as the norm, measures to guarantee the sustainability of the health system are warranted. Doctors may contribute by prescribing according to treatment guidelines. We should select patients with higher chances of benefit, hence the need for progress in the field of predictive biomarkers. Likewise, treatments administered with low evidence of activity or in extreme situations should be avoided [5]. Independent investigation should be supported, particularly when evaluating new indications for conventional drugs and low-cost technologies. Thorough evaluation of new technologies should be performed to avoid those yielding a marginal benefit. Along with above mentioned and other similar measures [3], cost streamlining and selective funding are the main factors that prevent overuse as a way to guarantee sustainability of the health system. The problem is how to achieve this and not produce inequality in a regionally fragmented health system. There are important differences in patient access to antineoplastic treatment in Spain, so some drugs are provided in some regions but not in others. Even if a drug has been approved for use in a given region, every single hospital has the legal authority to decide about its use, regardless of medical criteria. As a consequence, access to a given drug may be granted in a centre but denied in a nearby institution because of local economical constraints. Considering this landscape, it would be reasonable to support the creation of a nation-wide agency to evaluate and decide about the financing of drugs, with binding effect on regional health systems and hospitals in terms of reimbursement, coverage level and price. This would avoid inequality and the need for re-evaluation at every region and every single hospital. In this regard, the National Institute for Health and Clinical Excellence (NICE) was set up in 1999 in the UK to reduce variation in the availability and quality of the British National Health System J. Feliu (&) E. Espinosa Medical Oncology Service, La Paz Hospital, P de la Castellana, 261-28046 Madrid, Spain e-mail: jaimefeliu@hotmail.com; jaime.feliu@salud.madrid.org

Developing Improved Tools for the Economic Analysis of Innovations in the Bioeconomy: Towards a Life Cycle-Strengths-Weaknesses-Opportunities-Threats (LC-SWOT) Concept?

The bioeconomy is one of the areas with the greatest innovation potential and also the highest degree of complexity, in relation to both the articulation of technologies using biological resources and the range of human values involved. As a result, this area of the economy increasing calls for the early evaluation of new technologies both from a business and societal perspective. The objective of this paper is to review the literature on the existing instruments designed to provide an (economic) analysis of new technologies in the bioeconomy sectors (in particular the well -known concepts of Life Cycle Analysis - LCA and Strengths-Weaknesses-Opportunities-Threats -SWOT), and to devise avenues for the improvement of such instruments. Specifically, the paper focuses on developing the idea of a Life Cycle-Strengths-Weaknesses-Opportunities-Threats methodology (LC-SWOT) as a potential tool for improving the ability to evaluate early stage technologies in relation to the entire technology/product life cycle.

Ethical Considerations Regarding the Use of Social Robots in the Fourth Age

The debate about the use of robots in the care of older adults has often been dominated by either overly optimistic visions (coming particularly from Japan), in which robots are seamlessly incorporated into society thereby enhancing quality of life for everyone; or by extremely pessimistic scenarios that paint such a future as horrifying. We reject this dichotomy and argue for a more differentiated ethical evaluation of the possibilities and risks involved with the use of social robots. In a critical discussion surrounding the capabilities approach to the ethical evaluation of quality of life, we develop an ethical framework that is more appropriate to the situation of the oldest old. We urge employment of a context-dependent approach to the ethical evaluation of new technologies in the care and therapy of older adults, and using the example of the robotic seal Paro, we show how this can be accomplished in a sensible and practical way.

Emerging technologies for the detection of melanoma: achieving better outcomes

Every year around 2.5–3 million skin lesions are biopsied in the US, and a fraction of these – between 50,000 and 100,000 – are diagnosed as melanoma. Diagnostic instruments that allow early detection of melanoma are the key to improving survival rates and reducing the number of unnecessary biopsies, the associated morbidity, and the costs of care. Advances in technology over the past 2 decades have enabled the development of new, sophisticated test methods, which are currently undergoing laboratory and small-scale clinical testing. This review highlights and compares some of the emerging technologies that hold the promise of melanoma diagnosis at an early stage of the disease. The needs for detection at different levels (patient, primary care, specialized care) are discussed, and three broad classes of instruments are identified that are capable of satisfying these needs. Technical and clinical requirements on the diagnostic instruments are introduced to aid the comparison and evaluation of new technologies. White- and polarized-light imaging, spatial and spectroscopic multispectral methods, quantitative thermographic imaging, confocal microscopy, Optical Coherence Tomography (OCT), and Terahertz (THZ) imaging methods are highlighted in light of the criteria identified in the review. Based on the properties, possibilities, and limitations of individual methods, those best suited for a particular setting are identified. Challenges faced in development and wide-scale application of novel technologies are addressed.

