Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrob...Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。展开更多
The advent of pandemics such as COVID-19 significantly impacts human behaviour and lives every day.Therefore,it is essential to make medical services connected to internet,available in every remote location during the...The advent of pandemics such as COVID-19 significantly impacts human behaviour and lives every day.Therefore,it is essential to make medical services connected to internet,available in every remote location during these situations.Also,the security issues in the Internet of Medical Things(IoMT)used in these service,make the situation even more critical because cyberattacks on the medical devices might cause treatment delays or clinical failures.Hence,services in the healthcare ecosystem need rapid,uninterrupted,and secure facilities.The solution provided in this research addresses security concerns and services availability for patients with critical health in remote areas.This research aims to develop an intelligent Software Defined Networks(SDNs)enabled secure framework for IoT healthcare ecosystem.We propose a hybrid of machine learning and deep learning techniques(DNN+SVM)to identify network intrusions in the sensor-based healthcare data.In addition,this system can efficiently monitor connected devices and suspicious behaviours.Finally,we evaluate the performance of our proposed framework using various performance metrics based on the healthcare application scenarios.the experimental results show that the proposed approach effectively detects and mitigates attacks in the SDN-enabled IoT networks and performs better that other state-of-art-approaches.展开更多
Most of the neural network architectures are based on human experience,which requires a long and tedious trial-and-error process.Neural architecture search(NAS)attempts to detect effective architectures without human ...Most of the neural network architectures are based on human experience,which requires a long and tedious trial-and-error process.Neural architecture search(NAS)attempts to detect effective architectures without human intervention.Evolutionary algorithms(EAs)for NAS can find better solutions than human-designed architectures by exploring a large search space for possible architectures.Using multiobjective EAs for NAS,optimal neural architectures that meet various performance criteria can be explored and discovered efficiently.Furthermore,hardware-accelerated NAS methods can improve the efficiency of the NAS.While existing reviews have mainly focused on different strategies to complete NAS,a few studies have explored the use of EAs for NAS.In this paper,we summarize and explore the use of EAs for NAS,as well as large-scale multiobjective optimization strategies and hardware-accelerated NAS methods.NAS performs well in healthcare applications,such as medical image analysis,classification of disease diagnosis,and health monitoring.EAs for NAS can automate the search process and optimize multiple objectives simultaneously in a given healthcare task.Deep neural network has been successfully used in healthcare,but it lacks interpretability.Medical data is highly sensitive,and privacy leaks are frequently reported in the healthcare industry.To solve these problems,in healthcare,we propose an interpretable neuroevolution framework based on federated learning to address search efficiency and privacy protection.Moreover,we also point out future research directions for evolutionary NAS.Overall,for researchers who want to use EAs to optimize NNs in healthcare,we analyze the advantages and disadvantages of doing so to provide detailed guidance,and propose an interpretable privacy-preserving framework for healthcare applications.展开更多
Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge...Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.展开更多
The healthcare data requires accurate disease detection analysis,real-timemonitoring,and advancements to ensure proper treatment for patients.Consequently,Machine Learning methods are widely utilized in Smart Healthca...The healthcare data requires accurate disease detection analysis,real-timemonitoring,and advancements to ensure proper treatment for patients.Consequently,Machine Learning methods are widely utilized in Smart Healthcare Systems(SHS)to extract valuable features fromheterogeneous and high-dimensional healthcare data for predicting various diseases and monitoring patient activities.These methods are employed across different domains that are susceptible to adversarial attacks,necessitating careful consideration.Hence,this paper proposes a crossover-based Multilayer Perceptron(CMLP)model.The collected samples are pre-processed and fed into the crossover-based multilayer perceptron neural network to detect adversarial attacks on themedical records of patients.Once an attack is detected,healthcare professionals are promptly alerted to prevent data leakage.The paper utilizes two datasets,namely the synthetic dataset and the University of Queensland Vital Signs(UQVS)dataset,from which numerous samples are collected.Experimental results are conducted to evaluate the performance of the proposed CMLP model,utilizing various performancemeasures such as Recall,Precision,Accuracy,and F1-score to predict patient activities.Comparing the proposed method with existing approaches,it achieves the highest accuracy,precision,recall,and F1-score.Specifically,the proposedmethod achieves a precision of 93%,an accuracy of 97%,an F1-score of 92%,and a recall of 92%.展开更多
Aging and crises like pandemics and climate change are global concerns that affect community environments. These social and natural changes influence people’s health worldwide. Aging impacts human health, including p...Aging and crises like pandemics and climate change are global concerns that affect community environments. These social and natural changes influence people’s health worldwide. Aging impacts human health, including physical and mental aspects, and increases the need for care. Recent crises have affected not only the elderly but also younger populations, necessitating further efforts to develop a systematic community strategy. The goal of such a strategy is to maintain or enhance people’s well-being. As we face aging and crises like pandemics and climate change, it becomes essential to consider health holistically and globally, taking into account the community environment and social determinants without boundaries. The present study aimed to explore the necessary aspects of incorporating social determinants into clinical practice, enabling healthcare providers to view health from a holistic and planetary perspective. This approach facilitates the development of integrated community strategies. The study reviewed literature from PubMed, MEDLINE, and CINAHL databases, focusing on medicine, health, and welfare. An electronic search for English-language articles in peer-reviewed journals was conducted up to July 2024, using search terms such as “holistic health,” “planetary health,” and “social determinants.” Eight articles were identified through the search. After excluding three based on their titles, abstracts, and full texts, five articles were selected. The research focused on three areas: perceiving health in ecosystems, considering health-related policy in clinical situations, and addressing health in primary care settings. This study emphasizes the need for further research on innovative, integrated community strategies in the context of a globally aging society, focusing on non-medical aspects like pandemics, climate change, and social determinants to achieve a holistic and planetary understanding of people’s health. It suggests that understanding the social aspects of ecosystems in clinical settings, through interdisciplinary collaboration, is crucial for developing systematic community strategies for people’s well-being life in medical, health, and welfare contexts.展开更多
Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers s...Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers sustain Needle stick injuries each year. This study was conducted to assess healthcare workers’ knowledge, attitude and practices regarding needle stick injury. Materials & Methods: A cross-sectional study was conducted in a Tertiary Care Hospital over the period of 3 months. The study population consisted of Intern Doctors, Post Graduate resident Doctors, Staff Nurses, laboratory technicians of Government Medical College and New Civil Hospital, Surat (n = 300). The data were collected using a self-administered questionnaire via the means of Google Forms. Questionnaire was made with prior review literature. The data obtained were entered and analysed in Microsoft Excel. Results: The prevalence of NSI in our study was 46%, with a higher prevalence among the PG residents (72%). Overall scores regarding knowledge and attitude were better in PG residents (knowledge score > 7 in 71% and Attitude Score > 7 in 68% of PG Residents). Even though the PG residents scored highest in the knowledge category, the majority of them suffered needle stick injuries as a result of poor practice scores. Among those who had NSI (n = 139/300), 70% of study participants had superficial injuries, only 9% reported the incident, 18% got medical attention within 2 hours of the incident, and 7% followed up to recheck their viral markers status. Most incidents of NSI were due to hypodermic needles while recapping needles. Conclusion: Exposure to needle stick injuries and their underreporting remains a common problem. It is imperative that healthcare workers receive regular training on the proper handling of sharp objects. We can also draw the conclusion that preventing NSIs requires putting knowledge into practice.展开更多
Federated learning is an innovative machine learning technique that deals with centralized data storage issues while maintaining privacy and security.It involves constructing machine learning models using datasets spr...Federated learning is an innovative machine learning technique that deals with centralized data storage issues while maintaining privacy and security.It involves constructing machine learning models using datasets spread across several data centers,including medical facilities,clinical research facilities,Internet of Things devices,and even mobile devices.The main goal of federated learning is to improve robust models that benefit from the collective knowledge of these disparate datasets without centralizing sensitive information,reducing the risk of data loss,privacy breaches,or data exposure.The application of federated learning in the healthcare industry holds significant promise due to the wealth of data generated from various sources,such as patient records,medical imaging,wearable devices,and clinical research surveys.This research conducts a systematic evaluation and highlights essential issues for the selection and implementation of federated learning approaches in healthcare.It evaluates the effectiveness of federated learning strategies in the field of healthcare.It offers a systematic analysis of federated learning in the healthcare domain,encompassing the evaluation metrics employed.In addition,this study highlights the increasing interest in federated learning applications in healthcare among scholars and provides foundations for further studies.展开更多
Racial, ethnic, and socioeconomic disparities present daunting hurdles that prevent equitable health outcomes for patients with end-stage kidney disease (ESKD) on hemodialysis. Additional resources, such as the Novel ...Racial, ethnic, and socioeconomic disparities present daunting hurdles that prevent equitable health outcomes for patients with end-stage kidney disease (ESKD) on hemodialysis. Additional resources, such as the Novel Intervention in Children’s Health (NICH) at Lucille Packard Children’s Hospital Stanford, provide individualized support to best assist families by assessing barriers to care with the goal of improving health outcomes. In this retrospective cohort study, we reviewed patients with ESKD on hemodialysis involved in NICH to explore if NICH serves as a liaison between the patients and multidisciplinary medical team and to explore if NICH helps patients better manage the challenges of end-stage kidney disease. Through the electronic medical record system, EPIC, we reviewed the patients’ surveys to identify barriers to care, which included school and life engagement difficulty, lack of mental health resources, food and transportation insecurity, and cultural/language barriers. We also tracked the number of hospitalizations and ED visits before and during the patients’ enrollment in NICH. We discovered that through NICH, the aforementioned barriers to care were eliminated, the number of hospitalizations and emergency department visits was reduced, and all patients transitioned from inactive to active on the transplant list. NICH successfully improved the health outcomes of these patients and empowered patients to be more engaged in their care.展开更多
Explainable Artificial Intelligence(XAI)has an advanced feature to enhance the decision-making feature and improve the rule-based technique by using more advanced Machine Learning(ML)and Deep Learning(DL)based algorit...Explainable Artificial Intelligence(XAI)has an advanced feature to enhance the decision-making feature and improve the rule-based technique by using more advanced Machine Learning(ML)and Deep Learning(DL)based algorithms.In this paper,we chose e-healthcare systems for efficient decision-making and data classification,especially in data security,data handling,diagnostics,laboratories,and decision-making.Federated Machine Learning(FML)is a new and advanced technology that helps to maintain privacy for Personal Health Records(PHR)and handle a large amount of medical data effectively.In this context,XAI,along with FML,increases efficiency and improves the security of e-healthcare systems.The experiments show efficient system performance by implementing a federated averaging algorithm on an open-source Federated Learning(FL)platform.The experimental evaluation demonstrates the accuracy rate by taking epochs size 5,batch size 16,and the number of clients 5,which shows a higher accuracy rate(19,104).We conclude the paper by discussing the existing gaps and future work in an e-healthcare system.展开更多
