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.

A Case Report: Post-Operative Physiotherapy Rehabilitation Program for a Patient with Tibial Osteosarcoma

Tumour or bone tumour can occur in any bone and called it as a Osteosarcoma. It is more prone in the long bones of the body especially at metaphyseal growth plate of the bone. Femur, Tibia and Humours are the most common bone for the osteosarcoma and in some research pelvis bone and skull or jaw bone also involved. There are many factors which cause the sarcoma might be due lack of physical activity. The Chondroblastoma as Giant Cell Tumour of the Humours of Epiphysial Chondromatous in nature. Proximal humerus and Knee are the most common and most affected bone by the Chondroblastomas at the level of epiphyses of the longer bone. 62% cases show the thinning of the Subchondral structure and 33% cases shows the collapse and chondral breach Mostly (90%) it is found in the age group of 5 to 25 years of age with the male and female ratio is of 2:1. Psychological and physical improvement is seen in the patient of sarcoma and enhances participation in the exercise with great enthusiasm and help in the reduction the impact of symptoms of diseases. Physical therapy exercise protocol starts from low to moderate intensity which involved resistance exercise, aerobic exercise and combination of both exercises. Conclusion: Physiotherapy has been demonstrated to be useful in post-operative osteosarcoma patients in our case study. Physiotherapy assists the patient in de-stressing from both mental and physical stress. The goal of improving function through health-care management and goal-setting was met on schedule. Taking excellent care of yourself after surgery can help you avoid issues.

From Pandemic to Endemic–Redefining Excellence in Thoracic Surgery Service Delivery

Covid-19 has touched all corners of the globe and impacted our lives in more ways than one. Thoracic surgeons are frontliners impacted in both our professional and personal capacities. In this commentary we discuss the impact that Covid-19 has had on thoracic surgery as a practice highlighting the discrepant impact upon developed and developing countries, the state of affairs of the “new normal” that we live in and the challenges ahead as we transition from pandemic living to endemic living alongside Covid-19. We need to evolve as the virus does and keep abreast of the latest developments to continue providing excellent care to our patients. While the challenges brought about by the Covid-19 pandemic are unprecedented in this generation, it can bring forth tremendous opportunities for us to redefine excellence in thoracic surgery service delivery in this endemic times.

Reflections on Care: Older People Speak about Experiences of Nursing Care in Acute Medical and Surgical Wards

<p>This phenomenological study describes what it is like for people over 74 years to experience nursing care in acute medical and surgical wards, and relates their insights to implications for nursing practice. The six people who took part responded to newspaper stories inviting older people who had been in hospital recently to speak with a nurse researcher about the times they spent with nurses. They included eight episodes of hospitalisation in seven acute care public hospital wards. All chose to be interviewed in their own homes. The approach followed van Manen's (1990) method for researching lived experience. Their stories are contained in this thesis as individual chapters. The analysis moved from description largely in the respondents' own words, to the researcher's portrayal of the "free act of seeing" resulting in explication of salient features or structures of each story, and then to hermeneutic reflection using the four existentials of lived body, lived space, lived time and lived relation to others. Aggregation of the concerns revealed in each story illuminates the commonalities and differences of each and uncovers aspects of lived care for these people. Notions of care may be experienced negatively, as when care is absent or deficient in meeting patient need and expectation, or positively as when care is fully realised in the nurse-patient encounter. Nursing which includes negotiating the systems, mediating interpersonal issues, and practical help was excellent care for these patients. Value was given to the ability to quickly evaluate a patient's life ways of being and acknowledge these as of equal importance to the expected health outcomes from the particular medical diagnosis and intervention. The description of older people's experience of nursing care is useful for the potential to increase understanding of the needs and expectations of older people in acute wards. Through the phenomenological practice of reflecting and re-writing new perspectives on nursing are developed. These are expressed through myth and metaphor as one means of enhancing the caring work of nursing toward older people. The study offers some implications for nursing education, practice and the organisation of health (illness) care.</p>

Reflections on Care: Older People Speak about Experiences of Nursing Care in Acute Medical and Surgical Wards