Forty percent revenue increase by combining organic and mineral nutrient amendments in Ugandan smallholder market vegetable production

Linkages between poverty and soil fertility decline in sub-Saharan Africa indicate the need for effective strategies to restore soils, while improving smallholder incomes. Combining organic and inorganic nutrient resources offers a promising means to address this issue, via improvements to nutrient cycling and key soil properties. Yet few studies have examined this practice from an economic perspective and none have explored its potential in intensively managed, market vegetable crops. We address this issue through a demonstrative, on-farm research trial examining the agronomic and economic benefits of mixing manure and inorganic fertilizer for smallholder cabbage production in rural Uganda. Cabbage was grown on eight replicate farms in close association with a farmer field school on vegetable production. Inorganic fertilizer, urea and NPK, and cattle manure were applied alone and in combination, based on equivalent monetary inputs, yielding six treatments: (1) 100 % fertilizer, (2) 75 % fertilizer and 25 % manure, (3) 50 % fertilizer and 50 % manure, (4) 25 % fertilizer and 75 % manure, (5) 100 % manure, and (6) a control without nutrient inputs. Initial soil fertility was evaluated prior to planting and cabbage biomass, nutrient content, and market value were assessed at harvest. Our findings demonstrate that combining manure and inorganic fertilizers produced up to 26 % higher biomass and 40 % higher market value on average than fertilizer or manure alone treatments. Incomes could be increased by 114.68 USD per growing season based on the current area of land that farmers dedicate to cabbage production, compared to using manure or inorganic fertilizer alone. Furthermore, the input ratio of manure to fertilizer appears to be flexible and thus easily adjusted to price fluctuations. This research provides a clear means for smallholder farmers to better allocate soil fertility investments and enhance incomes from market vegetable production. This research also highlights the importance of involving farmers in agricultural research for efficient evaluation of new technologies, building local capacity and yielding rapid impacts.

Does the Organization Matter? A Multilevel Analysis of Organizational Effects in Homeless Service Innovations

This study examined the effects of organizational culture on staff members' use of management information systems (N= 142) within homeless service organizations (N= 24), using a multilevel model. The Organizational Social Context Questionnaire was used to measure organizational culture, defined by three sub-constructs: (1) proficiency, (2) rigidity, and (3) resistance. Results showed that organizational effects were moderated by gender, with male staff members reporting increased use of the technology in organizations with higher proficiency levels. Female staff members' use was not affected by organizational culture. The study also found substantial variability in organizational culture among homeless service providers. Some scored low on rigidity and resistance but high on proficiency, whereas others scored high on proficiency but low on rigidity and resistance. Overall, the sample showed higher proficiency, resistance, and rigidity compared with a national sample of children's mental providers. Implications of these findings are discussed for implementation and evaluation of new technologies in homeless services. KEY WORDS: homeless services; multilevel modeling; organizational culture; technology ********** Approximately 1.6 million individuals sought homeless shelter services on any given night in the United States in 2008 (U.S. Department of Housing and Urban Development [HUD], 2009). In the 2009 fiscal year, U.S. Congress allocated $1.636 billion in Homeless Assistance Grants to HUD alone. Although the need to improve service effectiveness has long been recognized (HUD, 2009; North, Pollio, Perron, Eyrich, & Spitznagel, 2005; Wright, Rubin, & Devine, 1998), a dearth of research examining the organizations serving homeless individuals and families remains. The adoption of new technologies is critical to understanding the role of the organization. Many human service organizations are slow and resistant to adopt new technologies (Camlio, 2005; 2007; Fitch, 2005), yet the effectiveness of innovations is contingent upon how well organizations support their implementations (Glisson & Schoenwald, 2005). Moreover, organizational culture has been shown to influence technology implementation (Carrilio, Packard, & Clapp, 2003; Racine, 2006) and client outcomes (McCoy & Vila, 2002). The purpose of this study is to examine how organizational culture influences staff members' use of new technologies in homeless services to determine whether innovation dissemination is partly a function of organizational culture. HOMELESS SERVICES Research on homeless services typically focuses on clients and is derived from the premise that homeless persons face a unique constellation of problems (North et al., 2005), including co-occurring disabilities, limited social and familial connections, and a distrust of traditional social services (Wright et al., 1998). It is implied that these factors make it difficult for clients to access services. This assumption may be misleading, however. Studies of client utilization of services have shown that the availability of services, rather than client efforts to access the services, was a primary predictor of client utilization (North & Smith, 1993; Padgett, Struening, & Andrews, 1995). Homeless individuals have reported that pleasant staff members and surroundings are instrumental in helping them to remain in supportive housing (Padgett, Henwood, Abrams, & Davis, 2008). In addition, research has shown that organizational characteristics such as size and leadership affect care coordination (Calloway & Morrisey, 1998), service intensity (Sosin, 2001), and service use (North et al., 2005). In 1999, HUD introduced a new technology, homeless service information systems (HMISs), that facilitates the migration from paper-based to electronic work systems and is designed to improve the efficiency of service delivery and effectiveness of homeless interventions (HUD, 2007). …

