Abstract With electronic healthcare systems undergoing rapid change, optimizing the crucial process of recording physician prescriptions is a task with major implications for patient care. The power ...of blockchain technology and the precision of the Raft consensus algorithm are combined in this article to create a revolutionary solution for this problem. In addition to addressing these issues, the proposed framework, by focusing on the challenges associated with physician prescriptions, is a breakthrough in a new era of security and dependability for the healthcare sector. The Raft algorithm is a cornerstone that improves the diagnostic decision-making process, increases confidence in patients, and sets a new standard for robust healthcare systems. In the proposed consensus algorithm, a weighted sum of two influencing factors including the physician acceptability and inter-physicians’ reliability is used for selecting the participating physicians. An investigation is conducted to see how well the Raft algorithm performs in overcoming prescription-related roadblocks that support a compelling argument for improved patient care. Apart from its technological benefits, the proposed approach seeks to revolutionize the healthcare system by fostering trust between patients and providers. Raft’s ability to communicate presents the proposed solution as an effective way to deal with healthcare issues and ensure security.
Blockchain technology must have sparked widespread interest, applications associated with data monitoring, banking sectors, computer security, the Internet of Things, and food chemistry to the ...healthcare sector and cognitive science. The use of multimedia in the healthcare architecture also allows for the storage, processing and transmission of patient information in a wide range of formats such as images, text and audio over the Internet using various smart particles. However, managing large amounts of data, including findings and images of each individual, increases human effort and increases protection risks. In this paper, to address these problems by using IoT in healthcare improves the performance of patient care while lowering costs by efficiently distributing healthcare resources. Nevertheless, various attackers can cause a variety of risks in IoT devices. To avoid these problems, Blockchain technology has been identified as the most effective method for maintaining the secrecy and security of control systems in real-time. This should provide a security architecture for healthcare multimedia content using blockchain technology by producing the hash of every information so that any transition or modification in information, as well as any breaches of medicines, would be evidenced across the whole blockchain platform.
The emergency medical response after a strong earthquake relies on a robust transportation-healthcare system and effective management. This article proposes a resilience assessment framework for the ...interdependent transportation-healthcare system (ITHS) integrating physical loss and organisational management during post-earthquake emergency response. Considering the earthquake-induced injured people, the seismic damage to transportation, and the quantification of the condition of the patients after being treated, a novel metric is proposed to evaluate the response effort during the first 72 h. Bi-objective optimisation is developed to solve the real-time dispatching and treating problems instead of overwhelming one single hospital. In addition, the separate impact of disrupted transportation and damaged healthcare on the interdependent system is calculated to measure the cascading effect. It is shown that proper resource allocation and practical management are crucial to guarantee the desired level of the response effort.
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly expanded; however, clinical trials excluded patients taking immunosuppressive medications such as those ...with inflammatory bowel disease (IBD). Therefore, we explored real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccination on subsequent infection in patients with IBD with diverse exposure to immunosuppressive medications.
This was a retrospective cohort study of patients in the Veterans Health Administration with IBD diagnosed before December 18, 2020, the start date of the Veterans Health Administration patient vaccination program. IBD medication exposures included mesalamine, thiopurines, anti-tumor necrosis factor biologic agents, vedolizumab, ustekinumab, tofacitinib, methotrexate, and corticosteroid use. We used inverse probability weighting and Cox’s regression with vaccination status as a time-updating exposure and computed vaccine effectiveness from incidence rates.
The cohort comprised 14,697 patients, 7321 of whom received at least 1 vaccine dose (45.2% Pfizer, 54.8% Moderna). The cohort had median age 68 years, 92.2% were men, 80.4% were White, and 61.8% had ulcerative colitis. In follow-up data through April 20, 2021, unvaccinated individuals had the highest raw proportion of SARS-CoV-2 infection (197 1.34% vs 7 0.11% fully vaccinated). Full vaccination status, but not partial vaccination status, was associated with a 69% reduced hazard of infection relative to an unvaccinated status (hazard ratio, 0.31, 95% confidence interval, 0.17–0.56; P < .001), corresponding to an 80.4% effectiveness.
