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.
IV.
PurposeThe COVID-19 pandemic is considered a major disruptive event of this decade, raising unforeseen socio-economic implications worldwide. This novel virus has increased the influx of patients in ...hospitals, and healthcare organisations are facing unprecedented constraints in their operations to deal with increased demand and pressed capacity. Thus, this article evaluates the impact of the COVID-19 pandemic on healthcare systems' demand, resources and capacity and provides research directions.Design/methodology/approachThis is a viewpoint article and uses timely information on healthcare operations from both scholars and managers, published by diverse sources during the COVID-19 outbreak.FindingsThe authors discuss the focus on “flattening the curve of infection” as a measure to protect healthcare, delay the impact of increased demand and reorientate healthcare supply chain practices. Furthermore, the authors evaluate the role of lean practices on managing demand and capacity and improving quality across healthcare operations and supply chain. Finally, the authors suggest research directions on modern operational issues that emerged during this pandemic, such as discussions around the sustainability of lean post-pandemic, “just in time” practices, inventory trade-offs and lack of organisational responsiveness during untenable events.Originality/valueIn this article, the authors provide a contemporary assessment of the implications of the COVID-19 pandemic on healthcare operations, underscoring main economic and operational elements that can be affected, such as unforeseen demand, resources and capacity shortage. Therefore, the authors assess that healthcare organisations, practitioners and governments have to anticipate operational and economic impacts and, ultimately, to reassess their plans to deal with such adverse events.
•In this paper, we cryptanalyze Liu-Chung’s, and Challa et al.’s authentication and access control protocol for WSNs.•We proposed an enhanced authentication and access control protocol for WSNs.•The ...proposed scheme is formally validated using AVISPA tool and BAN logic model.•Our informal security analysis showed that, the proposed scheme is secure.•The proposed scheme is efficient compared to other competitive and related protocol.
Wireless Healthcare Sensor Network (WHSN) has become one of the major research fields over the past decades that play a very prominent role in the medical field. Due to the rapid growth of technology in wireless communication, different security challenges have been raised in WHSN. Authentication protocols are used to secure the information transferred over the public channels by WHSN. For this prospect recently, Liu & Chung proposed an authentication and data transmission mechanism for WHSN. However, Challa et al. identified that Liu-Chung’s scheme is vulnerable to stolen smart-card, offline password guessing, privileged insider, and user impersonation attacks. Challa et al. then proposed an enhanced scheme to overcome beforehand stated flaws. This paper denotes out that in accession to before mentioned attacks, Liu-Chung’s scheme is also prone to users’ private key leakage and user impersonation attacks towards sensors. Moreover, Challa et al.’s scheme suffers from incorrectness, broadcasting problem, lack of authentication between Trusted Authority (TA) and sensor nodes, replay attack, Denial of Service (DoS) attack, forgery attack and delay in communication due to the involvement of the TA. Using the elliptic curve cryptography and bilinear paring, an improved scheme is proposed in this paper, to mitigate the weaknesses of Challah et al. and Liu-Chang schemes. The formal security analysis using simulation tool AVISPA and BAN logic demonstrate that the proposed scheme is secure. The rigorous informal security analysis also attests that our scheme is safe against well-known attacks.
The Internet of Things (IoT) is an innovative technology with billions of sensors in various IoT applications. Important elements used in the IoT are sensors that collect data for desired analyses. ...The IoT and sensors are very important in smart cities, smart agriculture, smart education, healthcare systems, and other applications. The healthcare system uses the IoT to meet global health challenges, and the newest example is COVID-19. Demand has increased during COVID-19 for healthcare to reach patients remotely and digitally at their homes. The IoT properly monitors patients using an interconnected network to overcome the issues of healthcare services. The aim of this paper is to discuss different applications, technologies, and challenges related to the healthcare system. Different databases were searched using keywords in Google Scholar, Elsevier, PubMed, ACM, ResearchGate, Scopus, Springer, etc. This paper discusses, highlights, and identifies the applications of IoT healthcare systems to provide research directions to healthcare, academia, and researchers to overcome healthcare system challenges. Hence, the IoT can be beneficial by providing better treatments using the healthcare system efficiently. In this paper, the integration of the IoT with smart technologies not only improves computation, but will also allow the IoT to be pervasive, profitable, and available anytime and anywhere. Finally, some future directions and challenges are discussed, along with useful suggestions that can assist the IoT healthcare system during COVID-19 and in a severe pandemic.
There exists a rising concern on security of healthcare data and service. Even small lost, stolen, displaced, hacked, or communicated in personal health data could bring huge damage to patients. ...Therefore, we propose a novel content-aware deoxyribonucleic acid (DNA) computing system to encrypt medical images, thus guaranteeing privacy and promoting secure healthcare environment. The proposed system consists of sender and receiver to perform tasks of encryption and decryption, respectively, where both contain the same structure design, but perform opposite operations. In either sender or receiver, we design a randomly DNA encoding and a content-aware permutation and diffusion module. Considering introducing random mechanism to increase difficulty of cracking, the former module builds a random encryption rule selector in DNA encoding process by randomly mapping quantity of medical image pixels to outputs. Meanwhile, the latter module constructs a permutation sequence, which not only encodes information of pixel values, but also involves redundant correlation between adjacent pixels located in a patch. Such design brings awareness property of medical image content to greatly increase complexity in cracking by embedding semantical information for encryption. We demonstrate that the proposed system successfully improve cybersecurity of medical images against various attacks in robustness and effectiveness when transmitting data in wireless broadcasting scenarios.
