Towards personalized services in the healthcare domain

Healthcare services are designed for enabling the provision of medical care to the patient. The traditional healthcare services are based on the doctor-centric paradigm. Essentially, they enable healthcare providers to assess patients’ health status based on information derived from medical examination and information stored in patient’s electronic Medical Health Records (eMHRs) [1]. Hence, it is crucial for patient’s health data to be digitalized and organized in such a way allowing their exploitation by the healthcare provider at a later point of time [2]. The doctor-centric healthcare services enhance healthcare providers’ diagnosing skills and enable them to give patients accurate treatment directions aiming to their earlier and safer de-hospitalization

Provision of Personalized Ubiquitous Healthcare Services over NGN Using Always Best Connected Service Provider

This paper presents a personalized middleware for mobile eHealth (mHealth) services for use in the Ubiquitous Consumer Wireless World (UCWW). The middleware was developed based on the ISO/IEEE 11073 personal health data (PHD) standards. It works as a multi-agent system (MAS) to provide intelligent collection of physiological data from medical sensors attached to human body, and subsequent sending of gathered data to a log data node by utilizing the Always Best Connected and best Served (ABC&S) communication paradigm. A number of design issues associated with the middleware implementation are outlined

Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer : protocol for a systematic review and network meta-analysis from the CIRCLE Group

Introduction Local treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications. Methods and analysis Literature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool. Ethics and dissemination Ethical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public. PROSPERO registration number CRD42018115508.Peer reviewe

Comparative fertility and pregnancy outcomes after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer : protocol for a systematic review and network meta-analysis from the CIRCLE group

Introduction There are several local treatment methods for cervical intraepithelial neoplasia that remove or ablate a cone-shaped part of the uterine cervix. There is evidence to suggest that these increase the risk of preterm birth (PTB) and that this is higher for techniques that remove larger parts of the cervix, although the data are conflicting. We present a protocol for a systematic review and network meta-analysis (NMA) that will update the evidence and compare all treatments in terms of fertility and pregnancy complications. Methods and analysis We will search electronic databases (CENTRAL, MEDLINE, EMBASE) from inception till October 2019, in order to identify randomised controlled trials (RCTs) and cohort studies comparing the fertility and pregnancy outcomes among different excisional and ablative treatment techniques and/or to untreated controls. The primary outcome will be PTB ( Ethics and dissemination Ethical approval is not required. Results will be disseminated to academic beneficiaries, medical practitioners, patients and the public.Peer reviewe

Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer : a systematic review and network meta-analysis

Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: The trade-off between comparative effectiveness and reproductive morbidity of different treatment methods for cervical intraepithelial neoplasia (CIN) remains unclear. We aimed to determine the risks of treatment failure and preterm birth associated with various treatment techniques. Methods: In this systematic review and network meta-analysis, we searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials database for randomised and non-randomised studies reporting on oncological or reproductive outcomes after CIN treatments from database inception until March 9, 2022, without language restrictions. We included studies of women with CIN, glandular intraepithelial neoplasia, or stage IA1 cervical cancer treated with excision (cold knife conisation [CKC], laser conisation, and large loop excision of the transformation zone [LLETZ]) or ablation (radical diathermy, laser ablation, cold coagulation, and cryotherapy). We excluded women treated with hysterectomy. The primary outcomes were any treatment failure (defined as any abnormal histology or cytology) and preterm birth (<37 weeks of gestation). The network for preterm birth also included women with untreated CIN (untreated colposcopy group). The main reference group was LLETZ for treatment failure and the untreated colposcopy group for preterm birth. For randomised controlled trials, we extracted group-level summary data, and for observational studies, we extracted relative treatment effect estimates adjusted for potential confounders, when available, and we did random-effects network meta-analyses to obtain odds ratios (ORs) with 95% CIs. We assessed within-study and across-study risk of bias using Cochrane tools. This systematic review is registered with PROSPERO, CRD42018115495 and CRD42018115508. Findings: 7880 potential citations were identified for the outcome of treatment failure and 4107 for the outcome of preterm birth. After screening and removal of duplicates, the network for treatment failure included 19 240 participants across 71 studies (25 randomised) and the network for preterm birth included 68 817 participants across 29 studies (two randomised). Compared with LLETZ, risk of treatment failure was reduced for other excisional methods (laser conisation: OR 0·59 [95% CI 0·44–0·79] and CKC: 0·63 [0·50–0·81]) and increased for laser ablation (1·69 [1·27–2·24]) and cryotherapy (1·84 [1·33–2·56]). No differences were found for the comparison of cold coagulation versus LLETZ (1·09 [0·68–1·74]) but direct data were based on two small studies only. Compared with the untreated colposcopy group, risk of preterm birth was increased for all excisional techniques (CKC: 2·27 [1·70–3·02]; laser conisation: 1·77 [1·29–2·43]; and LLETZ: 1·37 [1·16–1·62]), whereas no differences were found for ablative methods (laser ablation: 1·05 [0·78–1·41]; cryotherapy: 1·01 [0·35–2·92]; and cold coagulation: 0·67 [0·02–29·15]). The evidence was based mostly on observational studies with their inherent risks of bias, and the credibility of many comparisons was low. Interpretation: More radical excisional techniques reduce the risk of treatment failure but increase the risk of subsequent preterm birth. Although there is uncertainty, ablative treatments probably do not increase risk of preterm birth, but are associated with higher failure rates than excisional techniques. Although we found LLETZ to have balanced effectiveness and reproductive morbidity, treatment choice should rely on a woman's age, size and location of lesion, and future family planning. Funding: National Institute for Health and Care Research: Research for Patient Benefit.Peer reviewe

Patterns of Resilience during Socioeconomic Crises among Households in Europe (RESCuE): Concept, Objectives and Work. Packages of an EU FP 7 Project

