Secured Healthcare Data Analytics on the Cloud Using Blockchain-Based Techniques

Blockchain and the internet of things (IoT) are progressive technologies that are changing the world with additional special care within the healthcare system. In healthcare, IoT is a remote patient monitoring system that allows IoT devices to collect patient information such as remote monitoring, test results, pharmacy detailsm and medical insurance details, and allows doctors to provide excellent care. In order to facilitate data sharing among different hospitals and other organizations, it is necessary to secure data with caution. Blockchain is a decentralized, distributed, and an immutable digital ledger that records healthcare transactions using peer-to-peer technology in an extremely secure manner. It uses the cloud environment to store the huge amount of data on healthcare. The data generated from IoT devices uses blockchain technology to share medical information being analyzed by healthcare professionals in different hospitals in a secure manner. The objective is to benefit patient monitoring remotely and overcome the problem of information blocking.

La coordinación de los equipos docentes para la adquisiciónde la competencia transversal de la comunicación: laexperiencia en el grado en odontología de la Universidaddel País Vasco (UPV/EHU)

En la atención asistencial, las habilidades de comunicación resultan fundamentales en el quehacer de los profesionales de la salud. La adquisición adecuada de dichas habilidades por parte del alumnado ha de ser uno de los objetivos de los equipos docentes. Conscientes de esta necesidad, en el grado en odontología de la UPV/EHU, se está llevando a cabo un proyecto de innovación educativa impulsando la labor y coordinación horizontal y vertical de los equipos docentes, dando lugar a las siguientes acciones: i, definición de una guía de habilidades comunicacionales; ii, diseño de actividades complejas basadas en escenarios realistas, implementadas mediante metodologías activas; iii, evaluación continua con la pertinente retroalimentación; y iv, seguimiento de todo el proceso con registro de evidencias. Tras un periodo de dos años, dicha evaluación está permitiendo tomar conciencia de los avances y dificultades presentes, tanto en el proceso como en la adquisición de algunos de los resultados de aprendizaje. La discusión, reflexión y consenso de los equipos docentes, intra e interasignatura, ha dado lugar a la mejora de las guías docentes, al rediseño de algunas de las actividades académicas, a un mayor grado de colaboración para la mejora de documentos de comunicación (ej.: consentimiento informado, elaboración de informes médicos) y para unificar criterios de evaluación, e, incluso, al diseño de talleres formativos sobre comunicación dirigidos al profesorado. Todo ello traerá consigo un impacto educativo, fruto del esfuerzo de los componentes de dichos equipos docentes que, sin duda, redundará en beneficio de la atención de los pacientes. In healthcare, communication skills are essential in the work of health professionals. The suitable acquisition of these skills by the students must therefore be one of the objectives of the teaching teams. Aware of this need, in the degree in dentistry at the UPV/EHU, an educational innovation project is being carried out by promoting the horizontal and vertical coordination and work of teaching teams, which has led to the following actions: i, definition of a communication skills guide; ii, design of complex activities based on realistic scenarios, implemented using active methodologies; iii, continuous assessment with pertinent feedback; and iv, monitoring of the entire process with evidence record. After a period of two years, we are becoming aware of the advances and difficulties present, both in the process and in the acquisition of some of the learning outcomes. The discussion, reflection and consensus of the teaching teams, intra and intersubject, has led to the improvement of the teaching guides, the redesign of some of the academic activities, a greater degree of collaboration for the improvement of communication documents (eg., informed consent, preparation of medical reports) and to unify evaluation criteria, and even the design of training workshops on communication aimed at teachers. All of this will have an educational impact, as a result of the efforts of the members of the teaching teams, that will undoubtedly benefit patient care.

Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?

BackgroundDespite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). Patients and methodsWe identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. ResultsMedian follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. ConclusionUrine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.

Shared Decision Making

Shared decision-making (SDM) is a process in which patients and providers work together to make medical decisions with a patient-centric focus, considering available evidence, treatment options, the patient’s values and goals, and risks and benefits. It is important for all providers to understand how to effectively use SDM in their interactions with patients to improve patients’ experiences throughout their healthcare journey. There are strategies to improve communication between patients and their providers, particularly when communicating quantitative data, risks and benefits, and treatment options. Decision aids (DAs) can help patients understand complex medical information and make an informed decision. This review contains 9 figures, 4 tables and 45 references Key words: Shared decision-making, decision-making, communication, risk and benefit, patient-centered, health literacy, quality of life, decision aids, option grid, pictographs.

The Royal College of Psychiatrists’ Leadership and Management Fellow Scheme

Summary The Royal College of Psychiatrists’ Leadership and Management Fellow Scheme aims to develop and support a new cohort of leaders within psychiatry. This article provides an introduction to the scheme, which is accessible to all higher trainees with the support of their host organisation. We explore its development, structure and how it is evolving to provide a strong platform for achieving the College's ambition to benefit patient care by embedding a culture of medical leadership within mental health services.

