Traffic Privacy Study on Internet of Things – Smart Home Applications

Internet of Things (IoT) devices have been widely adopted in many different applications in recent years, such as smart home applications. An adversary can capture the network traffic of IoT devices and analyze it to reveal user activities even if the traffic is encrypted. Therefore, traffic privacy is a major concern, especially in smart home applications. Traffic shaping can be used to obfuscate the traffic so that no meaningful predictions can be drawn through traffic analysis. Current traffic shaping methods have many tunable variables that are difficult to optimize to balance bandwidth overheads and latencies. In this thesis, we study current traffic shaping algorithms in terms of computational requirements, bandwidth overhead, latency, and privacy protection based on captured traffic data from a mimic smart home network. A new traffic shaping method - Dynamic Traffic Padding is proposed to balance bandwidth overheads and delays according to the type of devices and desired privacy. We use previous device traffic to adjust the padding rate to reduce the bandwidth overhead. Based on the mimic smart home application data, we verify our proposed method can preserve privacy while minimizing bandwidth overheads and latencies

Prescribing patterns of cardiovascular drugs in cardiology outpatient department in a tertiary care hospital in Western Odisha

Background: Cardiovascular morbidity plays a villainous role globally as well as countries like India. Additionally, irrational prescription incurs greater damage to health and wellbeing. Drug utilization studies scrutinize the appropriateness of treatment and provide favorable feedbacks to strengthen clinical practices. The objective of the study was to describe treatment practices in cardiology outpatient and drug utilization pattern using core prescribing indicators by World Health Organization (WHO).Methods: A cross-sectional, observational study of 4-month duration was undertaken for cardiology Outdoor patients at a tertiary care hospital. 615 prescriptions were screened and analyzed.Results: Males (59.84%) were more in number than females (40.16%). Average number of the prescribed drugs per patient were 4.32±2.7 and (3.73±1.1 for cardiovascular drugs). Generic prescription was 60.98%. Percentage encounters with antibiotics 4.11, injectables 2.92%, fixed-dose combinations (FDCs) (11.8%) were documented. Drugs from the National List of Essential Medicines were 75.89%. The most common diagnosis was ischemic heart disease (68.29%). Hypolipidemics (78.25%) followed by antiplatelets (71.14%) were toppers in cardiovascular drug. Antiulcer drugs (PPI/Antacids) comprised 58.54% of total prescriptions.Conclusions: Less adherence to EDL, less generic prescriptions, use of FDC are major shortcomings. Areas to further rationalization like optimal use of evidence based medication like beta-blockers, newer anticoagulants/anti-platelet agents and newer anti-anginal agents are identified

Development and Use of a Tablet-Based Resuscitation Sheet for Improving Outcomes During Intensive Patient Care

Data documentation from resuscitation events in hospitals, termed code blue events, utilizes a paper form, which is institution-specific. Problems with data capture and transcription exists, due to the challenges of dynamic documentation of patient, event and outcome variables as the code blue event unfolds. We hypothesize that an electronic version of code blue real-time data capture would lead to improved resuscitation data transcription, and enable clinicians to address deficiencies in quality of care. To this effect, we present the design of a tablet-based application and its use by 20 nurses at the Mayo Clinic hospital. The results showed that the nurses preferred the tablet application over the paper based form. Furthermore, a qualitative survey showed the clinicians perceived the electronic version to be more accurate and efficient than paper-based documentation, both of which are essential for an emergency code blue resuscitation procedure

Utilization trends of drugs in patients admitted with ischemic heart disease in a tertiary care teaching hospital

Background: Coronary artery disease (CAD) takes the highest toll of lives across the world as well as India. Prompt diagnosis and effective treatment is lifesaving. Drug utilization studies scrutinize the appropriateness of treatment and provide favourable feedbacks to strengthen clinical practices. Several other studies have reported underuse of four evidence-based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD. Polypharmacy, injection overuse is some of the shortcomings. The objectives of this study was to describe treatment practices in terms of different disease spectrum and drug utilization (group-wise and individually) for inpatients with CAD using core prescription indicators by WHO.Methods: A cross-sectional study of 4-month duration was undertaken for patients with CAD admitted to cardiology indoor of a tertiary care hospital. A total no of 143 prescriptions was screened and analyzed.Results: Males (67.13%) were more in number than females (32.87%). Age group from (57-66) topped in frequency (61.05%) ahead of (67 to 76) group (38.46%). Average no of drugs per patient were 8.056±1.97 and 5.86±0.14 for cardiovascular drugs. Prescription in generics (45.49%), antibiotics (0.61%), fixed-dose combinations (FDCs) (0.52%) and injectables (28.47%) were noted. The most common categories of CAD were ST-segment elevated myocardial infarction (69.23%) followed by chronic stable angina (17.48%). Antiplatelets (100%), hypolipidemics (99.3%), antianginals (60.14%), β-blockers (37.06%) and ACE-I/ARBs (27.97%) were utilized. Drugs from the national list of essential medicines were 66.49%.Conclusions: Among four evidence-based drugs, use of β-blockers and ACE-I/ARBs were inappropriately low. Polypharmacy and overuse of Injectable drugs are noted

Sociodemographic Variations in the Uptake of Faecal Immunochemical Tests in Primary Care

Background: Faecal Immunochemical Testing (FIT) usage for symptomatic patients is increasing, but variations in use by sociodemographics are unknown. We introduced FIT for symptomatic patients in November 2017. Aim: Identify whether demographics, ethnicity or social deprivation affect FIT return in symptomatic patients. Design and Setting: FIT was introduced as a triage tool in Primary Care and was mandated for all colorectal referrals (except rectal bleeding/mass) to secondary care. FIT was used, alongside full blood count and ferritin, to stratify colorectal cancer risk. Method: All referrals November 2017-December 2021 were retrospectively reviewed. Sociodemographic factors affecting FIT return were analysed by multivariate logistic regression. Results: 35,289 patients returned their index FIT (90.7%), 3631 (9.3%) did not. On multivariate analysis, males were less likely to return FIT (OR 1.11, 95%CI 1.03-1.19). Patients over 65 were more likely to return FIT (OR 0.78 for non-return, 95%CI 0.72-0.83). Unreturned FIT was more than doubled in the most compared to the least deprived (OR 2.20, 95%CI 1.99-2.43). Patients from Asian (OR 1.82, 95%CI 1.58-2.10), Black (OR 1.21, 95%CI 0.98-1.49) and Mixed/Other ethnic groups (OR 1.29, 95%CI 1.05-1.59) were more likely to not return FIT compared to White ethnicity. 599 colorectal cancers were detected (1.5%), 561 in those who returned a first FIT request, 38 in those who did not. Conclusion: FIT return in those suspected of having colorectal cancer varies by gender, age, ethnicity, and socioeconomic deprivation. Strategies to mitigate effects on FIT return and colorectal cancer detection should be considered as FIT usage expands

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme