Transforming Healthcare Cybersecurity from Reactive to Proactive: Current Status and Future Recommendations.

The recent rise in cybersecurity breaches in healthcare organizations has put patients' privacy at a higher risk of being exposed. Despite this threat and the additional danger posed by such incidents to patients' safety, as well as operational and financial threats to healthcare organizations, very few studies have systematically examined the cybersecurity threats in healthcare. To lay a firm foundation for healthcare organizations and policymakers in better understanding the complexity of the issue of cybersecurity, this study explores the major type of cybersecurity threats for healthcare organizations and explains the roles of the four major players (cyber attackers, cyber defenders, developers, and end-users) in cybersecurity. Finally, the paper discusses a set of recommendations for the policymakers and healthcare organizations to strengthen cybersecurity in their organization.

Embedded librarian within an online health informatics graduate research course: a case study.

The Health Sciences Library and the Department of Health Informatics & Information Management at the University of Tennessee Health Science Center in Memphis piloted an embedded librarian project in summer 2012. The value and effectiveness of the pilot project was evaluated by analyzing the content of e-mail questions received from the students and the students' answers to the pre- and post-class surveys. The project received positive feedback from the students and course faculty. Librarians collaborating with teaching faculty and interacting one-on-one with students in health information-intensive courses proved to be helpful for student learning.

Teledentistry: a key component in access to care.

UNLABELLED: Teledentistry has the potential to address the oral care needs of those who have limited access to care. More research is needed to establish the evidence base to support teledentistry practice. BACKGROUND AND PURPOSE: Enormous potential exists to improve oral health services throughout the world by using information and communication technologies, such as teledentistry to expand access to primary, secondary and tertiary care. Comparison of teledentistry procedures with standard clinical procedures can demonstrate the relative effectiveness and cost of each approach. However, due to insufficient evidence, it is unclear how these strategies compare for improving and maintaining oral health, quality of life, and reducing health care costs. This review discusses the merits of teledentistry for the delivery of oral care. METHODS: This article summarizes the available literature related to the efficacy and effectiveness of teledentistry and presents possible barriers to its broader adoption. CONCLUSIONS: Teledentistry seems to be a promising path for providing oral health services where there is a shortage of oral health care providers.

Teleophthalmology assessment of diabetic retinopathy fundus images: smartphone versus standard office computer workstation.

PURPOSE: To evaluate the diagnostic capability of a smartphone handset compared with a standard office computer workstation for teleophthalmology fundus photo assessments of diabetic retinopathy. METHODS: Eligible, consenting participants' fundus images were acquired using a non-mydriatic camera. These images along with other medical data were transmitted 20 miles away through the Internet (gold standard) and also through an iPhone(®) (Apple, Cupertino, CA) to two ophthalmologists, who independently compared the images. RESULTS: The κ coefficient between the gold standard workstation display and iPhone images to detect retinopathy-related changes for both readers was more than 0.9. The image quality of the iPhone was scored high by the ophthalmologists. CONCLUSIONS: Ophthalmic images transmitted through both smartphone and Internet techniques match well with each other. Despite current limitations, smartphones could represent as a tool for fundus photo assessments of diabetic retinopathy. Further studies are needed to investigate the economic and clinical feasibility of smartphones in ophthalmology.

The Use of DMAIC to Improve Quality Vaccination Recommendations in Chain Community Pharmacies.

Community pharmacies provide the convenience and ease of administrating vaccinations outside traditional settings. Vaccinations are health initiatives that protect communities and improve health outcomes in all populations. Despite their accessibility and supporting clinical data, various influential factors contribute to the current suboptimal rates of vaccine administration. Given the common barriers to vaccine administration, this research narrows down to address a specific barrier and attempts to implement a method that focuses on improving vaccine rates in community pharmacies. This research is a case study that utilizes the Define, Measure, Analyze, Improve, Control (DMAIC) model of Lean Six Sigma and aims to use this quality improvement process to identify, measure, analyze, and implement a training program to facilitate pharmacists in high-quality vaccine recommendations to promote higher rates of pneumococcal vaccinations in community settings.

Patients' use of smartphone apps for health record access in 2019: A cross-sectional study.