Full vaccination (> 7 days after the second dose) against SARS-CoV-2 infection has an ∼80.4% effectiveness in a broad IBD cohort with diverse exposure to immunosuppressive medications. These results may serve to increase patient and provider willingness to pursue vaccination in these settings.
Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its ...relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians’ wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.
Oral health constitutes a significant public health concern in Sub-Saharan Africa. The precise burden of oral diseases and the adequacy of oral healthcare provision remain often unknown. The present ...study aims to evaluate key components of the healthcare system in Sudan and the delivery of oral healthcare across eight dimensions: Healthcare System Framework, Financing, Service Delivery, Epidemiology, Prevention, Personnel, Dental Education and Training System, and Health Benefit Package. The evaluation of Sudan's healthcare system and oral healthcare provision utilizing the extended World Health Organization building blocks healthcare systems analysis framework. The evolving healthcare landscape in Sudan is characterized by a transition towards a Bismarckian model, a shift facilitated by the implementation of a National Health Insurance Fund. In 2018, Sudan's total healthcare expenditure surged to 2.4 billion US dollars and dental care accounted for less than 1% of this financial allocation. During the period spanning from 2016 to 2019, there was an expansion in the healthcare infrastructure and utilization rates. The number of healthcare facilities and hospital admissions respectively increased from 2,083 to 3,578 and from 14,967,113 to 22,455,772, while the registered number of dentists in 2019 reached 8,964. Within the framework of the national healthcare system, medical consultations and emergency treatments are encompassed in the oral health benefit package. Sudan's healthcare system grapples with endemic vulnerabilities compounded by recurrent political and economic challenges. Nevertheless, strides towards an insurance-based healthcare system and the upward trend observed in oral healthcare provision and infrastructure assets offer promising prospects for future generations.
Sexuality is considered to be an important aspect of holistic care, yet research has demonstrated that it is not routinely addressed in healthcare services. A greater understanding of this can be ...achieved through synthesizing qualitative studies investigating healthcare professionals' experiences of talking about sex. In doing so, policy makers and healthcare providers may be able to better address the sexual issues of service users.
To gain an in-depth understanding of healthcare professionals' subjective experience of discussing sexuality with service users by identifying the factors that impede and facilitate such discussions.
Review of healthcare professionals' experience of discussing sexuality with service users.
Electronic databases and reference lists of published articles were searched in July 2011. Primary research studies were included in the review if they explored health professionals' experiences of discussing sexuality with adult service users, used qualitative methods, and were conducted in the United Kingdom over the last 10 years. Each study was reviewed and assessed. A secondary thematic analysis method was used where key themes were extracted and grouped and key concepts were explored.
Nineteen interconnected themes emerged relating to healthcare professionals' experience of discussing sexuality with service users, including fear about “opening up a can of worms,” lack of time, resources, and training, concern about knowledge and abilities, worry about causing offense, personal discomfort, and a lack of awareness about sexual issues. Some themes were particularly marked relating to the sexuality of the opposite-gender, black and ethnic minority groups, older and nonheterosexual service users, and those with intellectual disabilities.
The majority of healthcare professionals do not proactively discuss sexuality issues with service users, and this warrants further attention. An understanding of the perceived barriers and facilitators indicates that interventions to improve the extent to which sexuality issues are addressed need to take organizational, structural, and personal factors into consideration. Dyer K and das Nair R. Why don't healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United Kingdom. J Sex Med 2013;10:2658–2670.
•Feature extraction for multi-model autoencoder is designed to process features.•A high-level structured feature is extracted to get time-related information.•Multi-feature sequence anomaly detection ...with residual learning is proposed.•Comprehensive experiments are conducted to prove the effectiveness of our method.
