A Proxy-Based Solution for Asynchronous Telemedical Systems

Asynchronous telemedicine systems face many challenges related to information security as the patient's sensitive information and data on medicine dosage is transmitted over a network when monitoring patients and controlling asynchronous telemedical IoT devices. This information may be modified or spied on by a malicious adversary. To make asynchronous telemedicine systems more secure, the authors present a proxy-based solution against data modification and spying attacks in web-based telemedical applications. By obfuscating the executable code of a web application and by continuously dynamically changing obfuscation, the authors' solution makes it more difficult for a piece of malware to attack its target. They use a constructive research approach. They characterize the threat and present an outline of a proposed solution. The benefits and limitations of the proposed solution are discussed. Cyber-attacks targeted at the information related to patient's care are a serious threat in today's telemedicine. If disregarded, these attacks have negative implications on patient safety and quality of care.

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A Proxy-Based Solution for Asynchronous Telemedical Systems

International Journal of E-Health and Medical Communications ◽

10.4018/ijehmc.2017070105 ◽

2017 ◽

Vol 8 (3) ◽

pp. 70-83 ◽

Cited By ~ 1

Author(s):

Sampsa Rauti ◽

Janne Lahtiranta ◽

Heidi Parisod ◽

Sami Hyrynsalmi ◽

Sanna Salanterä ◽

...

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Web Application ◽

Cyber Attacks ◽

Research Approach ◽

Sensitive Information ◽

Web Based ◽

Malicious Adversary ◽

Iot Devices

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Access to care and worsening eating disorder symptomatology in youth during the COVID-19 pandemic

Journal of Eating Disorders ◽

10.1186/s40337-021-00421-9 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Rebecca Spigel ◽

Jessica A. Lin ◽

Carly E. Milliren ◽

Melissa Freizinger ◽

Julia A. Vitagliano ◽

...

Keyword(s):

Quality Of Care ◽

Eating Disorder ◽

Access To Care ◽

Treatment Quality ◽

Related Factors ◽

Web Based ◽

Face To Face ◽

Recovery Study ◽

And Behaviors

Abstract Background Shelter-in-place orders and social distancing guidelines, in response to the COVID-19 pandemic, have limited traditional face-to-face interactions and led to many clinical providers transitioning to the use of videoconferencing platforms. The present study aims to assess how the COVID-19 pandemic has impacted adolescents’/young adults’ (AYA) eating disorder (ED)-related care, and how access to, changes in, perceived disruptions to, and quality of care are associated with ED thoughts and behaviors. Methods AYA enrolled in the RECOVERY study, a pre-existing web-based longitudinal study, and completed a COVID-19-specific survey (n = 89). We examined bivariate associations of four markers of care: i) access to care, ii) changes in care, iii) perceived disruption to care, and iv) quality of care. Using multiple logistic regression, we examined the associations of pandemic-related markers of care with changes in ED thoughts and behaviors. We excluded those not engaged in treatment pre-pandemic (n = 16). Results In the remaining 73 participants, reported access to care was high, with 92% of respondents continuing care with at least one ED provider during the pandemic; however, 47% stopped some treatment during the pandemic. Nearly one-third (32%) perceived a disruption in treatment. Quality of care remained high with 67% reporting care to be better than or as good as pre-pandemic. Respondents acknowledged heightened symptomatology: 81% reported increased ED thoughts and 81% reported increased ED behaviors due to COVID-19-related factors. However, none of the markers of care described were significantly associated with ED thoughts or behaviors in regression analyses adjusting for demographic variables and baseline characteristics, except our quality of care measure which was approaching significance (p = 0.07). Conclusions Our findings show the majority of AYA who had care prior to the pandemic continued receiving some element of their multi-disciplinary ED treatment and perceived their care as high quality. None of the markers of care described were statistically associated with increased ED thoughts and behaviors.

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A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

Applied Clinical Informatics ◽

10.1055/s-0041-1722916 ◽

2021 ◽

Vol 12 (02) ◽

pp. 199-207

Author(s):

Liang Yan ◽

Thomas Reese ◽

Scott D. Nelson

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Controlled Trials ◽

Clinical Pharmacists ◽

Randomized Controlled ◽

The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

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Relationship Between Performance Measurement and Accreditation: Implications for Quality of Care and Patient Safety

American Journal of Medical Quality ◽

10.1177/1062860605277076 ◽

2005 ◽

Vol 20 (5) ◽

pp. 239-252 ◽

Cited By ~ 59

Author(s):

Marlene R. Miller ◽

Peter Pronovost ◽

Michele Donithan ◽

Scott Zeger ◽

Chunliu Zhan ◽

...

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Performance Measurement

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Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

Global Journal of Health Science ◽

10.5539/gjhs.v8n6p75 ◽

2015 ◽

Vol 8 (6) ◽

pp. 75 ◽

Cited By ~ 4

Author(s):

Mu'taman Jarrar ◽

Hamzah Abdul Rahman ◽

Mohammad Sobri Don

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Health Plan ◽

Care Service ◽

Health Care Service ◽

Working Environment ◽

Annual Reports ◽

Related Factors ◽

Global Initiatives

BACKGROUND & OBJECTIVE: Demand for health care service has significantly increased, while the quality of healthcare has become both a national and an international priority. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.DESIGN: A narrative review of the literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) and the MOH Annual Reports in Malaysia were reviewed.RESULTS: The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.CONCLUSION: There is no single intervention of optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

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Adjustment of oxygen use by means of pulse oximetry: an important tool for patient safety

Einstein (São Paulo) ◽

10.1590/s1679-45082010ao1377 ◽

2010 ◽

Vol 8 (4) ◽

pp. 449-455 ◽

Cited By ~ 5

Author(s):

Telma de Almeida Busch Mendes ◽

Paola Bruno de Araújo Andreoli ◽

Leny Vieira Cavalheiro ◽

Claudia Talerman ◽

Claudia Laselva

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Physical Therapy ◽

Confidence Interval ◽

Pulse Oximetry ◽

Patient Care ◽

Physical Therapists ◽

Severe Damage ◽

Margin Of Error

ABSTRACT Objective: To assess patient's level of oxygenation by means of pulse oximetry, avoiding hypoxia (that causes rapid and severe damage), hyperoxia, and waste. Methods: Calculations were made with a 7% margin of error and a 95% confidence interval. Physical therapists were instructed to check pulse oximetry of all patients with prescriptions for physical therapy, observing the scheduled number of procedures. Results: A total of 129 patients were evaluated. Hyperoxia predominated in the sectors in which the patient was constantly monitored and hypoxia in the sectors in which monitoring was not continuous. Conclusions: Professionals involved in patient care must be made aware of the importance of adjusting oxygen use and the risk that non-adjustment represents in terms of quality of care and patient safety.

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Use of medical emergency call data as a marker of quality of emergency department care in the post-National Emergency Access Target era

Australian Health Review ◽

10.1071/ah17089 ◽

2018 ◽

Vol 42 (5) ◽

pp. 607

Author(s):

Lorraine Westacott ◽

Judy Graves ◽

Mohsina Khatun ◽

John Burke

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Quality Of Care ◽

Emergency Admission ◽

Emergency Call ◽

Medical Emergency ◽

Negative Consequences ◽

Model Of Care ◽

Emergency Calls

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, ‘THERMoSTAT’ (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women’s Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222 645 presentations, 68 000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24 h or first 4 h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.

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