INTRODUCTION: The 21st Century Cures Act has expanded patients' access to portals through smartphone applications (apps). To date, the prevalence of patient portal smartphone apps use is unclear, especially on a national scale. METHODS: Using the 2019 Health Information National Trends Survey, we assessed factors associated with patient portal adopters accessing their records through a smartphone app. Multivariable logistic regression models were conducted and we reported results using predicted probability. RESULTS: Across a weighted sample of 75,324,288 respondents, 39 % reported using a smartphone app to access their health records. Adults with smartphone-only internet (40.0 %; 95 % CI: 35.4-33.3) were more likely to use a smartphone app compared to adults with home internet access (30.6 %; 95 % CI: 27.9-44.7). CONCLUSIONS: Optimizing the implementation and delivery of patient portal content via smartphone apps may improve their reach to patients.

Aligned Brain Extracellular Matrix Promotes Differentiation and Myelination of Human-Induced Pluripotent Stem Cell-Derived Oligodendrocytes.

Myelination by oligodendrocytes (OLs) is a key developmental milestone in terms of the functions of the central nervous system (CNS). Demyelination caused by defects in OLs is a hallmark of several CNS disorders. Although a potential therapeutic strategy involves treatment with the myelin-forming cells, there is no readily available source of these cells. OLs can be differentiated from pluripotent stem cells; however, there is a lack of efficient culture systems that generate functional OLs. Here, we demonstrate biomimetic approaches to promote OL differentiation from human-induced pluripotent stem cells (iPSCs) and to enhance the maturation and myelination capabilities of iPSC-derived OL (iPSC-OL). Functionalization of culture substrates using the brain extracellular matrix (BEM) derived from decellularized human brain tissue enhanced the differentiation of iPSCs into myelin-expressing OLs. Co-culture of iPSC-OL with induced neuronal (iN) cells on BEM substrates, which closely mimics the in vivo brain microenvironment for myelinated neurons, not only enhanced myelination of iPSC-OL but also improved electrophysiological function of iN cells. BEM-functionalized aligned electrospun nanofibrous scaffolds further promoted the maturation of iPSC-OLs, enhanced the production of myelin sheath-like structures by the iPSC-OL, and enhanced the neurogenesis of iN cells. Thus, the biomimetic strategy presented here can generate functional OLs from stem cells and facilitate myelination by providing brain-specific biochemical, biophysical, and structural signals. Our system comprising stem cells and brain tissue from human sources could help in the establishment of human demyelination disease models and the development of regenerative cell therapy for myelin disorders.

Automated determination of distance visual acuity: towards teleophthalmology services.

PURPOSE: The aim of this study was to evaluate the visual acuity scores of a computer-based visual function testing (CVFT) system. The automated chart uses logMAR notation (logarithm of the minimum angle of resolution) and randomised tilting E as optotype. The test was conducted using a laptop computer. METHODS: This prospective, clinic-based, test validation study was based on a model of repeatability in two observations. The right eyes of a total of 104 participants were randomly tested with both CVFT and the manual, gold standard Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. RESULTS: The mean difference between CVFT and ETDRS was -0.01+/-0.11 (SD) logMAR units. The Spearman Rank correlation coefficient (r) between the absolute difference and the average was 0.35. The average time for testing one eye was 54.7+/-11.89 seconds. The mean difference between two consecutive, repeated CVFT tests in the same eye was 0.02+/-0.07 logMAR units (paired t-test p=0.046). CONCLUSIONS: A novel, automated visual acuity testing application is reported. This automated system should be a useful tool for mass screening of visual impairment in rural and remote regions with its ease of use and shorter testing time.

Telerehabilitation

Telerehabilitation, as a subset of telehealth,is the use of telecommunications to deliver rehabilitation servicesat a distance and can bridge the gaps created by personnelshortages that exist in underserved and remote areas, as well asserve persons in urban settings who cannot easily leave their homesor offices to seek care. Given the mobile nature of our society,telerehabilitation can enable continuity of care while personstravel for work, vacation and/or education. While the technicalcapacities to conduct telerehabilitation have surged ahead in thepast 10 years, there has been slower, yet ongoing progress in thedevelopment of the policies (e.g., legislation; state licensure;reimbursement) that will be required to actualize widespreadtelepractice service delivery. Telerehabilitation presents awide-angle view of telerehabilitation worldwide at a seminal timein its development. The book contains contributions from authorsacross multiple disciplines, as well as a consumer-basedperspective.ÿ This book contributes significantly to thecurrent understanding of telerehabilitation, as well as elucidatingthe immense potential for telerehabilitation-based service deliveryto benefit persons with disabilities.