In an attempt to assess the Kenyan healthcare system, this study looks at the current efforts that are already in place, what challenges they face, and what strategies can be put into practice to foster interoperabili...In an attempt to assess the Kenyan healthcare system, this study looks at the current efforts that are already in place, what challenges they face, and what strategies can be put into practice to foster interoperability. By reviewing a variety of literature and using statistics, the paper ascertains notable impediments such as the absence of standard protocols, lack of adequate technological infrastructure, and weak regulatory frameworks. Resultant effects from these challenges regarding health provision target enhanced data sharing and merging for better patient outcomes and allocation of resources. It also highlights several opportunities that include the adoption of emerging technologies, and the establishment of public-private partnerships to strengthen the healthcare framework among others. In this regard, the article provides recommendations based on stakeholder views and global best practices addressed to policymakers, medical practitioners, and IT specialists concerned with achieving effective interoperability within Kenya’s health system. This research is relevant because it adds knowledge to the existing literature on how healthcare quality can be improved to make it more patient-centered especially in Kenya.展开更多
Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care w...Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care waste requires safe handling, treatment and disposal procedures. While incineration reduces the volume and quantity of waste for final disposal, it leads to the production of fly and bottom ashes laden with toxic incomplete combustion products such as Polycyclic Aromatic Hydrocarbons (PAHs), dioxins, furans and heavy metals. This exposes workers who handle and dispose the bottom ashes, hospital patients, the general public and environment. The goal of this study was to determine the total and individual levels of 16 most prevalent and toxic PAHs. Bottom ash samples were collected from incinerators in five county hospitals in Kenya, namely;Moi-Voi, Narok, Kitale, Makindu and Isiolo. Bottom ash samples were collected over a period of six months from the five hospitals. The samples were then sieved, homogenised and stored at 4°C in amber coloured glass containers. The PAHs were extracted using 30 ml of a hexane-acetone solvent (1:1) mixture by ultrasonication at room temperature (23°C) for 45 minutes. The PAHs were then analyzed with a GC-MS spectrophotometer model (Shimadzu GCMS-QP2010 SE) connected to a computer work station was used for the PAHs analysis. The GC-MS was equipped with an SGE BPX5 GC capillary column (30 m × 0.25 mm × 0.25 μm) for the separation of compounds. Helium was used as the carrier gas at a flow rate of 15.5 ml/minute and 14.5 psi. 1 μl of the sample was injected at 280°C, split mode (10:1). The oven programming was set for a total runtime of 40 minutes, which included: 100°C (2-minute hold);10°C /min rise to 200°C;7°C /min rise to 249°C;3°C /min rise to 300°C (2-minute hold). The interface temperature was set at 290°C. Analysis was done in Selected Ion Monitoring (SIM) mode and the peak areas of each of the PAHs were collected from the chromatograph and used for quantification of the 16 PAHs listed by the U.S. Environmental Protection Agency (EPA) which included, BaA (benz[a]anthracene: 4 rings), BaP (benzo[a]pyrene: 5 rings), BbF (benzo [b]fluoranthene: 5 rings), BkF (benzo[k]fluoranthene: 5 rings), Chr (chrysene: 4 rings), DbA (dibenz[a,h]anthracene: 5 rings), InP (indeno[1,2,3 - cd] pyrene: 6 rings) and Acp (acenaphthene: 3 rings), Acpy (acenaphthylene: 3 rings), Ant (anthracene: 3 rings), BghiP (benzo[g,h,i]perylene: 6 rings), Flu (fluorene: 3 rings), FluA (fluoranthene: 4 rings), Nap (naphthalene: 2 rings), PhA (phenanthrene: 3 rings) and Pyr (pyrene: 4 rings). Ion source-interface temperature was set at 200°C - 250°C. Internal standards from Sigma Aldrich were used in the analysis and the acquired mass spectra data were then matched against the NIST 2014 library [1] [2]. The mean PAHs concentration in the bottom ashes of each hospital varied broadly from 0.001 mg/kg to 0.4845 mg/kg, and the mean total concentration levels of individual PAHs ranged from 0.0072 mg/kg to 1.171 mg/kg. Low molecular weight PAHs (Phenanthrene, Naphthalene and Fluorene) were predominant in all the hospital wastes whereas Kitale and Narok presented the lowest PAHs concentrations and the lowest number of individual PAHs. Moi/Voi recorded the highest total PAHs concentration at 1.3129 ± 0.0023 mg/kg from a total of 11 PAHs being detected from the bottom ash samples. Narok had only three PAHs being detected at very low concentrations of 0.0041 ± 0.00 mg/kg, 0.0076 ± 0.00 mg/kg and 0.012 ± 0.00 mg/kg for phenanthrene, anthracene and chrysene respectively. This study presents hospital incinerator bottom ash as containing detectable levels of both carcinogenic and non-carcinogenic PAHs. Continued unprotected exposure of hospital workers (waste handlers) to the bottom ash PAHs could be hazardous to their health because of their cumulative effect. Preventive measures e.g. the use of Personal protective equipment (PPE) should be prioritised to minimise direct contact with the bottom ash. The study recommends an upgrade on incinerator technology for efficient combustion processes thus for better pollution control.展开更多
Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at ...Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: Healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this highly vulnerable occupational group.展开更多
In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contras...In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contrast,private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses.Once a patient with pain caused by a spinal disorder meets a pain medicine specialist,spinal intervention is quickly performed when indicated,and patients are provided lifestyle advice.Transforaminal epidural steroid injections are frequently administered to patients with radicular pain,and steroid injections are administered on a facet joint to control low back or neck pain.Additionally,medial branch blocks are performed prior to thermocoagulation.France’s universal healthcare system ensures accessibility at controlled costs.It emphasizes physical activity and provides free physical therapy services.However,certain interventions,such as transforaminal and interlaminar epidural injections,are not routinely used in France owing to limited therapeutic efficacy and safety concerns.This underutilization may be a potential cause of chronic pain for many patients.By examining the differences,strengths,and weaknesses of these two systems,valuable insights can be gained for the enhancement of global spinal pain management strategies,ultimately leading to improved patient outcomes and satisfaction.展开更多
In the intricate landscape of healthcare,vicarious liability looms large,shaping the responsibilities and actions of healthcare practitioners and administrators alike.Illustrated by a poignant scenario of a medication...In the intricate landscape of healthcare,vicarious liability looms large,shaping the responsibilities and actions of healthcare practitioners and administrators alike.Illustrated by a poignant scenario of a medication error,this article navigates the complexities of vicarious liability in healthcare.It explains the legal basis and ramifications of this theory,emphasizing its importance in fostering responsibility,protecting patient welfare,and easing access to justice.The paper explores the practical effects of vicarious responsibility on day-to-day operations,leadership practices,and decision-making processes via the eyes of senior consultants,junior doctors,and hospital administrators.Through comprehensive insights and real-world examples,it underscores the imperative of fostering a culture of accountability,communication,and quality care to navigate the intricate web of liabilities inherent in modern healthcare.展开更多
