Acute cardiovascular disease, such as acute myocardial infarction and aortic disease, can lead to a serious life-threatening state within minutes to hours, so early accurate diagnosis, and ...appropriate treatment without delay are essential. To provide high-quality and timely treatment, 24-h availability of medical staff and cardiologists, as well as a cardiac catheterization laboratory are needed. In Japan, the number of patients with acute cardiovascular disease is increasing with the aging population and westernization of lifestyle; however, workstyle reforms for physicians, including a policy to limit overtime work, have been legislated. Under these conditions, it is necessary to centralize hospitals that treat cardiovascular emergency diseases as high-volume centers and build a patient triage system for allocating patients before hospital arrival. The prehospital 12-lead electrocardiogram (ECG) plays a central role in prehospital diagnosis and triage, and its importance will increase in future. We discuss the current and future state of the cardiovascular emergency medical care system utilizing prehospital 12-lead ECG in urban areas of Japan.
In recent years, with the increase in degenerative diseases and the aging population in advanced countries, demands for medical care of older or solitary people have increased continually in ...hospitals and healthcare institutions. Applying wireless sensor networks for the IoT-based telemedicine system enables doctors, caregivers or families to monitor patients' physiological conditions at anytime and anyplace according to the acquired information. However, transmitting physiological data through the Internet concerns the personal privacy of patients. Therefore, before users can access medical care services in IoT-based medical care system, they must be authenticated. Typically, user authentication and data encryption are most critical for securing network communications over a public channel between two or more participants. In 2016, Liu and Chung proposed a bilinear pairing-based password authentication scheme for wireless healthcare sensor networks. They claimed their authentication scheme cannot only secure sensor data transmission, but also resist various well-known security attacks. In this paper, we demonstrate that Liu-Chung's scheme has some security weaknesses, and we further present an improved secure authentication and data encryption scheme for the IoT-based medical care system, which can provide user anonymity and prevent the security threats of replay and password/sensed data disclosure attacks. Moreover, we modify the authentication process to reduce redundancy in protocol design, and the proposed scheme is more efficient in performance compared with previous related schemes. Finally, the proposed scheme is provably secure in the random oracle model under ECDHP.
Background: Analyzing real-world data, including health insurance claims, may help provide insights into preventing and treating various diseases. We developed a database covering Shizuoka Prefecture ...(Shizuoka Kokuho Database SKDB) in Japan, which included individual-level linked data on health- and care-insurance claims and health checkup results.Methods: Anonymized claims data on health insurance (National Health Insurance age <75 years and Latter-Stage Elderly Medical Care System age ≥75 years), care insurance, subscriber lists, annual health checkups, and all dates of death were collected from 35 municipalities in Shizuoka Prefecture. To efficiently link claims and health checkups, unique individual IDs were assigned using a novel procedure.Results: From April 2012 to September 2018, the SKDB included 2,230,848 individuals (men, 1,019,687; 45.7%). The median age (min–max) of men and women was 60 (0–106) and 62 (0–111) years, respectively. During the study period, the median subscription time was 4.4 years; 40.8% of individuals continuously subscribed for the 6.5 years; 213,566 individuals died. Health checkup data were available for 654,035 individuals, amounting to 2,469,648 records. Care-service recipient data were available for 283,537 individuals; they used care insurance to pay for care costs.Conclusion: SKDB, a population-based longitudinal cohort, provides a comprehensive dataset covering health checkups, disorders, medication, and care service. This database may provide a robust platform to identify epidemiological problems and generate hypotheses for preventing and treating disorders in the elderly.
Aim: The late-stage medical care system for older people provides medical examinations, including questionnaires for frailty. We examined whether or not this approach is useful in clinical ...practice.Methods: We used this questionnaire for the screening of frailty as follows: according to the manual prepared by the Japan Geriatrics Society, each question was classified as concerning oral (Q4, 5), physical (Q6-9), cognitive (Q10, 11), or social (Q13-15) frailty. Each frailty was defined if there was at least one negative answer in each question. The grip power and skeletal muscle index (SMI) according to a bioelectrical impedance analysis were also evaluated. Subjects who showed a reduced grip strength and SMI were defined as having sarcopenia, and those who showed only a reduced grip strength were defined as having possible sarcopenia.Results: One hundred and seventy-one subjects aged 81.0±4.2 years old (63.1% female) were enrolled. A total of 12.3% of subjects showed sarcopenia, and 17.5% showed possible sarcopenia. The prevalence of physical, cognitive, and social frailties was associated with sarcopenia. Oral frailty, defined as having decreased swallowing and mastication functions (Q4 and 5), was significantly related to sarcopenia. Physical frailty was associated with age. In patients with hypertension, a low incidence of cognitive frailty was found. Social frailty was related to a decreased body weight.Conclusions: A questionnaire during medical examinations for older subjects may be useful for screening various frailties and may lead to promotion of the preventive care activities in the community. Further studies are needed to elucidate the relationship between each type of frailty and background characteristics.
Acute cardiovascular disease, such as acute myocardial infarction and aortic disease, can lead to a serious life-threatening state within minutes to hours, so early accurate diagnosis, and ...appropriate treatment without delay are essential. To provide high-quality and timely treatment, 24-h availability of medical staff and cardiologists, as well as a cardiac catheterization laboratory are needed. In Japan, the number of patients with acute cardiovascular disease is increasing with the aging population and westernization of lifestyle; however, workstyle reforms for physicians, including a policy to limit overtime work, have been legislated. Under these conditions, it is necessary to centralize hospitals that treat cardiovascular emergency diseases as high-volume centers and build a patient triage system for allocating patients before hospital arrival. The prehospital 12-lead electrocardiogram (ECG) plays a central role in prehospital diagnosis and triage, and its importance will increase in future. We discuss the current and future state of the cardiovascular emergency medical care system utilizing prehospital 12-lead ECG in urban areas of Japan.