Abstract
Objective: The article is devoted to the analysis of sociological information about the attitude of students to their health.
Methods: A sociological survey among students of Kazan ...educational institutions of Higher Education was conducted in September-November 2020.
Results: The study showed low knowledge of students about the main medical indicators of health, the absence of a healthy lifestyle in the system of value orientations, and lack of confidence in the healthcare system.
Conclusion: The study results on low knowledge of health indicators suggests that it is necessary to conduct competent educational work on the dissemination of medical knowledge among young people, to examine students more carefully in the course of medical examination, to improve the availability and quality of health services provided to students.
Introduction Despite the advancements in oncological medicine and research, cancer remains the second leading cause of death in Europe with Central and Eastern European countries, such as Slovakia ...and Croatia, showing the highest mortality rates and disparities in access to appropriate and comprehensive cancer care. Therefore, the primary aim of the current study is to investigate cancer patients’ perspectives and experiences to understand the possible underlying reasons for cancer disparities. Methods Croatian cancer patients (n=15) and Slovak patients (n=11) were recruited through social media platforms, patients’ organisations, and hospital websites and offered participation in online focus group discussions on perceived disparities, barriers or malfunctioning during and after their cancer journey. Transcripts of video and audio recordings of the interviews were translated and analysed using Thematic analysis. Results Six Croatian and five Slovak themes emerged from the focus group discussions highlighting encountered barriers and perceived disparities, as well as suggestions or unmet needs. Most of the themes are common to both groups, such as the lack of information and use of the internet, and the taboos regarding cancer or psycho-oncological support. However, some themes are specific to each group, for instance, Slovak cancer patients remarked the fact that they do not mind travelling to get treatment as long as they can be treated in the west of Slovakia, while Croatian patients highlighted the need for more information after the illness and the socioeconomic impact deriving from a cancer diagnosis. Discussion Urgent intervention is needed in addressing disparities in Central and Eastern Europe. Present results could inform dedicated guidelines or better resource allocation strategies to reduce disparities in cancer care and promote inclusive healthcare.
Background
Previous studies have shown that minorities and immigrants have low levels of trust in healthcare systems (HCSys), which might present a barrier in access to and utilization of healthcare ...services. We compared the levels of trust in Israel’s HCSys among the Arab minority, immigrant Jews, and non-immigrant Jew sand draw on the integrative model of organizational trust to explore factors that can explain differences in the trust level within and between the study groups.
Method
We obtained cross-sectional census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust based on a survey question: “Do you have trust in the HCSys?” We used logistic regression models to compare levels of trust in HCSys among the study groups, adjusting for components of the integrative model: characteristics (sex, age, education, religiosity, and healthcare service use), abilities (private health insurance ownership), integrity (discrimination, trusting the justice system and government), and perceived risk (self-reported health).
Results
Our findings revealed that Arabs (odds ratio (OR) = 4.20, 95% confidence intervals (CI) = 4.17, 4.23) and immigrant Jews (OR = 2.54, 95% CI = 2.51, 2.58) had more trust in the HCSys compared to non-immigrant Jews, even after adjusting for all the component variables. Different components of the integrative model explained trust in each population group.
Conclusion
Minority and immigrant groups had greater trust in the HCSys compared to the non-immigrant group. These findings may indicate different expectations with respect to patient–caregiver relations and HCSys utilization and raise questions regarding access to HCS and quality of care among minority and immigrant groups.
Despite the growing interest in transformational performance improvement among nearly all countries, international benchmarking has rarely been used. Cross-comparative research could allow an ...appreciation of the extent of Lean's use in healthcare and a better evaluation of possible cultural influences on Lean implementation. This study provides a comparative international benchmarking of Lean adoption, implementation, and outcomes of hospitals in the US and Italy.
The National Survey of Lean, developed in 2017 in the US and adapted in Italy in 2019 was used to compare the two healthcare systems along three dimensions: the maturity of adoption, the implementation approach, identifying both strategic and operational activities and tools, and the Lean performance, investigated through patients, employed, and affiliated staff, costs, and service provision areas. Descriptive statistics including T-tests were used to examine differences between the two countries on the study variables.
Lean has been adopted less by Italian public hospitals (36%) than US public hospitals (53%). Each country averages 4 years of experience with Lean. Italian hospitals reported being at a higher maturity stage while the US implemented a more system-wide approach, developing Lean in more operational units. The daily management system, leadership commitment, education and training indexes were higher or the same in the US while in Italy, hospitals had a higher self-reported performance index.
This exploratory work is one of the first international benchmarking studies on Lean implementation in healthcare systems using a standardized survey with a common set of definitions and questions. The study identifies different forms of Lean implementation that can be adopted, both at strategic and operational levels, with related perceived outcomes. Despite the US public hospitals being more likely to report a higher number of units using Lean, a higher daily management system index and use of Lean tools, Italian hospitals report more achievements primarily due to Lean. Further research can build on these findings by examining the relationship between Lean adoption/implementation and independent, objective performance measures.
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