Developing National Guidance on Genetic Testing for Breast Cancer Predisposition: The Role of Economic Evidence?

Advancements in genetic testing to identify predisposition for hereditary breast cancer (HBC) mean that it is important to understand the incremental costs and benefits of the new technologies compared with current testing strategies. This study aimed to (1) identify and critically appraise existing economic evidence for BRCA1/2 mutation testing for HBC and (2) establish whether economic evidence was used to inform national guidance in England and Wales. A telephone interview with diagnostic laboratories (n=14) offering BRCA1/2 mutation testing identified that 9 (64%) used Sanger DNA sequencing with multiplex ligation-dependent probe amplification and two offered next generation sequencing. A systematic review identified 15 economic studies that evaluated: genetic testing for HBC (5 studies); preventive management options for women at risk of HBC (8 studies); and different laboratory approaches for BRCA1 testing (2 studies). These evaluations were not relevant to U.K. practice, and therefore the development of national guidance using a risk threshold to trigger BRCA1/2 testing has not been informed by existing economic evidence. The lack of economic evidence supporting the current risk threshold for national guidance has implications for the efficient use of healthcare resources and the design of economic evaluations of new technologies for BRCA1/2 testing.

DNA Cytometry Testing for Cervical Cancer Screening: Approaches and Reporting Standards for New Technologies

Evaluation of new technologies requires rigorous methods to provide unbiased estimates of the performance and so inform future clinical practice. We review evidence on DNA cytometry reported earlier in this journal and point to the standards for reporting of diagnostic accuracy as a metric against which this article can be evaluated. The cross-sectional nature of the data and incomplete reporting limit the clinical utility of the study. With application of improved reporting standards for diagnostic tests and improved design and evaluation of new technologies for screening, we may better inform practices to improve clinical outcomes and population health.

Technology Assessment in the EU Institutions

Technology Assessment (TA) is the study and evaluation of new technologies with the objective of understanding the likely impacts (costs and benefits) of these technologies on society and the environment – with the explicit aim of improving regulatory decision making concerning these technologies. This is a prospective exercise helping to ensure that “better” regulatory decisions are made by decision makers. TA and “TA like” activities are embedded within the main EU institutions. The Commission carries out Regulatory Impact Assessments on every significant regulatory proposal. It also has at its disposal a range of advisory groups which includes the European Group on Ethics in Science and New Technologies and the Institute for Prospective Technological Studies. The European Parliament has its own TA unit – the Science and Technology Options Assessment unit. The institutions are committed to quality, transparency and effectiveness in their use of expert groups and all such assessments are published on the internet. Occasionally full citizens’ consultations are carried out but this is not a formal requirement. Recent changes in the regulatory development process have emphasised the concept of “smarter” regulations. This concept is concerned not just with prospective analyses in advance of new regulations but also with the retrospective evaluation of existing regulations asking the question“Did they meet the need that was the raison d’être for enacting the regulation under consideration.”The distinction highlighted by Churchill [2] that experts should advise but not decide is intended to ensure that regulators take account of aspects other than the expert view. Nevertheless, it is essential that expert groups have the right to introduce advice thatmight otherwise be overlooked by the regulators, as is the case in a number of expert groups in the EU institutions.

