Key Aspects of Bio-Engineering - Coursework Example

Bio-Engineering Introduction In addition to organic structures, advances are likely to continue in engineering artificial tissues and organs for humans. Multi-functional materials are being developed that provide both structure and function or that have different properties on different sides, enabling new applications and capabilities. For example, polymers with a hydrophilic shell around a hydrophobic core (biomimetic of micelles) can be used for timed release of hydrophobic drug molecules, as carriers for gene therapy or immobilized enzymes, or as artificial tissues. Sterically stabilized polymers could also be used for drug delivery. Bioengineering and its Application to Life Sciences Other materials are being developed for various biomedical applications. Fluorinated colloids, for example, are being developed that take advantage of the high electronegativity of fluorine to enhance in vivo oxygen transport (as a blood substitute during surgery) and for drug delivery. Hydrogels with controlled swelling behavior are being developed for drug delivery or as templates to attach growth materials for tissue engineering. Ceramics such as bioactive calcia-phosphate-silica glasses (gel-glasses), hydroxyapetite, and calcium phosphates can serve as templates for bone growth and regeneration. Bioactive polymers (e.g., polypeptides) can be applied as meshes, sponges, foams, or hydrogels to stimulate tissue growth. Coatings and surface treatments are being developed to increase biocompatibility of implanted materials (for example, to overcome the lack of endothelial cells in artificial blood vessels and reduce thrombosis). Blood substitutes may change the blood storage and retrieval systems while improving safety from blood-borne infections (Chang, 2000 [108]). New manufacturing techniques and information technology are also enabling the production of biomedical structures with custom sizing and shape. For example, it may become commonplace to manufacture custom ceramic replacement bones for injured hands, feet, and skull parts by combining computer tomography and “rapid prototyping” (see below) to reverse engineer new bones layer by layer (Hench, 1999 [139]). Beyond structures and organs, neural and sensor prosthetics could begin to become significant by 2015. Retinas and cochlear implants, bypasses of spinal and other nerve damage, and other artificial communications and stimulations may improve and become more commonplace and affordable, eliminating many occurrences of blindness and deafness. This could eliminate or reduce the effect of serious handicaps and change society's response from accommodation to remediation. Biomimetics and Applied Biology Recent techniques such as functional brain imaging and knock-out animals are revolutionizing our endeavors to understand human and animal intelligence and capabilities. These efforts should, by 2015, make significant inroads in improving our understanding of phenomena such as false memories, attention, recognition, and information processing, with implications for better understanding people and designing and interfacing artificial systems such as autonomous robots and information systems. Neuromorphic engineering (which bases its architecture and design principles on those of biological nervous systems)1 has already produced novel control algorithms, vision chips, head-eye systems, and biomimetic autonomous robots. Although not likely to produce systems with wide intelligence or capabilities similar to those of higher organisms, this trend may produce systems by 2015 that can robustly perform useful functions such as vacuuming a house, detecting mines, or conducting autonomous search. Surgical and Diagnostic Biotechnology Biotechnology and materials advances are likely to continue producing revolutionary surgical procedures and systems that will significantly reduce hospital stays and cost and increase effectiveness. New surgical tools and techniques and new materials and designs for vesicle and tissue support will likely continue to reduce surgical invasiveness and offer new solutions to medical problems. Techniques such as angioplasty may continue to eliminate whole classes of surgeries; others such as laser perforations of heart tissue could promote regeneration and healing. Advances in laser surgery could refine techniques and improve human capability (e.g., LASIK2 eye surgery to replace glasses), especially as costs are reduced and experience spreads. Hybrid imaging techniques will likely improve diagnosis, guide human and robotic surgery, and aid in basic understanding of body and brain function. Finally, collaborative information technology (e.g., “telemedicine”) will likely extend specialized medical care to remote areas and aid in the global dissemination of medical quality and new advances (Allison & McLaughlin, 1998). Broader Issues and Implications By 2015, one can envision: effective localized, targeted, and controlled drug delivery systems; long-lived implants and prosthetics; and artificial skin, bone, and perhaps heart muscle or even nerve tissue. A host of social, political, and ethical issues such as those discussed above will likely accompany these developments. Biomedical advances (combined with other health improvements) are already increasing human life span in countries where they are applied. New advances by 2015 are likely to continue this trend (Altman, et al. 1998), accentuating issues such as shifts in population age demographics, financial support for retired persons, and increased health care costs for individuals. Advances, however, may improve not only life expectancy but productivity and utility of these individuals, offsetting or even overcoming the resulting issues. Many costly and specialized medical techniques are likely to initially benefit citizens who can afford better medical care (especially in developed countries, for example); wider global effects may occur later as a result of traditional trickle-down effects in medicine. Some technologies (e.g., telemedicine) may have the opposite trend where low-cost technologies may enable cost-effective consulting with specialists regardless of location. However, access to technology may greatly mediate this dispersal mechanism and may place additional demands on technology upgrades and education. Countries that remain behind in terms of technological infrastructures may miss many of these benefits. Theological debates have also raised concerns about the definition of what constitutes a human being, since animals are being modified to produce human organs for later xenotransplantation in humans. Genetic