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2021 ◽  
Vol 50 (4) ◽  
pp. 674-685
Author(s):  
Bora Aslan ◽  
Kerem Ataşen

COVID-19 is a disease caused by a novel coronavirus originated in Wuhan, China. The virus rapidly spread over more than 200 countries around the world and caused deaths of more than 690.000 of people. To prevent rapid spreading of this disease, the information sharing related to the findings about the COVID-19 disease must be fast and secure between countries. Since the COVID-19 related health data such as the symptoms and private patient records are confidential, such information requires privacy protection. The blockchain and smart contracts are well-suited solutions for speed, privacy, and security needs of dissemination the COVID-19 related information. Blockchain based e-health solutions have been discussed for years. However, a pandemic is more important than the regular health problems. Thus, this study proposes how critical pandemic related information should be shared between the participating countries and can be accessed by health data actors such as researchers, doctors, laboratory staff, authorized institutions of different countries as well as the World Health Organization.


2021 ◽  
Author(s):  
Hannah Dahlen ◽  
Virginia Schmied ◽  
Cathrine Fowler ◽  
Lilian Peters ◽  
Simone Ormsby ◽  
...  

Abstract Background There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women. Methods A linked population data study of all women giving birth in NSW 2000-2012. Statistical differences were calculated using chi-square and student t-tests. Results In total 32 071 women and 33 035 babies were admitted to RPS with 5191 RPS women also having one or more hospital admissions (7607 admissions). There were 99 242 women not admitted to RPS but having hospital admissions (136 771 admissions). Women admitted to RPS who had a co-admission to a hospital were significantly more likely to be older, admitted as a private patient, born in Australia, having their first baby and be socially advantaged (p≤.001) compared to non-RPS admitted women also having a hospital admission. They also experienced more labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy), and were more likely to have multiple births, a male infant and babies admitted to Special Care Nursery/Neonatal Intensive Care (p≤.001). Additionally, these women were more likely to have another admission for mental health and behavioural disorders (p≤.001), and this appeared to increase over time. There was no between cohort differences regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses. Conclusion Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.


2021 ◽  
Vol 13 (3) ◽  
Author(s):  
Sami Hyrynsalmi ◽  
Sonja M. Hyrynsalmi ◽  
Kai K. Kimppa

Blockchain is a software innovation which is based on a cryptographically secured, decentralised, and distributed storage of data. The technological breakthrough was done as a part of and became familiar through cryptocurrencies, where it is used to openly store currency transactions among its users. Blockchain technology has been since proposed and used in various domains ranging from open contracts to electronic voting—as well as in various purposes in eHealth, medical and well-being applications. However, its usage in these sectors possesses several ethical questions as these environments are full of personal and private patient information. To study the state-of-the-art of the blockchain ethics in healthcare, this study presents a systematic literature study (SLR) on this phenomenon. By collecting the relevant primary studies from Scopus, the results show that the utilisation of blockchain is swiftly maturing with new research and applications published constantly in this domain. However, the ethical discussion related to the use of blockchain technologies is still taking its baby steps in healthcare. Despite a few openings, ethical research is practically non-existing when compared against the full extant literature on the topic. Therefore, remarkable amount of further work is needed to cover the potential ethical questions related to the adoption and use of the technology.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Samantha Quah ◽  
Hock Ping Cheah ◽  
Kenneth Wong

Abstract Aim Under the Australian Medicare Scheme, Australian residents are covered for many hospital-related costs. Patients with private insurance presenting with appendicitis can elect to be admitted as a private patient. Despite the stereotypes, little is known on whether the patients’ health cover actually affect clinical outcomes. This study aims to compare the differences in patient outcomes between public and private patients after undergoing operative management for appendicitis. Methods A multi-centre prospectively collected health service database of all appendicectomies performed over a 16-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon, complications and mortality rates were analysed. Results Of the total of 652 patients who underwent an appendicectomy, 203 patients were private, 444 patients were public, and 5 were overseas patients. During the post-operative period, public patients had higher rates of representation to the Emergency Department (ED) for post-operative symptoms (public 12.8% vs private 4.4%, p 0.0007, two-tailed chi square test). In comparison, the rate of post-operative complications with Clavien-Dindo (CD) score ≥ 2 is similar in both groups (p = 0.18, public 4.5% vs private 2%). There were no mortalities recorded for both groups. Conclusion Public patients have higher representation rates to the emergency department after an appendicectomy however post-operative outcomes are similar in both groups in our health system. The difference in complication rates were not significant with both groups recording low complication rates of under 5%.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. A. Dakka ◽  
T. V. Nguyen ◽  
J. M. M. Hall ◽  
S. M. Diakiw ◽  
M. VerMilyea ◽  
...  