Balloon Catheter Technology in Rhinology: Reviewing the Evidence

Program Description: Balloon catheter technology was introduced to otolaryngology in 2005 for management of paranasal sinus inflammatory disease. Since its introduction, it has engendered considerable controversy with proponents for and against adoption of the technology. Over time, alternate balloon devices have been advocated for office-based sinus ostia dilatation. Balloon technology has been promoted to be less invasive resulting in reduced pain and quicker recovery, generating significant press and interest by the lay public looking for new solutions for sinonasal problems. Thus, proper vetting of the balloon devices is essential to elucidate their proper role in the surgical paradigm for management of chronic rhinosinusitis. This miniseminar will objectively evaluate the currently available operative suite and office-based balloon catheter technology. Rhinologists with considerable experience without commercial conflicts on balloons will assess the frank advantages and limitations of the current balloon devices. Evidence-based review will be incorporated to assess the strengths and weaknesses of the existing peer-review literature. The potential complications unique to balloon catheters will be reviewed. The concerns of radiation exposure from fluoroscopy will be discussed. Current coding dilemmas and socioeconomic issues will also be addressed. At the conclusion of the miniseminar, participants should have a better understanding of the potential strengths and weaknesses of the balloon catheter technology in the context of management of paranasal sinus disease. This information will also serve as the foundation for better evaluation of new technologies that are introduced to our specialty. The miniseminar will be presented in a multimedia powerpoint format with video demonstrations, when applicable. Audience participation will be encouraged to stimulate discussion through the course of the miniseminar. Educational Objectives: 1) Review currently available balloon catheter technologies and to explore implications on the FESS paradigm. 2) Critically appraise the existing peer-review literature and address potential complications and radiation exposure. 3) Assess socioeconomic implications and CPT coding issues related to balloons.

Don't Be Shy and Retiring With Old Equipment

Don't Be Shy and Retiring With Old Equipment

Applying a framework for defining emergency management scenarios

Introduction: Scenarios are used extensively to support emergency management (EM). Virtually every user within the community, from policymakers to first responders, uses scenarios in one guise or another. They provide the context to characterize a dynamic problem space, to support the rehearsal of response options, and to facilitate the evaluation of new technology. With such far-reaching implications, there needs to be a means to guide scenario selection.Objective: The Canadian Centre for Security Science sponsored the development of a framework to characterize scenarios and to assist in evaluating EM capabilities, explicitly in the area of chemical, biological, radiological, and nuclear response. The framework also complements capability-based planning and provides a means to share scenarios.Methodology: The Public Safety and Security Planning Scenario Framework assists the EM community, which ranges from the national to the community level, by selecting scenarios based on user perspectives and objectives. In developing the framework, three challenges were addressed: a taxonomy was required to frame and define what constitutes a scenario; parameters were needed to describe and characterize scenarios; and structure was called for to assist in ordering the collection and comparison of representative scenarios.The first challenge involved reviewing existing literature to define the term “scenario.” Typically, scenarios are used to consider near-term threats, to capture planning assumptions, and to provide the perspective necessary to assess concepts and capabilities. The framework proposes a set of criteria or dimensions (eg, risks, triggers, and time horizons) that can be used to characterize scenarios. To test the framework, a representative set of scenarios was cataloged using these dimensions. Analysis of the resulting set was instructive in revealing the differences in planning scenarios across the chemical, biological, radiological/nuclear, and explosive communities. As the framework matures, it is hoped that it will promote information reuse and provide a valuable forum for capturing best practices and developing standards, enhancing efficiency and effectiveness improvements both locally and nationally.

Understanding human values in adopting new technology—A case study and methodological discussion

This paper proposes a method for understanding and modelling human values in the evaluation of new technology in social settings, and analyses the validity of the proposed method in a specific use case. The method, which is based on the Schwartz universal model of human values adopted from social psychology research, is used in the context of value analysis of the adoption of a technology-supported attendance control system in a primary school. The results are based on an evaluation of a 14-week trial where two classes of elementary school children used an attendance control system that was implemented using networked technology components, including smart cards, NFC-enabled mobile phones and card readers, a web portal, and SMS messaging. The findings from the trial are analysed from the viewpoint of three end-user groups, namely children, parents, and teachers.