Digital technology has fundamentally transformed healthcare delivery, exerting profound influence on patient outcomes. This paper delves into the roles played by telemedicine, electronic health records (EHRs), and mob...Digital technology has fundamentally transformed healthcare delivery, exerting profound influence on patient outcomes. This paper delves into the roles played by telemedicine, electronic health records (EHRs), and mobile health applications in augmenting healthcare services. The objective is to scrutinize the ways in which these digital innovations enhance healthcare delivery and patient outcomes, while also identifying the attendant challenges in their adoption. To achieve this, a rigorous literature review encompassing peer-reviewed articles, reports, and case studies that examine the impact of digital technology in healthcare settings was conducted. The findings underscore that digital technology significantly bolsters patient care by enhancing access, operational efficiency, and diagnostic accuracy. Nonetheless, persistent challenges such as safeguarding data privacy, ensuring interoperability across systems, and managing implementation costs continue to pose significant hurdles.展开更多
The medical metaverse and digital twin are set to revolutionise healthcare.Like all emerging technologies their benefits must be weighed against their ethical and social,impacts.If we consider the advances of medical ...The medical metaverse and digital twin are set to revolutionise healthcare.Like all emerging technologies their benefits must be weighed against their ethical and social,impacts.If we consider the advances of medical technology as an expression of our values,such as the pursuit of knowledge,cures and healing,an ethical study allows us to align our values and steer the technology towards an agreed goal.However,to appreciate the long-term consequents of a technology,those consequences must be considered in the context of a society already shaped by that technology.This paper identifies the technologies currently shaping society and considers the ethical,and social consequences of the medical metaverse and digital twin in that future society.展开更多
As the volume of healthcare and medical data increases from diverse sources,real-world scenarios involving data sharing and collaboration have certain challenges,including the risk of privacy leakage,difficulty in dat...As the volume of healthcare and medical data increases from diverse sources,real-world scenarios involving data sharing and collaboration have certain challenges,including the risk of privacy leakage,difficulty in data fusion,low reliability of data storage,low effectiveness of data sharing,etc.To guarantee the service quality of data collaboration,this paper presents a privacy-preserving Healthcare and Medical Data Collaboration Service System combining Blockchain with Federated Learning,termed FL-HMChain.This system is composed of three layers:Data extraction and storage,data management,and data application.Focusing on healthcare and medical data,a healthcare and medical blockchain is constructed to realize data storage,transfer,processing,and access with security,real-time,reliability,and integrity.An improved master node selection consensus mechanism is presented to detect and prevent dishonest behavior,ensuring the overall reliability and trustworthiness of the collaborative model training process.Furthermore,healthcare and medical data collaboration services in real-world scenarios have been discussed and developed.To further validate the performance of FL-HMChain,a Convolutional Neural Network-based Federated Learning(FL-CNN-HMChain)model is investigated for medical image identification.This model achieves better performance compared to the baseline Convolutional Neural Network(CNN),having an average improvement of 4.7%on Area Under Curve(AUC)and 7%on Accuracy(ACC),respectively.Furthermore,the probability of privacy leakage can be effectively reduced by the blockchain-based parameter transfer mechanism in federated learning between local and global models.展开更多
Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,whi...Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.展开更多
Digital integration within healthcare systems exacerbates their vulnerability to sophisticated ransomware threats, leading to severe operational disruptions and data breaches. Current defenses are typically categorize...Digital integration within healthcare systems exacerbates their vulnerability to sophisticated ransomware threats, leading to severe operational disruptions and data breaches. Current defenses are typically categorized into active and passive measures that struggle to achieve comprehensive threat mitigation and often lack real-time response effectiveness. This paper presents an innovative ransomware defense system, ERAD, designed for healthcare environments that apply the MITRE ATT&CK Matrix to coordinate dynamic, stage-specific countermeasures throughout the ransomware attack lifecycle. By systematically identifying and addressing threats based on indicators of compromise (IOCs), the proposed system proactively disrupts the attack chain before serious damage occurs. Validation is provided through a detailed analysis of a system deployment against LockBit 3.0 ransomware, illustrating significant enhancements in mitigating the impact of the attack, reducing the cost of recovery, and strengthening the cybersecurity framework of healthcare organizations, but also applicable to other non-health sectors of the business world.展开更多
基金the project:the Science and Technology Planning Project of Zhuhai City of China(No.20191206F060001)。
文摘Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。
文摘The advent of pandemics such as COVID-19 significantly impacts human behaviour and lives every day.Therefore,it is essential to make medical services connected to internet,available in every remote location during these situations.Also,the security issues in the Internet of Medical Things(IoMT)used in these service,make the situation even more critical because cyberattacks on the medical devices might cause treatment delays or clinical failures.Hence,services in the healthcare ecosystem need rapid,uninterrupted,and secure facilities.The solution provided in this research addresses security concerns and services availability for patients with critical health in remote areas.This research aims to develop an intelligent Software Defined Networks(SDNs)enabled secure framework for IoT healthcare ecosystem.We propose a hybrid of machine learning and deep learning techniques(DNN+SVM)to identify network intrusions in the sensor-based healthcare data.In addition,this system can efficiently monitor connected devices and suspicious behaviours.Finally,we evaluate the performance of our proposed framework using various performance metrics based on the healthcare application scenarios.the experimental results show that the proposed approach effectively detects and mitigates attacks in the SDN-enabled IoT networks and performs better that other state-of-art-approaches.