<p>This phenomenological study describes what it is like for people over 74 years to experience nursing care in acute medical and surgical wards, and relates their insights to implications for nursing practice. The six people who took part responded to newspaper stories inviting older people who had been in hospital recently to speak with a nurse researcher about the times they spent with nurses. They included eight episodes of hospitalisation in seven acute care public hospital wards. All chose to be interviewed in their own homes. The approach followed van Manen's (1990) method for researching lived experience. Their stories are contained in this thesis as individual chapters. The analysis moved from description largely in the respondents' own words, to the researcher's portrayal of the "free act of seeing" resulting in explication of salient features or structures of each story, and then to hermeneutic reflection using the four existentials of lived body, lived space, lived time and lived relation to others. Aggregation of the concerns revealed in each story illuminates the commonalities and differences of each and uncovers aspects of lived care for these people. Notions of care may be experienced negatively, as when care is absent or deficient in meeting patient need and expectation, or positively as when care is fully realised in the nurse-patient encounter. Nursing which includes negotiating the systems, mediating interpersonal issues, and practical help was excellent care for these patients. Value was given to the ability to quickly evaluate a patient's life ways of being and acknowledge these as of equal importance to the expected health outcomes from the particular medical diagnosis and intervention. The description of older people's experience of nursing care is useful for the potential to increase understanding of the needs and expectations of older people in acute wards. Through the phenomenological practice of reflecting and re-writing new perspectives on nursing are developed. These are expressed through myth and metaphor as one means of enhancing the caring work of nursing toward older people. The study offers some implications for nursing education, practice and the organisation of health (illness) care.</p>

1092 Impact Of MSLT-II on Lymph Node Clearance Surgery in A Tertiary Plastic Surgery Centre

Aim Cutaneous malignant melanoma is a significant public health challenge in the United Kingdom. Wide local excision with Sentinel Lymph Node Biopsy (SLNB) is the current standard of treatment for most lesions. Some patients with positive SLNB would routinely undergo locoregional Lymph Node Clearance (LNC). Results of the Multicenter Selective Lymphadenectomy Trial II (MSLT-II) published in August 2017 challenged this approach, showing no melanoma specific survival benefit, but significant morbidity associated with routine LNC. Our study aims to show a change in practice at a tertiary plastic surgical referral centre in response to these results. Method We retrospectively reviewed our prospectively maintained database for all LNCs performed for cutaneous, non-head and neck malignant melanoma using the search terms ‘clearance’ and ‘dissection’ between 2015 and 2019. Results We performed 128 axillary and groin LNCs for cutaneous malignant melanoma 2015-2019. The range of LNCs per year varied from 38 in 2015 to 10 in 2019 (mean 25.6, median 28). The total number of LNCs, as well as LNCs performed following positive SLNB decreased after August 2017. Conclusions The data shows that our centre acknowledged evidence and reduced the number of LNCs performed after publication of MSLT-II. We expect that the number of avoided LNCs has saved significant resources due to reduced length of stay, and avoided our patient’s significant morbidity, including seromas, infections and lymphoedema. We recommend all skin cancer treatment centres to follow the evidence in order to provide excellent care and save resources.

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains—the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system—and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions—for example, between demand management and patient choice—leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.

Joy in the Workplace: The Mayo Clinic Experience

The COVID-19 pandemic has changed dynamics in the healthcare setting, through social distancing guidelines and new protocols to promote safety for employees and patients. Although some find themselves more productive in this spread out or virtual environment, the social aspect of the work day has dramatically changed. Staying connected during the day or week comes with additional efforts to seek out opportunities to network and collaborate with colleagues with this work environment shift. Healthcare workers are already at high risk of occupational burnout. In addition, the COVID-19 pandemic has brought additional stressors to individuals outside of their workload compromising a balanced work–life integration. Consequently, personal well-being may become jeopardized due to physical, mental, and social constraints brought on by the pandemic. Mayo Clinic has implemented a joy in the workplace structure to support individual well-being and create space for healthcare workers to be energized in order to put the needs of the patient first and deliver excellent care. Joy at Mayo Clinic contributes to joy in the workplace, reduced burnout, and personal well-being.

Person-Centered Care Coordination Next Steps in a Long Journey

Citizens of the Netherlands receive excellent care, when they need it, insurance based funded according to the solidarity principle. Maintaining this system is a huge challenge, as we live longer and the demand for care is growing. With an increasing percentage of multi-morbidity in all age groups the need for integrated network organized care is growing at equal pace. Gradually the need to shift focus to prevention is increasingly understood, but a challenging business model is still lacking. The involvement of citizens in maintaining their health requires a focus on managing the social determinants of health. The concept of the holistic problem list and the overarching care plan provides a unique way to combine both health and disease management. Our vision is to bring control to the patient and promote coordination of all active problems across the health and social care network.