Procedures of soil farming allowing reduction of compaction

Evaluation of new technologies using guidance systems is very important and can help producers with choosing the right equipment for their applications. Without using satellite navigation during field operations, there is a tendency for passes to overlap. That results in waste of fuel and pesticides, longer working times and also environmental damage. When utilising satellite guidance for field operations, there is a close connection with controlled traffic farming (CTF) as well. CTF is currently a quite quickly developing farming system based on fixed layout of machinery passes across a field. Tracks precisely set out for a machine’s tyres in the field could be a tool for minimising soil compaction risk which is another threat to the environment. The purpose of this paper was to evaluate the accuracy of currently available guidance systems for agricultural machines. Real pass-to-pass errors (omissions and overlaps) in a field were measured. Consequently, comparison between observed guidance systems was made regarding final working accuracy. Further, intensity of machinery passes, percentage of wheeled area and repeated passes in fields were monitored. These measurements were made in fields under real operating conditions using a conventional tillage system with ploughing and also a conservation tillage system, both systems with randomly organized traffic. Finally, the same parameters were monitored in fields where fixed machinery tracks were used for all operations and passes but only under a conservation tillage system. Pass-to-pass accuracy was measured for the evaluation of different guidance systems. Size of missed areas or overlaps was evaluated statistically. Concerning intensity of machinery passes and total field area affected by machinery passes, the following facts were found out. The experiments with randomized traffic showed a significant difference of the parameters mentioned above between a conventional tillage system with ploughing and a conservation tillage system. Wheeled area was 86 and 64%, respectively which proves benefits of conservation tillage. The experiments with a fixed track system showed that the total run-over area by machinery tyres decreased even more (up to 31%) in comparison to randomized traffic in a field (only fields under conservation tillage system were monitored and evaluated). The following statements based on our results can be made. The navigation and therefore possibility for better accuracy of machinery passes in fields together with permanent machinery tracks utilization could help with soil condition improvement and also energy savings which would result from that. The CTF system will help with further development of a system for soil compaction protection which is currently a real necessity.

Adoption of New Technology in Sports Medicine: Case Studies of the Gore-Tex Prosthetic Ligament and of Thermal Capsulorrhaphy

Evaluation of new technology in sports medicine is supposed to promote improvements in the care of patients. It is also supposed to prohibit technology that can harm patients. This evaluation process is not perfect and at times can promote technology that not only does not help patients but may harm them. Two examples of new sports medicine technology that were widely adopted but eventually abandoned are thermal capsulorrhaphy for treatment of shoulder instability and the Gore-Tex prosthetic ligament (W. L. Gore & Associates, Flagstaff, AZ) for patients with anterior cruciate ligament deficiency. On analysis of the quick adoption of these 2 failed procedures, certain recommendations are apparent for improvement of the evaluation process. There must be a sound rationale behind any new technology, basic science research into the theory of the medical technology, and demonstrated improvements in animal models and clinical studies that are prospective cohort studies or randomized controlled trials, and finally, there must be careful follow-up and postmarket surveillance.