Recent advances in medical treatment and emergency applications, the need of integrating wireless body area network (WBAN) with cloud computing can be motivated by providing useful and real time ...information about patients’ health state to the doctors and emergency staffs. WBAN is a set of body sensors carried by the patient to collect and transmit numerous health items to medical clouds via wireless and public communication channels. Therefore, a cloud-assisted WBAN facilitates response in case of emergency which can save patients’ lives. Since the patient’s data is sensitive and private, it is important to provide strong security and protection on the patient’s medical data over public and insecure communication channels. In this paper, we address the challenge of participant authentication in mobile emergency medical care systems for patients supervision and propose a secure cloud-assisted architecture for accessing and monitoring health items collected by WBAN. For ensuring a high level of security and providing a mutual authentication property, chaotic maps based authentication and key agreement mechanisms are designed according to the concept of Diffie-Hellman key exchange, which depends on the CMBDLP and CMBDHP problems. Security and performance analyses show how the proposed system guaranteed the patient privacy and the system confidentiality of sensitive medical data while preserving the low computation property in medical treatment and remote medical monitoring.
Japan has a high suicide mortality rate compared to other developed countries. To reduce suicide mortality in Japan, it is important to systematically analyze factors related to death of patients ...with suicide attempt. This study aimed to analyze the characteristics of patients with suicide attempt, and the factors related to their death using the Diagnosis Procedure Combination (DPC) data— a nationally representative inpatient database. We collected 81,407 cases of suicide attempt from 2016 to 2018 from DPC data and performed a multilevel logistic analysis of factors associated with death discharges. The analysis results showed that patients who received psychiatric liaison care had a lower mortality rate, but only 0.6% of surviving patients received psychiatric liaison care after admission. The odds ratio (OR) of death was high for hanging (28.86; p < 0.001) and jumping (16.28; p < 0.001), compared to wrist cutting. Patients without a psychiatric diagnosis were more likely to choose means such as hanging (14.1%) than those with a psychiatric disorder. The weekend cases had a higher OR of death than weekday (Wednesday as reference) cases (Friday 1.14, p = 0.011; Saturday 1.60, p < 0.001; Sunday 1.67, p < 0.001). Based on these findings, we suggest that improving the availability and quality of psychiatric care in acute care hospitals and primary care settings, as well as enhancing the emergency department system on weekends, could help reduce the mortality of suicide attempts.
Due to the rapidly aging population in Japan, the government has been attempting to link the healthcare delivery system with the long-term care delivery system. However, there are complex challenges ...that must be overcome to link the two systems. A new methodology should be used to organize complex community challenges and propose solutions. This study aimed to visualize the unique challenges and worldviews of interested parties in each community, using the soft systems methodology (SSM). We aimed to visualize issues and clarify challenges associated with linking the healthcare and long-term care delivery systems; in turn, clarifying the thought process behind solution proposals. We gathered information regarding those who are actively linking these systems in communities in a Japanese municipality (community care coordinators) and organized the information according to the SSM procedure. By organizing information using the SSM, we were able to summarize the present situations of the community healthcare and long-term care delivery systems, visualize issues, clarify challenges associated with linking these two systems, and propose solutions. The SSM may be useful in organizing complex community information and deriving solutions.
Objective: We sought to demonstrate the factors involved in the death at home of terminal cancer patients receiving home palliative care within a well-established home medical care system.Methods: We ...conducted a retrospective study using home medical care records of deceased terminal cancer patients who had started receiving house calls by Corporation A, and who had also received home nursing care. Study variables were patient age, sex, disease name, primary carer attributes, whether or not patients and their family members had been informed of the patient’s disease and prognosis at commencement of house calls, whether or not patients wished to continue receiving home care, and time from commencement of house calls until death. After collecting the study data, we performed logistic regression analysis using death at home as the dependent variable.Results: The study population consisted of 933 patients. Our analysis showed that factors enabling death at home were the patient’s wish to continue receiving home care at the commencement of house calls (odds ratio, 95% confidence interval: 3.28, 2.30–4.68, p < .01), and a ≤30-day time period from the commencement of house calls until death (odds ratio, 95% confidence interval: 1.51, 1.13–2.03, p < .01).Conclusion: We found that the factors involved in the death at home of terminal cancer patients within a well-established home medical care system are the patient’s wish to continue receiving home care at the commencement of house calls, and a ≤ 30-day time period from the commencement of house calls until death.
The Internet of Things (IoT) is the collection of open intelligent devices. The fast development of IoT and the huge expansion of mobile technology are unveiling fresh growth opportunities in several ...areas, including education, transport, and farming and, in particular, healthcare. Introduction of IoT via medical applications has several advantages including cost savings by dropping hospital costs, health care costs, and transportation costs, costs of human resources and costs of insurance. Recently, the academic world has produced major progress in research and security development for IoT-based applications, particularly on IoT-based healthcare devices. It contributes to an additional benefit of enhanced healthcare quality. However, the increased use of IoT facilities in e-health applications, particularly in the insurance field, has resulted in increased security and privacy issues. Medical applications are prone to data violations and widening security problems due to the increase in access points to sensitive data through electronic medical records and the increasing popularity of wearable technology. So there is a need of an efficient lightweight, secure verification system, providing important security levels against various attacks, such as attacks by impersonation, a man in the middle attack and unidentified key-sharing attacks for IoT foundation E-health. This article presents a survey of problems, difficulties, and challenges a short analysis of multiple problems and problems suggested by different authors using different techniques and methods.
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