Patients' satisfaction with information at discharge

Background: Adequate patient knowledge and engagement with their condition and its management can reduce re-hospitalisations and improve outcomes after acute admission for circulatory system disease. Aim: To evaluate the perceptions of cardio- or cerebrovascular patients of their satisfaction with discharge processes and to determine if this differs by demographic groups. Methods: A sample of 536 eligible public hospital inpatients was extracted from a consumer experience surveillance system. Questions relating to the discharge process were analysed using descriptive statistics to compare patient satisfaction levels against demographic variables. Results: Dissatisfaction rates were highest within the ‘Written information provided’ (37.8%) and ‘Danger signals communicated’ (34.7%) categories. Women and people aged ≥80 were more likely to express dissatisfaction. Conclusion: Although respondents were largely satisfied, there are important differences in the characteristics of those that were dissatisfied. The communication of important discharge information to older people and women was less likely to meet their perceived needs

Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: Atherosclerosis risk in communities (ARIC) community surveillance

<p>Abstract</p> <p>Background</p> <p>Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting.</p> <p>Methods</p> <p>We evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta [β]-blockers and angiotensin converting enzyme [ACE] inhibitors; optimal therapy, defined as receipt of two or more treatments) received during hospitalization or at discharge among 9,608 MI events in the ARIC community surveillance study (1993-2002). Prevalence ratios (PR, 95% CI), adjusted for the clustering of hospitalized MI events within census tracts and within patients, were estimated using Poisson regression.</p> <p>Results</p> <p>Seventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving β-blockers (0.93, 0.87-0.98) and a higher likelihood of receiving ACE inhibitors (1.13, 1.04-1.22), compared to high nINC. Patients with Medicaid coverage were less likely to receive aspirin (0.92, 0.87-0.98), compared to patients without Medicaid coverage. These findings were independent of other key covariates.</p> <p>Conclusions</p> <p>nINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.</p

Transaction-Based Pseudonyms in Audit Data for Privacy Respecting Intrusion Detection

Abstract. Privacy and surveillance by intrusion detection are poten-tially conflicting organizational and legal requirements. In order to sup-port a balanced solution, audit data is inspected for personal data and identifiers referring to real persons are substituted by transaction-based pseudonyms. These pseudonyms are constructed as shares for a suitably adapted version of Shamir’s cryptographic approach to secret sharing. Under sufficient suspicion, expressed as a threshold on shares, audit an-alyzers can perform reidentification

A system for distributed intrusion detection

The study of providing security in computer networks is a rapidly growing area of interest because the network is the medium over which most attacks or intrusions on computer systems are launched. One approach to solving this problem is the intrusion-detection concept, whose basic premise is that not only abandoning the existing and huge infrastructure of possibly-insecure computer and network systems is impossible, but also replacing them by totally-secure systems may not be feasible or cost effective. Previous work on intrusion-detection systems were performed on stand-alone hosts and on a broadcast local area network (LAN) environment. The focus of our present research is to extend our network intrusion-detection concept from the LAN environment to arbitarily wider areas with the network topology being arbitrary as well. The generalized distributed environment is heterogeneous, i.e., the network nodes can be hosts or servers from different vendors, or some of them could be LAN managers, like our previous work, a network security monitor (NSM), as well. The proposed architecture for this distributed intrusion-detection system consists of the following components: a host manager in each host; a LAN manager for monitoring each LAN in the system; and a central manager which is placed at a single secure location and which receives reports from various host and LAN managers to process these reports, correlate them, and detect intrusions. 11 refs., 2 figs