profiling may help to inform this debate as we understand the genetic differences between humans and animals.3 Improved understanding of human intelligence and cognitive function could have broader legal and social effects. For example, an understanding of false memories and how they are created could have an effect on legal liabilities and courtroom testimony. Understanding innate personal capabilities and job performance requirements could help us determine who would make better fighter pilots, who has an edge in analyzing complex images4 and what types of improved training could improve people's capabilities to meet the special demands of their chosen careers (Altman, et al. 1998). Ethical concerns could arise concerning discrimination against people who lack certain innate skills, requiring objective and careful measures for hiring and promotion. Eventually, neural and sensory implants (combined with trends toward pervasive sensors in the environment and increased information availability) could radically change the way people sense, perceive, and interact with natural and artificial environments. Ultimately, these new capabilities could create new jobs and functions for people in these environments. Such innovations may first develop for individuals with particularly challenging and critical functions (e.g., soldiers, pilots, and controllers), but innovations may first develop in other quarters (e.g., for entertainment or business functions), given recent trends. Initial research indicates the feasibility of such implants and interactions, but it is unclear whether R&D and investments will accelerate enough to realize even such early applications by 2015 (Altman, et al. 1998). Current trends have concentrated on medical prosthetics where research prototypes are already appearing so it appears likely that globally significant systems will appear in this domain first. Utilization and Manipulation of Healthcare Advancements Healthcare facilities in all parts of the world have tried to address the ever-changing healthcare system. In the United States the creation of a community-based integrated delivery system appears to be the strategy of choice among most healthcare facilities. The design and intricacy of these systems vary among healthcare facilities. For example, some just have shared services (i.e., laboratory and/or radiology services), while others are far more multifaceted (i.e., the integration of healthcare services that provides a continuum of services from the tertiary care hospital to the patient's home). Such community-based integrated delivery systems can eliminate redundancy in their services and achieve economies of scale by “channeling” (Kleinke, 2001) patients to the appropriate facility to deliver treatment in the most cost-effective way. Hospitals can be owned by one entity, for-profit corporation or not-for-profit entity, or have separate ownership but form the network to achieve economies and negotiate managed-care contracts for the network. Interaction between Life Scientists and Engineers The integration of laboratory services with a regional core laboratory seems to have the greatest impact on improving efficiency and decreasing costs. In this scenario the core laboratory is usually placed at a tertiary care and/or teaching hospital where the testing is more sophisticated and personnel are at a higher level (i.e., Ph.D.). The remaining facilities have full service laboratories, rapid-response laboratories or STAT laboratories. On rare occasions, the regional laboratory is a freestanding structure. The regional core laboratory can have a variety of functions: it can perform the majority of all testing for the region, or it can be the centralized testing for outreach, low-volume esoteric testing, or other testing where turnaround time is not critical (Lerman, 1987). Some community-based integrated systems have elected to distribute laboratory testing to hospitals based upon their comparative advantage. For example, if one hospital has a specialty in virology and performs relatively high volumes of testing, it should be considered the desirable site for that area of testing. Some of the earlier systems implemented only STAT capabilities at all hospital laboratories, other than the one that housed the core laboratory. This strategy was short lived, as most hospitals found that physicians needed many of the routine tests, and their absence had a negative impact on patient length of stay in the hospital. Because of this and other reasons, most hospital laboratories have fully automated rapid response laboratories that process tests in “real time.” To accomplish this goal, automated instrumentation for chemistry, immunology, hematology, coagulation, and urinalysis should be available at each facility and located in one open room. This streamlines workflow, improves turnaround time, enhances communication among staff, and maximizes the advantages of cross training. Samples from all areas of the hospital should be sent to central accessioning for processing. It is best when these samples are sent via pneumatic tubes, thereby helping the lab meet turnaround time requirements. With this configuration, the additional laboratory space or personnel needed to process all of these highly automated tests on site is minimal when compared to a STAT-only model. Current instrumentation, with bar code readers, high throughput, direct tube sampling, and other laborsaving features minimize labor. As such, staffing required to process additional samples or perform more tests, (i.e., a Chem 20 profile versus the Chem 7 STAT panel) are comparable. The additional instrumentation costs are also minimal. This obviates the need to pack samples and move them to a central off-site location. Samples collected from physicians' offices, physicians' office laboratories, nursing homes, or clinics are processed at the designated regional laboratory (Zey, 2000). Intelligent Drug Delivery Systems Laboratories in a community-based integrated system are currently attempting to standardize their technology as well as their information systems. This change will reduce costs through sharing of reagents and supplies. As patients move through the system, their laboratory reference ranges will remain the same, therefore allowing physicians to compare previous data and better monitor changes in test results. While this might have been difficult to do a few years ago, it can be done today. This is primarily due to the recent introduction of technology with varying throughputs and the breadth of technology by a single vendor (Zey, 2000). A large hospital can utilize a similar instrument with the same