IoMT technology has many advantages in healthcare system, such as optimizing the medical service model, improving the efficiency of hospital operation and management, and improving the overall service level of the hospital. IoMT devices do not have a security authentication mechanism, and the trust between devices relies heavily on centralized third-party services. Blockchain can provide a secure interactive environment for the medical Internet of Things. However, security issues in the IoMT-Blockchain environment are also becoming increasingly prominent. Cyber-attacks targeting IoMT-Blockchain will not only compromise the security of IoT devices, but also seriously affect the security of the Internet. Therefore, how to detect abnormal traffic in the IoMT-Blockchain environment becomes particularly important. In this work, an abnormal traffic detection with deep neural network is designed for abnormal traffic detection in IoMT-Blockchain environment. First, this work proposes a feature extraction algorithm based on multi-model autoencoders. The algorithm processes the feature information in groups to reduce the complexity between traffic feature information. It builds a multi-model autoencoder to further extract fusion features between multi-model features. Second, to maximize use of traffic data information in detection network, this work proposes a multi-feature sequence anomaly detection algorithm. The algorithm extracts low-level fusion features and high-level temporal features in network traffic respectively, and applies the features to anomaly detection and classification tasks by means of residual learning.
Utilization of the Internet of Things and ubiquitous computing in medical apparatuses have “smartified” the current healthcare system. These days, healthcare is used for more than simply curing ...patients. A Smart Healthcare System (SHS) is a network of implanted medical devices and wearables that monitors patients in real-time to detect and avert potentially fatal illnesses. With its expanding capabilities comes a slew of security threats, and there are many ways in which a SHS might be exploited by malicious actors. These include, but are not limited to, interfering with regular SHS functioning, inserting bogus data to modify vital signs, and meddling with medical devices. This study presents HealthGuard, an innovative security architecture for SHSs that uses machine learning to identify potentially harmful actions taken by users. HealthGuard monitors the vitals of many SHS-connected devices and compares the vitals to distinguish normal from abnormal activity. For the purpose of locating potentially dangerous actions inside a SHS, HealthGuard employs four distinct machine learning-based detection approaches (Artificial Neural Network, Decision Tree, Random Forest, and k-Nearest Neighbor). Eight different smart medical devices were used to train HealthGuard for a total of twelve harmless occurrences, seven of which are common user activities and five of which are disease-related occurrences. HealthGuard was also tested for its ability to defend against three distinct forms of harmful attack. Our comprehensive analysis demonstrates that HealthGuard is a reliable security architecture for SHSs, with a 91% success rate and in F1-score of 90% success.
The influence of socioeconomic status on outcomes following total joint arthroplasty (TJA) in the Canadian single-payer healthcare system is yet to be elucidated. The objective of the present study ...was to evaluate the impact of socioeconomic status on TJA outcomes.
This was a retrospective review of 7,304 consecutive TJA (4,456 knees and 2,848 hips) performed between January 1, 2001 and December 31, 2019. The primary independent variable was the average census marginalization index. The primary dependent variable was functional outcome scores.
The most marginalized patients in both the hip and knee cohorts had significantly worse preoperative and postoperative functional scores. Patients in the most marginalized quintile (V) showed a decreased odds of achieving a minimal important difference in functional scores at 1-year follow-up (odds ratio OR 0.44; 95% confidence interval CI 0.20, 0.97, P = .043). Patients in the knee cohort in the most marginalized quintiles (IV and V) had increased odds of being discharged to an inpatient facility with an OR of 2.07 (95% CI 1.06, 4.04, P = .033) and OR of 2.57 (95% CI 1.26, 5.22, P = .009), respectively. Patients in the hip cohort in V quintile (most marginalized) had increased odds of being discharged to an inpatient facility with an OR of 2.24 (95% CI 1.02, 4.96, P = .046).
Despite being a part of the Canadian universal single-payer healthcare system, the most marginalized patients had worse preoperative and postoperative function, and had increased odds of being discharged to another inpatient facility.
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