基金supported in part by the National Natural Science Foundation of China (NSFC) under Grant No.61976242in part by the Natural Science Fund of Hebei Province for Distinguished Young Scholars under Grant No.F2021202010+2 种基金in part by the Fundamental Scientific Research Funds for Interdisciplinary Team of Hebei University of Technology under Grant No.JBKYTD2002funded by Science and Technology Project of Hebei Education Department under Grant No.JZX2023007supported by 2022 Interdisciplinary Postgraduate Training Program of Hebei University of Technology under Grant No.HEBUT-YXKJC-2022122.
文摘Most of the neural network architectures are based on human experience,which requires a long and tedious trial-and-error process.Neural architecture search(NAS)attempts to detect effective architectures without human intervention.Evolutionary algorithms(EAs)for NAS can find better solutions than human-designed architectures by exploring a large search space for possible architectures.Using multiobjective EAs for NAS,optimal neural architectures that meet various performance criteria can be explored and discovered efficiently.Furthermore,hardware-accelerated NAS methods can improve the efficiency of the NAS.While existing reviews have mainly focused on different strategies to complete NAS,a few studies have explored the use of EAs for NAS.In this paper,we summarize and explore the use of EAs for NAS,as well as large-scale multiobjective optimization strategies and hardware-accelerated NAS methods.NAS performs well in healthcare applications,such as medical image analysis,classification of disease diagnosis,and health monitoring.EAs for NAS can automate the search process and optimize multiple objectives simultaneously in a given healthcare task.Deep neural network has been successfully used in healthcare,but it lacks interpretability.Medical data is highly sensitive,and privacy leaks are frequently reported in the healthcare industry.To solve these problems,in healthcare,we propose an interpretable neuroevolution framework based on federated learning to address search efficiency and privacy protection.Moreover,we also point out future research directions for evolutionary NAS.Overall,for researchers who want to use EAs to optimize NNs in healthcare,we analyze the advantages and disadvantages of doing so to provide detailed guidance,and propose an interpretable privacy-preserving framework for healthcare applications.
文摘Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.
基金funded by King Saud University through Researchers Supporting Program Number (RSP2024R499).
文摘The healthcare data requires accurate disease detection analysis,real-timemonitoring,and advancements to ensure proper treatment for patients.Consequently,Machine Learning methods are widely utilized in Smart Healthcare Systems(SHS)to extract valuable features fromheterogeneous and high-dimensional healthcare data for predicting various diseases and monitoring patient activities.These methods are employed across different domains that are susceptible to adversarial attacks,necessitating careful consideration.Hence,this paper proposes a crossover-based Multilayer Perceptron(CMLP)model.The collected samples are pre-processed and fed into the crossover-based multilayer perceptron neural network to detect adversarial attacks on themedical records of patients.Once an attack is detected,healthcare professionals are promptly alerted to prevent data leakage.The paper utilizes two datasets,namely the synthetic dataset and the University of Queensland Vital Signs(UQVS)dataset,from which numerous samples are collected.Experimental results are conducted to evaluate the performance of the proposed CMLP model,utilizing various performancemeasures such as Recall,Precision,Accuracy,and F1-score to predict patient activities.Comparing the proposed method with existing approaches,it achieves the highest accuracy,precision,recall,and F1-score.Specifically,the proposedmethod achieves a precision of 93%,an accuracy of 97%,an F1-score of 92%,and a recall of 92%.
