Privacy-Preserving Federated Neural Network Learning for Disease-Associated Cell Classification

Training accurate and robust machine learning models requires a large amount of data that is usually scattered across data-silos. Sharing or centralizing the data of different healthcare institutions is, however, unfeasible or prohibitively difficult due to privacy regulations. In this work, we address this problem by using a novel privacy-preserving federated learning-based approach, PriCell, for complex machine learning models such as convolutional neural networks. PriCell relies on multiparty homomorphic encryption and enables the collaborative training of encrypted neural networks with multiple healthcare institutions. We preserve the confidentiality of each institutions' input data, of any intermediate values, and of the trained model parameters. We efficiently replicate the training of a published state-of-the-art convolutional neural network architecture in a decentralized and privacy-preserving manner. Our solution achieves an accuracy comparable to the one obtained with the centralized solution, with an improvement of at least one-order-of-magnitude in execution time with respect to prior secure solutions. Our work guarantees patient privacy and ensures data utility for efficient multi-center studies involving complex healthcare data.

A Validated Questionnaire to Evaluate Primary Care Pediatrician Satisfaction With the Use of Teledermatology

Background Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. Objective This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. Methods We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. Results We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. Conclusions TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome. Conflict of Interest None declared.

The Use of Information Technology in the Construction of a Nursing Communication Platform System

In order to effectively connect patient care information and reduce the amount of administrative work, a nursing care communication platform can effectively achieve 1. Real-time display of patient information while protecting patient privacy; 2. Integration of hospital information system, with individualized medical care team information; 3. Accurate and timely delivery of need for patient report; 4. Increase of interaction between the patient’s family and staff and breakthrough from the limit of paper-based health education information.

A Validated Questionnaire to Evaluate Primary Care Pediatrician Satisfaction With the Use of Teledermatology (Preprint)

BACKGROUND Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. OBJECTIVE This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. METHODS We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. RESULTS We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. CONCLUSIONS TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome.

Hyperledger Healthchain: Patient-Centric IPFS-Based Storage of Health Records

Blockchain-based electronic health system growth is hindered by privacy, confidentiality, and security. By protecting against them, this research aims to develop cybersecurity measurement approaches to ensure the security and privacy of patient information using blockchain technology in healthcare. Blockchains need huge resources to store big data. This paper presents an innovative solution, namely patient-centric healthcare data management (PCHDM). It comprises the following: (i) in an on-chain health record database, hashes of health records are stored as health record chains in Hyperledger fabric, and (ii) off-chain solutions that encrypt actual health data and store it securely over the interplanetary file system (IPFS) which is the decentralized cloud storage system that ensures scalability, confidentiality, and resolves the problem of blockchain data storage. A security smart contract hosted through container technology with Byzantine Fault Tolerance consensus ensures patient privacy by verifying patient preferences before sharing health records. The Distributed Ledger technology performance is tested under hyper ledger caliper benchmarks in terms of transaction latency, resource utilization, and transaction per second. The model provides stakeholders with increased confidence in collaborating and sharing their health records.

An Efficient Watermarking Based Matrix Manipulation and Optimization Based Cryptographic Method for Privacy Preservation in Biomedical Data

The biomedical processing of images is an important aspect of the modern medicine field and has an immense influence on the modern world. Automatic device assisted systems are immensely useful in order to diagnose biomedical images easily, accurately and effectively. Remote health care systems allow medical professionals and patients to work from different locations. In addition, expert advice on a patient can be received within a prescribed period of time from a specialist in a foreign country or in a remote area. Digital biomedical images must be transmitted over the network in remote healthcare systems. But the delivery of the biomedical goods entails many security challenges. Patient privacy must be protected by ensuring that images are secure from unwanted access. Furthermore, it must be effectively maintained so that nothing will affect the content of biomedical images. In certain instances, data manipulation can yield dramatic effects. A biomedical image safety method was suggested in this work. The suggested method will initially be used to construct a binary pixel encoding matrix and then to adjust matrix with the use of decimation mutation DNA watermarking principle. Afterwards to defend the sub keys couple privacy which was considered over the logical uplift utilization of tent maps and purpose. As acknowledged by chaotic (C-function) development, the security was investigated similar to transmission in addition to uncertainty. Depending on the preliminary circumstances, various numbers of random were generated intended for every map as of chaotic maps. An algorithm of Multi scale grasshopper optimization resource with correlation coefficient fitness function and PSNR was projected for choosing the optimal public key and secret key of system over random numbers. For choosing the validation process of optimization is to formulate novel model more relative stable to the conventional approach. In conclusion, the considered suggested findings were contrasted with current approaches protection that was appear to be successful extremely.

Comparing Findings From a Friends of Cancer Research Exploratory Analysis of Real-World End Points With the Cancer Analysis System in England

PURPOSE This study compared real-world end points extracted from the Cancer Analysis System (CAS), a national cancer registry with linkage to national mortality and other health care databases in England, with those from diverse US oncology data sources, including electronic health care records, insurance claims, unstructured medical charts, or a combination, that participated in the Friends of Cancer Research Real-World Evidence Pilot Project 1.0. Consistency between data sets and between real-world overall survival (rwOS) was assessed in patients with immunotherapy-treated advanced non–small-cell lung cancer (aNSCLC). PATIENTS AND METHODS Patients with aNSCLC, diagnosed between January 2013 and December 2017, who initiated treatment with approved programmed death ligand-1 (PD-[L]1) inhibitors until March 2018 were included. Real-world end points, including rwOS and real-world time to treatment discontinuation (rwTTD), were assessed using Kaplan-Meier analysis. A synthetic data set, Simulacrum, on the basis of conditional random sampling of the CAS data was used to develop and refine analysis scripts while protecting patient privacy. RESULTS Characteristics (age, sex, and histology) of the 2,035 patients with immunotherapy-treated aNSCLC included in the CAS study were broadly comparable with US data sets. In CAS, a higher proportion (46.7%) of patients received a PD-(L)1 inhibitor in the first line than in US data sets (18%-30%). Median rwOS (11.4 months; 95% CI, 10.4 to 12.7) and rwTTD (4.9 months; 95% CI, 4.7 to 5.1) were within the range of US-based data sets (rwOS, 8.6-13.5 months; rwTTD, 3.2-7.0 months). CONCLUSION The CAS findings were consistent with those from US-based oncology data sets. Such consistency is important for regulatory decision making. Differences observed between data sets may be explained by variation in health care settings, such as the timing of PD-(L)1 approval and reimbursement, and data capture.

Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic

Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional–patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.

Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.