Medical Research and its Impact on Healthcare Design - the ...

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HEALTH MEDICAL FACILITY RESEARCH AND ITS IMPACT ON HEALTHCARE DESIGNped. This will create possibilities for reconstructivesurgery or other invasive techniquesto restore circulation before the damage becomesirreversible.• Drugs with improved specificity <strong>and</strong> selectivity(receptor blockers) produced by biotechnologywill make it possible to more efficientlytreat several conditions without anyside effects e.g. heart failure, arrhythmias, hypertonia<strong>and</strong> hyperlipidaemia.Transplantation as therapeutic methodsThe immunological research has resulted in newdrugs which counteract the rejection/reactionduring transplantation. Furthermore, it has createdconditions which will make heterologousorgan transplantation possible. Thus, the indicationsfor organ transplantation as a therapeuticmethod will be broadened <strong>and</strong> the dem<strong>and</strong>sfor surgical <strong>and</strong> nursing capacity increased. Thepresent situation can be summarised as follows:• Kidney, liver, heart, lungs <strong>and</strong> pancreas aretransplanted practically on a routine basis atdifferent centres specialising in transplantation• Transplantation of the intestine is still at aninitial stage• Great efforts are made to develop methodswhich will make it possible to use animalsas organ donors (xenotransplantation), particularlythe pig. Furthermore, extensiveresearch is carried out in order to solve theproblems connected to the rejection of insulin-producingcells from pig pancreas.• Transplantation of nerve cells (adrenal medullarcells <strong>and</strong> cells from brains of foetuses) isused in clinical trials to cure e. g. Parkinsons,Alzheimer, diabetes, epilepsy, damages of thespinal cord etc.Surgical therapy – consequences of thescientific revolution• “Classical” general surgery (ventricle, gallbladder, intestines etc.) will decrease, partlybecause of the development of new drugs<strong>and</strong> partly because of the introduction ofnew technologies (laparascopy). The remainingpart will primarily consist of cancer surgery,trauma surgery <strong>and</strong> reconstructive surgery.This will result in a reduced number ofin patients.• Emergency surgery will decrease <strong>and</strong> be concentratedto fewer hospitals. This will meanthe closing of smaller surgical clinics or turningthem into elective un<strong>its</strong>. Fewer <strong>and</strong> largerhigh-technology un<strong>its</strong> with high emergencycompetence will be formed. These structuralchanges will be most pronounced in thedensely populated areas whereas the thinlypopulated areas will be changed less.• Orthopaedic surgery. This will increase becauseof the rapid development of new materialsfor prosthesis <strong>and</strong> new drugs, whichwill speed up the healing process of fractures<strong>and</strong> damages of the soft tissues. It is possiblethat cell transplantation will be a new methodto treat damage of cartilage <strong>and</strong> bone. Improvedmethods to prevent <strong>and</strong> treat osteoporosiswill be used.• Laparascopic surgery will be used on widenedindications. The results of the methodwill be improved which will bring about amore extensive use of this technique.• Laser surgery will increase e.g. within gynaecology(early cancer in the cervix, vagina orlabia); urology (tumours of the urinary bladder,especially condyloma); otorhinolaryngology(cancer of the vocal cords <strong>and</strong> certaincases of cancer of the pharynx <strong>and</strong> larynx);<strong>and</strong> surgery of the coronary vessels.Therapy in psychiatric disordersConcerning therapy of psychiatric disordersthe development is mostly concentrated to a refinementof the psychopharmacological drugsthat are used today. Increased knowledge of thetransmission systems in the brain <strong>and</strong> the mode44 (IADH) International Academy for Design <strong>and</strong> Health
MEDICAL RESEARCH AND ITS IMPACT ON HEALTHCARE DESIGNof action of different drugs will make it possibleto improve the therapeutic precision <strong>and</strong>efficiency.• Selective drugs (serotonin inhibitors) withminimal side effects have been introduced<strong>and</strong> will be improved.• New drugs are being designed which will affectthe serotonin system according to a differentmechanism of action. These drugs willalso be effective against so called “therapyresistant”conditions.• The mode of action of lithium will be solvedwhich will create a basis for the developmentof new substances with less toxicity.• Development of more selective drugs withfewer side effects for the treatment of schizophrenia.• New methods for the optimisation of thedose of neuroleptica based on PET studiesof dopamine-receptor localisation.• A breakthrough in the underst<strong>and</strong>ing of thepathogenesis of schizophrenia can be expected.Therapy in the future – some speculations• Production of new types of drugs <strong>and</strong> vaccinesusing biotechnology. E.g. TPA producedby biotechnological methods will be usedin treatment of thrombosis in the brain <strong>and</strong>heart (acute myocardial infarction) <strong>and</strong> erythropoietinat anaemia caused by renal disorders.The genes coding for most of thelymphocytes have been sequenced which willmake recombinant substances available fortherapeutic use.• Gene therapy will be possible for monogeneticdiseases like Duchenne’s muscular dystrophy,using adenovirus vectors.• The etiological mechanisms behind the originof immunologicalinflammatory diseases likediabetes type 1, multiple sclerosis, rheumatoidarthritis will be solved <strong>and</strong> make preventionpossible.• HIV <strong>and</strong> AIDS treatment will be improvedby the introduction of new drugs. It is howeverdoubtful whether it will be possible tocreate a vaccine against HIV.• Vaccines against malaria, cholera <strong>and</strong> ordinarycold will be developed.Healthcare developmentThe development in the healthcare organisationis directed towards a process-oriented systemwhich honour keywords such as “patient orientation”,“knowledge navigation”, “coordination/feedback”<strong>and</strong> “benchmarking” <strong>and</strong> whichforms a logistic chain from “Social security system”– “Pre vention care” – “Primary medicalcare” – “Diag nostics” – “Therapeutics” – Rehabilita tion” – “Work/retirement” to “Follow-upmeasures” <strong>and</strong> includes patient-centred hospitals.The evolution can be illustrated as followsTodayFragmented servicesTreating illnessesAcute, inpatient careInstitutional measuresPerceived qualityIndividual IT systemsTomorrowContinuum of careManaging healthPreventive/primarycareCommunity measuresOutcome measures,report cardsIntegrated IT networksThis shift will most likely lead to a partial disintegrationof the omnipotent “Mega-institutions”,which try to cover everything in the medicalarea, <strong>and</strong> the formation of smaller customized<strong>and</strong> specialized un<strong>its</strong> which will collaborate inan integrated network, much based on moderninformation-communication technologies. Thehealth care system will gradually move from an“information hierarchy” to an “informationhyperarchy”. We will see the development ofa health network which integrates the informationflow related to the individual patient in thefollowing way.In this way it will be possible to integrate the45
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