文摘Aging and crises like pandemics and climate change are global concerns that affect community environments. These social and natural changes influence people’s health worldwide. Aging impacts human health, including physical and mental aspects, and increases the need for care. Recent crises have affected not only the elderly but also younger populations, necessitating further efforts to develop a systematic community strategy. The goal of such a strategy is to maintain or enhance people’s well-being. As we face aging and crises like pandemics and climate change, it becomes essential to consider health holistically and globally, taking into account the community environment and social determinants without boundaries. The present study aimed to explore the necessary aspects of incorporating social determinants into clinical practice, enabling healthcare providers to view health from a holistic and planetary perspective. This approach facilitates the development of integrated community strategies. The study reviewed literature from PubMed, MEDLINE, and CINAHL databases, focusing on medicine, health, and welfare. An electronic search for English-language articles in peer-reviewed journals was conducted up to July 2024, using search terms such as “holistic health,” “planetary health,” and “social determinants.” Eight articles were identified through the search. After excluding three based on their titles, abstracts, and full texts, five articles were selected. The research focused on three areas: perceiving health in ecosystems, considering health-related policy in clinical situations, and addressing health in primary care settings. This study emphasizes the need for further research on innovative, integrated community strategies in the context of a globally aging society, focusing on non-medical aspects like pandemics, climate change, and social determinants to achieve a holistic and planetary understanding of people’s health. It suggests that understanding the social aspects of ecosystems in clinical settings, through interdisciplinary collaboration, is crucial for developing systematic community strategies for people’s well-being life in medical, health, and welfare contexts.
文摘Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers sustain Needle stick injuries each year. This study was conducted to assess healthcare workers’ knowledge, attitude and practices regarding needle stick injury. Materials & Methods: A cross-sectional study was conducted in a Tertiary Care Hospital over the period of 3 months. The study population consisted of Intern Doctors, Post Graduate resident Doctors, Staff Nurses, laboratory technicians of Government Medical College and New Civil Hospital, Surat (n = 300). The data were collected using a self-administered questionnaire via the means of Google Forms. Questionnaire was made with prior review literature. The data obtained were entered and analysed in Microsoft Excel. Results: The prevalence of NSI in our study was 46%, with a higher prevalence among the PG residents (72%). Overall scores regarding knowledge and attitude were better in PG residents (knowledge score > 7 in 71% and Attitude Score > 7 in 68% of PG Residents). Even though the PG residents scored highest in the knowledge category, the majority of them suffered needle stick injuries as a result of poor practice scores. Among those who had NSI (n = 139/300), 70% of study participants had superficial injuries, only 9% reported the incident, 18% got medical attention within 2 hours of the incident, and 7% followed up to recheck their viral markers status. Most incidents of NSI were due to hypodermic needles while recapping needles. Conclusion: Exposure to needle stick injuries and their underreporting remains a common problem. It is imperative that healthcare workers receive regular training on the proper handling of sharp objects. We can also draw the conclusion that preventing NSIs requires putting knowledge into practice.
基金This work was supported by a research fund from Chosun University,2023。
文摘Federated learning is an innovative machine learning technique that deals with centralized data storage issues while maintaining privacy and security.It involves constructing machine learning models using datasets spread across several data centers,including medical facilities,clinical research facilities,Internet of Things devices,and even mobile devices.The main goal of federated learning is to improve robust models that benefit from the collective knowledge of these disparate datasets without centralizing sensitive information,reducing the risk of data loss,privacy breaches,or data exposure.The application of federated learning in the healthcare industry holds significant promise due to the wealth of data generated from various sources,such as patient records,medical imaging,wearable devices,and clinical research surveys.This research conducts a systematic evaluation and highlights essential issues for the selection and implementation of federated learning approaches in healthcare.It evaluates the effectiveness of federated learning strategies in the field of healthcare.It offers a systematic analysis of federated learning in the healthcare domain,encompassing the evaluation metrics employed.In addition,this study highlights the increasing interest in federated learning applications in healthcare among scholars and provides foundations for further studies.
文摘Racial, ethnic, and socioeconomic disparities present daunting hurdles that prevent equitable health outcomes for patients with end-stage kidney disease (ESKD) on hemodialysis. Additional resources, such as the Novel Intervention in Children’s Health (NICH) at Lucille Packard Children’s Hospital Stanford, provide individualized support to best assist families by assessing barriers to care with the goal of improving health outcomes. In this retrospective cohort study, we reviewed patients with ESKD on hemodialysis involved in NICH to explore if NICH serves as a liaison between the patients and multidisciplinary medical team and to explore if NICH helps patients better manage the challenges of end-stage kidney disease. Through the electronic medical record system, EPIC, we reviewed the patients’ surveys to identify barriers to care, which included school and life engagement difficulty, lack of mental health resources, food and transportation insecurity, and cultural/language barriers. We also tracked the number of hospitalizations and ED visits before and during the patients’ enrollment in NICH. We discovered that through NICH, the aforementioned barriers to care were eliminated, the number of hospitalizations and emergency department visits was reduced, and all patients transitioned from inactive to active on the transplant list. NICH successfully improved the health outcomes of these patients and empowered patients to be more engaged in their care.
文摘Explainable Artificial Intelligence(XAI)has an advanced feature to enhance the decision-making feature and improve the rule-based technique by using more advanced Machine Learning(ML)and Deep Learning(DL)based algorithms.In this paper,we chose e-healthcare systems for efficient decision-making and data classification,especially in data security,data handling,diagnostics,laboratories,and decision-making.Federated Machine Learning(FML)is a new and advanced technology that helps to maintain privacy for Personal Health Records(PHR)and handle a large amount of medical data effectively.In this context,XAI,along with FML,increases efficiency and improves the security of e-healthcare systems.The experiments show efficient system performance by implementing a federated averaging algorithm on an open-source Federated Learning(FL)platform.The experimental evaluation demonstrates the accuracy rate by taking epochs size 5,batch size 16,and the number of clients 5,which shows a higher accuracy rate(19,104).We conclude the paper by discussing the existing gaps and future work in an e-healthcare system.