Since 2008, Europe has been shaken by an ongoing crisis. If relevant parts of populations are exposed to socioeconomic risks, it is a distinctive characteristic of European political ethics that they must not be left alone, but should be subject to support and solidarity by budget support policy, economic development policies and social policy at different levels. But, in analogy with medical and psychological findings, some parts of the vulnerable population, although experiencing the same living conditions as others, are developing resilience, which in our context means that they perform social, economic and cultural practices and habits which protect them from suffer and harm and support sustainable patterns of coping and adaption. This resilience to socioeconomic crises at household levels is the focus of the project. It can consist of identity patterns, knowledge, family or community relations, cultural and social as well as economic practices, be they formal or informal. Welfare states, labour markets and economic policies at both macro or meso level form the context or ‘environment’ of those resilience patterns. For reasons of coping with the crisis without leaving the common ground of the implicit European social model (or the unwritten confession to the welfare state) under extremely bad monetary conditions in many countries, and for reasons of maintaining quality of life and improving social policy, it is a highly interesting perspective to learn from emergent processes of resilience development and their preconditions. Thus, the main questions are directed at understanding patterns and dimensions of resilience at micro-/household level in different types of European member and neighbour states accounting for regional varieties, relevant internal and external conditions and resources as well as influences on these patterns by social, economic or labour market policy as well as legal regulations

Analysis and development of fuzzy-probabilistic models for designing trust management systems for ubiquitous healthcare environments oriented on anxiety disorders

Trust is considered to be cornerstone of patient-psychotherapist interaction, therefore lack of trust into Ubiquitous Healthcare (UH) environments oriented on anxiety disorders affects quality of delivered services. To meet that challenge is proposed trust to be taken into consideration as key-factor on selection of UH Provider when a UH service is requested. This accomplished via a Trust Management System (TMS) that foresight trustworthiness of UH Providers on the basis of requestor’s Personal Interaction Experience (PIE) and Reputation as calculated by his/her group therapy partners’. Under the perspective of accurate trustworthiness estimation as well as robust against malicious attacks affecting Reputaion, TMS internal mechanisms are proposed to be mathematically modeled on the basis of Cloud Theory. Essentially, Cloud Theory permits TMS to be modeled into fuzzy-probabilistic terms on a basis of a linguistic reasoning. Furthermore, the exploitation of Cloud Theory permits PIE and Reputation to be modeled by Cloud that facilitate their eigen-features to be expressed. Both simulation and experimental cooperative study confirm the proposed TMS outperformance within clean environment and under malicious attacks even the more complex.Η εμπιστοσύνη παίζει κυρίαρχο ρόλο στοην ποιότητα παροχής διάχυτων υπηρεσιών υγείας σε ασθενείς με διαταραχές άγχους καθώς εάν δεν υπάρχει σχέση εμπιστοσύνης μεταξύ παρόχου-χρήστη παρατηρείται περιορισμένη πρόθεση διαμοιρασμού προσωπικών δεδομένων ή/και υλοποίησης των οδηγιών. Ως εκ τούτου απατείται η λήψη του παράγοντα εμπιστοσύνης κατά την επιλογή παρόχου εντός περιβάλλοντος διάχυτης και εξατομικευμένης παροχής υπηρεσιών υγείας. Η ανάγκη αυτή επιλύεται μέσω ενός Συστήματος Διαχείρισης Εμπιστούνης (ΣΔΕ) το οποίο προβλέπει την εμπιστοσύνη του παρόχου με βάση την Ατομική Εμπειρία (ΑΕ) του χρήστη που αιτείται την υπηρεσία και την Φήμη του παρόχου εντός της ομάδας θεραπείας του αιτούντα. Με στόχο την ακριβή και σθεναρή διαδικασία εκτίμησης εμπιστοσύνης ακόμη και ενάντια σε κακόβουλες επιθέσεις οι Μηχανισμοί του ΣΔΕ προτείνεται να μοντελοποιηθούν μαθηματικά στη βάση της θεωρίας των Νεφών. Ουσιαστικά πρόκειται για μια ασαφοπιθανοτική προσέγγιση της λειτουργίας του ΣΔΕ που βασίζεται στον λεκτικό λογισμό. Η συγκριτική προσομοιωτική και πειραματική μελέτη του ΣΔΕ αποδεικνύει την υψηλή απόδοσή του σε καθαρό περιβάλλον και υπό την επίδραση κακόβουλων επιθέσεων

Towards personalization of trust management service for ubiquitous healthcare environment

In healthcare, trust is considered to be the key factor for the provision of effective healthcare services. Thus, ubiquitous healthcare environment incorporate Trust Management systems or services for enabling the creation of confident and secure background required for the provision of healthcare services. In this paper the concept of personalized Trust Management service is introduced. However, since this approach makes the service vulnerable to user's subjectivity in this paper is proposed a mechanism that determines the proper in case personalization factor. Especially, it quantifies the Quality of trust Information that user has acquired from past interactions and determines if he/she is capable to discover and select healthcare providers. The introduced mechanism is deployed on a Fuzzy Interference System and its performance was evaluated through simulations in MATLAB/SIMULINK environment

A profile-based trust management scheme for ubiquitous healthcare environment

Ubiquitous Healthcare environment materializes the patient-centric paradigm providing healthcare services without spatial and temporal limitations. However, the nature of Ubiquitous Healthcare services requiring exchange of sensitive personal data raises trust issues. In this paper, we propose a profile-based Trust Management scheme that enables the patient to select the most trustworthy Healthcare Provider in a Ubiquitous Healthcare environment. Furthermore, we propose an extended User Profile structure integrating trust-related information in order to enhance the functionality of the proposed Trust Management scheme