Blood safety: bacterial screening of blood products

Bacterial contamination of blood components can cause death and serious morbidity in transfusion recipients [1–3]. Numerous measures to prevent and detect bacterial contamination have been introduced to reduce this hazard. Detection methods, including screening of blood components, are the subject of this review. Preventive measures include careful donor selection and predonation health screening, with donor deferral and follow-up of postdonation information as required [4,5]; optimization of blood collection and manufacturing processes, including improvements in skin cleansing procedures [6–9], choice of collection method and consumables, diversion of initial volume away from the collection bag [10–16], environmental monitoring, and greater availability of the use of apheresis platelets to minimize exposure to donor skin flora [17,18]; developments in pathogen reduction technologies [19–24]; attention to component storage and handling; and promotion of evidence-based clinical transfusion practice [24,25]. However, in spite of the introduction of advancements such as these, haemovigilance programs internationally continue to report serious adverse events because of bacterial contamination. For example, in spite of an overall reduction in numbers of cases reported annually to the French national haemovigilance programme since 2000, there were nine clinical cases in 2008 with imputability ratings of ‘likely ⁄ possible’ to ‘certain’, including one death because of Escherichia coli contamination of a platelet transfusion [26]. In the same year, the annual report from the Serious Hazards of Transfusion (SHOT) scheme described six confirmed clinical cases of sepsis in the United Kingdom because of bacterial contamination of platelet units, with consequences ranging from minor morbidity to death [27]. The spectrum of bacterial contamination ranges from detection of bacteria on routine component surveillance testing without apparent consequence to fatal sepsis. Recognition of transfusion-related sepsis can be difficult at the bedside, especially where patients may be already febrile and ⁄ or on antibiotics for suspected sepsis from other sources [28,29]. In order for bacterial contamination events to be captured by haemovigilance systems, the cases must first be identified clinically, confirmed with appropriate investigations, and then reported at institutional and programme levels. Haemovigilance programs are at various stages of development in different regions. Where they do exist, in some jurisdictions participation is mandatory and in other cases voluntary and therefore not universal. Different systems require variable levels of clinical certainty and laboratory confirmation, and some cases which are deemed highly likely on clinical grounds are unable to be confirmed because of unavailability or inappropriate handling or storage of blood component or patient samples. Thus, the number of confirmed and reported transfusion-related clinical cases can be considered the ‘tip of the iceberg’ or perhaps ‘the nose of the crocodile’ – with the majority of bacterial contaminations of blood components hidden below the surface, and many associated with no apparent harm, but with the potential for devastating outcomes. The cases included in haemovigilance reports therefore represent only a subset of total bacterial events. Even the definition of what constitutes a case of transfusion-transmitted bacterial contamination is a matter of some discussion. SHOT [27] defines a confirmed transfusion-transmitted infection as a case where: • the recipient had evidence of infection post-transfusion, and there was no evidence of infection prior to transfusion, and no evidence of an alternative source of infection; • and either at least one component received by the infected recipient was donated by a donor who had evidence of the same transmissible infection • or at least one component received by the infected recipient was shown to contain the agent of infection. The Dutch Transfusion Reactions in Patients (TRIP) haemovigilance system has recently expanded its scope of reportable bacterial events [30]. To the previous category of ‘post-transfusion bacteraemia ⁄ sepsis’, defined as ‘clinical symptoms of bacteraemia ⁄ sepsis arising during, directly after or some time subsequent to a blood transfusion, for which there is a relevant, positive blood culture of the patient with or without a causal relation to the Correspondence: Erica Wood, Australian Red Cross Blood Service, PO Box 354, 3205 South Melbourne, Victoria, Australia E-mail: woodericam@hotmail.com ISBT Science Series (2010) 5, 46–51

Evaluation of new technologies PET/CT nuclear imaging

Nuclear imaging has used initially anatomic and volumetric technologies as CT or MRI. In recent years new dimensions of non invasive studies, as PET, have shown a higher utility in the effectiveness of the treatment. The evaluation of need must be done according to a principle of Horizontal Equity, equal treatment for equal need and of a principle of Vertical Equity, Different treatment, at regional level, according to each hospital level. The evaluation of need has been made according to the Potential Demand by Potential User Groups: diabetes, type 2, (50 years and more); screening colorectal (50 years and more); morbidity by cancer; surgery of lung cancer; cardiology; heart surgery; acute chest pain in the emergency department. In a Macro Perspective need has been evaluated using the Population Estimations for 2007, at municipality level. Relatively to Lisbon and Porto data at locality level has been used, from the 2001 Census. According to Campos, J.R. (2007), in 2006, it existed 1 PET by 1 million inhabitants and after that date 2 more were created (Quadrantes and Hospital ad Luz), belonging to the private sector. Mores 15 PET are needed in the NHS, 1 PET for about 504128 inhabitants. According to The Potential Demand perspective 18 new PET are needed, 15 from the public sector. The private sector will cover progressively the demand. Dorado and Albertino (2002), in Spain, mention that the introduction of this new technique in our Health System must be done slowly due to the cost and complexity. In Portugal exists already 6 PET and this applies also. As a first priority the intervention in Oncology in the IPO (Coimbra). A priority must be given to the University Hospitals of Santa Maria and São João. The Central Hospitals of Viseu and VilaReal/Régua must have also 1 PET. A priority must be given to the interior in order to avoid transports of patients and families. In fourth place the HC Central Lisbon must have also 1 PET, which will go to the New Hospital of Todos-os-Santos. The Hospital Garcia de Orta must have also 1 PET, what will avoid the patients from the Setúbal district to come to Lisbon. The HC of Coimbra and the HC of Ocidental Lisbon must have 1 PET in order to cover the population of the Centre Region and of Lisbon Region. The HC of VN de Gaia, the Hospital Pedro Hispano, Matosinhos, and the Hospital of Guimarães, must have 1 PET due to the population density of the North Region. The New Central Hospitals of Evora and Faro must also have 1 PET and the New Hospital of Braga. The estimation of diabetes, type 2, has been made using the minimum prevalence of 3%. The prevention of cardiac illness in the population of 50 years need with diabetes, type 2, must be done with PET annual examinations in the Hospital, referred by the family doctor in the health centre. The screening colorectal has not a tradition in Portugal. Sun L et al (2008) mention that according to criteria of specificity, sensibility and precision PET/CT presents higher advantages in the colorectal screening. It has been estimated that it must be done in 10% of the adults of 50 years and more with annual examinations in the Hospital, referred by the family doctor in the health centre. The use of PET in cancer treatment must be done only in the cancer of mama; cáncer colorectal; cancer of esofagus; cancer of head and neck; lung cancer; linfoma; melanoma; and Solitary Pulmonary Nodules; cancer of thyroid; cancer cervical . Those types of cancer are 46,7 % of total cancer mortality. The use of PET in cardiology in CAD is also important. If the prevalence of CAD is less than 70% PET has a lower value per QALY. The number foreseen of examinations is of about 3114 examinations/ year. The application of Pet in acute chest pain makes that the localization of PET must be done near the Emergency Department. Mowatt, G. et al. (2008) conclude that, based in some studies of Acute Chest Pain there is an evidence of prognostic that the use of 64-slice CT has influence in the way as patients are treated, what gives origin to a reduction in some inpatient care and avoids the development of invasive CAD.

