Telemedicine Security: Challenges and Solutions

The proliferation of telemedicine spurred by the COVID-19 pandemic has come with a variety of human factors challenges. Such challenges include mitigating potential risks associated with the quick transition to virtual care. We identify challenges and solutions related to telemedicine security, and analyze our results using Schlarman’s People, Policy, Technology framework (2001). Our systematic literature review synthe-sizes gray literature (white papers, news articles, and blog posts) in addition to formal (published) litera-ture. This methodology closes the gap between academic research and professional practice and aids in providing timely, practical insights related to cybersecurity and safety in virtual care environments. As the transition from traditional care continues to develop, we seek to better understand emerging vulnerabilities, identify crucial cyber hygiene practices, and provide insights on how to improve the safety of paitent data in virtiual care. Telemedicine is here to stay, and lessons learned from the pandemic are likely to remain useful

PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: The PREVENT multi-center study

BACKGROUND: Recommended structured clinical practices including implant technique, anti-coagulation strategy, and pump speed management (PREVENT [PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management] recommendations) were developed to address risk of early (<3 months) pump thrombosis (PT) risk with HeartMate II (HMII; St. Jude Medical, Inc. [Thoratec Corporation], Pleasanton, CA). We prospectively assessed the HMII PT rate in the current era when participating centers adhered to the PREVENT recommendations. METHODS: PREVENT was a prospective, multi-center, single-arm, non-randomized study of 300 patients implanted with HMII at 24 participating sites. Confirmed PT (any suspected PT confirmed visually and/or adjudicated by an independent assessor) was evaluated at 3 months (primary end-point) and at 6 months after implantation. RESULTS: The population included 83% men (age 57 years ± 13), 78% destination therapy, and 83% Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1-3. Primary end-point analysis showed a confirmed PT of 2.9% at 3 months and 4.8% at 6 months. Adherence to key recommendations included 78% to surgical recommendations, 95% to heparin bridging, and 79% to pump speeds ≥9,000 RPMs (92% >8,600 RPMs). Full adherence to implant techniques, heparin bridging, and pump speeds ≥9,000 RPMs resulted in a significantly lower risk of PT (1.9% vs 8.9%; p < 0.01) and lower composite risk of suspected thrombosis, hemolysis, and ischemic stroke (5.7% vs 17.7%; p < 0.01) at 6 months. CONCLUSIONS: Adoption of all components of a structured surgical implant technique and clinical management strategy (PREVENT recommendations) is associated with low rates of confirmed PT

Early intervention for lactate dehydrogenase elevation improves clinical outcomes in patients with the HeartMate II left ventricular assist device: Insights from the PREVENT study

BACKGROUND: Hemolysis, assessed by elevated serum lactate dehydrogenase (LDH), is strongly associated with HeartMate II pump thrombosis (PT). However, it is unknown whether early intervention for elevated LDH circumvents the risk of serious PT requiring pump exchange. We sought to evaluate the relationship between elevated LDH and clinical outcomes, the effectiveness of early medical intervention, and risk factors for elevated LDH. METHODS: We studied 268 patients in the prospective, multicenter PREVENT study who had 2 or more LDH measurements at ≥30 days post-implant. Elevated LDH was defined as LDH ≥2.5× upper limit of normal (ULN) for 2 consecutive measurements. RESULTS: Fourteen percent of patients had elevated LDH. Stroke-free survival at 6 months was lower in patients with elevated LDH vs patients with normal LDH (83 ± 6% vs 93 ± 2%, p = 0.035). Elevated LDH resolved without intervention in 19% of patients, with intensified medical therapy in 43% and required surgical intervention in 38%. For patients receiving only medical therapy, survival was 94 ± 6% at 6 months post-treatment. In this subgroup, resolution of symptoms with intensified medical therapy was sustained in 15 of 16 patients, with PT occurring in 1 patient at 171 days after initial treatment for elevated LDH (202 days post-implant). Early medical intervention at moderately elevated LDH (2.5× to 3.2× ULN), as compared with higher levels (>3.2× ULN), led to more sustained resolution of symptoms without subsequent PT or need for surgical intervention (91% vs 26% at 6 months post-treatment, p = 0.002). CONCLUSIONS: Early medical intervention can successfully resolve moderate LDH elevations (2.5× to 3.2× ULN) with a low incidence of death or PT at 6 months post-treatment

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

The Effects of Gender, Flow and Video Game Experience on Combat Identification Training

ABSTRACT: The present study examined the effects of gender, video game experience (VGE), and flow state on multiple indices of combat identification (CID) performance. Individuals were trained on six combat vehicles in a simulation, presented through either a stereoscopic or non-stereoscopic display. Participants then reported flow state, VGE and were tested on their ability to discriminate friend vs. foe and identify both pictures and videos of the trained vehicles. The effect of stereoscopy was not significant. There was an effect of gender across three dependent measures. For the two picture-based measures, the effect of gender was mediated by VGE. Additionally, the effect of gender was moderated by flow state on the identification measures. Overall, the study suggests that gender differences may be overcome by VGE and by achieving flow stPractitioner Summary: This work investigates the effect of gender, VGE and flow state on CID performance. For three measures of performance, there was a main effect of gender. Gender was mediated by previous VGE on two measures, and gender was moderated by flow state on two measures

Review Of Combat Identification Training: Technologies, Metrics, And Individual Differences

Combat identification (CID) has been studied throughout the 20th and into the 21st century, with a renewed interest in the topic in the past few decades. CID research has demonstrated that an emerging set of technologies could potentially mitigate some of the negative battlefield outcomes of failures in CID, including high rates of fratricide due to friendly fire. This paper discusses major CID research and provides an update on previous CID research by the authors. We review training technologies, effective measurement tools in this research, and important individual differences to consider for others researching training outcomes in relation to learning to differentiate between highly similar combat vehicles

Telemedicine Security: Challenges and Solutions

The proliferation of telemedicine spurred by the COVID-19 pandemic has come with a variety of human factors challenges. Such challenges include mitigating potential risks associated with the quick transition to virtual care. We identify challenges and solutions related to telemedicine security, and analyze our results using Schlarman’s People, Policy, Technology framework (2001). Our systematic literature review synthe-sizes gray literature (white papers, news articles, and blog posts) in addition to formal (published) litera-ture. This methodology closes the gap between academic research and professional practice and aids in providing timely, practical insights related to cybersecurity and safety in virtual care environments. As the transition from traditional care continues to develop, we seek to better understand emerging vulnerabilities, identify crucial cyber hygiene practices, and provide insights on how to improve the safety of paitent data in virtiual care. Telemedicine is here to stay, and lessons learned from the pandemic are likely to remain useful