The analyses of current healthcare systems in Russia and Romania made by different scholars in the specialty literature highlight a below-medium health quality index worldwide, which is especially ...low when compared to leading EU countries. The prevailing need to address health features with quantitative customer research has prompted this paper to focus on the challenges of the healthcare systems in two countries from the customer’s perspective. The main goal of the research is to capture the main problems of the analyzed healthcare systems which require certain improvements, changes, and innovations, and to find proper strategies for their future development from a marketing approach. The attitudes of 410 people from Russia and Romania have been collected using an electronic survey, based on a questionnaire that contained some items concerning the marketing mix in the public and private clinics from the two analyzed countries. These items have been evaluated by respondents from both the importance and satisfaction perspectives, and the Importance–Satisfaction (IS) matrix was used to discover marketing strategies that are the best fit for each component of the marketing mix in the healthcare clinics. The outcomes of this study highlight the need to focus efforts mainly on improving the quality of the services in both countries, with some peculiarities for the public and private sectors. It was also revealed that both countries need massive improvements in their public clinic sectors.
Personalized healthcare systems deliver e-health services to fulfill the medical and assistive needs of the aging population. Internet of Things (IoT) is a significant advancement in the Big Data ...era, which supports many real-time engineering applications through enhanced services. Analytics over data streams from IoT has become a source of user data for the healthcare systems to discover new information, predict early detection, and makes decision over the critical situation for the improvement of the quality of life. In this paper, we have made a detailed study on the recent emerging technologies in the personalized healthcare systems with the focus towards cloud computing, fog computing, Big Data analytics, IoT and mobile based applications. We have analyzed the challenges in designing a better healthcare system to make early detection and diagnosis of diseases and discussed the possible solutions while providing e-health services in secure manner. This paper poses a light on the rapidly growing needs of the better healthcare systems in real-time and provides possible future work guidelines.
"Gluing" together integrated Geriatric Clinical Service lines (GCSL) within the US healthcare system is a significant challenge. Reasons encompass health professional workforce shortages, ...inconsistent requirements for geriatric educational competencies among the health professional disciplines, preconceived ageist attitudes about older adults with complex illnesses, and a US healthcare system infrastructure that is not aligned with longitudinal and interdisciplinary care needs for older adults. This review focuses on three major characteristics of the US healthcare system that have impeded widespread dissemination of GCSLs: 1) the US's historical fee for service (FFS) reimbursement system; 2) increasing reliance upon disease specific specialty care services for older patients that have resulted from advances in medicine; and 3) rising consolidation of US healthcare systems over the last 30 years. Three specific options are also provided that might help change the current and future trajectories of GCSLs: 1) local political advocacy to implement health policy legislation; 2) expand geriatric physician and health professional workforce by nontraditional means; and 3) reprioritize expansionist healthcare systems corporate behavior. Each of these interventions will be hard to achieve, but it is time to unite if GCSLs are to thrive as pathways to improve care outcomes for older adults with complex medical, cognitive and neuropsychiatric disorders.
With the rapid development of medical and computer technologies, the healthcare system has seen a surge of interest from both the academia and industry. However, most healthcare systems fail to ...consider the emergency situations of patients, and are unable to provide a personalized resource service for special users. To address this issue, in this paper, we propose the Edge-Cognitive-Computing-based (ECC-based) smart-healthcare system. This system is able to monitor and analyze the physical health of users using cognitive computing. It also adjusts the computing resource allocation of the whole edge computing network comprehensively according to the health-risk grade of each user. The experiments show that the ECC-based healthcare system provides a better user experience and optimizes the computing resources reasonably, as well as significantly improving in the survival rates of patients in a sudden emergency.
•We present a ECC-based smart healthcare system.•We describe the dynamic resource allocation mechanism.•Experimental results show that the system realizes optimization of resources.
The healthcare industry has revolutionized from 1.0 to 4.0 where Healthcare 1.0 was more doctor centric and Healthcare 2.0 replaced manual records with electronic healthcare records (EHRs). ...Healthcare 3.0 was patient-centric and Healthcare 4.0 uses cloud computing (CC), fog computing (FC), Internet of things (IoT), and telehealthcare technologies to share data between various stakeholders. However, framing a secure technique for Healthcare 4.0 has always been a challenging task. An in-secure technique for Healthcare 4.0 may lead to the healthcare data breach where hackers can gain full access to patients’ email accounts, messages, and reports. On the contrary, a secured technique for Healthcare 4.0 can provide satisfaction to all stakeholders, including patients and caregivers. Motivated from these facts, this paper presents an extensive literature review and analysis of state-of-the-art proposals to maintain security and privacy in Healthcare 4.0. We also explored the blockchain-based solution to give insights to both researchers and practitioners communities. Different taxonomies used for exploring various security and privacy issues in Healthcare 4.0 are also presented in a structured manner. Then, the advantages and limitations of various security and privacy techniques are explored and discussed in the paper. Finally, existing challenges and future research directions of security and privacy in Healthcare 4.0 are presented.
Background: Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients ...experience metabolic, musculoskeletal, and psychological disorders. Objectives: To determine the delay in HS diagnosis and its consequences for patients and the healthcare system. Methods: This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated. Results: The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians – most frequently general practitioners, dermatologists, surgeons, gynecologists – and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed. Conclusion: This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.