Video stream and teaching channels: quantitative analysis of the use of low-cost educational videos on the web

This paper presents the results of using low-cost educational videos, aimed at complementing face-to-face and distance courses of the Degrees in Industrial Engineering, Industrial Organization and Aeronautical Engineering at ETSEIAT (Technical School of Industrial Engineering and Aeronautical Engineering of Terrassa). The high speed access and the ability to create knowledge networks in which all authors can actively participate are only some of the advantages of Video Stream (Fiil and Ottewill, 2006; Michelinch, 2002) and Web 2.0, that have motivated this project. The elaborated videos, combined with text, images and questionnaires can be easily inserted into the ETSEIAT teaching platform ATENEA (Moodle), thus developing new teaching methodologies to support independent learning and enhance students’ motivation. Based on a sample of 487 students enrolled in different courses and degrees, this paper analyzes both quantitatively and qualitatively different dimensions of evaluation of new technologies in teaching (Breen et al., 2001) as well as the professors’ perspective and their perceived cost. The main research findings revealed an improved student motivation and an increase of the perceived efficiency in the learning and teaching process, without substantially raising costs.

Paul Sollie and Marcus Düwell (eds): Evaluating New Technologies. Methodological Problems for the Ethical Assessment of Technology Developments

Paul Sollie and Marcus Düwell (eds): Evaluating New Technologies. Methodological Problems for the Ethical Assessment of Technology Developments

Imaging Technology and Practice Assessments: What Next?

A recent study conducted by our research group revealed that there may be a significant “laboratory effect” in retrospective observer performance studies that may in turn limit the relevance of inferences generated as a result of these studies to the clinical environment (1). Even though we found a considerable consistency among the performance levels of the readers regardless of the specific method or rating scale used (i.e., binary, receiver operating characteristic (ROC) or free-response ROC (FROC)) (2,3), our study showed that radiologists may perform significantly different in the clinic than in the laboratory when reading the very same cases. The differences were reflected in terms of both their overall performance levels (e.g. sensitivity and specificity) and, perhaps more important, in terms of variability, or “spread”, among the observers’ performance levels (1). Although the results of our study should definitely be validated experimentally in other studies before general acceptance, there is a reasonably solid rationale for the observed outcome of our own study (1). Indeed radiologists may perform differently in the laboratory in ways that are not a-priori predictable; therefore, differences in their behavior can not always be completely accounted for during retrospective studies. Even attempting to duplicate seemingly simple conditions such as practice guidelines (e.g. aim for 10% recall rate) during the experiment ultimately may not reflect actual behavior in the clinic. Clinical decisions that affect patient management can not be duplicated in laboratory studies. Because differences in behavior are difficult to account for in retrospective observer performance studies we, the investigators, have to ask ourselves what next? How do we proceed with appropriate evaluations of new technologies and practices in a manner that is both practical and, at the same time, clinically relevant?