Remote ophthalmology services: cost comparison of telemedicine and alternative service delivery options.

We calculated the cost of an established tele-ophthalmology service, from a health-provider's perspective, and compared this with the cost of three other existing eye-care service delivery options. During a 12-month study period, 118 persons took part in the tele-ophthalmology consultations between a rural clinic located approximately 900 km from the Lions Eye Institute in Perth. The variable costs of tele-ophthalmology were 166.89 dollars(Australian dollars) per patient, and the alternatives cost 445.96 dollars, 271.48 dollars and 665.44 dollars per patient. Tele-ophthalmology incurred a set-up cost of 13,340 dollars. The threshold at which tele-ophthalmology became cheaper than any of the alternative options occurred at a workload of 128 patients. Tele-ophthalmology offers a viable alternative to conventional eye-care service in rural and remote areas.

Attention deficit/hyperactivity disorder medication and dental caries in children.

PURPOSE: Few studies have been conducted to investigate the effects, if any, of specific medication used to manage the symptoms of attention deficit/hyperactivity disorder (ADHD) as a risk factor for dental caries. A reported side-effect of the medication is a reduction in saliva. Healthy saliva has been shown to play many important functions in the prevention of dental caries. The focus of this review is to determine if any evidence exists to confirm that stimulant medication used to treat the symptoms of ADHD in children increases the risk of dental caries by virtue of its effect on the reduction of salivary flow. METHODS: A MEDLINE search was conducted for relevant studies. Search terms used were dental caries, attention deficit/hyperactivity disorder, ADHD, pharmacologic treatment of ADHD, stimulant medication, xerostomia, dry-mouth and saliva flow. Publication dates ranged from 2002 to 2012. RESULTS: Although dental caries prevalence has been found to be higher in children with ADHD, decreased salivary flow as a side-effect of pharmacological treatment does not appear to be responsible. CONCLUSION: Dental caries is a multi-factorial disease process. The most effective method of reducing dental caries in ADHD children is more frequent recare visits focusing on home plaque removal practices along with dietary counseling to reduce the consumption of cariogenic foods and drinks. This can only be accomplished with inclusion of the parent/guardian in the process.

Teleradiology

Written by experts from around the globe, i.e.,from USA, Europe, Australia and Asia, this book explains technicalissues, digital information processing and collective experiencesfrom practitioners in different parts of the world practicing awide range of Teleradiology applications. This includes roboticteleradiology, wireless teleradiology for renal trauma,teleradiology: freehand haptic device, international trade inteleradiology, teleradiology: economic and legal considerations,teleradiology in the US Army, teleradiology for head injurymanagement etc. This book lays the foundations for theglobalisation of tele radiological procedures, making it possibleto know that a radiological analysis could perform on a patientanywhere in the world.

Telesurgery

Written by renowned experts from Australia,Canada, the United States, Asia, and Europe, Telesurgery explainstechnical issues, digital information processing, and providescollective experiences from practitioners in different parts of theworld who perform a wide range of telesurgery applications. Thisincludes transatlantic telesurgery and telesurgery for urology,brachytherapy, Heller myotomy, etc. There are numerous graphics andclinical photographs throughout, which illustrate and illuminatethe text well, providing high-quality visual reference material.Telesurgery lays the foundation for the globalization of surgicalprocedures, making possible the ability of a surgeon located in onepart of the world to operate on a patient located inanother.

Teledentistry: a systematic review of clinical outcomes, utilization and costs.