Wireless Sensor Network (WSN) is a very important part of Internet of Things (IoT), especially in e-healthcare applications. Among them, wireless medical sensor networks (WMSNs) have been used in the ...personalized healthcare systems (PHSs). In recent years, professionals use their mobile devices to access the data collected from sensors which are placed in or on patients’ bodies. Due to the danger of wireless transmission circumstance, the security of the data which are collected by the sensors and also transmitted to the doctors faces challenges. In the past decade, many authentication schemes for WMSNs are proposed. However, security disadvantages have been found in such schemes. To overcome the historical security problems, we propose a robust and lightweight authentication scheme for WMSNs, which meets the common security requirements, and keeps away user tracking from attackers. The popular tool Proverif is employed to express that our scheme resists the simulated attacks. Also, the informal security analysis is demonstrated. With the comparison to several very recent schemes and simulation by NS-3, the proposed scheme is suitable for PHSs.
•A lightweight two-factor authentication scheme using WMSNs away from being tracked is presented.•We use the famous tool Proverif to prove that our scheme is secure against the common attacks.•The informal analysis and performance comparison with recent schemes show that ours is the best.•The simulation with NS-3 shows that our scheme is applicable for practice.
“Gluing” together integrated Geriatric Clinical Service lines (GCSL) within the US healthcare system is a significant challenge. Reasons encompass health professional workforce shortages, ...inconsistent requirements for geriatric educational competencies among the health professional disciplines, preconceived ageist attitudes about older adults with complex illnesses, and a US healthcare system infrastructure that is not aligned with longitudinal and interdisciplinary care needs for older adults. This review focuses on three major characteristics of the US healthcare system that have impeded widespread dissemination of GCSLs: (1) the US's historical fee for service (FFS) reimbursement system; (2) increasing reliance upon disease specific specialty care services for older patients that have resulted from advances in medicine; and (3) rising consolidation of US healthcare systems over the last 30 years. Three specific options are also provided that might help change the current and future trajectories of GCSLs: (1) local political advocacy to implement health policy legislation; (2) expand geriatric physician and health professional workforce by nontraditional means; and (3) reprioritize expansionist healthcare systems corporate behavior. Each of these interventions will be hard to achieve, but it is time to unite if GCSLs are to thrive as pathways to improve care outcomes for older adults with complex medical, cognitive and neuropsychiatric disorders.
See related articles by Ouslander et al., Ross et al., and Chad Boult in this issue.
Patients with metastatic triple-negative breast cancer (mTNBC) have poor prognosis and survival outcomes. Sacituzumab govitecan was newly approved into Chinese market for mTNBC. However, whether its ...price matches the survival benefit still needs exploring. Here, this study aimed to evaluate the cost-effectiveness of sacituzumab govitecan versus chemotherapy in patients with mTNBC from the perspective of Chinese healthcare system.
A partitioned survival model consisting of three discrete health states was constructed to assess the cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy. The key clinical data in the model were from the ASCENT trial. Costs and utility inputs were collected from published literatures. Life-years gained, quality adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits, and incremental net monetary benefits were calculated between 2 treatment strategies. One-way and probabilistic sensitivity analyses were conducted to account for uncertainty and verify model robustness. Subgroup and cost-threshold analysis were also performed.
Sacituzumab govitecan provided an additional 0.25 QALYs and an incremental cost of $ 81,778.61 compared with chemotherapy, which was associated with an ICER of $ 323,603.84/QALY. One-way sensitivity analysis revealed that the model was most sensitive to the cost of sacituzumab govitecan, weight, and utility of progression-free survival. The probabilistic sensitivity analysis indicated that the probability of sacituzumab govitecan being cost-effective was 0%. Considering a willingness-to-pay (WTP) of 3 times GDP, the maximum cost of sacituzumab govitecan that would make it cost-effective was $155.65 per unit (180 mg).
Sacituzumab govitecan was not cost-effective for patients with mTNBC compared with chemotherapy at the commonly adopted WTP threshold of 3 times GDP per capita per QALY in China.
Sacituzumab govitecan was newly approved into Chinese market for triple-negative breast cancer. However, whether its price matches the survival benefit still needs exploring. Here, this study aimed to evaluate the cost-effectiveness of sacituzumab govitecan. A partitioned survival model consisting of three discrete health states was constructed. The ICER of sacituzumab govitecan was $ 323,603.84/QALY, and was not cost-effective in China.
The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in China at December 2019 had led to a global outbreak of coronavirus disease 2019 (COVID-19) and the disease started to ...spread all over the world and became an international public health issue. The entire humanity has to fight in this war against the unexpected and each and every individual role is important. Healthcare system is doing exceptional work and the government is taking various measures that help the society to control the spread. Public, on the other hand, coordinates with the policies and act accordingly in most state of affairs. But the role of technologies in assisting different social bodies to fight against the pandemic remains hidden. The intention of our study is to uncover the hidden roles of technologies that ultimately help for controlling the pandemic. On investigating, it is found that the strategies utilizing potential technologies would yield better benefits and these technological strategies can be framed either to control the pandemic or to support the confinement of the society during pandemic which in turn aids in controlling the spreading of infection. This study enlightens the various implemented technologies that assists the healthcare systems, government and public in diverse aspects for fighting against COVID-19. Furthermore, the technological swift that happened during the pandemic and their influence in the environment and society is discussed. Besides the implemented technologies, this work also deals with untapped potential technologies that have prospective applications in controlling the pandemic circumstances. Alongside the various discussion, our suggested solution for certain situational issues is also presented.
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•The technology shift occurred in society during the COVID-19 pandemic and its influence.•Technology-based strategies in controlling the pandemic and to support the society.•Key technologies include Artificial Intelligence and Machine learning, supply chain, communication and surveillance.•Potential roles of IoT, Drone &Robotic technologies and mobile applications.•Influence of existing technologies, challenges and future impacts on society.
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