AbstractThe detection and removal of poor-quality data in a training set is crucial to achieve high-performing AI models. In healthcare, data can be inherently poor-quality due to uncertainty or subjectivity, but as is often the case, the requirement for data privacy restricts AI practitioners from accessing raw training data, meaning manual visual verification of private patient data is not possible. Here we describe a novel method for automated identification of poor-quality data, called Untrainable Data Cleansing. This method is shown to have numerous benefits including protection of private patient data; improvement in AI generalizability; reduction in time, cost, and data needed for training; all while offering a truer reporting of AI performance itself. Additionally, results show that Untrainable Data Cleansing could be useful as a triage tool to identify difficult clinical cases that may warrant in-depth evaluation or additional testing to support a diagnosis.


2021 ◽  
Author(s):  
Juan C Quiroz ◽  
David Brieger ◽  
Louisa Jorm ◽  
Raymond W Sy ◽  
Michael O Falster ◽  
...  

Objective: To investigate clinical and health system factors associated with receiving catheter ablation (CA) for non-valvular atrial fibrillation (AF). Study Design and Setting: We used hospital administrative data linked with death registrations in New South Wales, Australia for patients with a primary diagnosis of AF between 2009 and 2017. We investigated factors associated with receiving CA (using Cox regression) and early ablation (using logistic regression). Results: Cardioversion during index admission (hazard ratio [HR] 1.96; 95% CI 1.75-2.19), year of index admission (HR 1.07; 1.07; 95% CI 1.05-1.10), private patient status (HR 2.65; 95% CI 2.35-2.97), and living in more advantaged areas (HR 1.18; 95% CI 1.13-1.22) were associated with a higher likelihood of receiving CA. Private patient status (odds ratio [OR] 2.04; 95% CI 1.59-2.61) and a history of cardioversion (OR 1.25; 95% CI 1.0-1.57) and diabetes (OR 1.6; 95% CI 1.06-2.41) were associated with receiving early ablation. Conclusion: Beyond clinical factors, private patients are more likely to receive CA and earlier ablation than their public counterparts. Whether the earlier access to ablation procedures in private patients is leading to differences in outcomes among patients with atrial fibrillation remains to be explored.


2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Juliana de Oliveira Costa ◽  
Sallie-Anne Pearson ◽  
Adam Elshaug ◽  
Kees van Gool ◽  
Louisa Jorm ◽  
...  

Abstract Background Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients. Methods We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models. Results Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant. Conclusions Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured. Key messages Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level.


Author(s):  
Nandhini Subramanian ◽  
Somaya Al-Maadeed

Background: The COVID-19 pandemic has been life-threatening for many people and as such, a contactless medical system is necessary to prevent the spread of the virus. Smart healthcare systems collect data from patients at one end and process the acquired data at the other end. The cloud is the central point and the communication happens through insecure channels. The main concern, in this case, is the violation of privacy and security as the channel is untrusted. Traditional methods do not provide enough hiding capacity, security, and robustness. This work proposes an image steganography method using the deep learning method to hide the patient's medical images inside an innocent cover image in such a way that they are not visible to human eyes which reduces the suspicions of the presence of sensitive data. Methods: An auto encoder-decoder-based model is proposed with three components: the pre-processing module, the embedding network, and the extraction network. Features from the cover image and the secret images are extracted and fused to reconstruct the stego image. The stego image is then used to extract the ingrained secret image.shows the overall system workflow. Results: Peak Signal-to-Noise Ratio (PSNR) is the evaluation metrics used. The ImageNet dataset was used for training and testing the proposed model.shows the image results of the proposed method. Conclusion: During a COVID-19 screening test, private patient data such as mobile number and Qatari identity card are collected, transferred, and stored through untrusted channels. It is of paramount importance to preserve the privacy, security, and confidentiality of the collected patient records. A secure deep learning-based image steganography method is proposed to secure the sensitive data transferred through untrusted channels in a cloud-based system.


Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3753
Author(s):  
Leila Ismail ◽  
Huned Materwala ◽  
Alain Hennebelle

Blockchain is a disruptive technology for shaping the next era of a healthcare system striving for efficient and effective patient care. This is thanks to its peer-to-peer, secure, and transparent characteristics. On the other hand, cloud computing made its way into the healthcare system thanks to its elasticity and cost-efficiency nature. However, cloud-based systems fail to provide a secured and private patient-centric cohesive view to multiple healthcare stakeholders. In this situation, blockchain provides solutions to address security and privacy concerns of the cloud because of its decentralization feature combined with data security and privacy, while cloud provides solutions to the blockchain scalability and efficiency challenges. Therefore a novel paradigm of blockchain-cloud integration (BcC) emerges for the domain of healthcare. In this paper, we provide an in-depth analysis of the BcC integration for the healthcare system to give the readers the motivations behind the emergence of this new paradigm, introduce a classification of existing architectures and their applications for better healthcare. We then review the development platforms and services and highlight the research challenges for the integrated BcC architecture, possible solutions, and future research directions. The results of this paper will be useful for the healthcare industry to design and develop a data management system for better patient care.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 166.1-167
Author(s):  
Y. Oh ◽  
A. Hennessey ◽  
L. Young ◽  
D. Yates ◽  
C. Barrett

Background:Telehealth via phone (TPhone) or video conference (TVideo) in rheumatology has been a topic of interest for many years. Its use was rapidly expanded due to the international public health emergency of coronavirus disease-19 (COVID-19) outbreak in 2020. Australian Medicare Benefits Schedule (MBS) swiftly enabled temporary MBS telehealth items on 13 March 2020, currently extended until 31 March 20211. In the early phase of the COVID-19 pandemic, Antony et al. conducted a single-centre public survey to assess patient perception of rheumatology telehealth. Their results showed that 98.4% of patients consider telehealth acceptable during the pandemic2. It is unclear, however, whether this positive perception persists after patients experience a telehealth. In addition, a survey data in 2019 suggested more than half of Australian rheumatologists work in private practice3. Therefore, inclusion of private patients will better represent patient perception of telehealth.Objectives:The aim of this study was to evaluate patient satisfaction with telehealth during the COVID-19 pandemic. This would determine its feasibility to be integrated in future rheumatology outpatient model.Methods:A questionnaire containing 30 questions was sent to rheumatology patients who attended telehealth appointments at a level 2 public hospital and a local private clinic between April and May 2020. The questionnaires aimed to obtain information on baseline demographics (sex, age, public or private patient, employment status, visual or auditory impairment), appointment details (TPhone or TVideo, usual arrangement for face-to-face (F2F) appointment, cost effectiveness) and appointment satisfaction using a 5-point Likert scale. Descriptive statistical analysis was conducted.Results:The questionnaire was sent to 1452 patients, of which 494 patients responded (34%). Female predominance (77.1%) and a higher proportion of TPhone (79.1%) was seen in the respondents. A majority of patients were existing patients known to the services (90.9%). More than 70% of responses indicated overall satisfaction in specialist care via telehealth, and 88.7% perceived this suitable during a pandemic. Of all respondents, 21.7% were prescribed new medication, and the majority of these patients were confident in taking the new medication after the telehealth appointment. Future acceptability for TPhone was significantly lower in private patients compared to public patients (p= 0.01). Subgroup analysis revealed that higher telehealth satisfaction was associated with needing to take time off work to attend face-to-face appointment (p= 0.02), perception of cost effectiveness (p<0.001) and TVideo (p=0.03).Conclusion:This is the first study which included both public and private rheumatology patients to evaluate patient satisfaction for telehealth during the COVID-19 pandemic. Overall high level of satisfaction was seen in telehealth most notably associated with its cost effectiveness. A higher percentage of patients who had TVideo compared to TPhone were receptive to future telehealth via TVideo, supportive of the importance of visual cues. This in turn will have significant administrative and technological burdens to coordinate in comparison to a F2F or TPhone review. This qualitative study provides valuable insight of patient perception of telehealth, which has the potential to compliment the traditional rheumatology outpatient model of care following the pandemic.References:[1]COVID-19 Temporary MBS Telehealth Services 2020 [Available from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB.[2]Antony A, Connelly K, De Silva T, Eades L, Tillett W, Ayoub S, et al. Perspectives of Patients With Rheumatic Diseases in the Early Phase of COVID-19. Arthritis Care & Research. 2020;72(9):1189-95.[3]Association AR. Workforce Survey Exective Summary 2019 2019 [Available from: https://rheumatology.org.au/members/documents/WorkforceSurveyExecutiveSummary-websiteMay2019.pdf.Acknowledgements:University of QueenslandNursing staff at Redcliffe Hospital and Administration officers at Redcliffe & Northside RheumatologyDisclosure of Interests:None declared


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