Digital health and perioperative care

According to the U.S. Food and Drug Administration ‘the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalised medicine, and is used by providers and other stakeholders in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalised for patients (FDA 2016). More recently, Paul Sonier, a digital health strategist and founder of the Linkedin Digital Health Group with more than 40,000 members, defined digital health as ‘the convergence of the digital and genomic revolutions with health, healthcare, living, and society’ ( storyofdigitalhealth.com 2016). </jats:p

What factors influence an early COPD diagnosis in primary care?

This systematic literature review aimed to identify factors influencing late- and under-diagnosis of COPD in primary care Background: There are millions of people living with chronic obstructive pulmonary disease (COPD) who have not been diagnosed. Patients have regularly lost half of their lung function by the point of diagnosis, and therefore there are fewer interventions available. Aim: The aim of this systematic literature review was to identify factors influencing late- and under-diagnosis of COPD in primary care. This includes considering the current methods of COPD screening, and whether early screening would benefit diagnostic rates. Methods: A comprehensive, systematic literature search was undertaken using the following databases: BNI, CINAHL, Medline, NHS Evidence, PubMed, ScienceDirect, Wiley Online. Following this, a critical review of the literature was performed on 10 relevant articles. A thematic analysis followed. Results: There is a significant lack of up-to-date research on COPD screening and early detection. Generalised screening versus case-finding may be a method of identifying the undiagnosed population; however, evidence needs to improve. There is a lack of COPD education in healthcare and wider society. COPD among women is on the rise, yet they are less likely to be identified. There is a necessity for guidance and research to be provided. Screening is likely to be the future preferred method for identifying those undiagnosed, but research needs to identify the benefits of screening versus casefinding. Conclusion: The findings can be applied to primary care nursing, to combat COPD under-diagnosis. </jats:sec

The lived experiences of operating theatre scrub nurses learning technical scrub skills ‘I’m doing this right, aren’t I? Am I doing this right?’

Operating theatre scrub nurses (OTSNs) are not required to have undertaken a secondary or specialist post-registration theatre qualification to work in the operating theatre (OT) setting in the UK. From the systematic review there is only very limited literature or research in how technical scrub skills are acquired. This study explores the lived experiences of OTSNs learning technical scrub skills. The study employed the qualitative methodology of interpretative phenomenological analysis. Data was collected from six participating OTSNs using semi-structured interviews. Four superordinate themes emerged: How technical scrub skills are established, Gatekeepers, How the learner feels whilst learning and, Reflections of the experienced scrub nurse. The study found that the experiences of OTSNs learning technical scrub skills are varied and a variety of teaching and learning methods are utilised. These experiences were influenced by the team, mentor and surgeon within the OT environment. Lived experiences were also influenced by organisational structure and service pressures within the NHS. </jats:p

Wearable devices in palliative care for people 65 years and older:A scoping review

publishedVersio

The supply chain of a Living Lab: Modelling security, privacy, and vulnerability issues alongside with their impact and potential mitigation strategies

Worldwide, vulnerabilities and weak security strategies are exploited everyday by adversaries in healthcare organizations. Healthcare is targeted because these crimes are high-reward and low-risk. The attacks differ every time, from hacking medical devices, such as sensors, to stealing patients’ data from electronic health records databases. The effects of these attacks are both short and long term lived, depending on the incidence handling process that each sector is adopting. The Covid-19 pandemic has exposed, in full, that healthcare systems are vulnerable and vastly unprotected while representing a threat to global public health. An important part of the healthcare ecosystem, for the development and validation of innovative tools and methodologies, is the Living Labs which are community-based and adopt co-creation as their primary approach. Because of the many stakeholders involved in the processes of the Living Labs, cybersecurity ought to be in their center. Besides the proven great importance of the Living Labs as part of healthcare, there is no research on security and privacy issues around them. The main purpose of this paper is to explore the supply chain of a Living Lab and identify its security and privacy challenges alongside with its vulnerabilities. The SecTro tool has been used to provide a thorough analysis which follows the Privacy-by-Design approach. The originality and novelty of our work are shown from: (i) moving one step further from desk studies by including requirements from citizens and professionals; (ii) being integrated into an effort from various researchers to supply a holistic approach to Data Privacy Governance; (iii) the first time which a paper is considering and analysing the supply chain of the Living Labs

The Importance of Conceptualising the Human-Centric Approach in Maintaining and Promoting Cybersecurity-Hygiene in Healthcare 4.0