methodologies as a smaller hospital. While the laboratory and other strategies vary among community based integrated systems, all have attempted to reduce a patient's hospital length of stay. Under the U.S. reimbursement system, Diagnostic Related Groups (DRGs), which reduce the patient's length of stay, provide economic gains. This reduction of patient stay has significantly decreased the number of hospital beds in the United States (Zey, 2000). Another outcome of this reimbursement policy has been to send patients home earlier, even though many still require the attention of healthcare providers (e.g., registered nurses). This has created some concerns for many healthcare payors (i.e., private insurance and government healthcare payors), as they are realizing increased costs in home health care. In addition to the growing number of patients needing health services after their hospital stay, the United States is faced with a growing population of aged citizens (65 years or older). The projections are that there will be more than 69 million individuals over 65 years of age by the year 2030 (Zey, 2000). Presently in the United States, when an individual reaches the age of 65 he or she is entitled to health insurance by the government (Medicare). The U.S. government is concerned that the numbers and long-term chronic ailments of this aged population will place an economic strain on the healthcare system. In 1997, 3.5 million Medicare enrollees received home health services; an increase of about 100 percent since 1990. The 1999 cost for home health care reached $36 billion and is expected to grow substantially. Most of this growth is due to a patient's decreased length of hospital stay. However, the greater growth in home health will not be seen until the year 2013 when the “Baby Boomers” are first predicted to enter the Medicare system (Chang, 2000). Many health care agencies today realize the key to cost containment is better management of the patient. Better management not only improves the patient's well being, it reduces the number of encounters that the patient has with emergency departments, hospital admissions, and possibly visits to the physician's office. There are three key elements in providing economical patient management outside the hospital: self-testing, connectivity, and telemedicine. Telemedicine will play a vital role in providing home health care, especially now that real-time visualization of the patient can occur. Telemedicine Technology The introduction of telemedicine technology that allows visualization of both the practitioner and patient as well as the collection of clinical data is a major breakthrough for this market. For example, the technology offered by HomMed Sentry collects the patient's heart rate, blood pressure, O2 saturation, weight, and temperature (Chang, 2000). In addition, some of the technology will have ports, which enable patients to connect a spirometer and POCT technology (e.g., glucose monitor). Over the same time period there has been an increase in the number of approved point-of-care testing methods for self-testing, which will allow patients to send their self-test results via their vital sign technology. Self-testing and telemedicine will provide needed economical means for managing patients in a community-based healthcare system (ambulatory care). One of the largest costs of providing health care to homebound patients is labor. Sending a healthcare provider to a patient's residence, either to visit the patient or collect a laboratory sample, is very expensive. Telemedicine should help decrease overall costs of labor, since vendors have demonstrated that a home healthcare nurse can see more than double the number of patients when using telemedicine. The other element that is helping to decrease costs of the homebound patient is “patient management.” Research has demonstrated that management of homebound patients not only expedites recovery but also decreases the patient's encounters with emergency departments, hospitals, and/or physicians' offices. In the future, the management of the patient in a community-based healthcare system, especially when home health care is a component, will rely heavily on information systems. The connectivity will be somewhat complex. However, this connectivity will be a necessary component if the community-based healthcare system is going to provide an efficient and economical system. Conclusion The process of connecting hospital clinical laboratories in a community-based healthcare system has been very slow even without home health care. This has been because many hospital laboratories have different laboratory information systems (LIS) and the replacement of these systems to create one common LIS would be costly. This would be compounded even further if the community-based system tried to integrate home healthcare data into their LIS system. However, just recently some LIS vendors have offered application service provisioning as a solution. An application service provider (ASP) deploys, hosts, and manages software applications, which in return could reduce the costs of standardizing laboratory information systems. Under the ASP model there is the potential to reduce costs by 30 to 60 percent. ASPs provide the infrastructure and support services without hardware costs. A full service ASP offers continuous access to their latest technology. They take on full responsibility for maintaining the information technology. This in turn allows hospitals to spend less on information technology personnel and spend more on other operations. Resources Allison, S., and K. McLaughlin-Renpenning, Nursing Administration in the 21st Century (Thousand Oaks, CA: Sage Publications, 1998). Altman, S., U. Reinhardt, and A. Shields (Eds.), The Future U.S. Healthcare System: Who Will Care for the Poor and Uninsured? (Chicago: Health Administration Press, 1998). Chang, Thomas Ming Swi, “Artificially boosting the blood supply,” Chemistry & Industry, Apri1 17, 2000, pp. 281–285. Hench, L. L., “Medical materials for the next millennium,” MRS Bulletin, Vol. 24, No. 5, May 1999, pp. 13–19 Intelligent Drug Delivery Systems. Kleinke, J., Oxymorons: The Myth of a U.S. Health Care System (San Francisco: Jossey-Bass, 2001). Lerman, D. (Ed.), Home Care: Positioning the Hospital for the Future (Chicago: American Hospital Publishing, 1987). World Market Research Center, Hospital Engineering and Facility Management (London: International Federation of Hospital Engineering, 2002). Zey, M., The Future Factor: The Five Forces Transforming Our Lives and Shaping Human Destiny (New York: McGraw-Hill Professional Publishing, 2000). Read More