文摘In an attempt to assess the Kenyan healthcare system, this study looks at the current efforts that are already in place, what challenges they face, and what strategies can be put into practice to foster interoperability. By reviewing a variety of literature and using statistics, the paper ascertains notable impediments such as the absence of standard protocols, lack of adequate technological infrastructure, and weak regulatory frameworks. Resultant effects from these challenges regarding health provision target enhanced data sharing and merging for better patient outcomes and allocation of resources. It also highlights several opportunities that include the adoption of emerging technologies, and the establishment of public-private partnerships to strengthen the healthcare framework among others. In this regard, the article provides recommendations based on stakeholder views and global best practices addressed to policymakers, medical practitioners, and IT specialists concerned with achieving effective interoperability within Kenya’s health system. This research is relevant because it adds knowledge to the existing literature on how healthcare quality can be improved to make it more patient-centered especially in Kenya.
文摘Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care waste requires safe handling, treatment and disposal procedures. While incineration reduces the volume and quantity of waste for final disposal, it leads to the production of fly and bottom ashes laden with toxic incomplete combustion products such as Polycyclic Aromatic Hydrocarbons (PAHs), dioxins, furans and heavy metals. This exposes workers who handle and dispose the bottom ashes, hospital patients, the general public and environment. The goal of this study was to determine the total and individual levels of 16 most prevalent and toxic PAHs. Bottom ash samples were collected from incinerators in five county hospitals in Kenya, namely;Moi-Voi, Narok, Kitale, Makindu and Isiolo. Bottom ash samples were collected over a period of six months from the five hospitals. The samples were then sieved, homogenised and stored at 4°C in amber coloured glass containers. The PAHs were extracted using 30 ml of a hexane-acetone solvent (1:1) mixture by ultrasonication at room temperature (23°C) for 45 minutes. The PAHs were then analyzed with a GC-MS spectrophotometer model (Shimadzu GCMS-QP2010 SE) connected to a computer work station was used for the PAHs analysis. The GC-MS was equipped with an SGE BPX5 GC capillary column (30 m × 0.25 mm × 0.25 μm) for the separation of compounds. Helium was used as the carrier gas at a flow rate of 15.5 ml/minute and 14.5 psi. 1 μl of the sample was injected at 280°C, split mode (10:1). The oven programming was set for a total runtime of 40 minutes, which included: 100°C (2-minute hold);10°C /min rise to 200°C;7°C /min rise to 249°C;3°C /min rise to 300°C (2-minute hold). The interface temperature was set at 290°C. Analysis was done in Selected Ion Monitoring (SIM) mode and the peak areas of each of the PAHs were collected from the chromatograph and used for quantification of the 16 PAHs listed by the U.S. Environmental Protection Agency (EPA) which included, BaA (benz[a]anthracene: 4 rings), BaP (benzo[a]pyrene: 5 rings), BbF (benzo [b]fluoranthene: 5 rings), BkF (benzo[k]fluoranthene: 5 rings), Chr (chrysene: 4 rings), DbA (dibenz[a,h]anthracene: 5 rings), InP (indeno[1,2,3 - cd] pyrene: 6 rings) and Acp (acenaphthene: 3 rings), Acpy (acenaphthylene: 3 rings), Ant (anthracene: 3 rings), BghiP (benzo[g,h,i]perylene: 6 rings), Flu (fluorene: 3 rings), FluA (fluoranthene: 4 rings), Nap (naphthalene: 2 rings), PhA (phenanthrene: 3 rings) and Pyr (pyrene: 4 rings). Ion source-interface temperature was set at 200°C - 250°C. Internal standards from Sigma Aldrich were used in the analysis and the acquired mass spectra data were then matched against the NIST 2014 library [1] [2]. The mean PAHs concentration in the bottom ashes of each hospital varied broadly from 0.001 mg/kg to 0.4845 mg/kg, and the mean total concentration levels of individual PAHs ranged from 0.0072 mg/kg to 1.171 mg/kg. Low molecular weight PAHs (Phenanthrene, Naphthalene and Fluorene) were predominant in all the hospital wastes whereas Kitale and Narok presented the lowest PAHs concentrations and the lowest number of individual PAHs. Moi/Voi recorded the highest total PAHs concentration at 1.3129 ± 0.0023 mg/kg from a total of 11 PAHs being detected from the bottom ash samples. Narok had only three PAHs being detected at very low concentrations of 0.0041 ± 0.00 mg/kg, 0.0076 ± 0.00 mg/kg and 0.012 ± 0.00 mg/kg for phenanthrene, anthracene and chrysene respectively. This study presents hospital incinerator bottom ash as containing detectable levels of both carcinogenic and non-carcinogenic PAHs. Continued unprotected exposure of hospital workers (waste handlers) to the bottom ash PAHs could be hazardous to their health because of their cumulative effect. Preventive measures e.g. the use of Personal protective equipment (PPE) should be prioritised to minimise direct contact with the bottom ash. The study recommends an upgrade on incinerator technology for efficient combustion processes thus for better pollution control.
文摘Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: Healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this highly vulnerable occupational group.
基金Supported by National Research Foundation of Korea Grant,No.00219725.