The cyberspace depicts an increasing number of difficulties related to security, especially in healthcare. This is evident from how vulnerable critical infrastructures are to cyberattacks and are unprotected against cybercrime. Users, ideally, should maintain a good level of cyber hygiene, via regular software updates and the development of unique passwords, as an effective way to become resilient to cyberattacks. Cyber security breaches are a top priority, and most users are aware that their behaviours may put them at risk; however, they are not educated to follow best practices, such as protecting their passwords. Mass cyber education may serve as a means to offset poor cyber security behaviours; however, mandatory education becomes a questionable point if the content is not focused on human factors, using human-centric approaches and taking into account end users’ behaviours, which is currently the case. The nature of the present paper is largely exploratory, and the purpose is two-fold: To present and explore the cyber hygiene definition, context and habits of end users in order to strengthen our understanding of users. Our paper reports the best practices that should be used by healthcare organisations and healthcare professionals to maintain good cyber hygiene and how these can be applied via a healthcare use case scenario to increase awareness related to data privacy and cybersecurity. This is an issue of great importance and urgency considering the rapid increase of cyberattacks in healthcare organisations, mainly due to human errors. Further to that, based on human-centric approaches, our long-term vision and future work involves facilitating the development of efficient practices and education associated with cybersecurity hygiene via a flexible, adaptable and practical framework

Factors Associated With Retinal Vessel Diameters in an Elderly Population: the Thessaloniki Eye Study

Purpose: To identify the factors associated with retinal vessel diameters in the population of the Thessaloniki Eye Study. Methods: Cross-sectional population-based study (age ≥ 60 years). Subjects with glaucoma, late age-related macular degeneration, and diabetic retinopathy were excluded from the analyses. Retinal vessel diameters were measured using the IVAN software, and measurements were summarized to central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole to venule ratio (AVR). Results: The analysis included 1614 subjects. The hypertensive group showed lower values of CRAE (P = 0.033) and AVR (P = 0.0351) compared to the normal blood pressure (BP) group. On the contrary, the group having normal BP under antihypertensive treatment did not have different values compared to the normal BP group. Diastolic BP (per mm Hg) was negatively associated with CRAE (P < 0.0001) and AVR (P < 0.0001), while systolic BP (per mm Hg) was positively associated with CRAE (P = 0.001) and AVR (P = 0.0096). Other factors significantly associated included age, sex, alcohol, smoking, cardiovascular disease history, ophthalmic medication, weight, and IOP; differences were observed in a stratified analysis based on BP medication use. Conclusions: Our study confirms previous reports about the association of age and BP with vessel diameters. The negative correlation between BP and CRAE seems to be guided by the effect of diastolic BP as higher systolic BP is independently associated with higher values of CRAE. The association of BP status with retinal vessel diameters is determined by diastolic BP status in our population. Multiple other factors are also independently associated with retinal vessel diameters

Difficult intubation provokes bacteremia

Abstract Purpose: To evaluate the prevalence of bacteremia after mask ventilation, laryngoscopy, and endotracheal intubation before induction of general anesthesia and to discover any correlation between traumatic manipulations and bacteremia. The specific bacteria responsible, knowledge of which may guide the prophylactic use of antibiotics, also were investigated. Methods: Fifty patients were enrolled. Three 10-mL blood samples were collected from a peripheral vein 10 min before induction of anesthesia, 10 min after mask ventilation, and 10 min after intubation. All samples were placed in aerobic and anaerobic bottles for culture and bacterial identification. Results: Cultures received 10 min after intubation were positive in 12% of patients. The following strains were isolated: Escherichia coli in two cases, Staphylococcus aureus in three cases, and Peptostreptococcus anaerobius in one case. A strong positive correlation was found between difficult intubation and bacteremia. No correlation between bacteremia and easy intubation or between bacteremia and face mask ventilation was identified. Conclusion: Traumatic manipulations during difficult laryngoscopy and endotracheal intubation could cause bacteremia. This finding may justify and guide prophylactic use of antibiotics. 52

Regional anaesthesia versus general anaesthesia in endovascular aneurysm repair: the surgical nursing interventions

Minimally invasive surgical techniques are a revolutionary and innovative approach to the practice of surgery. Endovascular aneurysm repair (EVAR) may offer a number of significant advantages in comparison with conventional open surgical repair. The purpose of this study was to compare regional anaesthesia (RA) and general anaesthesia (GA) in EVAR, and to describe the surgical nursing interventions. This included a retrospective analysis of 160 consecutive patients (age 55 to 96 years) who underwent EVAR under: epidural anaesthesia (EDA = 60 patients), combined spinal and epidural anaesthesia (Combined = 40 patients) and GA = 60 patients. Results were successful in all patients and no mortality was noticed. Among the GA group, 11 patients needed ICU support while only 5 from the other 2 groups. Furthermore, a statistically significant difference regarding median hospital stay was also noticed in favour of the regional group. In conclusion, RA is a safe and effective anaesthetic method for endovascular repair of abdominal aneurysms, offering several advantages including simplicity, haemodynamic stability, less need for ICU management and reduced hospital stay. The anaesthetic nurse can play a major role in the management of this anaesthesia throughout the procedure