PURPOSE: The purpose of this systematic review is to identify clinical outcomes, health care utilization and costs associated with teledentistry. Relevant databases were searched for articles on teledentistry published until March 2012, reference lists examined and key journals hand searched. Of a possible 58 articles, 19 studies met the inclusion criteria. Clinical outcomes were generally improved following a teledentistry intervention and satisfaction with teledentistry was consistently high. The few studies examining health care utilization reported mixed findings, but preliminary evidence suggests cost savings for health care facilities. There is a consistent trend in the literature supporting the efficacy and effectiveness of teledentistry. Further research is needed to identify the effectiveness, efficiency, utilization and costs of teledentistry as it could provide the key to improving access to care.

Tele-ICU: efficacy and cost-effectiveness of remotely managing critical care.

Tele-ICU is the use of an off-site command center in which a critical care team (intensivists and critical care nurses) is connected with patients in distant ICUs to exchange health information through real-time audio, visual, and electronic means. The aim of this study is to review the available literature related to the efficacy and cost-effectiveness of tele-ICU applications and to study the possible barriers to broader adoption. While the available studies draw conclusions on cost based on mortality and length of stay, actual costs were not reported. Another problem with the studies is the lack of consistent measurement, reporting, and adjustment for patient severity. From the data available, tele-ICU seems to be a promising path, especially in the United States, where there is a limited number of board-certified intensivists.

Tele-ICU: Efficacy and Cost-Effectiveness Approach of Remotely Managing the Critical Care.

Tele-ICU has an off-site command center in which a critical care team (intensivists and critical care nurses) is connected with patients in distance intensive care units (ICUs) through a real-time audio, visual and electronic means and health information is exchanged. The aim of this paper is to review literature to explore the available studies related to efficacy and cost effectiveness of Tele-ICU applications and to study the possible barriers to broader adoption. While studies draw conclusions on cost based on the mortality and Length of Stay (LOS), actual cost was not reported. Another problem in the studies was the lack of consistent measurement, reporting and adjustment for patient severity. From the data available, Tele-ICU seems to be a promising path, especially in the United States where there is a limited number of board-certified intensivists.

Glaucoma screening: analysis of conventional and telemedicine-friendly devices.

PURPOSE: Portable, telemedicine-friendly devices offer novel opportunity for screening and monitoring glaucoma in the remote and rural regions of the world. This study examines the effective combination of telemedicine-friendly screening devices for detection of glaucoma in relation with conventional, hospital-based devices. METHODS: A total of 399 eyes were screened with telemedicine-friendly devices and conventional, hospital-based devices such as ophthalmoscope, tonometer and perimeter. RESULTS: Combination of age and family history of glaucoma alone has a sensitivity of 35.6% (specificity 94.2%, area under the curve 0.81, correctly classified 81.1%) and an addition of telemedicine-friendly or conventional visual field tests optimized the sensitivity to 91.1% (specificity 93.6%, area under the curve 0.95, correctly classified 93%). Analysis indicates good agreement between vertical cup-to-disc ratio by ophthalmoscopy and digital image reading. An addition of intraocular pressure test does not change sensitivity (35.6%) and specificity (94.2%). CONCLUSION: This study indicates that evaluations of cup-to-disc ratio and visual field, using telemedicine-friendly devices, are most useful tools in screening for glaucoma. When used together these devices may be an alternative for conventional glaucoma screenings.

Telenursing

Developments in telenursing are occurring at agreat pace. In a very short time and driven by technicaldevelopments, the field of telenursing has become too extensive tobe covered by only a small number of experts. As a consequence,there is a need for a broad overview of the field to enable theconcepts to be understood by a wider population. Telenursing ispresented in such a way that it should make it accessible toanyone, independent of their knowledge of technology and has beenwritten with contributions from a host of renowned internationalauthorities in telenursing. Books on theoretical and technicalaspects inevitably use technical jargon, and this book is noexception, but it is kept to a minimum in an effort to maximizeclarity. Moreover the book has been organised systematically, thusensuring that the content is concise and easy to read. Everychapter provides a comprehensive list of citations and referencesfor further reading. Figure drawings and clinical photographsthroughout the book illustrate and illuminate the text, providingreaders with high-quality visual reference material. It istherefore appropriate for all professionals, including nurses,physicians, allied health professionals and computer scientists tohelp them understand the changes going on and how best to make useof them in practice.