文摘In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contrast,private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses.Once a patient with pain caused by a spinal disorder meets a pain medicine specialist,spinal intervention is quickly performed when indicated,and patients are provided lifestyle advice.Transforaminal epidural steroid injections are frequently administered to patients with radicular pain,and steroid injections are administered on a facet joint to control low back or neck pain.Additionally,medial branch blocks are performed prior to thermocoagulation.France’s universal healthcare system ensures accessibility at controlled costs.It emphasizes physical activity and provides free physical therapy services.However,certain interventions,such as transforaminal and interlaminar epidural injections,are not routinely used in France owing to limited therapeutic efficacy and safety concerns.This underutilization may be a potential cause of chronic pain for many patients.By examining the differences,strengths,and weaknesses of these two systems,valuable insights can be gained for the enhancement of global spinal pain management strategies,ultimately leading to improved patient outcomes and satisfaction.
文摘In the intricate landscape of healthcare,vicarious liability looms large,shaping the responsibilities and actions of healthcare practitioners and administrators alike.Illustrated by a poignant scenario of a medication error,this article navigates the complexities of vicarious liability in healthcare.It explains the legal basis and ramifications of this theory,emphasizing its importance in fostering responsibility,protecting patient welfare,and easing access to justice.The paper explores the practical effects of vicarious responsibility on day-to-day operations,leadership practices,and decision-making processes via the eyes of senior consultants,junior doctors,and hospital administrators.Through comprehensive insights and real-world examples,it underscores the imperative of fostering a culture of accountability,communication,and quality care to navigate the intricate web of liabilities inherent in modern healthcare.
文摘Digital technology has fundamentally transformed healthcare delivery, exerting profound influence on patient outcomes. This paper delves into the roles played by telemedicine, electronic health records (EHRs), and mobile health applications in augmenting healthcare services. The objective is to scrutinize the ways in which these digital innovations enhance healthcare delivery and patient outcomes, while also identifying the attendant challenges in their adoption. To achieve this, a rigorous literature review encompassing peer-reviewed articles, reports, and case studies that examine the impact of digital technology in healthcare settings was conducted. The findings underscore that digital technology significantly bolsters patient care by enhancing access, operational efficiency, and diagnostic accuracy. Nonetheless, persistent challenges such as safeguarding data privacy, ensuring interoperability across systems, and managing implementation costs continue to pose significant hurdles.
文摘The medical metaverse and digital twin are set to revolutionise healthcare.Like all emerging technologies their benefits must be weighed against their ethical and social,impacts.If we consider the advances of medical technology as an expression of our values,such as the pursuit of knowledge,cures and healing,an ethical study allows us to align our values and steer the technology towards an agreed goal.However,to appreciate the long-term consequents of a technology,those consequences must be considered in the context of a society already shaped by that technology.This paper identifies the technologies currently shaping society and considers the ethical,and social consequences of the medical metaverse and digital twin in that future society.
基金We are thankful for the funding support fromthe Science and Technology Projects of the National Archives Administration of China(Grant Number 2022-R-031)the Fundamental Research Funds for the Central Universities,Central China Normal University(Grant Number CCNU24CG014).
文摘As the volume of healthcare and medical data increases from diverse sources,real-world scenarios involving data sharing and collaboration have certain challenges,including the risk of privacy leakage,difficulty in data fusion,low reliability of data storage,low effectiveness of data sharing,etc.To guarantee the service quality of data collaboration,this paper presents a privacy-preserving Healthcare and Medical Data Collaboration Service System combining Blockchain with Federated Learning,termed FL-HMChain.This system is composed of three layers:Data extraction and storage,data management,and data application.Focusing on healthcare and medical data,a healthcare and medical blockchain is constructed to realize data storage,transfer,processing,and access with security,real-time,reliability,and integrity.An improved master node selection consensus mechanism is presented to detect and prevent dishonest behavior,ensuring the overall reliability and trustworthiness of the collaborative model training process.Furthermore,healthcare and medical data collaboration services in real-world scenarios have been discussed and developed.To further validate the performance of FL-HMChain,a Convolutional Neural Network-based Federated Learning(FL-CNN-HMChain)model is investigated for medical image identification.This model achieves better performance compared to the baseline Convolutional Neural Network(CNN),having an average improvement of 4.7%on Area Under Curve(AUC)and 7%on Accuracy(ACC),respectively.Furthermore,the probability of privacy leakage can be effectively reduced by the blockchain-based parameter transfer mechanism in federated learning between local and global models.
基金The authors are the awardees of the Indian Council of Social Science Research(ICSSR)Research Program(F.No.G-11/2021-22/ICSSR/RP)This paper is largely an outcome of the research program sponsored by the ICSSR.However,the responsibility for the facts stated,opinions expressed,and conclusions drawn is entirely that of the authors.
文摘Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.
文摘Digital integration within healthcare systems exacerbates their vulnerability to sophisticated ransomware threats, leading to severe operational disruptions and data breaches. Current defenses are typically categorized into active and passive measures that struggle to achieve comprehensive threat mitigation and often lack real-time response effectiveness. This paper presents an innovative ransomware defense system, ERAD, designed for healthcare environments that apply the MITRE ATT&CK Matrix to coordinate dynamic, stage-specific countermeasures throughout the ransomware attack lifecycle. By systematically identifying and addressing threats based on indicators of compromise (IOCs), the proposed system proactively disrupts the attack chain before serious damage occurs. Validation is provided through a detailed analysis of a system deployment against LockBit 3.0 ransomware, illustrating significant enhancements in mitigating the impact of the attack, reducing the cost of recovery, and strengthening the cybersecurity framework of healthcare organizations, but also applicable to other non-health sectors of the business world.