A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Direct observation (DO) of residents by supervisors is a highly recommended educational tool in postgraduate medical education, yet its uptake is poor. Residents and supervisors report various reasons for not engaging in DO. Some of these relate to their interaction with patients during DO. We do not know the patient perspectives on these interactions, nor, more broadly, what it is like to be a patient in a DO situation. Understanding the patient perspective may lead to a more complete understanding of the dynamics in DO situations, which may benefit patient wellbeing and improve the use of DO as an educational tool. We conducted a phenomenological interview study to investigate the experience of being a patient in a DO situation. Our analysis included multiple rounds of coding and identifying themes, and a final phase of phenomenological reduction to arrive at the essential elements of the experience. Constant reflexivity was at the heart of this process. Our results provide a new perspective on the role of the supervisor in DO situations. Patients were willing to address the resident, but sought moments of contact with, and some participation by, the supervisor. Consequently, conceptions of DO in which the supervisor thinks she is a fly on the wall rather than a part of the interaction, should be critically reviewed. To that end, we propose the concept of participative direct observation in workplace learning, which also acknowledges the observer’s role as participant. Embracing this concept may benefit both patients’ wellbeing and residents’ learning.

Adverse drug reactions associated with the use of biological agents

Introduction Biological drugs open new possibilities to treat diseases for which drug therapy is limited, but they may be associated with adverse drug reactions (ADRs). Objective To identify the ADRs associated with the use of biological drugs in Colombia. Methods This was a retrospective study of ADR reports from 2014 to 2019, contained in the database of Audifarma SA pharmacovigilance program. The ADRs, groups of associated drugs, and affected organs were classified. Results In total, 5,415 reports of ADRs associated with biological drugs were identified in 78 Colombian cities. A total of 76.1% of the cases corresponded to women. The majority were classified as type A (55.0%) and B (28.9%), and 16.7% were serious cases. The respiratory tract was the most affected organ system (16.8%), followed by the skin and appendages (15.6%). Antineoplastic and immunomodulatory drugs accounted for 70.6% of the reports, and the drugs related to the greatest number of ADRs were adalimumab (12.2%) and etanercept (11.6%). Conclusions The reporting of ADRs has increased in recent years and these reactions are mostly classified as tyoe A or B, categorized as serious in almost one-fifth of the reported cases and associated mainly with immunomodulators and antineoplastic agents. This type of study can support decision makers in ways that benefit patient safety and interaction with health systems.

In Silico-Enhanced Treatment and Rehabilitation Planning for Patients with Musculoskeletal Disorders: Can Musculoskeletal Modelling and Dynamic Simulations Really Impact Current Clinical Practice?

Over the past decades, the use of computational physics-based models representative of the musculoskeletal (MSK) system has become increasingly popular in many fields of clinically driven research, locomotor rehabilitation in particular. These models have been applied to various functional impairments given their ability to estimate parameters which cannot be readily measured in vivo but are of interest to clinicians. The use of MSK modelling and simulations allows analysis of relevant MSK biomarkers such as muscle and joint contact loading at a number of different stages in the clinical treatment pathway in order to benefit patient functional outcome. Applications of these methods include optimisation of rehabilitation programs, patient stratification, disease characterisation, surgical pre-planning, and assistive device and exoskeleton design and optimisation. This review provides an overview of current approaches, the components of standard MSK models, applications, limitations, and assumptions of these modelling and simulation methods, and finally proposes a future direction.

Public involvement and engagement in primary and emergency care research

BackgroundPolicy throughout the United Kingdom promotes involvement of patients and public members inresearch to benefit patient care and health outcomes. PRIME Centre Wales is a national researchcentre, developing and coordinating research about primary and emergency care which forms 90%of health service encounters. In this paper, we describe our approach to public involvement andengagement in PRIME Centre Wales (hereafter called PRIME), in particular: how this approachhas developed; ways in which public members contribute to PRIME activity; the strengths andlimitations of our approach, challenges and future opportunities. PRIME ensures work is relevantto service users, carers, the public and policy makers by incorporating comprehensive patient andpublic involvement in every phase of our work ApproachPRIME has policies and processes to enable and promote successful public involvement andengagement across research activities. This ensures public perspectives and patient experiences areintegrated throughout research development, implementation and dissemination and in managingand delivering PRIME strategy over a 10 year timescale. A public/patient group called SUPER is akey resource providing wide-ranging perspectives via email and face-to-face discussion. We collectinformation on processes and experiences to assess value and impact, to guide ongoing involvementand engagement. A funded post provides leadership and support to staff and to public/patientcontributors to facilitate collaborations. DiscussionA stable, well-resourced structure has provided the timescales to build strong relationships andembed diverse approaches to public involvement and engagement within PRIME. Researchers andpublic contributors have committed to collaborations, developed knowledge and skills and sustainedrelationships. Effective approaches incorporate values and actions which, when operating together,strengthen processes and outcomes of public involvement and engagement. ConclusionSupportive context, motivation and time are necessary to foster values and practices that enableeffective public involvement and engagement. PRIME has embedded public involvement andengagement across research activities and structures. Central is the public/patient group SUPERoffering experience-based expertise to add value to the research cycle. This innovative model, alignedwith best practice, enhances relevance and quality of primary and emergency care research to benefitpatients and the general population.